Unprofessional Behavior Diagnosis Part 1

In October I wrote about physicians labeled as “disruptive” (Disruptive Physician: An Unfortunate Label). In that post, I identified that labeling physicians as disruptive is often not only unhelpful, but potentially counterproductive. It treats the behavior as the root cause. Treating the symptom as the diagnosis unfairly labels and stigmatizes the involved physician, and, importantly, may misdirect responses to the behavior.


From my experience and research there are at least 7 possible root causes that can present as patterns of unprofessional behavior:


1) Burnout

2) Cognitive decline

3) Substance use disorders

4) Toxic work environments

5) Personal or professional crisis

6) Personality disorders/mental conditions

7) Dysfunctional responses to professional stressors


This month I will delve into the first three of the root causes, or diagnoses, that may manifest as unprofessional behavior. In later posts I will look at the remaining root causes.


Burnout

Burnout results from chronic workplace stress that has not been successfully managed. Recent studies indicate that, even before the pandemic, over 40% of physicians reported symptoms of burnout.[i] Burnout takes a terrible toll, not only on the physician, but also on everyone the physician interacts with. Burnout can be helped at an individual level, but also requires systemic changes that usually go far beyond the person exhibiting symptoms. (Contact me to talk about how you can successfully combat burnout in your organization)


Burnout is characterized by:


  • feelings of energy depletion, exhaustion, and compassion fatigue;

  • increased mental distance from one’s job, or feelings of negativism or cynicism related to one's job; and

  • reduced personal and professional efficacy (a loss of a sense of meaning).


In the face of burnout, physicians are less able to respond constructively to the challenges of clinical practice. Physicians who were previously models of professionalism may become increasingly unprofessional as they become burned out, presenting a picture of escalating disruptive behavior.


By properly identifying burnout when it is the root cause of disruptive behavior, interventions can be developed that allow the physician to once again become a constructive, valued care giver and medical staff member.

Cognitive Decline


Recent statistics indicate that the physician population continues to age. Data from 2018 indicated the median age of the physician population was 51.5 years old, compared with a median age of 50.7 years old eight years before, in 2010. Even more striking is the fact that over the same the eight-year period, the number of physicians practicing into their 70s increased by nearly 40% and those practicing into their 60s increased by 38%.[ii] Due to numerous factors this trend is likely to continue and may even accelerate.


Early in my career I dealt with a nationally respected physician in his 70s. People noticed changes in his behavior, including turning over more and more patient care to his residents and fellows, and becoming increasingly demanding and intimidating to others around him, especially when his personal nurse was not with him. As we looked into the circumstances more closely, it became clear that his behavioral changes were the result of cognitive decline. We worked with the physician and his partners to make an expeditious, successful and graceful transition to retirement.


If a senior physician becomes disruptive over time or is particularly unprofessional when he/she is deprived of their usual team, one must consider cognitive decline as a possible root cause.


Substance use disorders

Studies indicate that the prevalence of substance use disorders are similar for physicians and the general public (15% vs 13%).[iii] Like many others, physicians often initiate drug or alcohol use in attempts to self-medicate emotional or physical pain. Physicians who are struggling with substance use disorders will often present with a constellation of signs and symptoms that frequently include the acute onset of unprofessional behavior.


Over my career I have helped numerous physicians and other health care professionals through difficult times in their lives during which they turned to self-medication, with all the personal and professional complications this usually produces. Identifying and focusing on the root cause is the beginning step to a successful outcome. Focusing on the behavior alone, without seeking and responding to deeper root causes, often unintentionally accelerates the downward spiral.


In future posts I will discuss additional root causes for unprofessional behavior. As you can see from the examples above, “disruptive behavior” is a symptom not a diagnosis. Treating the behavior without treating the underlying root cause is not only unlikely to be effective in mitigating the behavior, it may place the physician, staff and patients at further risk.


I will also introduce, in future blog posts, a framework for responding to “disruptive physicians” that has been shown to be highly effective. It begins by correctly diagnosing the underlying root cause of the behavior and continues with pathways for assisting the involved physicians to become appreciated, valued, contributing members of the medical staff and health care team.


To learn how I can help you address your organization’s most pressing issues, including unprofessional behavior, go to contact us and schedule a free introductory one on one meeting with me, send me a message or give me a call.


 

[i] Shanafelt TD , West CP , Sinsky C , et al. Changes in burnout and satisfaction with work-life integration in physicians and the general US working population between 2011 and 2017. Mayo Clin Proc. 2019;94(9):1681-1694. [ii] Robeznieks, Andis: “For growing numbers of doctors, life in medicine extends into 70s”, Oct. 7, 2019, https://www.ama-assn.org/practice-management/physician-diversity/growing-number-doctors-life-medicine-extends-70s [iii] Oreskovich MR, Shanafelt T, Dyrbye LN, et al.: The prevalence of substance use disorders in American physicians. Am J Addict 2015; 24:30–38

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