Under the new JCAHO Guidelines for “disruptive physicians”, many physicians nationwide are being mandated to attend counseling, psychotherapy or substance abuse treatment. Many of the providers to whom these physicians are referred have little knowledge or training in anger management or emotional intelligence. Any physician who undergoes a psychiatric assessment can be sure that he will be diagnosed with some type of Axis I and Axis II diagnosis as a way of justifying his admission to the program and treatment.
“‘Disruptive physicians’ are doctors whose behavior undermines their personal and professional effectiveness”, Ronald Schouten, M.D. said at the annual conference of the Academy of Organizational and Occupational Psychiatry.
“We are talking about people who engage in problematic behavior that interferes with their relationships at work or at home and has a potential impact on patient care, productivity, and administrative functions,” said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital, Boston.
Displays of anger proved to be the most common reason for referrals. In 36 cases (out of 69), doctors were referred because they had lashed out physically or verbally, or because they had spooked their colleagues with behaviors such as wearing a gun in the operating room.
Diagnosing disruptive doctors involves a caveat, Dr. Schouten said. When physician referral programs send doctors for a psychiatric evaluation, they often are unable to keep physicians in a behavior improvement program without a diagnosis of an Axis I or II disorder.
“There is a bias in favor of finding something to write on the form,” Dr. Schouten said. As a result of that bias, the most common diagnosis in his sample was “personality disorder not otherwise specified,” for 37 doctors, followed by 15 cases of major depression. There were also 10 cases of substance abuse, 9 diagnoses involving personality traits, 7 cases of adjustment disorder, and 6 cases each of bipolar disorder and sleep disorder.
“Motivating anyone–even physicians–to sustain behavioral change is difficult”, Dr. Schouten said. The process of seeing a psychiatrist causes a short-term change in behavior; however, over time, people tend to revert to their baseline habits. Many physicians who are referred for a psychiatric consultation resent any suggestion that they be held accountable for their actions. But the term “anger management” meets with less resistance than does “psychotherapy”, because it lacks the stigma associated with a mental health problem, he noted.
Programs designed exclusively to provide help for “disruptive physicians” should not mirror the programs designed for psychiatric treatment, substance abuse or sexual abuse/boundary issues. This means that no psychiatric assessment is indicated.
Non-psychiatric assessments focusing on anger management, stress management, communication and emotional intelligence are far more appropriate. Anger is a problem, but is not a DSM IV diagnostic category.
Anderson & Anderson is the largest provider of assessments and intervention for “disruptive physicians”. Our services are provided nationwide on-site or at our offices in Los Angeles.
George Anderson, MSW, BCD, CAMF, CEAP
Diplomat, American Association of Anger Management Providers
Anderson & Anderson®, The Trusted Name in Anger Management