Why Are Abusive Physician’s Reluctant to Seek Help?

As a part of the medical training of all physicians, it is necessary to rotate through all of the specialties in medicine. This means that all physicians must rotate through a period of exposure in psychiatry as well as all other areas of medicine. One of the obvious reasons for this practice is to make certain that all physicians have enough knowledge and experience to appropriately make use of all specialties other than their own.

Unfortunately, psychiatry is an area of specialization that is often viewed by surgeons, cardiologists, oncologists and neurologists as somewhat soft, as it relates to being scientific. Psychiatry is considered to be highly subjective with questionable scientific evidence. In addition, any mental health intervention carries with it a stigma that may be damaging to a physician’s professional career.

One of the first questions posed by physicians inquiring about resources for “disruptive physicians” is ‘Do I have to undergo a psychiatric assessment?’. This question is extremely important to any practicing physician, as it will almost certainly affect his or her entire career if there is anything in any file suggesting psychiatric impairment or even a psychiatric examination.

Therefore, if the goal of a coaching program is to help disruptive physicians who are not addicted to drugs/alcohol, or are not psychiatrically disturbed, a psychiatric assessment must not be made mandatory. Anderson & Anderson, the largest provider of Executive Coaching/Anger Management for abusive physicians in the nation, uses an assessment tool that focuses on the physician’s level of functioning in certain skill areas, and not psychiatric impairment. Our method emphasizes enhancement in level of anger management, stress management, communication styles, and emotional intelligence, or empathy. There are many case examples of physicians who purposely selected the Anderson & Anderson program for its lack of focus on psychopathology. They understand that one’s anger has more to do with a life style choice than it does with psychopathology.

The Anderson & Anderson Executive Coaching/Anger Management course provides skill enhancement in the same four areas mentioned above: stress management, anger management, assertive communication and emotional intelligence. This non-psychiatric model is consistent with the new 2009 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) standards. Potential clients who demonstrate a lack of motivation to change (based on their scores from the “Personal Orientation to Change” scale) are not accepted into the program.

For more information about Executive Coaching/Anger Management for physicians, please contact our office at (310) 207-3591.

George Anderson, MSW, BCD, CAMF

Fellow, American Orthopsychiatric Association
Diplomate, American Association of Anger Management Providers

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Comprehensive Assessments are The Key to Success in Programs for “Disruptive Physicians”

Hospitals and healthcare organizations throughout the United States are beginning to implement the new Joint Commission (JCAHO) Standards for “disruptive physicians”. Anderson & Anderson is currently one of the major providers of Executive Coaching/Anger Management for Physicians in the nation. Our extensive data base of on-site coaching for physicians has provided us the opportunity to get an inside look at the work environments of participating doctors at many hospitals throughout the nation. As I write this entry, I am sitting in the Air Port in Corpus Christi, Texas, where I have been working on-site for much of the past week providing coaching for a local physician.

The most startling finding to date is the degree to which stress and burnout are factors in decreasing the resiliency of these physicians to appropriately manage anger and use assertive, rather than aggressive, communication with professional staff and patients. Prolonged stress also tends to erode empathic responses to colleagues, ancillary staff and patients. We have learned that it is our comprehensive assessments at the beginning of the intervention that quickly break through resistance and denial of the presenting complaint (disruptive behavior).

Since the presenting complaint is almost always related to “disruptive behavior” rather than symptoms of psychopathology, non-psychiatric assessments designed to determine skill levels in recognizing and managing anger, stress, assertive communication and emotional intelligence are indicated rather than psychological or psychiatric evaluations.

Two of the three Anderson & Anderson assessments are made available on-line to the physician clients prior to the first live meeting. To date we have been told by client physicians that it is the self-reflection that is triggered by the questions posed in the assessment instruments that helps them acknowledge the need for change/help.

The third assessment is completed in the presence of the Coach. This offers the Coach an opportunity to observe a wide range of non-verbal responses to the assessment contents by the participant.

Each of the assessment instruments used in the comprehensive battery provides an action plan for every scale in which the participant scores in the deficit range. This is critical as it offers the participant an immediate answer to the question “how can I change that behavior?”

These action items are incorporated into the coaching plan from the very first hour of intervention. They are, in fact, a natural flow between assessment and intervention. Therefore, it is not a challenge to get the physician client engaged in the change process as the resistance quickly dissipates based on the content of the assessments.

