One of the challenges in trying to deal with disruptive physicians is that they often don't understand that they're disruptive, says psychiatrist Kent Neff, MD, FAPA, a noted lecturer and workshop leader, and an expert on managing disruptive behavior. "The most common scenario," he says, "is the doctor who says, I want the best care for my patients, and the only way I can get nurses to listen to me is to yell at them. They do it in the service of patient care, but it actually has the opposite effect. It hurts patient care." In Dr. Neff's presentation, "Giving Disruptive Docs a Second Chance," he'll explain how you can reach and rehabilitate physicians who knowingly or unknowingly make life tougher for everyone around them.

The culture issue. The culture in your facility is often at the root of some of these issues. If you have a tolerant attitude about bad behavior, it's more likely to occur. What we find over and over again is that these things have been going on forever. People start to say, that's how it is, and they make workarounds, so the behavior continues.

Not just yelling. Disruption can occur in many forms. Some doctors are nasty to nurses or can't seem to get along with their peers. Some may actually have physical encounters. Some refuse to follow instructions or safety procedures. Some repeatedly make errors, and no one can figure out why. And occasionally, you have a doctor who gets into a romantic relationship, or tries to, with one of the nurses — what I call the Bill O'Reilly Syndrome.

How it starts. In studies we've done of more than 300 disruptive doctors over a number of years, we found that about two-thirds came from a background of either emotional abuse or neglect. Also, about one-fourth had addiction issues — alcoholism, drug abuse or both.

Kent Neff, MD, FAPA

Noted psychiatrist has worked with hospitals, health systems, professional associations and licensing boards regarding physician health and wellness for more than 30 years.

Frequently conducts widely acclaimed seminars on influencing physician behavior, establishing respectful workplaces and managing change.

Was director of the professional assessment program at Abbott Northwestern Hospital in Minneapolis.

The med school factor. The way we physicians are socialized is also a factor. Starting in our teens, for 10, 12 or 14 years we're out of normal circulation in terms of socialization. We spend those years studying like mad in college and in med school, and when we get out, we're in our 30s. It explains why so many have difficulty with the interpersonal aspects of medicine.

First steps. The key is getting disruptive doctors to realize their behavior isn't acceptable. Often, people don't feel they have the right to call out a doctor. But the word unacceptable is powerful without being emotionally charged. That doesn't mean it's OK to duke it out with the doctor, but it's OK to say, Excuse me, I don't expect to be treated that way, or I felt disrespected when you said that.

High success rate. Some may be beyond hope, but good outcomes are possible in a much larger percentage of cases than most people expect. The effort to rehabilitate physicians is a good idea for several reasons: It's expensive to replace them; many, even most, are solid practitioners — and some are exceptional; and giving physicians a chance to change is consistent with our mission in health care to promote health and wellness. OSM