Treatment program targets 'disruptive physicians': reasons for program referral include anger, performance and compliance issues, sexual misconduct, and theft.(Practice Trends)

ARLINGTON, VA. -- Can a surgeon who brings a gun to the operating room be trusted not to use it? That's an extreme example of the kinds of questions that psychiatrists must address when doctors are referred to them for evaluations.

"Disruptive physicians" are doctors whose behavior undermines their personal and professional effectiveness, Ronald Schouten, M.D., said at the annual conference of the Academy of Organizational and Occupational Psychiatry.

"We are talking about people who engage in problematic behavior that interferes with their relationships at work or at home and has a potential impact on patient care, productivity, and administrative functions," said Dr. Schouten, director of the law and psychiatry service at Massachusetts General Hospital, Boston.

Dr. Schouten presented data from his experience with 82 cases of physicians who had been referred for disruptive behavior. The doctors studied were evaluated for Axis I disorders, but the primary problems proved to be disruptive or non-compliant behavior. The sample excluded disability cases.

Overall, 69 doctors were referred by Physicians' Health Services at their hospitals, 7 by their practices or facilities, 3 by attorneys, 2 by residency programs, and 1 by the medical board.

Surprisingly, 15 were internists and family practice physicians, compared with only 3 general surgeons. "We expected to see more surgical specialists," since surgery is stereotypically considered to be a particularly stressful field, he said. The average age was 48 years, and most of the doctors (82%) were men. Six of the internal medicine physicians were cardiologists, making cardiology the most common subspecialty in the sample.

Anesthesia was the most common specialty, comprising 13 cases, followed by ob.gyn., with 12 cases. Four of the cases involved emergency medicine physicians, three involved neurologists, and two involved psychiatrists.