Dealing with an Abrasive Doc

shouting doctorOnce I month I visit a local physicians practice group for 2 hours of leadership training and real-time performance management coaching. At one of these sessions, a Practice Manager asked me about a frustrating situation with a doctor, one that is, unfortunately, all too common.

”What do I do with a doc that constantly goes crazy on us?”

He described a physician who has angry, confrontational reactions to any and all hiccups, delays, questions, or problems that arise during the course of the day. Large, small, or common, it doesn’t matter. These violent outbursts are regular, predictable, and are directed toward the staff much of the time. This behavior has resulted in a constant quest, by the staff, to avoid this man at all costs. They all dread the days when they are scheduled to work under him.

So what’s a leader to do? Here are 5 strategies to Deal with an Abrasive Doc:

Discuss Your Concerns. As an operational manager, any attempt to address this behavior is going to have to start with a conversation. You have to decide whether you go first to the physician in question or look for support elsewhere. The quality of your relationship with this physician, your standing in the eyes of other leaders in the organization, and your own confidence level will all influence how you approach this conversation. My advice: Start with the offending doc. Steal a few minutes some place private and be direct and concise. Specifically describe the troubling behavior and it’s impact. To get buy-in, connect the dots between his or her actions and something they care about. It may be as simple as this:

“Dr. So-and-So, How direct can I be with you?”

(Wait for his answer, which will always be in the affirmative).

“I want to ask you to stop being so curt and demanding toward the staff. It saps them of their energy, slows down everything in the clinic, and patients are picking up on all the tension it creates.”

Then wait.

Don’t fill the silence. Let the doctor react. Be prepared to participate in a more sophisticated discussion with examples if the opportunity arises. Highlight social consequences, like the opinions of the staff and peers, as well as the impact his or her behavior has on the metrics and measurables of the site. Don’t assume malice – that this person is a bad, mean, or uncaring person. At all times remain calm, respectful, and resolute. This is a problem, and you’re bringing it to them for discussion.

Involve Others. If the conversation above doesn’t go well or behavior change doesn’t occur, identify others who can help address this behavior. Are there other physicians on the team or in the practice that can assist? A peer is a powerful, influential force in discussions like these. Can you involve a high-ranking administrator or medical officer? These folks are your allies. In most cases they recognize the costs of this kind of bad behavior. Get them involved as early as possible. Ask for their help in addressing the situation directly and as often as it takes.

Stand Up for Yourself…and Your Team. In the presence of persistent, continued bad behavior, there will inevitably come a moment when you’ve had enough. Where any fear or instinct toward self-preservation is finally drowned out by the anger and discomfort created by this person. This is the day when you draw a line in the sand and make it clear that this person’s behavior is unacceptable. You may have to get angry. You may have to truly confront the behavior, not as mid-level manager to powerful doctor, but human being to human being. This is the “Enough is enough, pal.” conversation, and sometimes it’s not pretty.

This involves a certain amount of risk that some just aren’t willing (or wired) to take. But it may be the only strategy that works. A few years ago a former colleague of mine told me about a time when one of her physicians threw a folder at her because “I didn’t put the right size paperclip on it.” Without thinking, she threw it right back at him. “Don’t you ever do that again,” she said and walked away. He was stunned. And he never did anything like that again.

I’m certainly not advocating for any kind of physical altercation. That’s never appropriate. But you may have to use words to “lay down the law,” as they say.

Report It. Most organizations have policies and expectations around harassing or bullying behavior. If you’ve involved others in power and had the kinds of conversations outlined herein, you may have no choice but to take more formal action. Consult with your Human Resources or Physician Relations team on next steps. If you are in a small or independent site where those resources don’t exist, type up a formal letter outlining your concern and hand it to the head of the site, even if that person is the offending party. If the behavior of the physician in question isn’t just abrasive but is truly harassment, it may be a good idea to consult with an attorney.

I’ve been in healthcare for many, many years now. I’m not naive. I know that many times bad actors are allowed to continue being bad actors, and those that push back against them end up leaving, or being told to leave. There are a wide range of “what ifs” to consider when determining what action to take, but remember: everyone deserves to be treated with courtesy and respect, regardless of their position, station, or make-up. If you aren’t going to get that from someone, despite repeated attempts at an adult conversation, do you really want to be there anyway?

The good news is that an overwhelming majority of docs treat those around them with grace, kindness, and affection.  They know, as well as anyone, what I once heard a well-respected physician tell a group of 3rd year residents:

“Having a license to practice medicine doesn’t give you a license to be an a**hole.”

[Now it’s your turn. The options explored in this article certainly aren’t the only ways for managers to navigate this kind of behavior. What other strategies do you suggest? Post your thoughts in the comments box below!]

Joe Mull is author of Cure for the Common Leader: What Physicians & Managers Must Do to Engage & Inspire Healthcare Teams. He is President of Ally Training & Development, which provides leadership, management, and staff development programs to healthcare professionals.

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