The JCAHO (Joint Commission) standards for physicians make a clear distinction between “disruptive physicians”, psychiatrically impaired physicians, substance abusers and/or sexual abusers. Unfortunately, some resources for “disruptive physicians” demand that all participants undergo a formal psychiatric examination that may include all of the following according Dr. Donna Yi, MD. of the Menninger Clinic in Texas: “Evaluation of disruptive behavior may require a multiplicity of assessments, including a psychiatric assessment, medical and laboratory work-up, addictions and trauma evaluations, psychological and neuropsychological testing, and brain imaging studies such as an MRI or even functional scans such as PET or SPECT examinations. Note that even negative findings can assist in establishing that disruptive behavior is not neurologically, but rather personality based, for instance”.
Physicians who are mandated to seek intervention for “disruptive behavior” must be careful in selecting a provider. If the physician is suspected of being psychiatrically impaired, it is reasonable for him or her to receive any or all of the assessments listed above. However, none of these examinations should be required for “disruptive behavior” unless the symptoms suggest psychiatric impairment or substance abuse.
When physicians are subjected to such examinations, it may become difficult or impossible to explain to a Hospital Credential Committees or Medical Licensing Board why these exams were conducted for behavior that is not considered pathological. A mandated psychiatric assessment places inappropriately referred physicians at risk of being entered into the National Practitioner Data Bank. Once a physician is listed in this data bank, it is almost impossible to get any information removed.
Available current research data does not indicate a significant relationship between “disruptive/angry behavior” and psychopathology. In practice, the largest number of referrals are surgeons who are burned our, extremely stressed with poor skills for managing impulse control, assertive communication, stress management, empathy and/or interpersonal relationships.
Rather than psychiatric treatment, psychotherapy, psychotropic medication or some other mental health intervention, all of the three major providers of service for “disruptive physicians” that are listed below offer non-psychiatric interventions.
The Program for Distressed Physicians
The CME program was designed as part of the ongoing mission of the Vanderbilt Center for Professional Health’s commitment to physician well being. We have titled the course “distressed” instead of disruptive since the basic behavior of these physicians results from internal factors that is obvious from the experiences we have seen in the physicians attending the course. The central theme for the course is to provide physicians with disruptive behavior a safe, confidential environment where they can learn with their peers about the origins and consequences of their actions. This environment must be conducive to open discussion in small groups with no more than seven and no less than five physicians in each group. The therapeutic modality is guided small group interaction. Each physician is given the opportunity to tell their story and confide their fears and hopes with other physicians in the group.
The Program for Distressed Physicians provides services in groups of 7 physicians each quarter for total of 27 physicians per year.
Anger Management For Healthcare Professionals Program
This course is designed to help those physicians and healthcare providers who have contributed to a disruptive working environment by way of inappropriate expression of anger. Conflict, stress and disruption in the hospital and clinic setting create low morale, heightened rates of staff turnover, and patient safety concerns.
The Anger Management for Healthcare Professionals program is a small, (6-8) participants), intensive and highly interactive three -day course taught by UC San Diego faculty from the Department of Psychiatry. Participant coursework in the form of self-reported inventories of mood and interpersonal conflict as well as reading is required.
The objectives and goals of this course include:
- Aiding participants to identify triggers in the workplace leading to disruptive behavior.
- Didactic instruction providing constructive tools and strategies to aid in diffusing and managing anger and conflict in an appropriate and professional manner including:
◦ Increasing Emotional Intelligence
◦ Empathy Training
◦ Transforming conflict into cooperation
- Practicing both behavioral and cognitive strategies, including coping mechanisms, leading to healthier communication and interactions in the healthcare environment.
- Developing a personalized plan of action (Commitment to Change)
PACE provides a dynamic training program that offers professionals an opportunity to obtain educational information and personalized assessment in a highly sensitive, supportive and confidential environment away from the workplace.
The Anderson & Anderson Executive Coaching for “disruptive physicians”
This is the largest program currently in existence for the assessment and coaching of “disruptive physicians. Services are available nationwide seven days per week with no limit on the number of referrals.
Services are provided either at Anderson & Anderson in Los Angeles or On-site, at the convenience of the physician anywhere in the United States. The Anderson & Anderson coaching for “disruptive physicians” uses a coaching curriculum based on Emotional Intelligence skill enhancement. This curriculum was designed in conjunction with physicians.
Each participant completes the Bar On EQ-i-2.0 Emotional intelligence Assessment that is considered the industry standard in emotional intelligence assessments worldwide. All training material is mailed to the participant in advance of the first session.
The Coaching is offered in two phases. The Bar On EQ Assessment is administered on-line prior to Phase One. Phase One consists of two days of assessment debriefing and skill enhancement coaching. All services are provided individually and are strictly confidential.
Phase two consists of twice monthly coaching sessions via phone over a 6- month period. At the conclusion of this six-month period, the physician completes the Bar On EQ Assessment again to determine the success or lack of success of the coaching.
In summary, Physician Well-Being Committees, Local, Regional and National Medical Associations should caution their physician members against taking risks that may unintentionally damage their careers such as information provided to The National Practitioners Data Bank based on inappropriate assessments for “disruptive behavior”. Such assessments are far more damaging than the “disruptive physician” label that fortunately is being changed to disruptive behavior.