Burned-out physicians can express exaggerated anger and disappointment to colleagues, staff and even patients. But behaviorally-impaired physicians (“disruptive physicians”) can too. Is it possible to differentiate one type of troubled physician from the other? Yes. Does it matter? Also yes.
Physician burnout can be reliably diagnosed when physicians manifest one or more of the classic triad: (1) emotional exhaustion (blunted affect with absence of discretionary effort), (2) depersonalization, particularly of patients, and (3) a belief one’s efforts no longer make a difference. The consequences to patients can be profound: worse clinical outcomes, care experience and costs. Treatment of the burned-out physician depends upon the particular root causes in that practice, but interventions directed toward Electronic Medical Record (EMR) proficiency, team workflows, and empowering physicians to create beneficial change in the practice and in the workday usually help.
Disruptive Physicians use a combination of verbal and behavioral tactics to intimidate or discourage team members or derail the latter’s well-intentioned efforts. The negative consequences for the care team are even greater than that of burned-out physicians: (1) inadequate or false communication, (2) mistrust, and (3) unsafe work environment, all leading to more patient harm and staff turnover. In short, truly disruptive physicians will eviscerate your Triple-Aim Culture to the certain detriment of patients and staff.
Treatment of disruptive physicians is as simple in design as it is complex to execute. First and foremost, the governing body (e.g. Medical Executive Committee, physician leader of the medical group, Board of the hospital) must be willing to follow through with the progressive disciplinary action plan (“walk the talk”). Second, the right physician leader (talent + skill + enthusiasm + time) must be chosen to oversee the intervention for the 3-12 months typically required. Lastly, a clearly written code of conduct, coupled with progressive disciplinary action for non-adherence, must be consistently used and reinforced with repeated cycles of observation and feedback.
Prognosis for disruptive physicians hinges upon two factors: (1) his/her self-insight (the ability to see yourself as others see you, and the ability to understand why we behave the way we do), and (2) the belief that the governing body will follow through on progressive disciplinary action for failure to fully and always meet the minimum standards of behavior.
It behooves us to differentiate the burned-out physician from the disruptive physician, because the interventions are so different. Contact the Physician Service Line (PSL) at Studer Group for more information or help.