Disruptive Physicians and the Emotional Toll of Medical Practice

Many physicians work in a demanding professional climate fraught with looking-for-perspective3long hours, rapidly paced schedules and, most often, an overwhelming clinical responsibility.  As a backdrop to these daily rigors, the onus of legal liability along with professional isolation, will, over the long haul, exponentially compound the emotional toll of a medical practice.

While these are powerful dynamics in the work-a-day world of the physician, they can also become corrosive forces in the private lives of physicians.  Opportunities for social support, collegial relationships outside the workplace, participation in family life, recreation and self-care activities can take a costly backburner to the daily practice of medicine.  The physician is consistently challenged to find a balance in daily living that will support and rejuvenate the ability to practice and practice well.

Training does not prepare physicians for the balanced management of a practice.  Medical school does not focus upon the well-being the physician.  Conversely, training more frequently reinforces the denial of personal needs in various ways. Early on the career path, the physician is expected to work to full capacity even when physically and emotionally spent.  Additionally, often victims of the nonprofessional behavior of superiors themselves, younger physicians are soon initiated into the professional world of power and control.

Professional role models often expose the physician-in-training to their own emotional distress in the workplace.  Emotionally-driven behavior and poor, even abusive interpersonal behaviors, are not uncommon ‘lessons’ for the student or resident.  Superiors can model powerful and self-sabotaging workplace behavior that the younger physician internalizes. Students often learn early on that those in charge can behave in marginal or even abusive ways to those with ‘lesser rank’.

The training of a physician is lengthy and arduous.  It takes place, throughout its course, within the rank and file of a rigid hierarchy.  The need to please superiors in order to be successful is always front and center.  Moreover, medical training is a difficult and costly investment.  While the majority of physicians will begin practice in deep financial debt, the emotional investment of training is deep as well.  Consequently, young physicians will endure much to succeed.  Unfortunately, in a profession that demands so much over the long haul, and in the confines of a work day, many will struggle to cope with the emotional costs of practice while their training has often ill-prepared them to do so.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.dvi-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert 
 

Disruptive Physicians: Evaluating Your Own Interactional Style – Passivity and Passive Aggression

retreating-to-my-own-world_jpgPassivity and passive aggression in medical practice may actually be one and the same.  A passive physician can be disruptive to effective patient care and the performance of the work team.  An ‘absent’ physician can also greatly increase the risk of error and adverse incidents.  Passive behaviors such as not communicating pertinent clinical information through timely or thorough charting, not seeking consultations, not answering pages or calls promptly or at all are some of the ways in which physicians can undermine effective patient care.
 
These types of behavior, while not open displays of verbal abuse or aggression, also fall under concerns raised by JCAHO in their Behaviors That Undermine a Culture of Safety.  Sentinel Event Alert Bulletin:  Issue 40. July 9 2008.  It is significant that JCAHO also considers the passive physician to be disruptive.  The bulletin states:

 “Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing  to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities.”

JCAHO now recommends core competencies for the credentialing of medical staff.  These recommendations cite the need for physicians to demonstrate competencies “including interpersonal skills and professionalism” in the work environment.  Refusal of privileges by credentialing committees, and administrative action against already hired physicians, could apply equally to the passive physician and the more openly aggressive one.

It is likely that the passive physician is responding to the same stressors as the aggressive physician, but that individual coping styles and personality structures account for the dissimilar presentations.  Some individuals, across professions, will act out when chronically stressed while others will express themselves indirectly and in a more internalized way. 

Passive physicians would do well to repair their clinical demeanor by moving from their end of the expressive continuum toward assertiveness as well.  Increased engagement with teammates in person and through call begins to build relationships.  Re-affirming the importance of one’s role in the clinical setting can help increase motivation to communicate one’s knowledge through notes and consultations with team mates.  Increased interaction with team mates will help foster a sense of being needed and having a vital contribution to make in the clinical setting.
 
If the physician’s withdrawal from the clinical setting is reactive to being overwhelmed by the team’s approach then more proactive interaction will help ‘teach’ and ‘train’ the team members to communicate and interact with the physician in supportive ways.  Passive physicians will have to rehearse assertion skills in order to convey what would help diminish workplace stress and facilitate a better, more comfortable alliance with other team members.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

Anger Management Classes and Anger Management – Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.dvi-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Managing Disruptive Physician-Generated Risk in Communication Patterns

the-highwireA physician’s communication style can dramatically increase the risk of serious error in patient care.  Simple adjustments in style can conversely reduce risk and liability.  The One Minute Manager by Ken Blanchard and Spencer Johnson written in 1981 has sold millions of copies. It is still a gold standard of manageable ways to reduce work stress, empower workmates, improve efficiency and manage good communication.
 
