Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System
We have always had and will always have “disruptive” or “dysfunctional” doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called “unprofessional behaviour”) was described almost 150 years ago, but remains a persistent, wicked problem in healthcare...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-09-01
|
| Series: | Healthcare |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2227-9032/11/17/2455 |
| _version_ | 1797582461809459200 |
|---|---|
| author | Carmelle Peisah Betsy Williams Peter Hockey Peter Lees Danette Wright Alan Rosenstein |
| author_facet | Carmelle Peisah Betsy Williams Peter Hockey Peter Lees Danette Wright Alan Rosenstein |
| author_sort | Carmelle Peisah |
| collection | DOAJ |
| description | We have always had and will always have “disruptive” or “dysfunctional” doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called “unprofessional behaviour”) was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system. In doing so, we hope to shift the systemic effect from nihilism and despair, to one of hopeful realism about disruptive or unprofessional behaviour. We suggest that solutions lie in cultural change to ensure systemic awareness, responsiveness and early intervention, and an understanding of what systemic failure looks like in this context. Staff education, policies and procedures that outline a consistent reporting and review process including triaging the problem, its source, its effects, and the attempted solutions, are also crucial. Finally, assessment and intervention from appropriately mental-health-trained personnel are required, recognising that this is a complex mental health problem. We are not doing anyone any favours by ignoring, acting as bystanders, or otherwise turning a blind eye to disruptive or unprofessional behaviour; otherwise, we share culpability. |
| first_indexed | 2024-03-10T23:22:39Z |
| format | Article |
| id | doaj.art-849b8cc82a364bd8bb6ecd84981878ce |
| institution | Directory Open Access Journal |
| issn | 2227-9032 |
| language | English |
| last_indexed | 2024-03-10T23:22:39Z |
| publishDate | 2023-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Healthcare |
| spelling | doaj.art-849b8cc82a364bd8bb6ecd84981878ce2023-11-19T08:11:12ZengMDPI AGHealthcare2227-90322023-09-011117245510.3390/healthcare11172455Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health SystemCarmelle Peisah0Betsy Williams1Peter Hockey2Peter Lees3Danette Wright4Alan Rosenstein5Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, AustraliaProfessional Renewal Center<sup>®</sup>, Lawrence, KS 66049, USAFaculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, AustraliaFaculty of Medical Leadership and Management, London WC1R 4SG, UKWestern Sydney Local Health District, Sydney, NSW 2145, AustraliaInternal Medicine, Health Care Behavioral Management, San Francisco, CA 94118, USAWe have always had and will always have “disruptive” or “dysfunctional” doctors behaving unprofessionally within healthcare institutions. Disruptive physician behaviour (also called “unprofessional behaviour”) was described almost 150 years ago, but remains a persistent, wicked problem in healthcare, largely fuelled by systemic inaction. In this Commentary, we aim to explore the following aspects from a systemic lens: (i) the gaps in understanding systemic resistance and difficulty in addressing this issue; and (ii) pragmatic approaches to its management in the healthcare system. In doing so, we hope to shift the systemic effect from nihilism and despair, to one of hopeful realism about disruptive or unprofessional behaviour. We suggest that solutions lie in cultural change to ensure systemic awareness, responsiveness and early intervention, and an understanding of what systemic failure looks like in this context. Staff education, policies and procedures that outline a consistent reporting and review process including triaging the problem, its source, its effects, and the attempted solutions, are also crucial. Finally, assessment and intervention from appropriately mental-health-trained personnel are required, recognising that this is a complex mental health problem. We are not doing anyone any favours by ignoring, acting as bystanders, or otherwise turning a blind eye to disruptive or unprofessional behaviour; otherwise, we share culpability.https://www.mdpi.com/2227-9032/11/17/2455disruptivephysicianshealthcaresystemsprofessionalismphysicians’ health |
| spellingShingle | Carmelle Peisah Betsy Williams Peter Hockey Peter Lees Danette Wright Alan Rosenstein Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System Healthcare disruptive physicians healthcare systems professionalism physicians’ health |
| title | Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System |
| title_full | Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System |
| title_fullStr | Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System |
| title_full_unstemmed | Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System |
| title_short | Pragmatic Systemic Solutions to the Wicked and Persistent Problem of the Unprofessional Disruptive Physician in the Health System |
| title_sort | pragmatic systemic solutions to the wicked and persistent problem of the unprofessional disruptive physician in the health system |
| topic | disruptive physicians healthcare systems professionalism physicians’ health |
| url | https://www.mdpi.com/2227-9032/11/17/2455 |
| work_keys_str_mv | AT carmellepeisah pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem AT betsywilliams pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem AT peterhockey pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem AT peterlees pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem AT danettewright pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem AT alanrosenstein pragmaticsystemicsolutionstothewickedandpersistentproblemoftheunprofessionaldisruptivephysicianinthehealthsystem |