How to deal with a difficult physician

So what do you do with a physician who's acting out? One thing is certain: Ignoring the problem won't make it go away. This article provides some practical advice on handling the difficult physician.

Develop rules of conduct

It is important for your practice to develop standard rules of conduct that are part of the office policy manual. These rules should include issues of behavior that are not acceptable, and they should apply to both physicians and staff. Consequences for violation, as well as how the physician leadership will address and resolve the performance issue, should be clearly described in writing. Once these are prepared and agreed upon by the physicians (or, in larger practices, the board of directors), administrators will have the tools to address unacceptable behavior.

When a physician behavior issue first emerges, it is important to analyze the outburst. Is this a difficult physician, or is it a physician with high standards and high performance expectations? Is the doctor upset because an employee is slacking off and he is demanding better performance, or are his expectations unreasonable and he's using heavy-handed methods and abusive behavior in order to confront a problem?

Sure, there are plenty of situations when a physician can be frustrated over legitimate gripes. However, if there is more than an occasional outburst, it's probably affecting practice performance, and the time is right to review the rules of conduct established by the practice.

Carefully document performance history

If the offending physician is in violation, it's time to go to the next level. This means the administrator will need to call on the other physicians for help. But before doing so, review documentation to make sure you have recorded the prior performance history and how each situation was handled. This is a key element in helping the other physicians understand the gravity of the situation. It's up to them to call their partner on his behavior and take appropriate action. Physicians addressing physician behavior is a serious matter and will get the problem physician's attention.

In addition to establishing disciplinary procedures, the practice can offer the difficult physician support by engaging a counselor to work on behavioral problems. However, physicians must be prepared to terminate a physician who is a repeat offender. This is difficult in a small practice that dreads the time and expense of recruiting and hiring a physician, especially in a specialty facing a work force shortage.

There are certainly challenges in dealing with impatient and temperamental physicians, but no one should have to work in an environment where they worry about a physician lashing out at them. The sooner unacceptable behavior is dealt with, the better off everyone will be.

A skilled manager understands it's their job to deal with problems and keep them from getting bigger, but they need the support of leadership to achieve the best results. It is the leadership team's responsibility to provide a culture of respect and cooperation. Effective and timely communication, fairness, and management's support of staff are the basic tenets in building open and strong relationships throughout the practice.

Modern Medicine NETWORK

NEWS UPDATE
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In Practice Judy CapkoJudy Capko is a health care consultant and the author of Take Back Time- Bringing Time Management to Medicine . She can be reached at 805-499-9203 or judy@capko.com
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