Guide III: Handling the Disruptive Physician Summary

Hospital decision-makers often hesitate to initiate a review of a disruptive physician. In addition to internal political considerations, this reluctance arises, in many instances, because the evidentiary basis for the review may appear too subjective to support a peer review action. Despite these concerns, a hospital cannot ignore its legal obligation to take action to protect the safety of patients and the hospital staff from the disruptive behavior of a physician.

But what constitutes “disruptive behavior” and what kind of evidence is needed to show an “adverse affect” on patient care?

Although most medical staff bylaws contain provisions for the education or discipline of disruptive physicians, these provisions often fail to provide the guidance needed to initiate and investigate a peer review action based on disruptive behavior. By its very nature, the professional review action for a disruptive physician is complex, involves high-level hospital and medical staff politics and poses a serious threat to the hospital. Therefore, the probability of mishandling the process is substantial and can have severe effects.

Additional issues arise when the physician is reviewed due to disruptive behavior and concerns regarding their clinical competence. Of primary concern is maintaining the credibility of the peer review process while conducting a thorough investigation of both issues.

Hospital Peer Review Guide III: Handling the Disruptive Physician will assist hospital decision-makers in recognizing disruptive behavior, avoiding hospital actions that can exacerbate the effects of the disruptive behavior for both the hospital and the physician and initiating the appropriate procedures to comply with legal obligations.

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