Are you disruptive or disruptive, doctor?

A friend and colleague physician entrepreneur were recently lamenting the fact that, in business, being disruptive is a good thing , but, in medicine, it can result in , among other bad things, losing your license to practice. Despite that, the AMA wants you to be disruptive.

Medical professionalism is defined as a set of values, behaviors, and relationships that demonstrate a doctor's central determination to devote their knowledge, skills, and judgment to the protection and restoration of human well-being. It includes integrity, compassion, altruism, continuous improvement, excellence, and working in partnership with members of the wider healthcare team.

Niccolò Machiavelli got it right with this quote on Change and Innovation in his 16th century political treatise,?The Prince:

“There is nothing more difficult to take in hand, more perilous to conduct, or more uncertain in its success, than to take the lead in the introduction of a new order of things. For the innovator has enemies in all those who profit by the old order, and only lukewarm defenders in all those who would profit by the new order, this lukewarmness arising partly from fear of their adversaries … and partly from the incredulity of mankind, who do not truly believe in anything new until they have had actual experience of it.”

Gag orders seem to be pervasive during the pandemic,

In business, disruptive innovation , a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.

Medicine sees it a different way .Patients identify being confident, empathetic, humane, personal (ie, viewing the patient as a person, not a disease), forthright, respectful, and thorough as ideal physician behaviors. Valuing teamwork, handling stress, punctuality, and self-motivation to pursue professional and personal growth are also ideal physician behaviors. On the other hand, the American Medical Association, in its Code of Medical Ethics, states that “personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care constitutes disruptive [physician] behavior.” Such behaviors include inappropriate language, yelling, gossip, facial expressions and other mannerisms as well as physical boundary violations.

Radiologists, like all other people, can sometimes react to difficult situations with disruptive behavior. On April 11,?Clinical Imaging?published an article citing numerous underlying causes that can lead to radiologists becoming uncooperative or unprofessional, from general burnout and stress to skill deficiencies, impairment, or frustrations with the electronic medical record. Suggested ways to manage "disruptive" radiologists include:

1.?Training:?Use training to correct deficiencies in hard skills as well as deficiencies in communicating with colleagues. Try to identify any issues and offer training as early as possible.?

2.?Interviews:?Revamp the interview process to include a structured interview. Then, use that interview as an opportunity to share information about the organization’s code of behavior. This sets expectations and gains buy-in?before?the radiologist is hired.?

3.?Intervention and Assistance:?Develop and utilize an employee assistance program for employees whose personal problems are contributing to burnout or otherwise affecting their workplace behavior. Often, contracting with outside organizations for this purpose can offer a more confidential process that physicians can trust.?

4.?Evaluation of systemic challenges:?Understand that each and every new product or procedural change can be a source of stress and a time burden for physicians. Continuously consult with physicians and staff to ensure that they are able to complete their scheduled work during their scheduled shift, and adjust scheduling as necessary — especially when technology is involved, where there may be a steep learning curve.

5.?Coaching:?Individual or group coaching sessions can help radiologists prevent or combat counterproductive behaviors and work toward meaningful, long-term change.?

6.?Cultural changes:?Creating a culture of mutual respect, where leadership clearly communicates the organization’s expectations and values

Unfortunately, the line between the two is not so clear and some doctors are branded as disruptive, not because they cause patients harm, but because, through their efforts and actions, they are disruptive to the existing sickcare business model. Those that dare to tell truth to authority are branded as provacateurs, naysayers, grenade-throwers and "just not team players".

Those who threaten the status quo in any industry at any time are outsiders and run the risk of suffering from the full force of those seeking to resist change. Physician entrepreneurs are no different. Being disruptive in pinstripes is one thing. Being disruptive in a white coat is another. Few vested interests are tolerated either in the clinic, the bedside, or the OR.

So, what differentiates a disruptive from a disruptive doctor? What's the difference between a good rebel and?a?bad rebel? Here are the differences.

The disruption lexicon gets even more complicated. Do you want to know what else is disruptive in sick care?

1. Alarm fatigue

2. Change fatigue

3. Cell phones in the OR

4. Music in the OR

5. Non-ergonomically designed surgical instruments and ORs

6. Shooters in the ER

7. Electronic medical records ?and workflow

8. Electronic medical records and the doctor-patient relationship

9. Meetings

10. Two words

11. Being Dr.Asshole

Here are some tips on how to deal with rule breakers.

• Let employees?define their missions .
• Tailor jobs ?to employees' strengths.
• Ask "Why?" and "What if?"
• Stress that the company is not perfect.
• Maximize variety.
• Continually inject novelty into work.
• Hire people with diverse perspectives.
• Design processes to include dissent.

Ask,?"What information suggests this might not be the right path to take?"

If you are making waves, you need to learn to manage up.

Raising a potentially emotional topic to your manager can be difficult — you don’t know how they will react or whether you will be judged or punished in some way. Based on the science of conflict resolution, dissent, upward communication, and this authors’ own research on one-on-one meetings, they share a clear process for raising these issues with your manager. It involves first recognizing the importance of one-on-ones to you, the direct report; then clearly understanding the core need you are trying to address. Then it’s a process of picking your battles carefully, preparing yourself, starting well, executing with composure, curiosity, and a willingness to adapt, and finally wrapping up while maintaining momentum.

Making your workplace psychologically safe takes taking aim at some misperceptions about the consequences of disagreeing with your coworkers.

Here are 15 ways to promote psychological safety at work.

Part of doctors acting badly might be traced to loss of control or threatened masculinity.

Digital disruptors are making their mark in healthcare. The new triple threat is a doctor/technologist/entrepreneur. Many are outside of the industry, some are physician entrepreneurs and, increasingly, many are patients. As more a more doctors shift their attention from the practice of medicine to the business of medicine, the medical establishment will have a tough time distinguishing one disruptor from the other.

Arlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs on Subtack