One minute is the time it takes, according to Blanchard and Johnson, to do effective completion of many tasks, give praise to workmates and give reprimands when appropriate. In 60 seconds, a busy and harried physician can conceivably clear a piece of paperwork from his path by handling it only once and attending to it when it is first picked up.  This technique works for several reasons.  The paperwork does not pile up into a seemingly insurmountable and tedious task; quickly disposing of that obligation eliminates having that and other similar tasks brewing on the backburner to distract and ‘haunt’ you through the workday and if you have the inclination and time to pick up a piece of paper to inspect it in the first place, chances are you also can spare 60 seconds to process it so you don’t have to touch it again.
This philosophy is easily translated into improving communication, improving work relationships and de-stressing as you go through the typical workday or answer call.
 
Another technique described by Blanchard and Johnson is the one-minute praising.  Ending an exchange with workmates with 60 seconds (or less!) of appreciation for their contribution is a fantastic investment with high return.  Giving the details of why you appreciate them, and/or the current interaction, builds a supportive and cooperative work alliance that will, over time, become a valuable resource in further supporting you.
 
These 60 seconds also become ‘training’ for team members in which you teach how best to communicate with you and what decisions and behaviors of theirs best help you to do your work. Praise boosts morale and empowers others to operate with authority within their scopes of practice so that your own practice is complemented and better empowered.  This small investment will mobilize your available work resources, increase the likelihood that your need-to-know information is readily communicated and reduce risk and liability in patient care.  It is a minute investment for big pay-off’s in professional self-care and a sense of enhanced work related well-being
.
The third technique offered by Blanchard and Johnson is the one-minute reprimand.  There are times when reprimands are necessary.  Limiting this exchange to 60 seconds of a clear, calm explanation of the problem, as well as the corrective action needed, will greatly reduce your own stress, contain any emotionality that might rise in lengthier interactions and take that issue off the mental backburner where resentment and potential emotionality will simmer.  Taking 60 seconds immediately to address an error in a professional tone and to suggest a corrective plan again is a small investment in clearing the air, maintaining good working relationships and ‘teaching’.

Keeping in mind that praise is greatly enhanced in its power when an audience is listening and that reprimands are received much more easily and without resentment when care is taken for discretion will make those 60 seconds of communication even more potent, effective and empowering to your work team.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

For more information please visit http://www.ami-tx.com

“Anger Management Institute of Texas is a certified Anderson & Anderson provider.”

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Professional Consequences for the Disruptive Physician—the role of other physicians and professional organizations

consequences13Physicians considered “disruptive” in their professional lives are now faced with a greater possibility of administrative interventions due to JCAHO standards.  Interventions could result in loss of facility privileges, limited or lost privileges to practice medicine and even legal proceedings.  Physicians should be aware that administrative agencies could require that a disruptive physician undergo psychological assessment in order to determine fitness for practice and that a disposition of impairment is possible.
 
Such proceedings are distinct from civil or criminal proceedings reactive to malpractice. These are not to examine a case of patient care per se, but are to evaluate a physician’s fitness to continue medical practice. Interventions to address professional disruptive behavior and professional impairment can result in revoked licensure.  While revocation has been appealed in state courts, typically courts defer to the discretion of medical boards.
 
The AMA stands firm that all physicians are responsible for maintaining health and wellness in order to be fit for medical practice.  The following is from the AMA Ethics Policy E-9.0305 Physician Health and Wellness:

“To preserve the quality of their performance, physicians have a responsibility to maintain health and wellness, construed broadly as preventing or treating acute of chronic diseases, including mental illness, disabilities, and occupational stress.  When health or wellness is compromised, so may the safety and effectiveness of the medical care provided.  When physical or mental health reaches the point of interfering with a physician’s ability to engage safely in professional activities, the physician is said to be impaired.

In addition to maintaining healthy lifestyle habits, every physician should have a personal physician whose objectivity is not compromised.  Physicians whose health or wellness is compromised should take measures to mitigate the problem, seek appropriate help and engage in an honest self-assessment of their ability to continue practicing.”

The AMA Code of Medical Ethics states that a “physician shall respect the rights of patients, colleagues, and other health professionals” and that a “physician shall…report physicians deficient in character or competence…to appropriate entities.”

Hospitals mandated by JCAHO to develop policies to address disruptive physicians may make decisions about their own organization’s relationship with a physician against whom allegations of disruption are made.  They may also, based upon the results of an investigation, involve the state medical society’s impaired physicians’ health service program. 

