Become a disruptive physician: How to do it right

“Disruptive physician” is one of the most misused terms in healthcare these days. In many organizations, those two words have become the c-suite’s trump card to quash any physician resistance to new administrative programs. These programs are often have purely financial motives or are a brazen attempt to dump additional tasks on the physicians with no regard for their workload or stress levels.

The doctor’s legitimate concerns about quality of care don’t matter. They are lost in the politics of the silos of the administrative and clinical sides of the organization. They are quickly seen as not being a team player. The disruptive physician label comes flying out and the doctor is deftly tossed under the bus so the meeting can move on to the next topic.

Often, this is bullying, plain and simple. It can create permanent consequences for the physician, including diversion into any number of treatment programs and not uncommonly losing their job.

However, sometimes the disruptive name calling is just a consequence of a fundamental clash of communication styles between physicians and administrators. In this situation, the skills inside the disruptive physician’s toolkit will allow you to do the following:

  • Air your legitimate concern
  • Be heard by the administration
  • Avoid being labeled disruptive in the process

Physician vs administrator communication clash

Physicians are highly trained experts at finding a unifying diagnosis, the crux of the problem, the thing that is likely to go wrong. We see clinical issues administrators are completely unaware of.  We do all of this at lightening speed, because in our diagnoses often must be made quickly.

When we see a problem, we point it out without hesitation and we are not used to having to explain ourselves. And we shoot from the hip, without regard to the social setting or the politically correct thing to say in the given situation. One word for this is “blurting.”

This is not how you make your point in the midst of a meeting to a group of administrators. They do not think or communicate in this fashion. It is not what you say, but how you are saying it. Disruptive physician labeling can be the result of this clash of communication styles.

The disruptive physician’s toolkit

If you have a concern, talk to as many people as possible before the meeting where this program will be discussed

To raise a concern for the first time in the midst of a meeting is the definition of rude to an administrator. Discovery and building of consensus is best done before the meeting occurs – much like the work in politics is done in conversations before they vote on the bill on the floor. You want your concern to be discussed, shared, understood and at least a partial consensus on what to do about it. All done before any committee meeting.

Always ask questions, rather than making statements

Ask questions of everyone involved in the proposal and everyone who will be part of the decision on whether or not it goes forward.  Always start your questions with the word “what” or “how.“ This guarantees an open ended question that will draw the maximum of information from the person to whom you are speaking.

Here are some very simple and powerful examples:

  • “What are your thoughts on program “X”?”
  • “How do you see program “X” affecting the quality of care?”
  • “I have some concerns about “X”. How do you see we might be able to address them?”

Channel Columbo

Do your best to imitate the character of “Columbo” in the old TV series. Hand to the forehead, self deprecating, “Maybe this is a silly question, but I was wondrin’ … ”

Columbo’s style goes against our doctor programming to be “seldom wrong and never in doubt” and I encourage you to let that go. Columbo was never called disruptive and was always very effective.

  • Try asking questions instead of telling people what to do (giving orders)
  • Try channeling Columbo when you speak
  • You have no idea how massively effective this is with administrators (and everywhere else in your life)

Find solutions and build consensus

In your pre-meeting discussions, if you find your concern is shared by your colleagues, build consensus (before the meeting) on several solutions or ideas to address your concerns. You will have consensus on the concern and the possible solutions in your back pocket before the meeting begins.

Appeal to the highest value possible at all times

Always keep the team focused on the highest possible corporate value – one that everyone can agree to. Usually this will be quality of care or patient satisfaction. This is your trump card. When you are bringing up any clinical concern about an administration proposal, relate it to one of these  higher values whenever you can. It can sound like this.

“I know we all agree that none of us wants the quality of care to suffer as a result of this initiative.”

This phrase used early and often keeps everyone focused on the big picture, and not your objection. It states something no one can disagree with and keeps them from immediately disagreeing with you.

What not to do

  • Don’t communicate like a doctor
  • Do not raise your concern the way you would normally do on automatic pilot, as a declarative statement of fact. Example: “I think this is a bad idea and here’s why.
  • Always ask a question. Remember to channel Columbo. Be either curious or confused.
    • “I am confused here.” (Columbo)
    • This patient flow initiative is supposed to make it easier to see 35 patients a day, but a number of us here are concerned it will only increase the EMR documentation backlog and that will affect the quality of care. I am curious what your thoughts are about our concerns here Mr. CEO?” (open ended question)
  • Do not show any emotion that could be perceived as negative
  • Do not:
    • Stand up
    • Raise your voice
    • Furrow your brow
    • Slam your fist on the table, point fingers, slam doors, swear, throw things
    • Or send any body language signals of anger, frustration or hostility.
  • Focus on your breathing and ask question
  • If you do feel any of these emotions, name them out loud
  • Let people know what you are feeling with a civil tongue. Just make sure you have done the work before the meeting so that everyone is aware of your concerns and feelings.
    • “I must admit when I hear your answer, what comes up for me is frustration.  I am curious (Columbo) what we can come up with for a proposal here that could address both of our concerns. “ (open ended question)
  • Do not leave a paper trail or voice mail trail
    • It is completely appropriate to be seriously paranoid about documentation of any of your concerns in a format that could be shared. Do not send emails, text messages, messages through your EMR or leave voice mails especially if you are upset and venting to someone you feel is a trusted colleague. If you must vent in an email, write it and then delete it. Do not create a paper or voice mail trail.
    • If you do leave recorded or written evidence of your concerns, you are running an almost 100% risk of those documents or voice mails falling into the hands of someone who will label you as the next disruptive physician on staff. Here’s why.
    • It is impossible for them NOT to take your concerns and tone out of context.
    • Make sure you raise your concerns only in conversations, where the other person can understand your energy, tone, body language and caring for everyone involved – especially the patients. There is no way any of that can be understood through a text, email or voice message, especially by an administrator who does not agree with or understand your position.

