◙ REHAB SPECIALIST "Love the sinner, hate the sin," says Kent Neff, MD, FAPA, a psychiatrist who specializes in treating disruptive doctors.

Disruptive physician behavior took center stage at OR Excellence. Psychiatrist Kent Neff, MD, the nation's foremost expert on troubled surgeons, presided over an intensive 2-day "Disruptive Doctor" pre-conference workshop and then led off ORX with an engaging talk that focused on the underlying causes of disruptive behavior and practical strategies to defuse the name-calling, the scissor-throwing and the drape-ripping. "It's an ongoing problem that affects the morale, efficiency, outcomes and patient satisfaction in the OR," says Dr. Neff. "At its core, disruptive behavior is a patient safety issue. It's impossible to have a truly safe unit when disruptive, disrespectful behavior is present." As always, Dr. Neff was enlightening and empowering.

• What causes disruptive behavior? Play psychologist for a moment and consider how doctors are socialized and developed. It's not normal, says Dr. Neff. Many docs lack social skills and social maturity. "They act like teenagers, and sometimes less," he says. "That's the level of emotional development. They're made to feel entitled at an early age, then subjected to abuse in medical school as they strive to become perfectionists."

What happens then? The abused become the abusers, says Dr. Neff. The surgeon who stops in the middle of a case to lecture for 15 minutes about something that was said and he did not like. The surgeon who walks into the OR and remarks, "I see I have the crap team today." The surgeon who calls you at all hours, insisting that he do his surgery immediately even though his procedure is not emergent.

• How to defuse it? A "good-doctor, bad-behavior" mindset is the key to exorcising your ORs of rude and crude physician behavior, says Dr. Neff. "Love the sinner, hate the sin," he says. "Treat people with respect, but then get really tough about their behavior. Be hard on the behavior, but soft on the person."

Next time you face off with an intimidating and temperamental doctor with a history of verbal and emotional tirades, try this proven intervention technique. Use the term "unacceptable" to address specific, observed behavior: "Doctor, I'm empowered to tell you that this behavior is unacceptable."

If, for example, a surgeon yelled at a tech and called her "stupid," note the time and date of the behavior and address it with the doctor in non-judgmental terms. Nurse managers must lower their tolerance for harsh behavior and feel empowered to tell surgeons that their behavior is unacceptable, says Dr. Neff. Simply saying, "Doctor, that behavior is inappropriate and is not acceptable" is a powerful way to disarm a disruptive doc without ranting and raving yourself, he says. "Docs don't see their behaviors as you do."

Physicians with disruptive behavior are often unaware of how serious the problem truly is. "No consequences means no change," says Dr. Neff. "Most physicians with disruptive behavior have not had meaningful consequences." Whether it's rescinding block times or suspending privileges, have a hammer, and don't be afraid to swing it. Find out what really matters to your docs and hit them where it hurts.