Handling Problematic Physicians
By Marshall Colt,
Ph.D.
Managing Principal, Corporate Psychological Management
1761 Hotel Circle S, Suite 218, San Diego, CA 92108-3318 USA
E-mail:
mcolt@corp-psych-mgmt.com
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, difficult docs 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,
with case examples to follow.
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.
Three case
examples in dealing with difficult docs
After many,
long, grueling years of schooling and training, physicians realize they occupy a
revered place in society by holding great sway over disease or wellness,
suffering or relief, life or death. Those without MD’s appreciate this and are
respectful and deferential to physicians due to their virtue and/or by social
conditioning. However, many ego-driven docs trade unfairly on the respect and
deference they receive. When you find physicians (there are many) who consider
themselves gifted and privileged to be able to help others in such meaningful
ways, honor them, for they have proper perspective.
Oppositional-defiant:
“Doctors too often see communication as a one-way street,” says Michele Heisler,
M.D., a University of Michigan internal medicine professor.1 Often
paternalistic, doctors are rarely models of listening skills. For example, when
speaking to patients, doctors interrupt “within 23 seconds, on average, studies
suggest.” 1 Therefore, your challenge may be to get a word in
edgewise.
Near the upper
end of the medical food chain, surgeons are used to being in charge in the O.R.
As a result, there is often difficulty in differentiating the O.R. command
structure from those appropriate in other arenas, such as in dealing with
hospital administrators or practice managers.
One hospital
administrator faced this problem with a surgeon who was particularly ornery and
usually attempted to “win” an argument by overpowering her “adversary.”
However, instead of allowing himself to be drawn into battle, the administrator
kept his eye on the prize: problem resolution.
First and
foremost, the administrator did not allow public argument. Rather, he changed
the venue to a private area. Then he asked the surgeon everything he
could to let her completely vent her concerns, and to truly try to understand
the logic of her position. Once the surgeon was spent, without any
defensiveness or counterattack by the administrator, he said he’d give her
points more thought. As a final question, he asked what authority the surgeon
thought he, the administrator, had in the matter.
Three days
later, the administrator called a private meeting with the surgeon, saying he’d
thought over what she’d said and agreed with much of it. He proposed a solution
and asked her to join him in the compromise, saying her stature in the hospital
would help set an example of good teamwork, just as she expected in her O.R.
Having been heard, and getting some of what she’d argued for, the surgeon
agreed.
Silent-superior:
It’s important to avoid power struggles whenever possible. However, those
smugly avoid verbally communicating create or continue a power struggle in a
disingenuous and ignoble way.
A practice
manager had tried to use Data Gathering with one of his physicians, who would
not engage in a mutually respectful, communicative process. Instead, he
patronizingly responded to the manager, as if he were a child, with one-word
answers.
Rather than
allowing that, however, the manager asked the physician if his actions
meant he would rather not be part of the practice’s governance process. The
physician said, “You seem to think you know better” and left. So the manager
continued the process of managing the practice without including the physician
unless absolutely necessary. Predictably, others began to marginalize the
physician, too.
Periodically,
the manager asked the physician back into the governing process. After
several attempts to no avail, the physician finally returned and participated in
a more cooperative manner.
Weak-helpless:
At times, a physician might claim lacking knowledge/skills or power. If either
is true, guide him to the knowledge/skills (i.e., management classes, executive
coaching) or give him the power (authority) necessary to effect positive
change. However, if his claim is merely an obstructive tactic, you might handle
it like this practice manager did.
The physician
claimed to be unable to manage his staff, which he regarded as continually
complaining and not as motivated as he. If fact, the physician was not leading
properly, listening well or motivating his team; and he kept complaining himself
that he did not have enough of the right equipment.
In response, the
practice manager called a meeting with the physician and asked how she
could help him. Once again, the physician played the weak-helpless child. So
the manager asked how the physician motivated himself through medical school
with the limited resources he had at the time. The physician explained he was
motivated by the example of his own father physician and how much he enjoyed
helping the sick. “So you drew inspiration from his motivation?” “Yes,” said
the doc. “Did he force you to be a physician?” “No.” “I see,” said the
manager, “and what happened when you got discouraged in your studies?” “He
re-instilled in me the importance of his work and the gift of his ability to
help people.” “Pretty neat,” said the manager. “Yeah,” said the doc,
reflectively. “Well, let me think more about the problem you’re currently
having with your staff,” said the manager, “and let’s meet again next week.”
Sure enough, the
physician called a few days later, saying things were actually improving, that
his staff was beginning to respond better and that he’d like more time to work
things out without the manager intervening. So simply by asking questions, the
practice manager was able to help the physician martial the internal resources
he already had to better lead his staff.
Practice,
practice, practice
Becoming good at
conflict resolution in dealing with physicians and other medical group members
takes lots of practice. You’re trying to gain and improve a skill, and
establish a new behavior habit. It’s not easy when your head tells you to
respond, but your emotions tell you to react. Practicing Data Gathering, you
should become better at managing difficult practice members and situations, when
they arise. Try it.
notes
1. Consumer Reports on Health. November
2004-2008;16(11):1-6.
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