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It's important to address misbehavior by healthcare providers towards others in the practice.
A common complaint I hear from physician clients concerns how they are treated by others with whom they practice or come into contact in a professional setting. Both in the training stages of residency and fellowship, and when in practice, physicians (and other healthcare professionals) are often subject to abuse by other healthcare providers.
To address misbehavior by healthcare providers, it is not unusual for physician contracts to contain provisions that require a physician to "work cooperatively with others," "not engage in conduct or habits that reflect poorly on the employer," or comply with a code of conduct that governs physician behavior. These types of provisions can be used to effectively take disciplinary action against a physician or another healthcare provider, or even effectuate a termination. I always take the time to point out such provisions when reviewing a contract on behalf of a provider so they are aware that their conduct can dictate their continued employment.
Unfortunately, provisions intended to prevent physician misbehavior are often misused. For example, I have seen a physician (or staff loyal to this physician) make claims against another colleague for simply raising their voice or expressing frustration about something in the workplace. This is often done to harass someone seen as a competitor or to paint them in a bad light to the employer or other third parties. Too often, these types of provisions are not accompanied by a proper process to interview witnesses or investigate the situation and it can greatly affect the career of the accused. Additionally, the handling of such matters often lack privacy or are not handled by a neutral party. There are a lot of politics in healthcare and behavior provisions are often used to achieve political goals.
On the other hand, providers may have valid claims against an abusive or inappropriate colleague and be afraid to complain for fear of retribution. This is particularly true when a physician is in a position of authority, has a reputation that is important to the employer or is a significant source of revenue for a practice or healthcare facility. An employer might be apt to dismiss the concerns raised or simply transfer the complaining provider, rather than ruffle the feathers of the "abusive" party. Although this certainly raises legal issues under workplace laws, it is the unfortunate truth about what happens in many workplaces.
There is no doubt that physician contracts should contain provisions that govern conduct and behavior, and which hold a provider responsible. However, consider the following:
1. Make sure there is a fair and appropriate policy in place to investigate behavioral complaints. This process should provide for statements from witnesses and others who work with the accused provider and should be conducted by someone neutral. In a smaller practice, this might need to be the lawyer or accountant, particularly if the consequences might be severe. Have a process in writing that will be followed at all times.
2. Provide opportunities to correct behavior. When someone yells at a colleague or is rude/dismissive, that person should be reprimanded, but this may not be grounds for termination, particularly if it is unusual or out of character. Everyone can lose their cool once in a while. Consider suggestions such as anger management, talking with a counselor or working out an issue among colleagues as an appropriate response. Some smaller employers also like to use team building to improve relationships in the workplace.
3. Extreme behavior requires an extreme response. Throwing items, yelling and screaming, slamming doors or equipment, or regularly being abusive are signs of a more significant issue. I still believe working with a valued provider to address these issues is always optimal when possible. Sometimes a treatment program may be required and should be considered in order to save the provider and the relationship. Many physicians are tired, frustrated and angry in general, and lack any ability to manage stress. These providers can be helped. However, to be clear, where someone poses a threat to others or is likely to create liability for an organization, there is no option but to take final and immediate action. Worrying about reputation and revenue should never be a reason not to act affirmatively to address behavioral issues!
4. Some physicians are simply abusive, arrogant, and entitled. These providers are rude to patients, staff, colleagues, and others (or put on a different face depending on with whom they interact). Taking no action can put an organization in jeopardy, cause a loss of other valued providers in the workforce, and impact the reputation of the employer.
In developing policies or contracts that serve your organization, work with counsel to properly address the type of behaviors which create concern. Make sure your process to address unacceptable behavior is fair and balanced. Most importantly, have a process in place before you need it!