retreating-to-my-own-world_jpgPassivity and passive aggression in medical practice may actually be one and the same.  A passive physician can be disruptive to effective patient care and the performance of the work team.  An ‘absent’ physician can also greatly increase the risk of error and adverse incidents.  Passive behaviors such as not communicating pertinent clinical information through timely or thorough charting, not seeking consultations, not answering pages or calls promptly or at all are some of the ways in which physicians can undermine effective patient care.
These types of behavior, while not open displays of verbal abuse or aggression, also fall under concerns raised by JCAHO in their Behaviors That Undermine a Culture of Safety.  Sentinel Event Alert Bulletin:  Issue 40. July 9 2008.  It is significant that JCAHO also considers the passive physician to be disruptive.  The bulletin states:

 “Intimidating and disruptive behaviors include overt actions such as verbal outbursts and physical threats, as well as passive activities such as refusing  to perform assigned tasks or quietly exhibiting uncooperative attitudes during routine activities.”

JCAHO now recommends core competencies for the credentialing of medical staff.  These recommendations cite the need for physicians to demonstrate competencies “including interpersonal skills and professionalism” in the work environment.  Refusal of privileges by credentialing committees, and administrative action against already hired physicians, could apply equally to the passive physician and the more openly aggressive one.

It is likely that the passive physician is responding to the same stressors as the aggressive physician, but that individual coping styles and personality structures account for the dissimilar presentations.  Some individuals, across professions, will act out when chronically stressed while others will express themselves indirectly and in a more internalized way. 

Passive physicians would do well to repair their clinical demeanor by moving from their end of the expressive continuum toward assertiveness as well.  Increased engagement with teammates in person and through call begins to build relationships.  Re-affirming the importance of one’s role in the clinical setting can help increase motivation to communicate one’s knowledge through notes and consultations with team mates.  Increased interaction with team mates will help foster a sense of being needed and having a vital contribution to make in the clinical setting.
If the physician’s withdrawal from the clinical setting is reactive to being overwhelmed by the team’s approach then more proactive interaction will help ‘teach’ and ‘train’ the team members to communicate and interact with the physician in supportive ways.  Passive physicians will have to rehearse assertion skills in order to convey what would help diminish workplace stress and facilitate a better, more comfortable alliance with other team members.

Anger Management Institute of Texas’ Executive Coaching Program is utilized by management of accredited hospital/organizations for physicians displaying disruptive behaviors in the workplace.

Anger Management Classes and Anger Management – Executive Coaching available in Houston, Texas.

Gregory A. Kyles, M.A., LPC, CEAP, CAMF
Director, Anger Management Institute of Texas
Diplomate, President of Texas Chapter
American Association of Anger Management Providers

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