Handling Problematic Physicians
Handling Problematic Physicians by Marshall Colt, Ph.D.
Medical group managers must frequently deal with problematic
physicians and the resulting negative organizational dynamics.
It costs many practices valuable time, energy and money. One of
the most important skills in handling difficult physicians is
how to manage conflict.
Physicians come in all shapes and sizes. Some know business,
many don't; some know how to lead people, most don't. But that's
why they have you, to help them with those things. Primarily,
physicians want to practice medicine, period. When forced to
practice medicine in the real world, they largely view the other
things as distractions. Just as myopic as bottom-liners who
forget they must work with people to improve the bottom line,
many docs forget they must work in a peopled system, too.
In my experience working in and consulting to hospitals and
medical group practices, problematic physicians behave in ways
that fall into roughly three categories:
● Oppositional-defiant (being argumentative, acting out,
refusing direction, etc.) ● Silent-superior (a form of
passive-aggressiveness) ● Weak-helpless (another form of
being passive-aggressive)
Here is a practical model of how to deal with a physician in
such situations:
Why conflict happens and how people keep it going
Most arguments start because one person reacts too soon to
inaccurate and/or incomplete information. Of course, sometimes
both parties completely understand the other's position and they
still disagree. However, usually, the former holds. Add in the
complicating status or power differentials that often occur
between group managers and physicians and you've got a
particularly challenging, sensitive situation. If mishandled, it
could fester or get even worse.
Instead of coming to resolution, people keep arguments going by:
● getting defensive, ● counterattacking, ●
leaving the field ("I'm not going to address that"), or ●
changing the subject ("Well, look at how much vacation you
take!").
Any of the above is basically used to "win" an argument, not
resolve it. As an effective manager of conflict, you must get
your ego out of it: give up winning in favor of resolution.
Nipping conflict in the bud
Prolonged arguments predominantly involve statements, or
sarcastic questions masking statements. However, statements
alone don't work in resolving disagreements because they don't
address the two factors that start arguments: inaccurate and/or
incomplete information. So the key is to address these two
factors.
Additionally, you need to hold the line on getting defensive,
counterattacking, leaving the field or changing the subject.
Of several possible ways to curtail and resolve conflict, one
most effective is a process I call "Data Gathering." Not a
touchy-feely approach, Data Gathering is a practical method to
both defuse anger and begin to resolve an issue. Here's the
abbreviated version:
Step 1) Only ask questions...gather data...listen. Just try to
see how the physician views the situation. Don't respond with
your view (prevents getting defensive, counterattacking, etc.).
Only clarify, if necessary.
Step 2) After you feel you understand how the physician "ticks"
about the issue, ask "Is there anything else you think I need to
know about this?" At her conclusion, say you'll give the matter
more thought. This allows the physician to feel she's been
heard, with her points taken seriously enough by you to devote
your added consideration. We all want our day in court. This
serves that important purpose and cools things down.
Step 3) At the next meeting, thank the physician for her ideas
and propose a solution. Again, use mostly questions, not
statements, to respond to any objections. Using this process, a
mutually agreed resolution will most likely bubble up in time,
with a fight or power struggle avoided.
For more information:
http://www.corp-psych-mgmt.com/healthcare-industry-consulting.htm