What is a Disruptive Physician?
A disruptive physician is often targeted by medical staff or administration for personality issues that allegedly impact patient care, rather than for their professional work. These physicians are covertly accused of rudeness, failure to discuss issues rationally, being too assertive, demeaning, and of course, “bullying,” “intimidating,” and “angry” behavior.
Key Points from the Article Disruptive Physician Behavior: Use and Misuse of the Label by Dr. Norman Reynolds
Regulations: Since 2009, The Joint Commission (TJC) requires medical leaders to address disruptive behaviors in accreditation organizations, including disruptive physician behaviors. The Federation of State Medical Boards (FSMB) also emphasizes the importance of addressing such behaviors.
As Dr. Reynolds descrbes:
Although not a diagnosis, the disruptive label is useful in screening for disruptive physician behaviors. However, the disruptive label should not be applied to physicians just because they present controversial ideas or offer criticism of the medical system.
He discusses LD 03.01.01 from the Joint Commission and then cites EP 4: The hospital/organization has a code of conduct that defines acceptable and disruptive and inappropriate behaviors. • EP 5: Leaders create and implement a process for managing disruptive and inappropriate behaviors.
From the physician perspective and on paper but often not in practice the label should be limited to a truly aberrant individual who is negatively impacting patient safety.
Misuse of the Label: The disruptive label should not be applied to physicians merely for presenting controversial ideas or criticizing the medical system. It is intended to screen for genuinely disruptive behaviors that impact patient care and team dynamics.
False Allegations: Often, disruptive physician attacks are based on false allegations tied to lapses in patient safety. Many “disruptive” physicians are actually highlighting deficiencies in the hospital setting.
Ganging Up: The disruptive label can lead to collective behavior against the targeted physician, with multiple complaints piling up.
Consequences: Peer review proceedings, termination of contracts, and denial of credentials are long-term effects. Interim consequences include referrals to coaching and assistance programs, PIPs (Professional Improvement Programs), and FPPEs (Focused Professional Practice Evaluations), which may be reportable to the Medical Board or upon application for privileges elsewhere.
Legal Implications
Reporting Requirements: Any restriction taken against a physician due to disruptive behavior allegations is potentially reportable to the Medical Board of California and the National Practitioner Data Bank. Ensure that any coaching or PIP does not trigger a reporting requirement.
Legal Precedents
Rosner v. Eden Township Hospital District (1962): The Supreme Court emphasized that physicians should be allowed to assert their views on patient treatment and hospital practices without risking their right to practice medicine.
Miller v. Eisenhower Medical Center (1980): The Court warned against the arbitrary and irrational application of peer review to oust competent physicians who may not fit into the hospital culture.
AMA Code of Medical Ethics
Protection for Physicians: The AMA Code of Medical Ethics states that disruptive behavior is different from criticism offered in good faith to improve patient care. Physicians must not submit false or malicious reports of disruptive behavior.
The disruptive physician attack is one of the most contentious areas of physician representation. Doctors labeled as disruptive rarely recover, and their careers can be severely impacted. It is a subjective and easily manipulated type of discipline that can be unleashed against even the best practitioners.
The main difficulty defending a disruptive physician label is the subjectivity involved. It is relatively easy to evaluate medical care issues involving surgery, diagnosis or even communication skills with patients. Whether a doctor was rude to a nurse during surgery, bullying, intimidating and whether this affects patient care is maddeningly subjective and imprecise.
he AMA Code of Medical Ethics also protects physicians as it states “ Disruptive behavior is different from criticism offered in good faith with the aim of improving patient care and from collective action on the part of physicians. Physicians must not submit false or malicious reports of disruptive behavior.”
The court in Rosner v. Eden Township Hospital District (1962) 58 Cal.2d 592, 598 said “The fact that a doctor, due to criticisms made by him relating to treatment of patients or hospital practices, has been “unable to get along with” some doctors or hospital personnel is not a sufficient ground to exclude him from the use of hospitals” (Rosner at 598)
Act Early
It is important to recognize that any restriction taken against the physician due to allegations of disruptive behavior is taken for “medical disciplinary cause or reason” and is potentially reportable to the Medical Board of California (Sahlolbei v. Providence Healthcare, 112 Cal.App.4th 1137 (2003), and to the National Practitioner Data Bank (Leal v. DHHS, 623 Fed.Sup 1280 (11th Circuit 2010). While it may appear that coaching or a PIP is separate from medical care issues you can’t assume this and you or your attorney must be certain that a reporting requirement is not triggered. (See Business and Professions Code section 805 in California) You can easily slip into a vulnerable position by trying to work things out and get along.
The Horowitz Medical Group defends doctors who are unjustly targeted for sham peer review and orchestrated disruptive physician attacks. Call us for help before matters get out of hand.