While I’ve never yet (perhaps surprisingly) attracted the “disruptive physician,” label, I am uncomfortable with the designation on behalf of those who have. For so many reasons the term “disruptive doctor” is unhelpful at best, cruel and discriminatory at worst. As a label it has been used and misused. Very few physicians start out disruptive. Moreover, the term places the focus and responsibility on the doctor – much like corporate “resilience training” – when the reality is that disruptive behavior in physicians is often a symptom of a larger systemic problem. It may be related to stress, burnout, mental health issues, addiction, and more. While abuse in any form must not be tolerated, we argue that a compassionate approach towards understanding the issues and a pathway to reform and remedy is needed.
“Disruptive physician behavior consists of a practice pattern of personality traits that interferes with the physician’s effective clinical performance…The disruptive behaviors negatively impact the persons with whom the physician interacts” – Reynolds (2012)
The American Medical Association (AMA) defines disruptive behavior as personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care. This includes but is not limited to conduct that interferes with one’s ability to work with other members of the healthcare team.
Disruptive behavior is different from criticism offered in good faith with the aim of improving patient care and from collective action on the part of physicians.
Doctors don’t start out as disruptive. If we did, we would never make it through pre-med, med school, or residency. We would be filtered out by the high standards and enormous stresses that characterize medical training. No, something happens to tip a small percentage of us over the disruptive edge.
Doctors don’t start out as disruptive. If we did, we would never make it through pre-med, med school, or residency. We would be filtered out by the high standards and enormous stresses that characterize medical training.
No, something happens to tip a small percentage of us over the disruptive edge.
It is important to note that while disruptive behavior may be less prevalent in medical school, it is not entirely absent. Instances of unprofessional conduct or disruptive behavior can still occur, but they are often addressed through mentoring, counseling, or educational interventions to ensure that students develop appropriate professional behavior as they progress in their medical careers.
Transitioning from medical school to professional practice brings about new challenges and stressors that can contribute to the manifestation of disruptive behavior. Factors such as increased responsibility, long working hours, complex patient cases, and organizational culture can influence behavior differently than the more controlled environment of medical school.
To gain a comprehensive understanding, we must delve into the factors that contribute to disruptive behavior among physicians.
Stress and Burnout: Physicians face numerous stressors, including heavy workloads, long hours, and the emotional toll of dealing with patient suffering. This chronic stress can lead to burnout, which may manifest as disruptive behavior (Wallace et al., 2009).
Organizational Factors: The organizational culture and work environment can significantly influence physician behavior. High-pressure settings, lack of support, and a hierarchical structure that discourages open communication can contribute to the development of disruptive behavior (O’Connor et al., 2018).
Substance Abuse and Mental Health Issues: Substance abuse and mental health disorders are prevalent among physicians but often remain unrecognized and undertreated. These underlying issues can contribute to disruptive behavior, highlighting the importance of addressing physicians’ well-being and providing appropriate support (Gregory et al., 2019).
Personal Challenges: Physicians, like anyone else, face personal challenges outside of work that can impact their behavior. Relationship problems, financial stress, or health issues may contribute to emotional distress, which can manifest as disruptive conduct in the workplace (Wallace et al., 2009).
Doctors don’t start out as disruptive. If we did, we would never make it through pre-med, med school, or residency. We would be filtered out by the high standards and enormous stresses that characterize medical training. No, something happens to tip a small percentage of us over the disruptive edge.
Disruptive behavior among physicians can have significant consequences, affecting patient care, healthcare team dynamics, and organizational outcomes. Understanding these consequences underscores the importance of addressing and preventing disruptive behavior in healthcare settings.
1. Patient Safety and Quality of Care: Disruptive behavior compromises patient safety and the quality of care delivered. Studies have shown that disruptive behavior is associated with communication breakdowns, medical errors, poor patient outcomes, and decreased patient satisfaction (Rosenstein & O’Daniel, 2008).
2. Healthcare Team Dynamics: Disruptive behavior negatively impacts the dynamics and morale of the healthcare team. It can create a hostile work environment, hinder effective communication and collaboration, and erode trust among team members (Oser et al., 2019).
3. Employee Well-being and Job Satisfaction: Disruptive behavior contributes to increased stress and job dissatisfaction among healthcare professionals. It can lead to emotional distress, burnout, and a desire to leave the profession, impacting the overall well-being of physicians and other staff (Dexter et al., 2020).
4. Reputation and Organizational Culture: Instances of disruptive behavior can tarnish the reputation of healthcare organizations, leading to decreased patient trust and confidence. Additionally, a culture that tolerates or ignores disruptive behavior can perpetuate a toxic work environment and hinder recruitment and retention efforts (Rosenstein & Naylor, 2018).
5. Legal and Financial Consequences: In extreme cases, disruptive behavior can result in legal actions and financial consequences for both individuals and organizations. Lawsuits, damage to professional reputation, and negative financial impacts can arise due to the repercussions of disruptive behavior (Rosenstein & O’Daniel, 2015).
Disruptive physician as a term is in my view an unhelpful label.
We’ve researched a few options and would love to hear your views and suggestions:
1. Struggling physician: This term acknowledges that disruptive behavior may stem from underlying challenges and emphasizes the need for support and understanding.
2. Behaviorally challenged physician: This term recognizes that disruptive behavior is a manifestation of behavioral challenges and encourages a compassionate approach to address and resolve these challenges.
3. Emotionally distressed physician: This term highlights that disruptive behavior can be a result of emotional distress and emphasizes the need for empathy and support to address the underlying emotional issues.
4. Stressed physician: This term acknowledges that disruptive behavior may arise from excessive stress and underscores the importance of stress management and support for physicians.
5. Impaired physician: This term acknowledges that disruptive behavior may be related to impairments such as substance abuse, mental health conditions, or personal challenges. It emphasizes the importance of providing appropriate resources and interventions to support the physician’s well-being.
Our winner?
6. Wounded healer: Here we note the many traumas that we are exposed to in medicine in addition to our own burden of traumas before medicine. As previously written, very few professions outside of first responders and the armed forces are exposed to the degree of human trauma as clinicians. These wounds are part of us but can also destabilise us if we don’t deal with them.
What do you think?
Disruptive behavior in physicians is a complex issue that requires a multifaceted approach. We have argued that the label is unhelpful and we need to look at alternatives. Disruptive behavior can affect morale, patient outcomes, and cause suffering to those around and the doctor themselves, so it’s important to address issues early and with compassion. It is important to remember that behind the behavior of a disruptive physician, there may be underlying stress, burnout, mental health issues, or personal life struggles, and addressing these underlying issues can help prevent disruptive behavior from occurring in the first place.
