As noted in our first AdelMED Insight on abrasive physicians, these high-octane fellows often reject the notion that they cause problems and need help.  The so-called high-functioning difficult doctor may be a self-righteous rationalizer and externalizer.  He is often quick to lay blame on other team members, administration, the system, the EHR, etc., etc. Although this off-putting style tends to perpetuate the unpleasant status quo, the sooner we engage, evaluate and assist, the better.

It serves everyone (patients, staff, and the organization) when we provide help to these difficult physicians before they start crashing and burning.  Start by looking at each individual’s situation vis-à-vis the following 4 domains:

• Career stage
• Ownership of the problems
• Skill of the leader
• Complicating factors

Career stage:  Sooner is always better. Early career physicians (including trainees) are often very receptive to well-delivered corrective feedback.  Those who cannot turn things around on their own are usually able to do so with additional resources like courses, coaching and therapy.  Early-career docs, especially those with a large educational debt burden, are sometimes reluctant to spend money to help themselves.  Some training programs willingly cover or share in the cost of professionalism interventions. 

Remember:  Putting out small brush fires is a great deal easier (and less expensive), than taming those larger later-career blazes. 
And where there’s smoke early on…………

Ownership:  Although some physicians who behave badly are absolutely clueless about their impact on others, many are not.  What looks like lack of ownership may be defensive pushback – physicians hate being singled out as a problem.  When they are given a chance to tell their stories to skilled, empathic interviewers, it is common for them to display partial ownership of their challenges. They’ll say things like, “I know that I can be hard-driving to a fault and that I have a tough time giving others the benefit of the doubt.”  So, to determine what kind of help (and how much) is needed to eliminate the uncivil behavior, it is important to learn if this doctor ‘gets it.’

Skill of the leader:  The accountable leader may be on the medical side or the business side.  If more than one individual is holding the distressing doctor accountable, the team needs a captain.  The captain should have the extensive skill, commitment, and experience when it comes to orchestrating professionalism turnarounds.  When the situation is dire and one or more members of the team are starting to smell the smoke of a likely conflagration, the skilled leader may need to play the card of, “You’re going to have to sit on the sidelines until we can (a) figure out what’s broken and, (b) start fixing it.”  Benching a doc with that kind of tough love is often the quickest way to launch the turnaround.

Complicating factors:   These need to be considered and explored before a course of corrective action commences.  Is the distressing doc suffering from a significant medical, neurological, psychiatric or substance use disorder?  Are there confounding family or financial issues?  Factoring these in or out is complicated by physicians’ use of ‘impression management’ techniques when they find themselves backed into a corner.

In summary: Medical leaders should strive to address problematic physician behavior in a timely and effective fashion.  In conjunction with the complexity of complicating conditions, the doctor’s level of insight shapes the next steps. 

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Next AdelMED Insight: Can This Coaching Crap Really Help Me Keep My Job?