Tips for dealing with a difficult colleague

Your colleague hasn’t been acting like herself. What should you do?

Approach her, especially if patient safety is an issue, says David Frenz, MD, medical director of mental health and addiction care at St. Joseph’s Hospital in St. Paul.

Be direct and specific but don’t take on the role of “behavior police,” recommends Deb Wood, PhD, senior consultant and certified employee assistance professional with Minneapolis-based VITAL Worklife, a national behavioral health consulting organization. “Say, ‘I hear you yelling more than I have previously. I’m really concerned about you,’ ” she says. “Or, ‘I’ve been hearing about it from other people. I’m concerned.’ ”

Note if patients have said, “I don’t want to see Dr. X because he’s so cranky,” she advises.

If appropriate, review options to address the behavior with your colleague. If that doesn’t work, talk to a manager, especially if the behavior is problematic and hostile.

If there’s no resolution, “Get rid of the bad player. Their behavior can be damaging to the practice, demoralizing to coworkers and employees who are intimidated by this behavior, and ultimately bad for patient care and patient safety.” – Peter Moskowitz, MD, Center for Professional and Personal Renewal, Palo Alto, Calif. 

Peter Moskowitz, MD, gives one example of a hostile physician: A surgeon was having temper outbursts with scrub nurses or anyone who got in his way, screaming and yelling in front of patients, families and medical students. In the OR, he threw a scalpel at a nurse that ended up sticking in the floor like a pocket knife.

Dr. Moskowitz has also worked with other physicians who have threatened physical violence against nurses, students and other doctors. “Acting out behavior is unacceptable even if it’s caused by burnout, which it often is,” says Dr. Moskowitz, executive director, Center for Professional and Personal Renewal, Palo Alto, Calif.

Managers can discuss complaints in a supportive way and point out that they respect the physician’s work as a clinician but don’t like the observed acting out behavior. The key is to seek agreement from the physician and then take steps to correct the behavior. It’s also important to determine a time period to change the behavior.

If the behavior doesn’t change, the physician should be referred confidentially to the physician wellbeing committee, if available. If not, the physician can be given a choice of personal coaching or psychotherapy. Refusal to cooperate should create the possibility of loss of job or partnership for the offending physician. The practice can recommend a referral to therapy, set standards for expectations that will be tracked and warn physicians that they could lose medical staff privileges at the hospital if they don’t comply.

“That’s pretty powerful and gets the doctor’s attention,” Dr. Moskowitz says.

If a psychological evaluation shows the physician is burned out and clinically depressed, for example, a plan might be for the physician to be in psychotherapy once a week for six months and to take antidepressants. A reassessment six months later would revisit the issues.

“The group would say, ‘We want to support you in doing that. This will be secret and not discoverable. You’re not charged with anything as long as there’s an agreement to cooperate,’ ” Dr. Moskowitz says.

During this process, groups and hospitals should be careful to provide the physician with all rights to appeal based on the physician’s employment agreement, he notes. This stage should be done with the advice of counsel for the practice.

What if there’s still no resolution?

“Get rid of the bad player,” Dr. Moskowitz says. “Their behavior can be damaging to the practice, demoralizing to coworkers and employees who are intimidated by this behavior, and ultimately bad for patient care and patient safety.”

Click this to tweet if you liked this article: “Acting out behavior is unacceptable even if it’s caused by burnout, which it often is.”