Ultimately, if you work in an organization with a pattern of hostility towards the physicians and clinical staff and a habit of bullying with the disruptive label, you will decide whether that is something you will tolerate  or not. You always have the option to vote with your feet.

If you do decide to leave, it is my intention that this disruptive physician toolkit ensures the following:

  • Your concerns have been heard
  • You gave it your best shot at ensuring the program made clinical sense
  • You don’t have the disruptive physician label hanging round your neck to get in the way of you finding a better position

Have you ever been labeled as disruptive?

If you are in a leadership position, what communication tools do you use to avoid the disruptive physician label?

If you have tried channeling Columbo, how did that go for you?

Dike Drummond is a family physician and provides burnout prevention and treatment services for healthcare professionals at his site, The Happy MD.

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  • gooch

    i did it wrong 15 years ago…i never would have the time to do it right…they kept me on the defensive…i am glad i did it…i am proud of myself….some people will remember this even though it didnt change a thing….

    • Dike Drummond MD

      Gooch, you fought the good fight and that is all you can do. Give it your best and notice how the other side responds. If they don’t listen or care … get outta there. Whether or not they change is not the measure of your caring, concern or skill. Be proud of doing what you could.


      Dike Drummond MD

  • ninguem

    “…..You always have the option to vote with your feet…..”

    In most states, restrictive covenants make that extremely difficult unless you are prepared to move your entire family to another city.

    I mentioned that again to some lawyers I met a couple weeks ago, and once again they expressed surprise. Lawyers do not allow such covenants in their own practices, they’re specifically prohibited by the Bar.

    • Dike Drummond MD

      Depending on the conditions of your workplace … voting with your feet may be the best option. The thing that leads to career threatening burnout is when you fulfill Einstein’s definition of insanity, “Doing the same thing over and over and expecting a different result.”

      If you are working this toolkit of communication tools and it becomes clear that your administration does not understand or care about your clinical viewpoint … it is time to start looking for a new position and creating some interview questions so your next position does not have this culture and power structure.

      Dike Drummond MD

      • ninguem

        As long as the law allows hospital-run clinics to charge double what a private doctor can do for the same work…..

        As long as the law allows restrictive covenants in medical employment contracts, which lawyers forbid for themselves…..

        As long as the law in many states prohibits doctors from setting up their own specialty facilities…..

        … will be awful hard for doctors to extricate themselves from these traps.

        The hospitals do what they do, because they know they themselves have rigged the rules so that targeted doctor cannot go down the street to join the competition……or BECOME the competition.

    • LeoHolmMD

      Right. Even though the AMA will admit non-compete clauses are unethical, they do nothing to remedy the situation. Not that they would lift a finger to defend patients or physicians. I live in a “right to work” state…unless you are a physician. Then get your ass out on a rail.

  • buzzkillerjsmith

    I have quit 3 jobs: Kaiser in northern California, a hospital-owned system in MN, and a job in Oregon. I have never regretted leaving these job, although I do miss that CA weather.

    The Oregon job was because of inadequate income and a horrible pt population–rural poverty, lots of meth. This group was doctor-owned, with absolutely great people.
    Kaiser, although doctor-owned, was run by docs who had become admindocs. They were no better than business types. I hear things have improved but have no inclination to find out personally.
    The MN group was run by business types with absolutely no interest in clinical priorities.
    I tried reasoning with Kaiser. It was pointless. I must admit I sometimes did not keep a cool head. I was pretty young.

    With the MN job I did not say a word because I realized it was pointless, having been through it all before. They were stunned when I left and asked why. I made up something about wanting to be closer to family.
    I agree with Dr. D.’s advice, particularly for the young docs. Bring up your concerns in a fashion that admin can tolerate. Don’t lose your cool, but don’t be surprised if you are ignored. If so, leave.

  • southerndoc1

    If you don’t like being told what to do, how to do it, and when to do it, don’t go to work for The Man. If you do go to work for him, deal with it and move on.

    • Dike Drummond MD

      Agreed. If you decide to take an employee position you will be working for “the man”. When you make that choice, you have given away a bunch of your independence. You now must negotiate things with administration to get your voice heard and needs met. Here is a toolkit so the average doctor can learn what the fortune 500 business people learned a long time ago. How to be heard inside a bureaucracy. If you don’t like doing that or it doesn’t work … get the heck outta there.

