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ISMA's Physician Assistance Program
Part II of a two-part series:
Anger in the exam room: ISMA program helps physicians
*This originally appeared in the March 7, 2005 issue of ISMA Reports

The first article in this series provided a description of the behaviorally disruptive physician. In this second part of the series, Candace Backer, counselor with the ISMA Physician Assistance Program (PAP) offers some important first steps to take if you recognize the disruptive behavior of a physician colleague.

First, the pattern of behavior displayed by the physician must be clearly documented. "We strongly urge that each hospital have a clearly defined policy regarding angry and disruptive behaviors," Backer explained.

Examples of the specific behavior must be reviewed with the physician. Any prior efforts to counsel the physician on these issues must be documented as well.

"Generally, a physician will offer reasons for the particular offending behavior and may make promises to change," according to Backer. But if these efforts do not result in consistent improvement in the physician's behavior, a more intensive action plan needs to be devised.

The ISMA PAP recommends that the physicians be referred for a multi-disciplinary assessment. "It's essential that this referral originate from the highest level of authority," said Backer. "That means, for example, the medical executive committee or the employer. After the physician is clear about the specifics of the concerns, there are several centers around the country that specialize in assessing physicians, and they can help identify chemical dependency, psychiatric disorder and behavioral issues."

During the assessment, a variety of psychological testing is completed, as well as individual assessment and collateral data-gathering. If appropriate, a diagnosis is rendered and a plan is developed. Some type of counseling is generally recommended.

Some programs for treating the behaviorally disruptive physician are residential in nature. There are also brief intensive programs available, if recommended by the evaluation team.

Backer added, "Once the plan is implemented, it is important that the physician follow through with the recommendations and that necessary documentation of such be provided to the referring committee."

If the physician's behavior does not change over time, clear limits and consequences must be established and enforced.

For further details about the ISMA PAP, go to the Physician Assistance section of the Web site.

Part I here




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