It’s no secret that patients aren’t the only ones that can be difficult to deal with. Concerns regarding ‘disruptive physicians’ have been reported in medical literature for more than 35 years.
The problem isn’t going away and while there may seem to be an increase in this behaviour, it’s unclear if this is due to there being more disruptive doctors, or if we’re simply becoming less tolerant of abusive behaviour and are reporting it more often.
Disruptive behaviour refers to a style of interaction with others that adversely affect morale, focus, concentration, collaboration and communication. It can adversely affect the health care team’s ability to work effectively and it can lead to substandard patient care.
So, how do you deal with a disruptive doctor?
The answer is that it depends on what kind of disruptive behaviour is being displayed. The US-based Medical Group Management Association (MGMA) has in-depth material on how to manage doctors who have displayed aggressive behaviour – examples listed include suggestive sexual comments; degrading comments; yelling at colleagues in front of patients; and refusing to attend group meetings.
MGMA’s advice pertains to management-level staff and practice administrators; there’s one thing they make clear: disruptive behaviour can have a significant impact on the practice, jeopardising patients, valued staff members and the practice. Confronting the problem in a constructive manner is important, this means reporting disruptive behaviours and, if you’re in a management role, taking these reports and complaints seriously. Having a prevention plan to ensure that a good working culture is developed is another great tip.
But not all disruptive behaviour is the same. Sometimes, colleagues who are difficult to work with are more on the ‘annoying’ end of the scale than the ‘disruptive’ end. It’s important to distinguish between disruptive behaviour which may be abusive, sexist, racist, rude or negligent, and behaviour that’s irritating.
In a recent article of Gastroenterology, three US gastroenterologists identified four personality ‘doctor types’ that can cause havoc in the practice.
Four difficult doctor personality types
The Know-it-all – This doctor type are usually high achievers with a great clinical acumen, but they know this all too well. They talk in a condescending manner and use terms such as ‘obviously’ and ‘clearly’ when discussing their own ideas. The Know-it-all can be intimidating, unapproachable and difficult to negotiate with. Try setting yourself up as a peer; find common ground and set a professional tone.
The Insecure – Despite being perfectly adequate doctors, this personality type lacks confidence and constantly seeks positive affirmation. They might decline to take on roles they’re capable of doing, or are overly-thorough in their diagnosis process (i.e. ordering lots of tests to ‘rule everything out’). If you’re working with an Insecure doctor, help them build confidence and share responsibility if the patient has an unexpected outcome.
The Flake – While it is important to prioritise personal health and set good work-life boundaries, the Flake takes this a step too far. They’re always seeking cover for conflicting plans and family activities, but rarely offer help in return. They may have good interpersonal skills, but they don’t respond to emails in a timely manner or answer phone calls. This can be frustrating when you need to discuss a patient. For the Flake, you’ll need to convey to them the gravity of the patient’s needs.
The Combatant – Combatants wear their emotions on their sleeves, they take things personally, embrace emotional conflict and might even resort to physical intimidation. While it can be emotionally taxing to deal with a Combatant’s bullying behaviour, it’s in the best interests of you, your patients and your profession to address the situation before it gets worse.
How DEAL with it…
The Gastroenterology doctors also used the handy acronym, DEAL, which outlines how to negotiate with difficult doctors.
Remember that seriously disruptive or inappropriate behaviour should always be reported to management. But if you’re dealing with a difficult personality, try the tips above to work towards a better working environment. The doctors behind ‘DEAL’ recommend engaging in healthy conversations and discussions regularly, so that when emotions are high and you need to resolve a conflict, you’re confident and practiced enough to have confidence that you’ll be able to negotiate the best outcomes for your patients. Finally, remember that everyone is entitled to a bad day – sometimes, unacceptable behaviour is an exception.