2017 HSC Section 2 - Practice Management

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The Disruptive Physician:
A Legal Perspective
Michael J. Grogan, MD, JD, Paul Knechtges, MD
Rationale and Objectives: This article addresses the medical and legal implications of disruptive physician behavior. In addition, this ar-
ticle will address the appropriate use of due process in peer review of disruptive physician behavior.
Conclusions: While most hospitals and even national organizations, like the American Medical Association, have definitions for what
constitutes disruptive physician behavior, these definitions have been further examined and clarified in court rulings. These court rulings
not only further clarify what constitutes disruptive behavior but also establish a threshold for revocation/nonrenewal of a physician’s
hospital privileges.
Key Words: Disruptive physician behavior; professionalism; medical-legal issues.
ªAUR, 2013
A ll physicians experience pressures and frustrations
in their careers ranging from, literally, making life-
and-death decisions in medical management to
declining income and increasing regulatory burdens (1–3).
In this high-pressure setting, events and circumstances may
be enough to ‘‘test a saint’’ (3). Anger, frustration, and
even the occasional swear can be normal human responses
when confronted with the broad range of stressors and
responsibilities in a physician’s career. However, there is a
point where a physician’s behavior can cross the line from
expected emotional responses to disruptive behavior.
Professionalism has long been seen as an ‘‘Aunt Minnie’’
(eg, you know it when you see it). The same can be said about
unprofessional behavior. Unfortunately, such subjective
descriptions are of limited value when writing hospital policy,
evaluating a physician’s behavior, or trying a case in a court of
law. Subsequently, this article will explore the legal precedents
set by court rulings in which physician behavior was deemed a
legitimate reason to revoke or refuse renewal of physician staff
privileges.
While harassment, of any form, is certainly disruptive
behavior, in terms of legal precedent, this is typically addressed
under Title IVof the 1964 Civil Rights Act and Title IX of the
Education Amendments of 1972 (4). Instead, the focus of this
article will be the other unprofessional behaviors covered
under the increasing well-defined legal precedents defining
‘‘disruptive behavior.’’
DEFINITION AND PREVALENCE DISRUPTIVE
BEHAVIOR
As medical professionals, we have an instinctive understanding
of what constitutes disruptive physician behavior. Many of us
may be able to recall an example of a disruptive physician from
our training and subsequent careers:
‘‘They’re out there . browbeating nurses and pharmacists,
dressing down hapless staff, belittling patients to their faces,
swearing at the tops of their voices, muttering ominous
threats, dripping sarcasm and snide innuendo, slouching in
late day after day, raging, sulking, hurling surgical instruments,
blowing off appointments, sabotaging meetings, sneering at
administrators, insulting their colleagues, refusing to answer
pages, addling their judgment with drink or drugs, breaching
sexual boundaries.’’ (3).
Disruptive behavior is a common problem, with 18%
of physician executives stating they encounter disruptive
behavior on a monthly basis in their organization and another
14% dealing with it on a weekly basis (3). The Alabama,
Kentucky, and Wisconsin state medical societies have
published data showing disruptive behavior encompasses
30% of their complaints (5). The estimated prevalence of
disruptive behavior among all US physicians is 5% (3).
Usually the disruptive behavior results from conflict between
a physician and a nurse.
The American Medical Association (AMA) states, ‘‘Per-
sonal conduct, whether verbal or physical, that negatively
affects or that potentially may negatively affect patient care
constitutes disruptive behavior. (This includes but is not
limited to conduct that interferes with one’s ability to work
with other members of the health care team.) However,
criticism that is offered in good faith with the aim of
improving patient care should not be construed as disruptive
behavior’’ (6). Disruptive behavior includes verbal assaults
that are personal, irrelevant, rude, insulting, or otherwise
Acad Radiol 2013; 20:1069–1073
From the Saint Paul Radiology, 166 4th Street East, St. Paul, MN 55101
(M.J.G., P.K.). Received December 8, 2012; accepted April 25, 2013. Address
correspondence to: M.G. e-mail:
ªAUR, 2013
Reprinted by permission of Acad Radiol. 2013; 20(9):1069-1073.
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