The three major providers of intervention programs that are consistent with the JCAHO standards are: the PACE Program at the University of California School of Medicine (San Diego), the Distressed Physician Program at Vanderbilt University School of Medicine, and Anderson & Anderson, Executive Coaching/Anger Management Program for Physicians.

George Anderson, BCD, LCSW, CAMF
Anderson & Anderson
Trusted Name in Anger Management
http://www.andersonservices.com
http://www.aaamp.org
http://www.anger-management-resources.org

The College of Physicians and Surgeons of Saskatchewan

Definition Of Disruptive Workplace Behavior

Behavior, either verbal or non-verbal, which by its nature may:

·Demonstrate disrespect to others in the workplace.

·Affect or have the potential to affect adversely the care provided to patients.

·Reflect a misuse of a power imbalance between the parties

The quality of health care workplaces is enhanced when all health care personnel cooperate with one another and treat one another with respect and courtesy.

Conversely, the quality of health care workplaces is eroded when any health care personnel exhibit disruptive behavior and/or are disrespectful or discourteous in their interactions with one another.

Disruptive, discourteous, or disrespectful workplace behavior by any health care personnel should not be tolerated.

All personnel who govern, manage, or work at the frontlines of the health care system should strive to foster a positive workplace environment and to prevent behavior that may poison that environment.

When disruptive workplace behavior occurs, the perpetrator of such behavior ought to be held accountable and steps ought to be taken to prevent future recurrence of such behavior.

Disruptive workplace behavior is less likely to become entrenched if appropriate interventions are made promptly when such behavior is first manifested.

It is very strongly recommended that every Regional Health Authority in Saskatchewan should have strategies for preventing disruptive workplace behavior and strategies to deal effectively with such behavior when it occurs.

In respect to all personnel who are employees of RHAs or who work under contract with RHAs, the human resource department of each RHA should have in place mechanisms and protocol for prevention and response to disruptive workplace behavior that are as consistent as practical in a variety of employment circumstances. However, it is recognized that employment circumstances, unionized or non-unionized, contract, salary or self-employment will impact the mechanisms and protocol for response.

Some of the mechanisms could be:

·Clear policies in respect to workplace behavior that is inappropriate and will not be tolerated.

·Programs to raise awareness of workplace behavior expectations among all workers.

·Mechanisms for reporting disruptive behavior without fear of retaliation.

·Mechanisms for non-adversarial resolution of workplace conflict.

·Awareness of and referral access to educational programs designed to achieve behavioral change and personnel who exhibit disruptive workplace behavior.

·Application of progressive discipline to personnel who exhibit significant and persistent disruptive behavior and are refractory to non-punitive measures.

·A willingness to terminate the employment or contractual engagement of personnel who are persistently disruptive and are refractory to lesser sanctions.

SPECIFIC INFORMATION ABOUT DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

To the extent that it is possible, policies and strategies for prevention and early response to disruptive physician workplace behavior should be the same as those that apply to all other personnel.

However such policies and strategies may require some modification for the following reasons:

·There may be a real or perceived power gradient between physicians and other health care personnel that may make such personnel less inclined to:

·Directly challenge a physician who exhibits disruptive workplace behavior; and

·Report a physician who exhibits disruptive workplace behavior.

·Most physicians are not employees of RHAs or engaged under personal services contracts. For that reason, the disciplinary mechanisms pertaining to physicians may vary from those pertaining to employees and contractees.

The agencies that have served as members of the SAHO Committee on Disruptive Physician Workplace Behavior offer the following guidelines for preventing and addressing disruptive physician workplace behavior.

GUIDELINES FOR REGIONAL HEALTH AUTHORITIES FOR PREVENTION OF AND RESPONSE TO DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

·Physicians should be included in all RHA initiatives directed toward prevention of disruptive workplace behavior and the fostering of positive workplace environments.

·RHAs should ensure that all members of the RHA medical staff are informed about expected workplace behaviors and which behaviors will not be tolerated.

·RHA non-physician and physician personnel ought to be assured of protection from physician retaliation if they report disruptive physicians. A protocol for dealing with retaliation should be established.

·When disruptive physician workplace behavior is first identified, the most senior physician executive in the RHA should be notified and he or she shall determine the appropriate intervention including who works collaboratively with the RHA’s administrative personnel to address the problem. The problem should be addressed so far as is practical in the same manner as they would respond to disruptive workplace behavior by non-physician personnel (i.e. Alternative Dispute Resolution, behavior modification education, etc.).

