Presentation on theme: "Kendall L. Stewart, M.D. June 29, 2006"— Presentation transcript:
1Kendall L. Stewart, M.D. June 29, 2006 SOMC PressDealing with Difficult Doctors Some Practical Strategies for Building More Effective Nurse-Physician Relationships1,2,3 A Presentation for the VHA Central Nursing Leadership InstituteKendall L. Stewart, M.D.June 29, 2006
2What’s in this for you? Doctors can be difficult.1 Physicians are perceived as so intimidating that hospital CEOs often refuse to schedule a talk with this title.But you have to deal with difficult doctors every day—and you could probably use some help.The line between annoying and disruptive physicians is not always clear.This presentation focuses on annoying physiciansAfter listening to this presentation, you will be able toIdentify two common difficult physician behaviors.Describe how those behaviors “make” you feel.Explain how your feelings cause you to behave.Specify two practical strategies for building more effective relationships with physiciansExplain why those strategies make sense and how to deploy them successfully.
3Why is it so important that we learn how to deal more effectively with doctors? Good relationships with doctors are critical to the effective teamwork required in successful healthcare organizations.Doctors enjoy enormous power.Physicians are bright, highly motivated (for the most part), and we love to game systems.Physicians can be powerful allies or enemies.Doctors control most healthcare resources.Doctors can be difficult; we are often regarded as “barriers.”1,2,3Our relationships with physicians exert a huge impact on our lives and our work.
4What is the extent of this challenge? Preparing to Deal with Difficult DoctorsPreparing YourselfPreparing Physician LeadersPreparing ExecutivesPreparing ManagersPreparing EmployeesDealing with Annoying DoctorsThe Negative PhysicianThe Selfish PhysicianThe Unreasonable Physician1,2,3The Whining PhysicianThe Disorganized PhysicianThe Immature PhysicianDealing with Disruptive DoctorsThe Angry PhysicianThe Abusive PhysicianThe Dishonest PhysicianThe Arrogant PhysicianThe Pot-Stirring PhysicianDealing with Dangerous DoctorsThe Marginal PhysicianThe Impaired PhysicianThe Incompetent PhysicianThe Distracted PhysicianThe Overwhelmed Physician
5What commonly-employed strategies don’t work? Making up our minds to recruit only nice doctorsHoping that the difficult physicians will changeRuminating about how miserable these physicians are making our livesBlaming physician leaders for not whipping their difficult colleagues into shape1,2Faulting the executives for not shooting them at dawn
6What are some problematic physician behaviors?1 Failure to explainRudenessDisrespectCondescensionOrdering instead of requesting or consultingUndermining other team membersBlaming others publiclyNot listening or taking colleagues seriouslyIndulging in temper outburstsFailure to say, “Thank you”
7How do physicians’ difficult behaviors “make” us feel?1 HopelessResentfulAngryHurtDiscouragedFrustratedHelplessEnragedUnappreciatedRejected
8How do our bad feelings and flawed attitudes “cause” us to behave?1 WithdrawNagArgueGive upExplain talk behind others’ backsRuminateGossipTry harder to pleasePlot revenge
9What are some successful strategies for dealing with difficult people Label them.*Neutralize them.Describe them.Predict them.Inform them.Involve them.Ignore them.Convert them.Avoid them.Expose them.Circumvent them.Use them.Persuade them.Confront them.*Rehabilitate them.Discourage them.Ridicule them.Isolate them.Punish them.Extrude them.
10Label them. Why should you? How can you? Acknowledges they are differentRecognizes their need to be “managed,” not befriendedInitiates the management processMinimizes your unrealistic expectationsReminds you to become emotionally detachedSignals need to reach for suitable toolsLegitimizes others’ perceptionsForces you to take personal responsibilityHow can you?Remain sensitive to your own emotional arousal.Recognize the need to choke off your emotional arousal.Imagine a sticky note labeled, “A Real Nut” attached to their foreheads.View them as impaired (they are).Pity them.Concentrate on observing their behavior.Reflect on why someone might behave so unproductively—as a distraction, not as their therapist.1,2,3
11Confront them. Why should you? How can you? Challenges others’ toleranceWorries those who collude with misbehaversDisrupts usual response patternsSignals who’s in chargeProvides relief from feelings of helplessnessGives prior victims hopeReaffirms your commitment to organization’s stated valuesEncourages others to take the same vigorous action1How can you?Document their behavior.Ignore suspected motives, but record behavior in descriptive detail.Focus on patterns instead of isolated occurrences.Line up witnesses.Give emotions time to dissipate.Nail down the support you need.Confront in love and respect.Refuse to be distracted.Attach consequences and describe next steps.Deliver on your promises.
12What practical conclusions can you draw from this talk? More effective teamwork with physicians is essential to our organizational success.Our relationships with physicians and each other can be improved.Building effective relationships demands a considerable investment.We must focus on our own—not others’—attitudes and behaviors since we have no control over theirs.Total success is not possible.Incremental success is easily achievable.This is a process, not an occasion.Improved teamwork is an important key to increasing job satisfaction.1,2
13Where can you learn more? Stewart, Kendall L., et. al. A Portable Mentor for Organizational Leaders, SOMCPress, 2003 SStewart, Kendall L., “Physician Traps: Some Practical Ways to Avoid Becoming a Miserable Doctor” A SOMCPress White Paper, SOMCPress, July 24, 2002Stewart, Kendall L. et. al, “On Being Successful at SOMC: Some Practical Guidelines for New Physicians” A SOMCPress White Paper, SOMCPress, January 2001Stewart, Kendall L., “Bigwigs Behaving Badly: Understanding and Coping with Notable Misbehavior” A SOMCPress White Paper, SOMCPress, March 11, 2002Stewart, Kendall L., “Relationships: Building and Sustaining the Interpersonal Foundations of Organizational Success” A SOMCPress White Paper, SOMCPress, March 11, 2002Please visit to download related White Papers and presentations.
14How can you contact me? Kendall L. Stewart, M.D. VPMA and Chief Medical OfficerSouthern Ohio Medical CenterPresident & CEOThe SOMC Medical Care Foundation, Inc.th StreetPortsmouth, Ohio 45662
15 Safety Quality Service Relationships Performance Are there other questions? Safety Quality Service Relationships Performance