152. Dealing with Disruptive Physicians-the "Sorting Hat" Method to Build Your Action Plan

This is the second of two podcasts showing you how to deal with disruptive physician behavior. You are a physician leader who's been tasked by the senior administration to deal with disruptive behavior from one of your direct reports.

In the last episode, we showed you how to prepare for the conversation, how to structure the conversation, and always keep your legal part covered. Today, I'm going to show you how the doctor's reaction to your outreach determines which one of the three follow-up plans you'll use. Two of them will rehabilitate the doctor, if successful, to their good standing as a member of the staff. The third one is perhaps the most important one — how to know when to fire them on the spot. Check it out.

In the last podcast, we talked about the setup to the intervention conversation — making sure you know the bylaws and have copies of the disruptive physician policy, the impaired physician policy, and the discipline policy. If the organization doesn't have all those things, make sure you ask the CEO to get a legal consult so that you're covered by the organization's liability umbrella when you act as a member of the leadership team in this particular outreach.

We also talked about how you structure the conversation. We've gotten to the point you're telling the doctor exactly what you know about the incident that triggered this response, the exact behavior that must stop, and that you are notifying him as a member of the leadership team — and that this conversation will be documented in the minutes of some meeting somewhere in the organization.

It's crunch time. It's time to see what the doctor is going to do, and their reaction will typically fall into one of three groups. We call this the Sorting Hat, because what you do from this point forward after the outreach is determined by how the doctor reacts to this conversation.

In Harry Potter, the Sorting Hat has four houses to choose from. Our Sorting Hat here has three different basic reaction styles that get three different responses.

Style number one I’ll characterize as chagrin. The doctor would say:

“Oh my God. Oh my God. I would never want anybody to think that about me. Please say that again. What did I do? Oh, I'll do anything to make that go away. I don't want to get in any trouble. I love it around here. Please help me so that I don't ever do that again.”

Let’s call that chagrin. This is a doctor who agrees with you about the nature of your concern about whatever the incident was. They agree that they would never want to be perceived this way, that it was a mistake, and they don't want to do it again.

This is the only one of the three that gets a classic PIP — performance improvement plan. They agree there’s an issue. They’re willingly going into some sort of a plan to change their awareness and behavior. Typically, your organization is pretty well set up to deal with situations of performance improvement. Oftentimes it’ll involve someone in HR. Oftentimes it’ll involve a peer mentor — maybe even you — coaching them through conversations if it was a conversational snag, helping them with awareness and boundaries if it was something physical.

This is the simplest of the three.

Reaction number two is typically hostility, and typically they’ll deflect your concern by saying that there's something that you did to cause them to react this way:

“You know, I wouldn’t have to do this if you’d hire good nurses around here. Jeez. This isn’t about me — get out of my face.”

And we’ve all heard things like that.

This is a situation where the doctor does not agree with you calling them out on this behavior. They actually are going to use excuses to justify their behavior, and they’re going to resist your critique.

This person doesn’t get a performance improvement plan because they don’t agree with you that performance improvement is necessary. This person gets a behavior modification plan, meaning the behavior must stop.

Now, there are two kinds of behavior modification plans — one with teeth and one without.

“Go get a coach, Chuck, so you don’t talk like that to Betsy.”

Chuck says “Okay,” and everybody’s on good behavior, and nobody’s tracking anything, and it’s all missing accountability. Typically, those kinds of soft programs don’t work very well.

Most of the time, you’ll start somebody who’s hostile about your critique of their behavior on a voluntary program, and a significant percentage of folks will stop the behavior. However, a significant percentage will also recur — and that’s because the voluntary programs have no teeth.

Then you would step them up to a mandatory program, meaning you would give them a my way or the highway contract. You would rewrite their contract and have them sign a new contract that says: this behavior is out of bounds, if it happens again we will fire you immediately, and here’s the program we’re going to put you through to train you to stop that.

Typically a coaching program, typically with weekly or twice-a-month coaching, many times with 360 surveys so that everybody on the work teams in all their work settings can chime in on how they feel they’re doing — in terms of communication, behavior, trust, and leadership skill.

Over time, if the doctor is willing and diligent, they can fill the holes in their emotional intelligence, learn communication patterns, raise their awareness, and graduate out of their program back to a point where they would be a fully involved, contributing member of the staff.

