About 25 years ago, I was asked by the hospital administration to deal with a physician who had applied for privileges. This physician had a large practice in the community; he left the practice to ski for a few years. I remembered that he had a reputation for harassing female employees in the hospital and my laboratory.
The Difficult Personalities Glossary
We are all familiar with most of the difficult personalities we encounter in life — avoiding these individuals in our daily medical practice is not an option in many of these situations. Some examples of difficult personalities are:
- The Know It All. These physicians deal with their lack of confidence by expressing their breadth and depth of knowledge and letting you know how many of these cases that they have seen.
- The Bully. We know them from grade school. Bullies tend to pick on those people that they perceive as weak. The more you back down, the more the bully is encouraged. A show of backbone and standing up to the bully will usually mitigate their behavior. Sometimes using humor along with confidence will be enough to make them back down.
- The Gossip. These people traffic in gossip that may or may not be accurate. They may be motivated by certain inadequacies or self-hatred. Gossip can be very disruptive to a practice and can needlessly cause harm to others and may be self-destructive.
- The Lazy Partner. We all may try to avoid certain tasks (autopsy service?) that we find less than appealing. You may be familiar with Herman Melville’s Bartleby the Scrivener. The main character avoids work by saying “I prefer not to.”
- The Obsessive/Compulsive. We all have some of this in our personality, or we wouldn’t have become the professionals that we are. We can all tolerate this in colleagues who are highly functional, but those individuals with a more serious disabling disorder require psychiatric help.
- The Money Grubber/Miser. Keeping an eye on the practices financial responsibilities is essential, but misers can be annoying. As physicians everyone else expects us to be exceedingly wealthy. We need to learn to be generous toward our employees, colleagues, and patients.
- The Mentally Challenged. As physicians, we know that any of us may become mentally challenged by a variety of conditions particularly as we age.
- The Substance Abuser. You will encounter these colleagues, and they must be dealt with promptly.
- The Harasser. The Harvey Weinstein type is more common than one might think.
You may be thinking, “I hope I never encounter a colleague with some of these problems.” You should understand that in your hopefully long-career, you will have to deal with all of the above traits multiple times. How does one deal with these personality types?
Options to Deal with Difficult Personalities
There are many options available and all need to be carefully considered. An escalating scale of how to address people is one option. As a pathologist, you may want to use the plan, do, check, act method of improving the colleague’s behavior. There are three initial considerations:
- Should we merely avoid these individuals?
- Should we try to speak with them and possibly aggravate the situation?
- Should we consider ways to talk frankly and build a stronger relationship?
Your conversation should make the person feel safe and non-accusatory. Do not apologize for what you say to soften the blow. You are only saying what you think. If the person feels self-defensive and angry, it may be because you come across as attacking the person. The conversation should be friendly but should focus on the behavior and why it needs to change. Try to speak to the behavior you would like to see and help them envision the professional they could become.
If the problem personality is of a more serious nature, you may want to consider discussing it with your partners or colleagues. In the first few months of my new practice, we were confronted with a failing pathologist who appeared to have early stage of Alzheimer’s disease. We all noticed and eventually had a small group discussion about how to address it. My colleague initially denied there was anything wrong, but we asked him to seek medical help. When this was unsuccessful, we asked for help from his family to help him decide to retire. Despite one of his family members being a physician, they also denied the problem. We finally had to force him into retirement because he could endanger our patients.
You are likely to encounter an alcoholic physician or one who is addicted to opiates. If this person is within your group, you must address the problem promptly before anyone is grievously injured. As a hospital-based physician, you will likely be asked to become a member or chair a committee to investigate another physician with an addiction problem. Guidance from the human resources department needs to be considered, especially if the problem individual is not within your group. Initially, these physicians may be required to take a leave of absence and submit to detoxification and treatment. Never expect these problems to go away by themselves. Address the behavior as part of the appropriate group and demand that the individual seek treatment or termination will ensue.
Early in my career, I became aware of a laboratory supervisor in a small hospital who recently demonstrated careless behavior. On my next visit to the hospital, she did not show up for work for days — I was told that she went through the sharps container looking for needles. I reported the problem to my partners, and we suspected that a physician on the medical staff who had befriended her was supplying her with drugs. I contacted the Drug Enforcement Administration (DEA), the local police, the medical school where she was to start as a freshman in a few months, and the state medical board. Only the medical board was willing to step in and investigate, but it was too late. She was found dead in her home that weekend.
The problem of sexual harassment has recently become popular in the media with many examples in the entertainment and political world. The population is growing more understanding of its prevalence and seriousness. The medical community is certainly not immune to this problem. If a problem physician is not dealt with promptly and directly, serious consequences to the practice, employees, and others will ensue. Definite evidence of harassment may sometimes be difficult to obtain. Misunderstandings may occur, as well as and false accusations. However, the physician should promptly confront the other members of the practice and understand the severe nature of the allegations. Often other members of your group may be aware of some of the accusations and may be able to offer additional evidence of misbehavior. In the event after an investigation, it is evident that sexual harassment is a problem, a decision should be made to either terminate the offender’s employment promptly or at least threaten termination if any further complaints are received. The choice may largely depend upon the credibility of the evidence. Human resource and legal guidance should strongly be considered since there are legal ramifications to whatever action you take.
The first time we encountered a pathologist with this behavior we were slow to do anything other than issue a warning. Unfortunately, and predictably, the boorish and offensive behavior did not stop. Our practice was damaged, and he was eventually terminated despite his otherwise valuable contributions to our practice. He retired at an early age. Later a second pathologist was heard using offensive language when speaking to a young lady. A hospital employee reported him to the administration. This time there was no hesitation in terminating him promptly.
So how did I handle the boorish physician applying for hospital privileges? I called him as a friend and told him that I had learned he was applying for privileges. I suggested that some things might come out that might force the hospital to report him to the National Practitioner Data Bank. Once that information was reported to the National Practitioner Data Bank, or NPDB he would have difficulty obtaining privileges at any hospital. He thanked me, thought about it and called me the next day to tell me that he was withdrawing his application. The hospital and medical staff were greatly relieved that he would not be returning. I believe he eventually became a financial planner. True story.
Robert L. Breckenridge, MD, MBA, FCAP, is the Southwest Regional Medical Director for Quest Diagnostics, the largest medical lab company in the world. He is a former member of the CAP Board of Governors and has worked in clinical laboratories for 50 years.