      Dike Drummond MD

      • southerndoc1

        Even with the decreasing appeal of medicine as a career, I think the majority of future physicians will be of the “self-motivated” type who respond poorly to a bureaucratic, administrative-heavy environment.
        Things could get pretty ugly.

  • Dike Drummond MD

    Quick question as a follow up to the article.

    => Have YOU ever been labeled “Disruptive” for bringing up a legitimate clinical concern?

    40% of my physician community at (1100 doctors) say yes.

    How about you?

    Dike Drummond MD

    • buzzkillerjsmith

      Never been so labeled, but have been very disgruntled, especially at my first job. Had a good (MD) boss, who had about 8 out of his 15 docs being disgruntled, so he was used to it. Of course he had absolutely no power to change things either.

  • SaraJMD

    Playing devil’s advocate here, really, but it’s also important to hear out those administrators, as well, and really think before you speak. At times, they’re actually right, and often in cases where we all know it, even if we don’t want to admit it. Yes, the expanded EMR means that prominent Dr. X’s secretary will no longer be able to dictate and sign his op notes, which she’s been doing that for decades, but seriously, even Dr. X knows that this is not legitimately increasing his workload. It’s just doing the right thing. Don’t negate your own power by complaining about stuff like this. Save it for the real issues, particularly those that impact patient care. And yes, I’ve been called disruptive at times, myself.

    • Dike Drummond MD

      First seek to understand
      Choose your battles wisely

      Dike Drummond MD

    • buzzkillerjsmith

      Admin is wrong even when it is right. Its authority is illegitimate, the result of a dysfunctional HC system. We should be in charge, period. People are right to resent their oppressors, no matter what kind of decisions the oppressors make. Sad that some docs don’t realize this.

      That said, we have to live in the world as we find it, and we have perhaps not reached what Lenin called a revolutionary situation. If one occurs, I will be first in line to manage the managers, with a smile on my face.

  • NoAnswers

    Love the Columbo meme.
    Would add: never get personal with your comments. Attacking the other person’s motives is counterproductive. Focus on solutions not creating more problems for yourself.

    Also, in the end, thanks and acknowledgement of good efforts or help towards a solution…almost anything, a “thank you” is always warranted.

  • Jay B. Ham

    We’re implementing an EPIC transition throughout our multihospital system. Epic has forced physicians to better understand workflow and patient flow. In doing so, it has opened a large number of doctor eyes as to just how much everyone else in the hospital was cleaning up after us.

    • Dike Drummond MD

      Jay … tell me more about “cleaning up after us”? Not sure what you mean without specific examples.

      Dike Drummond MD

      • Jay B. Ham

        Unit secretary translations of written orders into electronic versions. The amount of paper/electronic work required to move a patient from one bed/ward to the next, the pharmacist cleaning up the orders, the nurse who interprets when to give the next dose of medicine, starting/stopping diets, medication reconciliation and counseling with patients. These are the simple ones that come to mind from the hospitalist perspective. Our IT VP suggested that we had less difficulting than other specialties such as surgery. I will try to get a more thorough list to share.

        • Dike Drummond MD

          And you feel those should all be the responsibility of the physician? The systems that allow the doctors to interface with unit secretaries, pharmacists, nurses and the way those members of the team deliver their piece of the therapeutic spectrum had better not be thrown on the back of the doctors … we are already overloaded.

          Work flow is the HOSPITALS RESPONSIBILITY. The physician is the highest level of strategy … diagnose and create a treatment plan. The hospital team carries out the plan.

          Sounds to me like the hospital is getting its act together and consistently pointing fingers at the doctors. That is typical. What they need to do is look in the mirror and make their systems physician friendly.

          My two cents,

          Dike Drummond MD
          117 ways to prevent burnout in the MATRIX report

  • Angie

    These are fabulous communication tips, not specific to interacting with administrators. Many physician: physician disputes could be resolved in the same manner and many conflicts with significant others could be avoided. Communicating this way, is common courtesy.

    One way to even further improve your success regarding the tip about Columbo: My advice would be not to “act curious,” but to genuinely be curious. You’ll have a better understanding of where the other person is coming from. You may actually see a point of view you weren’t able to before.
    Most administrators I know are patient-centered as well. They make the institution money so they can see patients, not see patients to make money. Without paying attention to the business, there would be no building to see patinets in and no money to pay the hard-working employees salaries and benefits.

    • Dike Drummond MD

      Agreed Angie … first seek to understand. And, of course, if you can muster some genuine curiosity that is great too.

      Patient centered is great … just remember who sees the patients and generates the income for the business. It is the physicians and staff. the doctors are the hardest working employees in the building for gosh sakes.

      It is important to remember it takes happy doctors to have happy patients …in that order – no chicken and egg conundrum here. If administrators knew that and went to bat for their doctors … we wouldn’t need this toolkit. Only about 2% of organizations understand this principle though.

      Dike Drummond MD

      • MyraMaines

        Without patients there would be NO doctors!

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