"Silence is not golden. Silence is permission." -- David Maxfield, on bullying in the medical workplace

Disruptive behaviour is not a normal part of medical culture.  That means that is it not common or normal for surgeons to throw instruments, psychiatrists to sleep with their patients, or internists to use tantrums to get their own way; the vast majority of physicians practice in a highly professional manner.  However, the profession and the health care system struggle - really struggle - to intervene and remediate such behaviour when it occurs.  Thankfully, only 3-7% of physicians demonstrate behaviour that can be described as disruptive.  But the impact of that small number of physicians can be profoundly strong and long-lasting.

Why?  Many practice environments don't have useful and practical Codes of Conduct for physicians. Many health care professionals struggle to effectively hold a physician accountable for inappropriate behaviour.  Many remediation programs take time, dollars, and hard work.  Many physicians who demonstrate inappropriate workplace behaviour are stressed, burnout out, ill, or addicted.  And, sometimes, the physician is under tremendous strain from practicing in a toxic practice environment that suffers from poor leadership and management.  The issues are typically very complicated.

Forbes published an article on this very issue last week - and highlighted some of the VitalSmarts courses that I teach at uOttawa - Crucial Conversations and Crucial Confrontations/Accountability.  I have seen these courses help many physicians rapidly develop insight into their behaviours (and that of others) and apply evidence-based skills to difficult situations in highly effective ways. 

How has your practice or training environment prevented, intervened, and remediated disruptive behaviour?