·If disruptive physician workplace behavior recurs in spite of non-punitive interventions, the RHA should invoke and effectively apply the disciplinary processes described in its Medical Staff Bylaws.

·In its application of its Medical Staff Bylaws, RHAs should follow the principles of progressive discipline as they would in respect to any other health care personnel who exhibit disruptive workplace behavior.

·If any RHA finds itself unable to deal effectively with disruptive physician workplace behavior, it should formally refer such matters to the attention of the College of Physicians and Surgeons.

ADVISORY AND SUPPORT SERVICES FOR RHAs IN DEALING WITH DISRUPTIVE PHYSICIAN WORKPLACE BEHAVIOR

The SAHO Committee on Disruptive Physician Workplace Behavior has assembled helpful resource materials on this issue. These resource materials include:

·Many articles from the published literature that describe the phenomenon of disruptive workplace behavior and approaches taken by health agencies to prevent and respond to this phenomenon.

·Information about an assessment program that may accept referral of physicians who demonstrate persistent disruptive workplace behavior.

·Information in respect to an educational resource that may be helpful in modifying patterns of disruptive physician workplace behavior.

RHAs are welcome to contact SAHO to access any of these resource materials.

RHAs are also welcome to contact the Registrar, Deputy Registrar or Associate Registrar of the College of Physicians and Surgeons for informal advice and guidance in the course of dealing with a physician who exhibits disruptive workplace behavior.

Emotional Intelligence & Advanced Small Group Facilitation

Continuing Education Seminars

Presented by Thomas L. Wentz, Ph.D, C.A.M.F.

December 6 & 7, 2008*
8:30 am – 4:30 pm
12301 Wilshire Blvd., Suite 418
Los Angeles, CA 90025

An Introduction to Emotional Intelligence for Anger Management Facilitators, Trainers, MFTs and LCSWs

Emotional intelligence is a learned ability needed to understand, use, and express human emotions in a healthy and skilled manner. Emotional experience and expression are unique to each person. No one else in the world thinks, expresses feelings, chooses behaviors and acts in the exact same way as you do or as we do. Consequently, any learning model for developing emotional intelligence must address this unique human quality. The Success Profiler addresses this uniqueness in positive and direct ways. Long-term and continuing research has confirmed that self-assessed personal and emotional skills are vital to academic achievement, effective and supportive relationships, career success, productivity, and personal health. This one day course is experiential rather than didactic. It will include the assessment of all participants and The Personal Success System skill development workbook. This training provides each participant the opportunity to learn first hand about his/her strengths and weaknesses, and helps to begin building on the information learned from this assessment.

Advanced Small Group Facilitation for Certified Anger Management Facilitators and Domestic Violence Facilitators

This one-day course is designed to equip the trained facilitator in the enhancement of his or her skills in effectively leading any type of skill building class or group. It will include small group demonstrations using DVDs, group discussions, mini-lectures and quizzes. It is designed to build on the skills of trained group leaders or facilitators. Each participant will receive a complimentary copy of the new Anderson & Anderson DVD entitled “Advanced Small Group Facilitation”.

COST: $150.00 per seminar includes emotional intelligence profiler, skills map, and continuing education certification

*The Emotional Intelligence Seminar will take place on Saturday, December 6, 2008

*The Advanced Small Group Facilitation Seminar will take place on Sunday, December 7, 2008

*Each seminar is worth eight continuing education units. You will receive sixteen units (yearly requirement) if you attend both seminars

*If you register for both seminars before November 26, 2008, you will receive a $50.00 discount on complete registration fee

This ceu training is approved for Certified Batterers Intervention Facilitators, BBSE Licensees, CADAC, CADE as well as Certified Anger Management Facilitators.

For More Information, Please Call 310-207-3591

Physician Self-Referrals are an Unintended Consequence of The New JCAHO “Disruptive Physician” Standards

A significant number of “at risk disruptive physicians” are seeking assistance voluntarily for problems in managing stress, anger, aggressive or passive aggressive communication or lack of empathy. This is a surprising and important, yet unanticipated, consequence of the new JCAHO “disruptive physician” policy.

A recurring theme of self-referred physicians to Executive Coaching/Anger Management Programs is the claim that most of them would have welcomed the chance to attend a physician coaching intervention program if given the information and opportunity. These doctors maintain that they lacked information relative to resources available to them for enhancing skills in managing stress, burnout, anger or aggressive behavior.

