Addressing Unprofessional Conduct

One of physician leaders’ most challenging tasks is managing and mitigating unprofessional physician conduct complaints from patients, colleagues, nurses, and staff. Newly appointed physician leaders may be uncomfortable confronting these issues with their colleagues.

In Dr. Matthew Mazurek’s leadership positions, he has conducted dozens of investigations of unprofessional and disruptive conduct, from the mundane to the serious. He offers insight on how to address disruptive behavior.

What is the best way to set the stage for a professional behavior meeting?

First, determine if the meeting should be one-on-one (with a witness) or if it warrants a formal professional behavior committee meeting. Minor concerns are best-handled one-on-one. If it is the attributed physician’s first offense, consider a one-on-one meeting. For more egregious or repeat behaviors, a committee meeting is the best option.

After this, communicate the need for a formal meeting with committee members and then contact the physician with a professional phone call. Phone calls are more personal and less threatening than an email or letter. If the physician is a repeat offender, a certified letter may be necessary.

What type of prework is necessary?

Prework includes gathering all objective facts, interviewing witnesses, and preparing the main points of the meeting. A preliminary meeting with committee members is especially useful as a rehearsal for how the committee would like to proceed. If the physician is a repeat offender, knowledge of past concerns and disposition is also helpful.

Additionally, it is essential to examine the bylaws, rules and regulations, and a copy of the signed professional conduct policy. Ensure you are following the process as outlined. Lastly, never discuss the conduct with physicians or colleagues who are not members of the committee.

In your experience, how do these meetings with physicians usually go?

It’s important to open the meeting with a brief introduction and assurance that all discussion is confidential. Then, jump in and ask the physician to tell their side of the story without interruption. This demonstrates respect and helps establish trust.

Most meetings with first-time offenders usually go well, and the physician acknowledges the concern and apologizes. However, some physicians will attempt to “hijack” the meeting, take control, and blame others. Keep the discussion focused on the behavior, not the causes.

Some physicians blatantly state the meeting is a waste of time or become hostile and angry. Other physicians are somewhat quiet and conciliatory. Most meetings go well despite these challenges if a clear expectation for a change in behavior is stated. It is difficult to defend poor behavior, and ensuring the meeting is solely about the physician’s behavior will keep it from going off on tangents.

A classic example is a surgeon who threw an instrument that was broken. The surgeon will “justify” the behavior due to the faulty equipment. The broken instrument is a separate and important concern. Acknowledge that you, too, would be frustrated and angry. Your acknowledgment of how a physician feels can go a long way during a meeting, but always make sure you are focused on the behavior itself.

Most meetings go well, but don’t be surprised when a physician becomes accusatory or angry at others.

Any hints for dealing with physicians who are repeat offenders?

Repeat offenders are your biggest challenge. It can be difficult to rehabilitate a physician who just doesn’t seem to “get it.” Your task is even more difficult if the physician lacks insight or remains unapologetic.

In these instances, it is essential to communicate that there will be a no-tolerance policy, and further incidents can lead to loss of privileges. It is a last resort, but the message needs to be clear. If you fail to escalate the consequences, you maintain the status quo and a double standard. Your own credibility is at risk.

It is also important to examine whether the physician is a “high producer.” Some organizations have a strong desire to protect high-earning physicians, and they will be granted a pass. It may not be overt, but it is a consideration.

If you believe this might be the case, your response is to point out that the physician seems to be “let off the hook” a lot without any consequences. Ask why. If there is a CMO, ask the CMO. If you are the CMO, then ask the CEO or chief-of-staff. The responses will tell you what is going on.

After the responses, tell them the behavior cannot continue and list the reasons. High turnover, for example, impacts patient care and finances in the department. Also, point out the risks and liabilities of not intervening.

Another tactic is to use another physician’s conduct and disposition as an example that there seems to be a double standard. Be firm in your resolve to find a solution. Recognize you will be cast as a “villain” by the attributed physician. Don’t take any of it personally. You are performing the duties the role requires.

Lastly, go slow and take a measured approach. Pressure applied slowly and consistently will usually get results.

And what about follow-up? What should happen post-meeting?

Post-meeting, write a professional, courteous letter that includes a personal thank you, discussion points, disposition, and professional closing. If it is the physician’s first event, explain that the process is not meant to be punitive. The purpose of the meeting is to discuss the events, hear the physician’s perspective, and ensure the physician understands why they have been summoned.

If the disposition includes any actionable items such as anger management programs, coursework, etc., make sure you include deadlines for the physician to complete the items as well as the consequences if they choose not to participate.