Disruptive"Mentally Ill" Physicians: STILL ABOVE THE LAW

February 18, 2011 — 1:58pm ET | By Sandra Yin

Fierce Healthcare has;

How To End Disruptive Behavior That Compromises Patient Safety

When faced with disruptive behavior, managers at hospitals and other healthcare facilities oftentimes will brush it under the rug. They're reluctant to deal with it, says Dr. Alan Rosenstein, medical director at Physician Wellness Services, which helps doctors with performance and behavioral issues. Rosenstein has written extensively on the topic of disruptive physicians.

Failing to confront the problem allows it to grow. A 2004 study by the American College of Physician Executives found that 70 percent of respondents said most problems involved repeat offenders.

The risks of not addressing bad behavior are significant. Taking the path of least resistance and doing nothing can not only compromise a person's ability to do a job and lower staff morale, it also can potentially harm the patient. A physician could end up on TV as the target of a malpractice suit.

Since the landmark Institute of Medicine report, To Err is Human, was published in 2000, much has been said about the need for the right systems and processes to improve patient safety. While human factors deserve far more attention than they tend to receive, though, it seems that no one ever wants to talk about them.

Hospitals fail to address behavioral problems, in part, because not everyone knows what disruptive behavior is. Some physicians see disruptive behavior as physical assault, while dismissing yelling and screaming as such. Others can overreact to the latter. Ultimately, there's a fine line, especially in the case of yelling. You have to distinguish when barked out orders are warranted. Perhaps a patient's care is on the verge of being compromised and someone had to take charge.

Dangerous behavior isn't always loud, nor does it necessarily have to involve overtly abusive language. In fact, one passive aggressive approach is to not respond at all to questions, or to withhold important information, David Danielson told me. Danielson is senior executive vice president and chief administrative officer for Sanford Clinic, which has over 340 physicians and more than 120 clinic sites in the Upper Midwest.

When poor behavior or interpersonal skills begin to interfere with another person's ability to think or do their job, it can affect patient care. Case in point, a physician doesn't return calls, or when he does, tends to be abrupt or antagonistic. People will not want to call that physician. A nurse's reluctance to make the call to a physician about a change in a patient's condition and resulting delays could lead to a compromise patient safety. (Note: Nurses too can be chronic disruptors.)

The good news is that in most interventions, it's enough to just sit down and tell the physician what happens when they behave a certain way, said Danielson. Show them how it affects other people and patients. Most people don't know the extent of their impact on another or downstream on patient care.

"They self correct," Rosenstein said. "When you show them the downstream effect of something bad happening to the patient, that's a wake-up call."

An informal discussion with the individual is one way to probe for underlying causes. Some offenders may be dealing with stress or burnout. Chronic offenders may benefit from stress management, anger management or diversity training. Others may need more intensive counseling, especially if something like substance abuse is involved.

Seven things organizations can do to prevent disruptive behavior from putting patient safety at risk include:

• Using a mediator who has no hiring or firing authority. People will open up more. And make sure any discussion of behavior does not come off as a witch hunt.
• Ensuring your organization has a disruptive behavior policy that doctors sign upon re-credentialing.
• Finding a champion for this, perhaps the chief medical officer or VP or medical affairs. A clinical head who aims to both improve staff relations and clinical outcomes could make a difference.
• Creating a reporting mechanism and formal process for reviewing incidents.
• Providing educational programs to define disruptive behavior and its impact. This will raise the level of awareness.
• Offering sensitivity training, conflict management, stress management and improving overall communication skills.
• Adding more behavioral expectations into your orientations.

Even if your hospital or healthcare organization doesn't have much in place right now to discourage disruptive behavior, it's never too late to get started. It's one way to make your care more patient-centered. -

Read more: How to end disruptive behavior that compromises patient safety - FierceHealthcare http://www.fiercehealthcare.com/story/how-end-disruptive-behavior-compromises-patient-safety/2011-02-18#ixzz1ELDRFYaf
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Here's how you address the Problem. Enforce the LAW.

Either Psychiatrically Diagnose these Physicians, FOR LIFE, Brain Bash them with their own Brain Eating Antipsychotics and Set Them Up with Life Time Police Registration - because Physicians 'Behavioral' medications are So Destructive that they CREATE a Homicide Risk - REVOKE their Licenses and Declare them Incurably Mentally Ill, ..... or Get Rid of those medications and the Baloney-Science Based, Behavioral Medicine Frauds who peddle them.

Amendment 14 US Constitution

Section. 1. All persons born or naturalized in the United States, and subject to the jurisdiction thereof, are citizens of the United States and of the State wherein they reside. No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.