The disruptive physician: A conceptual organization

Abstract

Disruptive physician behavior is now generally recognized to pose a potential threat to patient safety. Recent policy positions and sentinel event designations have acknowledged this. Disruptive behavior is a widespread event with some 1-5 percent of physicians acting in a disruptive manner although significantly higher rates are cited for incidents of verbal abuse. Disruptive behavior can be classified along at least two dimensions. The first dimension is whether the behavior is goal-oriented in the sense that the physician achieves some goal or end. The second dimension focuses on the physician's social/behavioral competence. In addition, the disruptive physician should be assessed for psychological or psychiatric conditions (Axis I and II) as well as medical conditions that could be contributing. After classification of the behavior and determination of the physician's mental and physical functioning, it is possible to develop appropriate remedial strategies. These may include knowledge and skill development, psychiatric and psychological treatment, medical treatment and modifications to the hospital or clinical system in which the physician works. Failure to consider the multifactoral causes and manifestations of disruptive behavior could lead to ineffective approaches that do not successfully address the problem and present a high risk of relapse, thus posing a continuing threat to patient safety.