It is common knowledge that volunteer clients are generally more motivated to change than those who are mandated. Therefore, it is extremely important that proactive efforts are considered for physicians who are at risk for “disruptive behavior”.

The Joint Commission on the Accreditation of Healthcare Organization (JCAHO), along with the Vanderbilt University School of Medicine, University of California School of Medicine at San Diego, and Anderson & Anderson in Los Angeles should all reach out to prospective physician clients. Ideally, a Directory of Providers of intervention programs for “disruptive physicians” should be established and widely marketed to Health Care Organizations nationwide.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

This Week in Anger Management at Anderson & Anderson

Nancy Anderson, President of Anderson & Anderson, is a popular Executive/Anger Management Coach for physicians. Most of her current clients are self-referred rather than mandated. This is an indication of how popular Nancy is as a coach.

Dr. Tom Wentz is currently preparing two PowerPoint presentations: one on Emotional Intelligence and a second on  on Advanced Anger Management Facilitator Certification. These continuing education courses are designed for Batterers Intervention Facilitators, Anger Management Facilitators, MFTs, LCSWs, CADAC counselors, and CAADE licensees. These programs will also be presented in two live continuing education training seminars scheduled on December 6, 2008 and December 7, 2008.

After a successful three-day Anger Management Facilitator Certification training in Hawaii, George is now heading to Corpus Christy, Texas to provide on-site coaching for a JCAHO defined “disruptive physician”. In December, he will provide an Organizational Anger Management training for Kaiser Permanente Los Angeles and a major insurance company in Newark, New Jersey.

Our office manager, Rasheed Ahmed, is working aggressively to update the Anderson & Anderson Provider List for Los Angeles. In addition, An aggressive marketing plan has been initiated to increase the Anderson & Anderson market share of “disruptive physician” referrals nationwide.

Faculty member, Colbert Williams, LCSW, CAMF, is busy preparing for the use of “The Practice of Control”, the new Anderson & Anderson client workbook for physicians.

Garry Galvan is doing an excellent job as the key anger management facilitator for the Brentwood office of Anderson & Anderson. Garry provides all day classes on Saturdays. He will soon join Dr. Wentz as a co-trainer for the facilitator certification.

Jairo Wong has fifteen years of experience providing anger management and batterers’ intervention at Anderson & Anderson at our Lawndale office. Jairo provides services in both English and Spanish.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org

Economic Crises Fuels Stress and Anger

One of the unfortunate consequences of the tragedy of 9/11 was a nationwide increase in the incidence of anger, stress, PTSD, depression, anxiety and substance abuse. Research conducted by the Rand Corporation and the Neuropsychiatric Institute at UCLA Medical Center indicated that the impact of this disaster on vulnerable persons was the same, independent of the proximity to New York or Washington, D.C.

The current worldwide economic crisis is having the same impact as 9/11. Mental health providers, certified anger management providers and family medicine practitioners in the U.S., Canada and Europe are reporting an increase in all of the disorders mentioned above.

Stress is so widespread that even clergy and the faith based community is opting to have select members of their congregations trained and certified in anger management, stress, management, communication and emotional intelligence.

The San Francisco the Pubic Defender, Jeff Adachi, has concluded that the role of the public defender should also include violence prevention and anger management for at-risk youth.

Stress is a common system that serves to create or exacerbate Post Traumatic Stress Disorder, anger, anxiety, depression and substance abuse.

Unlike anxiety, depression, substance abuse and PTSD, anger is not a mental or emotional disorder and is not responsive to counseling, psychotherapy or psychotropic medication. In fact, the American Psychiatric Association maintain that unhealthy anger is a lifestyle issue and therefore not a subject of interest to the APA.

The most appropriate intervention for problem anger, stress, aggressive communication and rage is anger management. Certified Anger Management Facilitators are trained to provide non-psychiatric assessments designed to determine a clients’ level of functioning in recognizing and managing anger, recognizing and managing stress, styles of communication and emotional intelligence. Following the assessment, the client is given a workbook and skill enhancement assignment in all of the areas mentioned above.

For a list of Certified Anger Management Facilitators, click here.

George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management
http://www.andersonservices.com/
http://www.aaamp.org
http://www.linkedin.com/in/geoanderson
www.anger-management-resources.org