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How to handle disruptive physicians on the medical staff

These are three recently-published articles dealing with the topic of how to deal with physicians who behave in an unprofessional manner.  Dr. Paskert, who is the chief medical officer at Mountain States Health Alliance (Washington County, TN), gives a first-person account of how to work with physicians in a collegial intervention approach.  This is an intervention that is informal, attempts to elicit voluntary cooperation of the physician, and is a step below corrective action.  Dr. Paskert mentions that a hospital should already have in place a disruptive behavior policy and physician’s code of conduct.

In the second article, Dr. Speck, et al., describe the professionalism committee approach put in place by Penn Health (Philadelphia) and present statistics on utilization of the approach since 2009.  In the first year, when the program was ramping up, only 2 physicians were brought before the professionalism committee.  In the following years, this many physicians were part of the committee’s caseload: 20 (2010), 42 (2011), 39 (2012).  About one-quarter of the cases involved full professors.  About one-third of the issues related to interpersonal problems, and another one-quarter to aggression or anger management.

In the third article, Dr. Shapiro, et al., describe the Center for Professionalism and Peer Support which was established in 2008 at the Brigham & Women’s Hospital (Boston), and which focuses on interprofessional issues.  In this study, the authors analyzed three and a half years of the concerns raised.  One quarter of the complaints were categorized as “demeaning,” and another quarter as “angry.”  One quarter of the complaints were  about surgeons.  There is also an interesting pie chart showing outcomes for those persons reported to the Center — over three-quarters remain in their role, but 11 percent left the organization due to professionalism issues.  Over half of individuals or teams reported to the Center were found to show either some improvement or signification improvement.

Sources: Paskert, J.  Collegial intervention and the disruptive physician.  PEJ. Physician Executive.  40(4):50-52, 54, July-Aug. 2014.  Click here for access to this article:  http://www.pej-acpe.org/pej-acpe/july_august_2014?pg=53#pg53 ; and, Speck, R.M., Foster, J.J., and others.  Development of a professionalism committee approach to address unprofessional medical staff behavior at an academic medical center.  The Joint Commission Journal on Quality and Patient Safety;40(4):161-167, Apr. 2014; and, Shapiro, J., Whittemore, A., and Tsen, L.C.  Instituting a culture of professionalism and peer support.  The Joint Commission Journal on Quality and Patient Safety;40(4):168-177, Apr. 2014.  Click here to access publisher’s website: http://www.jcrinc.com/the-joint-commission-journal-on-quality-and-patient-safety/   Posted by AHA Resource Center (312) 422-2050, rc@aha.org

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