Disruptive Physicians Get Makeover In Hospital Therapy Program

A physician worked in a hospital for a decade when a nurse with whom he had clashed threatened to file a lawsuit against him and the hospital. He allegedly waved an instrument in her face and had been verbally abusive for years, according to Glenn Siegel, M.D., a psychiatrist and medical director of Professionals-at-Risk Treatment Services at Elmhurst Memorial Health Care in Elmhurst, Ill.

The doctor targeted in the nurse’s lawsuit was shocked when a hospital administrator handed him his personnel file full of complaints from disgruntled nursing staff, said Siegel at APA’s 2003 annual meeting last month in San Francisco. He co-chaired a session with program administrator and psychiatric nurse Mary Pittman.

“No one said anything to him for 10 years about his behavior. The administration did not want to antagonize him because he brought in about $2 million in revenue. The nursing staff was told not to deal directly with him. When the vice president of nursing complained to administrators, she was told in essence to ‘suck it up,’ ” said Siegel.

The hospital administrator called the state physician assistance program for advice about how to deal with the disruptive physician and was told that the physician should first be evaluated for his fitness for duty.

“He came here for a two-day intensive assessment. We recommended he enter treatment and gave him several options,” said Siegel in an interview.

The physician chose to enter Professionals-at-Risk Treatment Services, where he was required to interact with other patients and staff at least 50 percent of the time and live in an off-campus apartment with other patients. To participate in the program, professionals must make a two- to three-month commitment, said Siegel.

The physician had a strong incentive to follow through; otherwise, the hospital planned to suspend his privileges. A suspension would have meant that his name most likely would be entered into the National Practitioner Data Bank, which is accessible by the public—a step that would have adversely affected his future medical career, said Siegel.

The intensive day-treatment program integrates multiple therapies designed to treat people with personality disorders and mood, anxiety, dissociative, and eating disorders. “We see a lot of people with narcissistic personalities who have issues with entitlement,” said Pittman.

Most physicians in the program are men; the ratio of men to women is 9 to 1.

The villain/victim dynamic is common in the relationship between physicians and nurses, said Pittman. As a result of verbal or physical attacks, communicating in an intimidating or demeaning manner, refusing to comply with assignments or participate in committees, and failing to respond to coverage or on-call duties in a timely and respectful way, offending physicians become “villainized” by the nurses, said Siegel. The nurses feel victimized and respond with passive/aggressive behavior, absenteeism, increased staff turnover, low morale, and poor self-esteem and may displace their anger onto patients and families.

These are among the costs to the hospital administration:

• Increased risk of employee lawsuits.

• More time spent counseling disgruntled staff and patients and family members.

• Increased staff turnover.

• More time spent with sexual harassment issues and conflict management.

• Increased expenses spent trying to satisfy the unrealistic demands of the disruptive doctor.

• Time, energy, and money spent in the rehabilitation process.

The costs to the physician are also great. More often than not, the villain/victim dynamic plays out in the physician’s marriage, often spilling over into the workplace, Pittman said. Thus, the program requires weekly marital and family therapy.

About half the physicians who enter the program have substance abuse problems. They can be treated in the hospital’s inpatient detoxification unit and join patient groups for chemical dependency, said Pittman. Other groups address trauma and abuse and eating disorders.

About 33 physicians are treated annually in the intensive day treatment program, which has operated since 1996. Siegel and Pittman created the program using an inpatient unit in 1990. “With managed care, we later converted that into a partial hospitalization or day-treatment model,” said Siegel.

“We believe our program is unique because in addition to offering dual-diagnosis treatment, the staff encourages patients to embrace values that form the foundation of healthy relationships. These values are open, honest, and direct communication, respect for oneself and others, responsibility for one’s choices, holding each other accountable, inclusion, and awareness,” said Siegel.

“We have seen a remarkable transformation in physicians who use these values. For example, the physician whom the nurse threatened with a lawsuit returned to work where the change in his behavior was noticed by others. The nurse told him, ‘Whatever you did worked,’ ” said Pittman.

The Web site of the Elmhurst intensive treatment program is www.professionalsatrisk.com. ▪