As health care has become increasingly complex there has been a focus on the team care of patients. This recognition that care needs to be coordinated among multiple care givers for the benefit of the patient has led to physicians needing skills they never anticipated needing and were never mentored or trained to develop during medical school or residency. Ironically, at the same time we recognized the need for team based care, the size and complexity of health care enterprises, and the financial constraints placed on those enterprises has led organizations to systematically dismantle traditional “health care teams” (private scrub techs for surgeons, specialty operating room or procedural teams, etc.) exposing physicians who struggle navigating team dynamics to new stresses. Now instead of having a group of people who know the physician and who the physician knows, it is a group of people who are often unfamiliar with one another. As a result of this focus on teams and teamwork within health care, the dismantling of established teams within the health care enterprise, as well as shifting behavioral norms and expectations, physicians that exhibit dysfunctional patterns of behavior within teams have been singled out and labeled as being disruptive physicians.
It is a reality that there are physicians whose behavior is at times disruptive to the functioning of the teams of which they are a part. It is a reality that sometimes there are physicians who have a propensity to act in an unprofessional manner.
Despite this reality, I am bothered by this label for a number of reasons:
1) Over the course of my career I have met and worked with a number of nurses, techs, executives and other health care workers that exhibit the same behaviors as “disruptive physicians” exhibit. Yet we never discuss “disruptive executives” as a problem needing to be addressed. Don’t get me wrong, I am not condoning unprofessional behavior on the part of any individual. What I am objecting to is the idea that seems to be implicit in this discussion--that this concern is somehow unique to physicians.
2) It seems to assume that this dysfunctional behavior is premeditated and a conscious choice on the part of the physician. In my years of dealing with physicians, I have never met a physician who wakes up in the morning and before he/she gets out of bed thinks “I’m going to be a jerk today. I want to see how many people I can make miserable by the end of the day.” In fact, a significant number of the physicians I have worked with didn’t even realize they were “disruptive.”
3) It assumes that the behavior is universally offensive and that it is exhibited universally. Again, as I deal with physicians who struggle with team dynamics, I am constantly amazed that, in certain settings, their behavior is deemed disruptive but in other settings they are esteemed and appreciated as wonderful caregivers and teammates, who are kind, compassionate and giving. This behavior is almost universally situational.
4) The label implies that all unprofessional behavior is rooted in a single cause. Which is definitely not the case and the subject of a future article. The presumption seems to be that “disruptive behavior” is a diagnosis, when in reality it is nothing more than a symptom.
5) The label doesn’t get to the root cause (the diagnosis) and therefore is universally unhelpful in effectively intervening to alter the behavior in the long term.
In future posts, we will explore in detail some of the root causes for unprofessional behavior among physicians and interventions that can help ensure that these physicians are appreciated and valued by the teams they are a part of, and who are respected for the professionalism they exhibit.
I would welcome your thoughts? Are my objections to the label valid? What have your observations been?