The Joint Commission (i.e., The Organization Formerly Known As JCAHO) is field-testing standards on disruptive behavior.  The working draft provides some insight into the Commission’s thinking; the elements for performance to this standard are as follows:

1. The leaders develop a code of conduct that applies to everyone who works in the organization.

2. The code of conduct defines desirable and disruptive behavior.

3. All who work in the organization are educated about both desirable and disruptive behaviors.

4. The leaders develop processes for managing disruptive behavior.

5. Leaders identify the roles of individual leadership groups in managing disruptive behavior.

6. The organized medical staff manages disruptive behavior exhibited by physicians or individuals who are granted clinical privileges.

7. Leaders establish a fair hearing process for those who exhibit disruptive behavior.

While noble, the sentiments behind these standards are not brand new.  In fact, a JCAHO standard, circa 2001, touched on these same issues and was addressed, for example, by the Massachusetts Board of Registration in Medicine by promulgation of its own related policy.  Apparently the lighter touch of the earlier standards (which is sometimes extremely important in trying to deal with difficult personalities who are also brilliant clinicians) has proven to be insufficient to deal with the sometimes intransigent issue of disruptive physician behavior.

A tip of the hat to Michael Cassidy at Med Law Blog for noting the proposed standard change.

Unfortunately, disruptive physicians may also be, at times, physicians involved in medical errors.  I heard a terrific piece on NPR a while back on apologies — exploring the question of whether apologies are a good idea, from both psychological and risk-management perspectives.  This is, of course, a hot topic these days (check out The Sorry Works Coalition).

Update 1/25/07:  A Healthy Blog posted yesterday: "Doug Wojcieszak, the founder and spokesperson for the SorryWorks! Coalition, spoke at Health Care for All about apology and disclosure following adverse medical events."  Doug’s slides are up at A Healthy Blog. 

Double hat tip to Michael Cohen at CAM Law Blog (a fellow Bay State blogger) and Daniel Goldberg at The Medical Humanities Blog for highlighting Marlynn Wei’s law review article in press on medical apologies (link to abstract and downloadable PDF).  The article explores whether insulation from legal liability exists under state laws out there, and whether existence of these laws promotes apologies.

Civility certainly ought to be promoted, whether through sanctioning disruptive physicians or through encouraging apologies where mistakes have been made.  Given the increasing availability of provider quality report cards and the like, and the increased ability of consumers to decide where to get their care (thanks to health savings accounts and other consumer-directed health care initiatives), civility is not simply an ethical goal, it should be recognized as a bottom-line business goal as well.

Update 4/13/07: More states are considering medical apology laws.  Check out the AP story here, which includes a discussion of laws already on the books as well.

David Harlow