by Sonia Brill, LCSW, CAMF
About nine years ago, a social worker was assigned a case load of 45 patients in the neonatal intensive care unit (NICU) of the renowned Westchester Medical Center, Level 3 trauma center, in New York. The environment was intensely fast-paced. On a good day, the work load was unmanageable. Crisis was the name of the game. Families in need and demands of staff were part of the daily routine. The eight-hour day never occurred.
In order to assist the families, the social worker created a resource manual containing local phone numbers, the hospital’s brochure, and NICU’s visiting hours. After receiving approval to pass out this information from the attending physician, the social work department, and the nursing staff, she provided the information to her families, who thanked her and felt grateful for the information.
Late one evening, the young social worker was called into the office of the chief of staff. The unit feared him for his bouts of anger, but no one said anything to redress the issue.
“Sit down,” he yelled at her. “I called this meeting; you are to not say anything. You are to hear me out. Who told you to pass out this information?” Before she could respond, he blurted, “This is my unit; everything goes through me!”
She passed him the packet and asked him to look at it. He scolded her again, saying, “This is my meeting. You are to remain quiet.”
Upon feeling disrespected and treated unprofessionally, I stood up and walked out. He was the one of the most intimidating and angry physicians I have worked with in my professional career.
Out-of-control anger, which has no bounds, is one’s inability to maintain professional decorum, and it harnesses the feeling of power, either directly or indirectly, to affect another person’s behavior. Angry physicians may ignore the directions of their supervisors, throw things, bang the phone, slam charts, and cross physical boundaries, ultimately creating a hostile work environment. Professionals may find themselves dealing with an angry physician if they are feeling overwhelmed by the abruptness, being berated in the presence of other staff members, and being ordered to fulfill a demand.
Often, if daily patient care is completed, then the physician’s behavior is “tolerated” and he or she is allowed to carry on from day to day. Most staff members try to avoid the physician or have limited conversation because the physician’s presence can make staff feely “jumpy.” Many facilities have no formal protocol on dealing with this type of inappropriate anger. The pace of work is swift and this behavior may take a backseat until it can take one no longer. However, ignoring or avoiding the issue will not make it disappear. As the behavior escalates, it can impact the delivery of patient care by affecting the physician and the facility in a profound way. Systematic impact can be avoided if appropriate intervention is sought.
On Jan. 1, 2001, the Joint Commission on Accreditation of Healthcare Organizations issued new medical staff standards that require hospitals to implement a non-disciplinary process for the identification and management of matters of individual physician health.(1)
JCAHO has stated that health care organizations have an obligation to protect patients from harm; are required to design a process that provides education and prevention of physical, psychiatric, and emotional illness; and facilitate the confidential diagnosis, treatment, and rehabilitation of potentially impaired physicians. The focus of this process is rehabilitation, rather than discipline, to aid a physician in retaining or regaining optimal professional functioning, consistent with the protection of patients. However, the standards also direct that if, at any time during this process, it is determined that a physician is unable to perform safely according to the privileges that he or she had been granted, the matter is forwarded to medical staff leadership for appropriate corrective action. This action can be education, self-referral, evaluation, confidentiality of referral, rehabilitation, reporting of unsafe standards, and monitoring of the physician (1.2).
Appropriate anger management in a confidential coaching meeting should be part of this remedial process and corrective action to mitigate risk management.
Youssi M. JCAHO standards help address disruptive physician behavior. The Physician Executive. Washington, D.C.: Joint Commission on Accreditation of Healthcare Organizations (JCAHO); 2002:12–13.
Blog Entry Written by
Sonia Brill, LCSW, CAMF, of SB Consulting (formerly Anger X change), which offers a specialized program called Conflict to Communication© to help divorcing couples stop the high-conflict battling so they can move on with their lives.