Follow-Up and Summary

Structure for Peer Support

  • Mentoring
  • Section or division support
  • Health and well-being committee
  • Outside referral sources  

The points presented in the above table should be considered in parallel with those of previous tables. It should be noted the suggestions made here, if accepted, should be consistent with the policies and bylaws of the hospital and its Medical Staff.

The physician whose inappropriate behavior has resulted in a conference with an officer of the Medical Staff, for example, may be helped by setting up a series of mentoring conferences with a senior, well respected member of the Medical Staff. These would be informal, based upon a schedule the two set, with regular reports from the mentor as requested by the officer. Example: a young surgeon appointed within the past year who is developing a reputation for “rubbing people the wrong way.”

An informal evaluation of a more comprehensive nature may result in a more structured set of interactions between the physician and the head of the unit (e.g., section, division, department) of the physician’s specialty. The structure and the goals of the intervention would be established mutually between the physician and the head, after consultation with the referring official.  Example: a cardiologist who has been on staff for five years, has developed a busy practice, but recently has been regularly late to the cath lab.

The physician whose behavior requires a formal, more intense, process of evaluation and record keeping may initially be referred to the hospital’s health and well-being committee, or its equivalent. Example: A pediatrician who has been known for some time to have domestic problems, has recently repetitively been late or absent to the hospital-based birth defects clinic, and is currently involved in  a DWI matter. Advice regarding the development and management of such a committee may be obtained by contacting the TMA PHR Committee.

Finally, recommendations from the evaluation of even more serious acts of disruptive behavior may require enlisting the services of outside resources for treatment and rehabilitation.  Thought must be given by the Medical Staff and hospital officials as to oversight and support of the physician if he or she returns to active status on the Medical Staff.  Example: a senior neurosurgeon who has developed serious medical problems related to exogenous obesity over the past three years has been repetitively late to the OR, verbally abusive to staff, reported to fall asleep during dictations of records, and reported by partners who are evaluating him themselves for performing spine surgery for questionable indications.
  

Monitoring/Follow-Up

  • All involved parties must understand  recommendations 
  • Physician must comply with recommendations of  evaluation/treatment team
  • Continued disruptive behavior is unacceptable and will lead to consequences  

As with all physician health and behavioral issues, documented and scheduled follow-up and feedback are essential.  After the evaluation/treatment, monitoring should occur to assure that the physician is following treatment recommendations; i.e., taking medications as prescribed, attending any recommended therapy on a regular basis, and getting blood levels of medication if appropriate (i.e., lithium levels in someone with bipolar disorder).

The option of random drug screens should be maintained during this time.
  

Immunity from Civil Liability  

A person, health-care entity, or medical peer review committee that, without malice, participates in medical peer review activity or furnishes records, information, or assistance to a medical peer review committee or the TMB is immune from any civil liability arising from such an act.  (Vernon's Texas Codes Annotated, Occupation Code §160.010)  

Reporting sources can include physicians, hospital personnel, other health are professionals, patients, family, or friends.

A person, health-care entity, or medical peer review committee that, without malice, participates in medical peer review activity or furnishes records, information, or assistance to a medical peer review committee or the Texas Medical Board, is immune from any civil liability arising from such an act.

No one is protected from an individual filing a suit against them.

How You Can Make a Difference  

  • Acknowledge that mental disorders and disruptive behavior have a negative impact on patient care and members of the health care team
  • Recognize symptoms and behaviors that are considered to be manifestations of mental disorders or disruptive behavior
  • Approach the affected colleague and offer assistance
  • Encourage affected colleagues to seek appropriate help  

Promoting the treatment and recovery of colleagues with mental disorders or disruptive behavior can provide a pathway to protecting patients and saving physicians’ lives and careers.

Assistance is available.

PHR Hotline: (800) 880-1640

Go to next page
Return to PHR CME courses

Last Updated On

January 26, 2012

Originally Published On

March 23, 2010