In the tight-knit community of an ambulatory surgery center, the difficult physician is immediately recognizable, says Michael Redler, MD, co-founder of the Orthopaedic & Sports Medicine Center in Trumbull, Conn. He yells and screams, speaks rudely to surgical team members and may even throw instruments. He is constantly making exorbitant demands, taking up many hours to get his point across and not giving an inch on scheduling. He demands specific scrub techs and makes the rest feel like second-class citizens. "Because of his behavior, this physician has made it difficult for surgical staff and others to do their jobs," Dr. Redler says. Here the Connecticut orthopedic surgeon gives eight tips on how to deal with such physicians. 1. Don't be heavy-handed. Take a step back before aggressively confronting him. If you say, "This is not going to be tolerated," you are just creating more resistance. "Take your own pulse first," Dr. Redler says. "Make certain you're not worked up, too. You have to be calm." 2. Put yourself in his shoes. Try to understand motivations behind the behavior. "When people act out, they want to be noticed," Dr. Redler says. "Maybe they don't feel important." Some things the physician is upset about may have some legitimacy. "There may be some things going on that he has a right to be upset about," he says. 3. Pick up on his body language. You can tell when someone is very upset by non-verbal behavior, such as huffing and puffing, pursed lips, stamping a foot or standing with arms folded. "Don't ignore these signs," Dr. Redler says. "Tell him: 'You seem to be really upset. Do you want to talk about it?' " 4. Tell him how others feel around him. Let the surgeon know how staff members feel when they are yelled at. "Tell him that screaming at the surgical tech is not creating a positive environment," Dr. Redler says. "It is not getting what you want in terms of a reaction." 5. Engage in a dialog with him. Repeat back to him what you hear him saying: "I think what you are saying is…" Ask him to help you find a solution and generally encourage him to improve his behavior. 6. Fellow physicians are often most effective. Administrators and head nurses often encounter a great deal of resistance when trying to work things out with a difficult physician. Bringing in the medical director or a physician champion is often more successful. "The difficult physician may feel that talking to anyone other than a colleague is diminishing the importance of his problems," Dr. Redler says. 7. Help him find a way for him to talk to staff. If he is ready and staff members are willing, ask him to sit down with them. He should be encouraged to discuss any concerns he has with staff in a low-key way. "Then he won't need to yell and scream," Dr. Redler says. 8. Support your staff. The problems with a disruptive physician should reach a resolution within a few weeks. "If things don't work out, you need to stand up for your staff," Dr. Redler says. "If you cannot resolve the situation and it drags on, the message to them is, 'Your feelings are not important.' " Source