Confidentiality is guarded in treatment and supervision of impaired physicians; however, some states do have disclosure laws that mandate certain types of information be reported.  Discovery of past serious misconduct and patient harm, or potential patient harm, are reported to the state medical board.
Additionally, some state medical boards will post findings of misconduct in print and/or electronically.  The National Practitioner Data Bank will also post allegations and findings that come to medical boards for review.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

For more information please visit http://www.ami-tx.com

“Anger Management Institute of Texas is a certified Anderson & Anderson provider.”

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Anger Management Executive Coaching Services for Physicians in Houston, Texas


Anger Management Institute of Texas’ Executive Coaching Program for Disruptive Physicians is experiencing a dramatic increase in referrals from Texas, and Louisiana.
 

All of the referrals have been made by management of accredited hospital/organizations as a result of JCAHO Sentinel Event Alert Issue 40, July 9, 2008 which became effective January 1, 2009 regarding physicians displaying disruptive behaviors in the workplace.

Our Anger Management Executive Coaching 10 Hour program is available for clients who would prefer a private setting or are not appropriate for mixed or open groups. Such individuals may include, but are not limited to, high profile individuals, physicians, attorneys, judges, faculty, law enforcement, and high-level management.
 
The program is designed to improve stress and anger management, communication, empathy, and emotional intelligence. Initially, a confidential Anger Management Map, and Emotional Intelligence Profile assessment is utilized to determine your current level of functioning in the following areas:
 
1. Interpersonal Aggression
2. Interpersonal Assertion
3. Interpersonal Deference
4. Interpersonal Awareness
5. Self-Esteem
6. Empathy
7. Drive Strength/Motivation
8. Decision Making
9. Time Management
10. Leadership
11. Commitment Ethic
12. Stress Management
13. Physical Wellness
14. Personal Change Orientation
 
Based on the results of the assessments, our Executive Coaching clients are provided with an individualized plan of action that includes exercises and behavior logging tools to facilitate the learning process. Sessions concludes with a review and a summary. If at all possible these classes should be completed in a timely manner; evening and weekend hours are available.
 The weekend program schedule is:
 
• Friday   6 – 8 PM   Assessment and review
• Saturday 1 – 5 PM  Executive Coaching
• Sunday    8 – 12 Noon   Executive Coaching
   
Note:  We provide optional 30 Day, 60 Day, and 90 Day 30 minutes (telephone or in-person) follow-ups.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com

http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Anger Management and Emotional Intelligence

The four domains of emotional intelligence are:

·Self-awareness/anger management

·Self-control

·Social Awareness

·Relationship Management

Anger management is actually the key to managing all intense, negative emotions. Emotions determine our styles of communication as well as our ability to make decisions. Anger is a common symptom of stress.

All legitimate anger management classes, as well as Executive Coaching Programs, must include an assessment that is designed to determine the participants level of functioning in managing anger, recognizing and managing stress, preferred styles of communication and the skill level in exhibiting empathy.

Following the non-psychiatric assessment, skill enhancements are provided via individual Coaching or small group facilitation. Both methods of intervention include client workbooks, DVDs, and videos.

Anger management coaching is, and should be, viewed as a positive intervention for people interested in increasing their emotional intelligence.

By George Anderson, MSW, BCD, CAMF, CEAP http://www.andersonservices.com/

Anger Management Institute of Texas is a certified Anderson & Anderson ® provider.

Anger Management Classes and Anger Management – Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert

Recession Increases the Demand for Anger Management Services

As our economy continues to decline, there is a dramatic increase in referrals to anger management coaching programs. It is generally recognized that stress is rampant among persons who have lost jobs, faced foreclosures and other consequences of a down economy. The holiday period exacerbates these stresses.

Anger is a secondary emotion that is always preceded by some other emotion. Generally, it is stress that precedes anger. As we become overloaded with stress, or become burned out, our potential for person-directed anger tends to lead to aggressive behavior.

In contrast to previous holiday periods, this holiday season is generating an unprecedented number of men who are mandated to attend anger management classes or coaching by their significant others. These clients tend to be highly motivated to change as they see their relationships are at risk.

While anger is a normal human emotion, it is a problem when:

·It impacts, damages or destroys interpersonal relationships

·Occurs too frequently

·Lasts too long

·Is too intense

·Has health consequences

Anger management coaching on an individual basis is more effective and focused than any intervention that is offered in groups. Some experienced, well-established anger management coaches are offering these services on-site nationwide.

By George Anderson, MSW, BCD, CAMF, CEAP http://www.andersonservices.com

Anger Management Institute of Texas is a Certified Anderson & Anderson® Provider

Anger Management Classes and Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers
http://www.ami-tx.com
http://www.ami-tx.org
https://gregorykyles.wordpress.com
http://www.linkedin.com/in/gregorykyles
http://www.myspace.com/anger_management_expert