Skip to Content
Top

Definitions of a Disruptive Physician

Physician angry with smoke out of his ears and clenched fist
|

Definitions of a Disruptive Physician

Disruptive physician behavior is physician conduct that actually or potentially has negative affects on patient care.  Any behavior that is viewed as non-collaborative, critical or dismissive can be  disruptive if this behavior is not focused on improving patient care and instead can be shown to undercut team cohesion and cooperation so that patient care is threatened.  However in practice the definition varies tremendously.

How Does the Joint Commission Describe a "Disruptive Physician"?

The Joint Commission defines disruptive physician behavior as "Intimidating and disruptive behaviors can foster medical errors, contribute to poor patient satisfaction and to preventable adverse outcomes, increase the cost of care,and cause qualified clinicians, administrators and managers to seek new positions in more professional environments.

How Does California Law Describe a Disruptive Physician?

The California Supreme Court in Miller v. Eisenhower Medical Center (1980) 27 Cal 3d 614 cautioned against limiting privileges pursuant to a by-law that specified a physician's “ability to work with others” as a requirement for medical staff membership. (Id. at pp. 621-622 & fn. 5.) The court explained: “An otherwise competent physician, although considered ‘controversial,’ outspoken, abrasive, hypercritical, or otherwise personally offensive by some of his hospital colleagues, may nevertheless have the ability to function as a valuable member of the hospital community and should not be denied the opportunity to do so as a result of personal animosities or resentments alone.” (Miller at pp. 631-632.)

All Agree: Disruptive Physician Conduct Must Affect Patient Care

Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.

In an article published by the Joint Commission titled “Addressing Disruptive and Unprofessional Physician Behavior” the authors stated that “This behavior can be overt, as with the use of profane, disrespectful, insulting, demeaning, insensitive, or abusive language; negative comments about colleagues (spoken or in the patient's chart); verbal intimidation; inappropriate arguments with patients, family members, or colleagues; rudeness; boundary violations; outbursts of anger; bullying behavior; throwing or breaking things; or use or threat of unwarranted physical force with patients, family members, or colleagues.”

9.4.4 Physicians with Disruptive Behavior AMA Rule

The American Medical Association Code of Medical Ethics, 9.4.4 Physicians with Disruptive Behavior warns that “Disruptive behavior is different from criticism offered in good faith with the aim of improving patient care and from collective action on the part of physicians. Physicians must not submit false or malicious reports of disruptive behavior.”

Washington State Department of Labor Defines a Disruptive Physician

On the other side the Washington State Department of Labor and Industry has published a document titled "Disruptive Behavior in Health Care A Threat to Health Care Safety" which so broadly defines disruptive behavior that it includes "rolling eyes in digust" and "Ignoring attempts at conversation."   

Is Disruptive Physician Conduct a Basis for Physician Discipline?

Disruptive physician conduct is often the basis for contract termination, privilege restriction, recredentialing denial and peer review.  Sham peer review is a term used when the disruptive physician label is used to terminate or restrict privileges when the physician's personal behaviors are not genuinely a patient care issue.

For more information on defenses to the disruptive physician label in the context of peer review, see our peer review page at our website.

Categories: