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We often get phone calls from persons inquiring about the services of the Center for Professional Well-Being after they have heard presentations by Dr. John-Henry Pfifferling, Center Faculty, or read an article by or about the Center. We want you to be informed of the activities and services of the Center as well as those of the Society.

The Disruptive Professional

The Problem: A disruptive professional can undermine practice morale, heighten turnover, diminish productivity, increase the risk of ineffective or substandard care, and cause distress to others in the work environment. The behaviorally disruptive physician (or professional) acts in such a way that others are angry, intimidated or fear harm.

Our Services: CPWB staff coaches clients to correct interpersonal deficits associated with disruptive behavior. Organizationally, we develop equitable, preventive oriented systems to promote professionalism while reducing the consequences of disruptive behavior.

Outcomes: Individual clients gain skills in anger management, relationship building, effective communication, and self-care. Our practice clients worry less about turnover, hostile work environment, and abuse litigation.

We deal with many facets concerning disruptive behavior among professionals. They include:

INDIVIDUAL BEHAVIORAL ASSESSMENT: A referred or self-referred person visits us for one to three days in which we review allegations of the "disruptive" history, the person's story, and begin behavioral change coaching. This may incorperate elements of conflict resolution, negotiation, assertive communication, anger management, and stress management. We prefer that the person's spouse or significant other attend the session. At times,we incorperate the workteam to assist in behavioral change. Any counselor or therapist involved in the client's care is considered part of our team.

Further work with our team, or referral to specific skill trainers or therapists is recommended if necessary. When the alleged data is equivocal, we are available to visit the practice for independent or corroboratory data collection. Sometimes we collect conformatory or disconformatory data in advance of personal assessment. Where needed, we meet with colleagues to design a re-entry plan. If monitoring is required, we can train the monitors as to their role. Permission is required to communicate with the monitors if we are involved in any after-care. Reports are available.

As for referral mechanics: We need to talk to you about the potential client. What are the allegationms? What does the referring source want to accomplish?(i.e. We want these x behaviors to change?). What monitoring contract does the institution or "Assistance Program" have for the person? Do you have mentors to collect positive and at-risk feedback? We need to hear your expectations for the client. For example, do you wish an assessment and a report, or a report and possible follow-up by our team? If the client presents voluntarily, we do not write a report. Is there any leeway for our independent data collection to verify allegations, and/or expectations of the referral party?

We do not diagnose. Our strength is that we assess and coach/train as the client visits. Historically, outcomes are highly effective.

During our assessment, a psychiatric, psychological, sleep disorder, ADHD, or other appropriate evaluation can be arranged. If a forensic assessment is needed, let us know. At times, our staff recommends further assessment (ADHD, sleep disorder, individual therapy, audiological testing, muscle dystonia, etc.). Does your monitoring contract allow that? Each process is customized.

DISRUPTIVE PROFESSIONAL POLICY DEVELOPMENT: CPWB staff meets regularly with medical centers or practices to help them design a disruptive physician policy and, at the same time, develop a preventative policy. Each intervention is customized, so what follows is suggestive. Designing a preventative "disruptive" physician policy is a step in defining the expected behaviors associated with professionalism. If available, State Medical Society "disruptive" physician policy guidelines are useful as policy is developed.

Commonly, CPWB offers training lecture/workshop sessions (one to three presentations) to members of the medical or professional staff. Often, one is a generic presentation to members of the medical committee and spouses/significant others on professional stressors and on ways to enhance supportive relationships and collegiality. A common second presentation is on promoting physician collegiality. A third may be on reducing malpractice stress.

On the second morning we meet with a core group to specifically discuss items of relevence to a disruptive physician policy. A core group member or recorder then develops a policy, which we can review, and their local by-laws/counsel fine tune. If at all possible, we invite high-risk physicians (recovering physicians or those already sanctioned for "disruptive" behavior) to critique the policy as it is developed. We are interested in their input, their ownership and wish their advice in developing an equitable policy.

RELATED COMPONENTS:

Medical malpractice relevance: A unique approach we use is crafting of the "disruptive" policy with an eye to loss control (medical malpractice risk reduction). We prefer to collaborate with the "med mal" carrier to sponsor the program as a good faith effort in loss prevention. Regularly, programs incorporate a session on "Managing Medical Malpractice Stress" into the introductory sessions. It is prudent to require every physician currently alleged to behave disruptively to receive extra coaching on preventing medical malpractice and managing medical malpractice stress.
Spouse retreats: We recommend that once every two years the practice send the spouse of the sanctioned physician to a spouse retreat to share and learn relationship skill building strategies. The Center for Professional Well-Being designs, manages, facilitates, sponsors and offers our own faculty for your group's retreats We have conducted scores of retreats over the last twelve years. The topics, design, number of faculty and sites are customized in cooperation with retreat sponsors.
Presentations/Workshops: Dr. Pfifferling and Center Associates offer presentations on all areas relevant to professional well-being -- from effective communication skills to conflict resolution in practices to self-care techniques --including the most popular topics, "Recapturing the Joy of Practice", "Things I Wish I Had Learned in Medical Training", and "Creating a Collegial Community".
Prevention: CPWB recommends that the programs develop behavioral feedback systems so that all professionals receive regular and timely feedback on their professionalism. These serve directly as components for JCAHO recommended physician health activities. CPWB designs forms for feedback, incorporate suggestions from our end users and the practice, and may collect the feedback for the professional's use.
Mediation: CPWB sometimes is asked to mediate disagreements with a practice(hospital) and the alleged disruptive physician. Before conflict extend for lengthy periods, consider mediation as an alternative dispute settlement option.
Individual assessments and career coaching: Individuals facing issues such as career transition, burnout, and malpractice stress come to the Center for a one- to two-day intensive one-on-one assessment with Dr. Pfifferling and our Faculty Associates. The process is individually tailored and will usually include a session identifying personal values and end with a plan to achieve the goals identified.
Monitor/Mentor training: Do you have identified monitors with highly regarded rapport skills, and serve in a feedback(early warning) capacity? Have your monitors received training as mentors for "disruptive" physicians? Have they received training in their capacity as re-entry mentors? CPWB staff is available as peer mentor trainers.
Practice interventions: For existing practices, our team of professionals analyze the situation and propose a custom intervention which results in an enhanced quality of life commitment in the practice workplace. Groups may wish to initiate an initial survey, a practice retreat, a practice diagnosis oriented around morale, turnover, or conflict problems, or a facilitation promoting a healthy practice. For professionals who are beginning a partnership, the consultation offers a framework for conversation so that each partner understands the others, thereby facilitating a smoother transition and a longer association.
Staff and Manager services: The Center for Professional Well-Being works with practice staffs and managers to enhance the quality of life commitment in the practice workplace. Groups may wish to initiate an initial survey or interview process to measure the stress levels in the practice and determine where improvement are needed and how to best go through changes.
Telephone consultations: Dr. Pfifferling and Faculty are available on a limited basis for telephone appointments.