the counterproductive and damaging behavior patterns
is likely to require prolonged and intensive counseling.
Physicians in this position generally must be mandated to
enter counseling programs, as they are unlikely to seek
In a structured format, the physician’s behaviors should
be discussed and include specific documentation. The physician should have an opportunity to self-evaluate. Relevant
cultural factors also should be addressed. A plan for future
actions should be developed, agreed upon, and documented
with stepwise progression up to and including dismissal
from the medical staff, if the disruptive behaviors continue.
Consequences of continued/repeated inappropriate behavior should also be explained to the physician. The conversation should be documented and the physician’s progress
monitored. The ultimate goal of these actions is focused on
two outcomes—improved patient care and a physician who
embodies optimal behaviors and capabilities.
Monitoring. As part of the corrective plan, a monitoring program should be put in place. Established behavior
patterns may be resolved incrementally, and while relapses are not uncommon, improved conduct is expected. If
the behaviors persist, the agreed-upon penalties should be
implemented. The monitoring period will vary, but it should
extend at least six to 12 months to encourage the maintenance of appropriate behavior. Most state medical boards
provide or contract with formal programs for the evaluation and rehabilitation of physicians who exhibit disruptive
behavior, and these are available to hospitals as an option
for resolution. These programs can be found on the website
of the Federation of State Health Programs and the Federation of State Medical Boards (see sidebar, page 23). These
programs provide the offending physician an opportunity to
confidentially undergo rehabilitative counseling or behavior modification without jeopardizing his or her licensure.
In an era in which quality care and patient safety are high
priorities, the surgical profession can no longer tolerate disruptive behavior in or out of the operating room. These
behaviors should be addressed early on and in a stepwise
fashion to reduce their impact and presence, to maintain
the morale of other members of the health care delivery
team, and to protect our patients’ well-being. ♦
1. Williams MV, Williams BW, Speicher M. A systems
approach to disruptive behavior in physicians: A case
study. J Med Lic Disc. 2004;90( 4): 18-24.
2. American Medical Association. 2011 AMA Code
of Medical Ethics. Opinion 9.045–Physicians with
disruptive behavior. Available at: www.ama-assn.org/
ama/pub/physician-resources/medical-ethics/code-medical-ethics/ opinion9045.page. Accessed January
3. Rosenstein AH, O’Daniel M. A survey of the
impact of disruptive behaviors and communication
defects on patient safety. Jt Comm J Qual Patient Saf.
2008; 34( 8):464-471.
4. Rosenstein AH, O’Daniel M. Disruptive behavior
and clinical outcomes: Perceptions of nurses and
physicians. Am J Nurs. 2005;105( 1): 54-64.
5. MacDonald O. Disruptive physician behavior. May
15, 2011. Available at: www.quantiamd.com/q-qcp/
December 9, 2014.
6. Johnson C. Bad blood: Doctor-nurse behavior problems
impact patient care. Physician Exec. 2009; 35( 6): 6-11.
7. Reynolds NT. Disruptive physician behavior: Use and
misuse of the label. J Med Regul. 2012;98( 1): 8-19.
8. Porto G, Lauve R. Disruptive clinical behavior: A
persistent threat to patient safety. Patient Safety and
Quality Healthcare. Lionheart Publishing Inc. July/
August 2006. Available at: www.psqh.com/julaug06/
disruptive.html. Accessed December 9, 2014.
9. Leape LL, Fromson JA. Problem doctors: Is there a
system-level solution? Ann Intern Med. 2006;144( 2):107-115.
10. Hickson GB, Federspiel CF, Pichert J W, Miller
CS, Gauld-Jaeger J, Bost P. Patient complaints and
malpractice risk. JAMA. 2002;287( 22):2951-2957.
11. Daniel AE, Burn RJ, Horarik S. Patients’ complaints
about medical practice. Med J Aust. 1999;170:576-577.
12. Patel P, Robinson BS, Novicoff WM, Dunnington
GL, Brenner MJ, Saleh KJ. The disruptive
orthopedic surgeon: Implications for patient safety
and malpractice liability. J Bone Joint Surg Am.
13. American College of Surgeons. Statements on
Principles. Available at: www.facs.org/about-acs/
statements/stonprin. Accessed December 9, 2014.
14. Papadakis MA, Teherani A, Banach MA, et
al. Disciplinary action by medical boards and
prior behavior in medical school. N Engl J Med.
15. Weber DO. Poll results: Doctors’ disruptive
behavior disturbs physician leaders. Physician Exec.
2004; 30( 5): 4, 6-14.
It is crucial that behavior standards are universally applied
and that no perception of favoritism occur (that is, higher
tolerance for inappropriate attitudes or actions exhibited
by prominent or highly productive physicians).