The third type of reaction is unmistakable. You tell them the behavior that you have seen in the reports and that must stop. The doctor pulls out their cell phone, looks you in the eye and says:

“I’m calling my lawyer.”

There’s only one legitimate response to that kind of hostility: they must be immediately fired.

Take their keys, empty their desk, and escort them out of the building. If you do not respond in that fashion, what message have they received?

Basically, it’s: “Carry on, my good man.”

Let me give you some case studies, because I’ve helped organizations through all of these situations a number of different times.

Response number one: chagrin.

“Oh my God, I wouldn’t want anybody to think that about me.”

I worked with a 47-year-old vascular surgeon who had outbursts in the OR. Over the course of a couple of years, he had three or four. When I sat down with him and asked him to slow-motion take me through one of those outbursts, it turns out they only occurred in very specific situations — specifically, when he had a patient on the schedule that was bumped by an emergency case. That’s when, once he finally got into the OR, he was nasty.

I asked him, “Where did that start?” He said, “That’s how everybody acted at my residency program.” He actually had a history of having had a patient who was bumped, have a bad outcome, and a lawsuit against him. He was traumatized and conditioned to feel that behavior was normal where he came from.

Given his circumstances, when we understood that that’s not normal, he was a diligent student of emotional intelligence and of the triggers that would cause this behavior. He graduated from his PIP in a matter of weeks.

Reaction number two: blame/hostility.

“If you just get some decent staff around here, I wouldn’t have to yell at them like that.”

I worked with a 53-year-old OB-GYN — a five-person practice. He was one of the senior members, and he had a habit of, when he was upset or uptight or behind, going into this stiff posture that all of the nurses in the building called the robot. He wasn’t a very big man, but when he was in the robot, and he would glare at you, people just put their back against the wall and stayed as far away from him as possible. It was quite intimidating to the staff.

When I let him know that that was affecting morale and caused them to see him in a particular fashion, he was appalled. He and I worked together to help him turn recovering his standing with the nurses as a good guy into his mission — his ministry. He approached it as a good Christian man and made it something that he prayed on. We actually studied books by preachers that helped you be a better person. He graduated out of that program with flying colors in about a year.

Another institution I worked with had a 58-year-old interventional radiologist. The hospital had a committee that put the interventional radiologists and the vascular surgeons in the same room once a month — and they didn’t get along very well.

The disruptive doctor was a 58-year-old radiologist, a white man. The person he was brutalizing in these committee meetings and in the hallways afterward was a younger Indian vascular surgeon. There were clearly racial overtones to the abuse he heaped on his junior colleague, and it came to a point where the senior team felt there could be liability here if we didn’t do something about it.

I coached the senior team to do the outreach conversation, and literally, that radiologist — when told that his behavior needed to stop — pulled out his phone and said, “I’m calling my lawyer now.”

I hadn’t been updated on what happened in the conversation for a couple of weeks. So I called them and I listened to this story. I said, “Well, what did you do?” And they said, “Nothing.”

They allowed him to continue to be the head of the committee. They ghosted me and didn’t communicate with me afterward, and I can guarantee you some very bad things happened after that.

Now, you may be afraid to can somebody right away, but that kind of behavior needs to stop now. That kind of threatening needs to stop now. If you back down, you’ve sent the person a message that they can carry on doing whatever they’ve always done — because you have no teeth.

And I must admit, we all know that firing a person like this is probably going to end up in a lawsuit — because psychopaths hire psychopath lawyers. But you have to bite the bullet and kick them out. Get them off the staff. Because it’s a poison that infects everybody if you fail to act. That’s my humble opinion.

You have to put some teeth into your action plan and your policies when confronted with a psychopath member of your staff like that.

So there you go — the Sorting Hat:

Who gets a PIP: the folks that are chagrined.

Who gets a behavior modification plan: the folks that blame it on something else.

Who gets fired: the person who pulls out their phone and calls the lawyer.

Just so you know, dealing with disruptive doctors — coaching programs to rehabilitate them — is something that we offer here. I personally have coached a number of these doctors, and I find it to be very rewarding work because we’ve weeded out the ones who are resistant to looking in the mirror by this Sorting Hat process.

And the link for a discovery session is in today’s show notes.