Kendall L. Stewart, M.D. June 29, 2006

1. Dealing with Difficult DoctorsSome Practical Strategies forBuilding More Effective Nurse-Physician Relationships1,2,3A Presentation for the VHA Central Nursing Leadership Institute SOMC Press Kendall L. Stewart, M.D. June 29, 2006

2. Doctors can be difficult.1 Physicians are perceived as so intimidating that hospital CEOs often refuse to schedule a talk with this title. But you have to deal with difficult doctors every day—and you could probably use some help. The line between annoying and disruptive physicians is not always clear. This presentation focuses on annoying physicians After listening to this presentation, you will be able to Identify two common difficult physician behaviors. Describe how those behaviors “make” you feel. Explain how your feelings cause you to behave. Specify two practical strategies for building more effective relationships with physicians Explain why those strategies make sense and how to deploy them successfully. What’s in this for you?

3. Why is it so important that we learn how to deal more effectively with doctors? • Good relationships with doctors are critical to the effective teamwork required in successful healthcare organizations. • Doctors enjoy enormous power. • Physicians are bright, highly motivated (for the most part), and we love to game systems. • Physicians can be powerful allies or enemies. • Doctors control most healthcare resources. • Doctors can be difficult; we are often regarded as “barriers.”1,2,3 • Our relationships with physicians exert a huge impact on our lives and our work.

4. Preparing to Deal with Difficult Doctors Preparing Yourself Preparing Physician Leaders Preparing Executives Preparing Managers Preparing Employees Dealing with Annoying Doctors The Negative Physician The Selfish Physician The Unreasonable Physician1,2,3 The Whining Physician The Disorganized Physician The Immature Physician Dealing with Disruptive Doctors The Angry Physician The Abusive Physician The Dishonest Physician The Arrogant Physician The Pot-Stirring Physician Dealing with Dangerous Doctors The Marginal Physician The Impaired Physician The Incompetent Physician The Distracted Physician The Overwhelmed Physician What is the extent of this challenge?

5. What commonly-employed strategies don’t work? • Making up our minds to recruit only nice doctors • Hoping that the difficult physicians will change • Ruminating about how miserable these physicians are making our lives • Blaming physician leaders for not whipping their difficult colleagues into shape1,2 • Faulting the executives for not shooting them at dawn

6. What are some problematic physician behaviors?1 • Failure to explain • Rudeness • Disrespect • Condescension • Ordering instead of requesting or consulting • Undermining other team members • Blaming others publicly • Not listening or taking colleagues seriously • Indulging in temper outbursts • Failure to say, “Thank you”

7. How do physicians’ difficult behaviors “make” us feel?1 • Hopeless • Resentful • Angry • Hurt • Discouraged • Frustrated • Helpless • Enraged • Unappreciated • Rejected

8. How do our bad feelings and flawed attitudes “cause” us to behave?1 • Withdraw • Nag • Argue • Give up • Explain talk behind others’ backs • Ruminate • Gossip • Try harder to please • Plot revenge

9. What are some successful strategies for dealing with difficult people?1 • Label them.* • Neutralize them. • Describe them. • Predict them. • Inform them. • Involve them. • Ignore them. • Convert them. • Avoid them. • Expose them. • Circumvent them. • Use them. • Persuade them. • Confront them.* • Rehabilitate them. • Discourage them. • Ridicule them. • Isolate them. • Punish them. • Extrude them.

10. Labelthem. • Why should you? • Acknowledges they are different • Recognizes their need to be “managed,” not befriended • Initiates the management process • Minimizes your unrealistic expectations • Reminds you to become emotionally detached • Signals need to reach for suitable tools • Legitimizes others’ perceptions • Forces you to take personal responsibility • How can you? • Remain sensitive to your own emotional arousal. • Recognize the need to choke off your emotional arousal. • Imagine a sticky note labeled, “A Real Nut” attached to their foreheads. • View them as impaired (they are). • Pity them. • Concentrate on observing their behavior. • Reflect on why someone might behave so unproductively—as a distraction, not as their therapist.1,2,3

11. Confront them. • Why should you? • Challenges others’ tolerance • Worries those who collude with misbehavers • Disrupts usual response patterns • Signals who’s in charge • Provides relief from feelings of helplessness • Gives prior victims hope • Reaffirms your commitment to organization’s stated values • Encourages others to take the same vigorous action1 • How can you? • Document their behavior. • Ignore suspected motives, but record behavior in descriptive detail. • Focus on patterns instead of isolated occurrences. • Line up witnesses. • Give emotions time to dissipate. • Nail down the support you need. • Confront in love and respect. • Refuse to be distracted. • Attach consequences and describe next steps. • Deliver on your promises.

12. What practical conclusions can you draw from this talk? • More effective teamwork with physicians is essential to our organizational success. • Our relationships with physicians and each other can be improved. • Building effective relationships demands a considerable investment. • We must focus on our own—not others’—attitudes and behaviors since we have no control over theirs. • Total success is not possible. • Incremental success is easily achievable. • This is a process, not an occasion. • Improved teamwork is an important key to increasing job satisfaction.1,2

13. Where can you learn more? • Stewart, Kendall L., et. al. A Portable Mentor for Organizational Leaders, SOMCPress, 2003 S • Stewart, Kendall L., “Physician Traps: Some Practical Ways to Avoid Becoming a Miserable Doctor” A SOMCPress White Paper, SOMCPress, July 24, 2002 • Stewart, Kendall L. et. al, “On Being Successful at SOMC: Some Practical Guidelines for New Physicians” A SOMCPress White Paper, SOMCPress, January 2001 • Stewart, Kendall L., “Bigwigs Behaving Badly: Understanding and Coping with Notable Misbehavior” A SOMCPress White Paper, SOMCPress, March 11, 2002 • Stewart, Kendall L., “Relationships: Building and Sustaining the Interpersonal Foundations of Organizational Success” A SOMCPress White Paper, SOMCPress, March 11, 2002 Please visit www.KendallLStewartMD.com to download related White Papers and presentations.

14. How can you contact me? Kendall L. Stewart, M.D. VPMA and Chief Medical Officer Southern Ohio Medical Center President & CEO The SOMC Medical Care Foundation, Inc. 1805 27th Street Portsmouth, Ohio 45662 740.356.8153 stewartk@somc.org Webmaster@KendallLStewartMD.com www.somc.org www.KendallLStewartMD.com

15. Are there other questions? www.somc.org SafetyQualityServiceRelationshipsPerformance 