Passive Aggressive Physician Responses in the Medical Practice

A lot of comments lately on the fact that the doctor does not want to change, they don’t feel the “pain” or accept a reason for change. More importantly, we hear that the administration brings up an issue at the monthly board meeting. There is discussion about the issue and eventually there is a vote or consensus reached that the recommendation for change it accepted.

The next day however, the doctor does not change to the new way. Instead indicates that the decision does not apply to them, it is for others. Or I’m about to retire and I don’t have to change. Or I don’t like someone telling me how to run my practice.

So passive response = yes to the vote followed by aggressive = no I won’t change is the result. In my years, this is a very common situation.

How do you deal with it? A recent article in Psychology Today offers some suggestions:

• Don’t over react when you find out about the response, this may lead to even more of that behavior 
• Don’t force the change 
• Proactively deal with the situation 
• Get the doctor involved with what might work in their specific practice. Work with the supportive staff to help. Identify the problem and seek a solution that will work. 
• There may have to be direct consequences for the lack of acceptance of the change. This can be accomplished with peer pressure, e.g., comments at the next doctor meeting. It may also be accomplished by some form of monetary penalty if there is a tie to the lack of change in behavior to some risk to the practice. 

How does this fit in with the purpose of this blog? If you believe that improvements in care are necessary, there will have to be changes made. These changes will impact the physician practice directly. Even though many changes can and will be transparent, there are others that be direct.

A Medical Practice Issue: Too Darn Many Decisions!

Recently an attendee at a conference answered the question about how much time do I waste with 90%! When asked if she really meant that, she said yes. There are constant interruptions throughout my day. When asked with another “why” (using the 5 why technique) it was that the staff kept asking questions. I think this is a very common trend for many administrators interruptions are impacting your productivity. Thus when we suggest implementation of Lean Principles and the use of the many tools available, the answer very often is we don’t have time.

It may be that we have not developed/trained the staff or maybe we haven’t provided the parameters within which others can and should be capable of making decisions. The staff is required to make decisions all the time. From deciding whether or not a patient who does not have their co-pay should be seen, to the patient at triage who wants to add the second child to the visit since the two kids are there, to what to do we do in a real emergency.

It would seem that if you tracked the reasons for your daily interruptions on a basic log you would begin to get patterns either by individuals, positions, or circumstances that you could begin to address. There may be immediate teachable moments.

There also may be opportunities to create guidelines for the staff to address the issues they face. Some of the guidelines will have to be addressed at the physician level and many may be addressed with common sense guidelines by you and your administrative team (assuming you have support!).

A decision involves defining the problem/issue, gathering the data, considering alternatives, choosing the best of these alternatives, and implementation. Simple straightforward model that you should use every time. The key in any of these decisions however may not be that you make them in a vacuum, instead you involve the staff on each of the steps!

The key though to long term success is follow up. The Continuous Process Improvement, CPI idea, where you re-visit the circumstances at an appointed time later, e.g., 4 weeks. You will find out whether or not the decision was appropriate and followed or if they have reverted back to their old ways. Ask the “why” set of questions to make sure that you are solving the problem that was presented.

Delegation through involvement and development will lead to better decision making but also free up more time for you to work on other issues with the constant goal of improving patient care.