Difficult Physicians

Question:

I became manager of a new clinic where the physicians moved from an existing clinic. The move was to enable more control over the physicians, who seemed to have become unruly. I hoped that the physicians would like our new facility with modern equipment and electronic medical records. This is not the case. They fight, constantly complain about everything, and won’t take new patients. They have small panel sizes and are generally miserable jerks! Was I dreaming to think they would be any different in new surroundings?

Signed,

Bad Dreams


Answer:

Dear Bad Dreams:

Your question seems to be how to deal with jerks; however, could it be that your question is not how to deal with spoiled doctors but what in the system allows and encourages such bad behavior? That is to say, are they in competition with one another and is there little for them to lose by incivility?

Bad habits continue so long as there’s no pain or reason to change. Reasons to change in your case might be situation-specific, but most generally, change occurs because of some loss or opportunity to profit. For example, what if your clinic was in threat of being shut because several patients had hospital-acquired infections, nosocomial infections or HAIs, superbug methicillin-resistant Staphylococcus aureus, aka MRSA: a drug-resistant staph infection. Possibly that would cause more blaming until they acknowledged that they had better clean that place and change their hand scrubbing and establish clinic-wide practices to rid it of risky behavior. Or on the other hand, what if the administration of your new clinic and the others it owns were to buy in to lean management practices that rewarded big bonuses for cooperative doctoring? Might the hostility lessen if a significant portion of the profits of the clinic were divided equally to all doctors and the profits hinged on what improvement was made on increasing the client load and satisfaction of patients? From this distance, diagnosing is impossible, so is prescribing. The fact is that you are not alone in being frustrated. You stated that it was thought by someone, probably administrators of your operations, that assigning these doctors to a new clinic would enable greater control of them. Of course, you as manager of this new clinic, can assert your self. You don’t have to put up with bad manners and incivility. You can treat these doctors individually with honey and vinegar appropriate to the occasion of their misbehavior. And that might be work in some cases if you have the backing of your boss.

But you are not alone. More importantly you can quietly consult with your administration and Human Resources about what undermining threats and overarching goals might change the system that has permitted incivility. It might be they and you will come up with a creative way to engage your physicians in a collaborative effort to improve the quality of doctoring your community. Sometimes pettiness is put aside when such an effort takes hold. Does this make any sense? I sent your question to an expert who heads up a program called Operations Excellence for a large hospital. Possibly he will have other advice. If he chooses to reply, I will forward his advice. As usual, I close with my signature thought: Working together with hands, head, and heart takes and makes big WEGOS, and I sense that is what you want. I predict that you are frustrated enough that you will do all in your power to make your clinic a less unpleasant place to work and even more committed to doctoring your community. We welcome an update on what you elect to do. It is those, like you, who work through what should be better who can best teach the rest of us. Follow Up: I am not posting addition specifics of your situation to protect your anonymity, but a few more remarks are in order: If you will permit a mix of metaphors, in such situations as yours, troubleshooting and fire fighting is par for the course. I sense that you are capable or you wouldn’t have been entrusted with this new position and new clinic. Apparently it is more than you expected. Now the matter is in your hands and you can be as assertive as is reasonable; however, you shouldn’t have to carry the whole load on your shoulders. You physicians should be made to face up to the problems of your clinic’s risk of failure and their own success. They should be informed of your concerns and those of your administration. They should be a team supporting the clinic and you. My friend to whom I sent you original question has sent the following advice: After much thought I believe you have summarized the following point the best, “Apparently it is more than you expected. Now the matter is in your hands and you can be as assertive as is reasonable; however, you shouldn’t have to carry the whole load on your shoulders. You physicians should be made to face up to the problems of your clinic’s risk of failure and their own success. They should be informed of your concerns and those of your administration. They should be a team supporting the clinic and you.”

We are finding, in our more difficult areas, that providers must be part of the solution. A well organized department/practice works best when all individuals work together. At some point, when providers act up, managers/department leaders must cut the loss. It might be difficult for the local community in the short term to get through the stress, but the long-term solution is have a team that works for what is best for the patient and not the providers. Lean Management’s first principle is, “Define the value in the eyes of the patient within healthcare”. I believe the organization below has allowed the providers to re-write this principle.

William Gorden