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#JHMChat Transcript

Healthcare social media transcript of the #JHMChat hashtag.
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Society of Hospital Medicine @SocietyHospMed
#JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: https://t.co/p9QwVtSBYZ https://t.co/Er5ET6p5Dx
Journal of Hospital Medicine @JHospMedicine
Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat. Go ahead and introduce yourself while we wait for others to join...
Journal of Hospital Medicine @JHospMedicine
RT @SHMLive: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: https://t.co/p9QwVtSBYZ https://t.co/Er5ET6p5Dx
Robert J. Mahoney, MD @mahoneyr
RT @SHMLive: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: https://t.co/p9QwVtSBYZ https://t.co/Er5ET6p5Dx
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Greetings, I'm @WrayCharles your moderator for tonight's #JHMChat. Go ahead and introduce yourself while we wait for others to join...
Journal of Hospital Medicine @JHospMedicine
Special thanks to our partners @SHMLive @CostsofCare @ABIMFoundation 4 bringing you #JHMChat tonight - Don't forget to claim your #CME afterwards!
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine @FutureDocs @WrayCharles Good evening, #JHMChat, from unseasonably cold (but not as cold as Chicago) Saint Louis, Missouri
HeittC3 @HeittC3
Hello. I'm Michael Heitt @HeittC3, co-author of the article we're discussing tonight.#JHMChat https://t.co/5mzM5DICja
Vinny Arora MD MAPP @FutureDocs
@JHospMedicine lurking until toddler bedtime - a totally different sort of “professional disruption” ;) #jhmchat @WrayCharles Good Luck!!
Journal of Hospital Medicine @JHospMedicine
@HeittC3 Thanks for joining us tonight, Michael! #jhmchat
Journal of Hospital Medicine @JHospMedicine
Be sure to register for #CME for participation in tonight's #JHMChat - sign up here!--> https://t.co/eF9tllkDbU
Journal of Hospital Medicine @JHospMedicine
Don't forget to tag your tweets with #JHMChat! T1 up in a moment…
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Looking forward to sharing thoughts about Disruptive Physician Behavior (DPB) and how to deal with this issue #JHMChat https://t.co/z5FDwYVQUv
Robert J. Mahoney, MD @mahoneyr
@FutureDocs @JHospMedicine @WrayCharles Toddlers are the original disrupters - and strategies that work on toddlers are highly effective for disruptive physicians. Or so I'm told. #JHMChat
Sanjay Saint @sanjaysaint
Sanjay Saint from Ann Arbor - home of the #Michigan Wolverines! - also here. 1 eye on this #JHMChat & other on #FinalFour
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Looking forward to sharing thoughts about Disruptive Physician Behavior (DPB) and how to deal with this issue #JHMChat https://t.co/z5FDwYVQUv
Vinny Arora MD MAPP @FutureDocs
RT @mahoneyr: @FutureDocs @JHospMedicine @WrayCharles Toddlers are the original disrupters - and strategies that work on toddlers are highly effective for disruptive physicians. Or so I'm told. #JHMChat
Journal of Hospital Medicine @JHospMedicine
T1: What are the various manifestations of Disruptive Physician Behavior (DPB) you all have experienced in your own work environments? #JHMChat https://t.co/z43SSdt4Mt
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Preeti John, author 'Disruptive Physician Behavior' article in @JHospMedicine - written with Psychologist @HeittC3 #JHMChat https://t.co/rbad5N8xRu
Kent Willis MD @KentWillisMD
RT @mahoneyr: @FutureDocs @JHospMedicine @WrayCharles Toddlers are the original disrupters - and strategies that work on toddlers are highly effective for disruptive physicians. Or so I'm told. #JHMChat
Society of Hospital Medicine @SocietyHospMed
T1 is live!! Join the #JHMChat conversation on disruptive #physician behavior https://t.co/5oXJ5ZO7TV
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T1 Seems like disruptive behavior can be classified into 1) Behaviors toward colleagues 2) Behaviors toward allied professionals (nursing, therapists, etc) 3) Behaviors toward trainees Possibly with different etiologies/motives underlying each #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @mahoneyr: @JHospMedicine T1 Seems like disruptive behavior can be classified into 1) Behaviors toward colleagues 2) Behaviors toward allied professionals (nursing, therapists, etc) 3) Behaviors toward trainees Possibly with different etiologies/motives underlying each #JHMChat
Jaime D. Lewis @JaimeDLewisMD
Breast surgeon lurking from Cincinnati. Our team never made it to the #finalfour so my other other eye is split between email and #EHR . #jhmchat
Rebecca Jaffe, MD @RJmdphilly
endorse #JHMChat https://t.co/z0lsGnYMxr
Journal of Hospital Medicine @JHospMedicine
@preeti_john, what were some of the things you saw/experienced to push you and @heittc3 to write this paper? #JHMChat
HeittC3 @HeittC3
@mahoneyr @JHospMedicine @mahoneyr disruptive behavior can all affect the patient or patient's family. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@JaimeDLewisMD Glad to have you join us, Jaime! When that email gets to be too much, just flip back over to #jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T1: T1: What are the various manifestations of Disruptive Physician Behavior (DPB) you all have experienced in your own work environments? #JHMChat https://t.co/z43SSdt4Mt
Rebecca Jaffe, MD @RJmdphilly
RT @SHMLive: T1 is live!! Join the #JHMChat conversation on disruptive #physician behavior https://t.co/5oXJ5ZO7TV
Vinny Arora MD MAPP @FutureDocs
RT @preeti_john: Looking forward to sharing thoughts about Disruptive Physician Behavior (DPB) and how to deal with this issue #JHMChat https://t.co/z5FDwYVQUv
Vinny Arora MD MAPP @FutureDocs
RT @preeti_john: Preeti John, author 'Disruptive Physician Behavior' article in @JHospMedicine - written with Psychologist @HeittC3 #JHMChat https://t.co/rbad5N8xRu
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: #JHMChat on disruptive #physician behavior starts NOW! Join the conversation, then claim #CME: https://t.co/p9QwVtSBYZ https://t.co/Er5ET6p5Dx
Sanjay Saint @sanjaysaint
@JHospMedicine T1. A physician who loses their temper and yells at a coworker or learner. When it is more of a 'snap' than a yell it's more gray #JHMChat
HeittC3 @HeittC3
@JHospMedicine @preeti_john As a clinical & consulting #psychologist, I work directly with #DisruptivePhysicians & other medical professionals referred by their hospital, professional association or board, to do “remedial coaching” with disruptive individuals. #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: @JHospMedicine @preeti_john As a clinical & consulting #psychologist, I work directly with #DisruptivePhysicians & other medical professionals referred by their hospital, professional association or board, to do “remedial coaching” with disruptive individuals. #JHMChat
Robert J. Mahoney, MD @mahoneyr
@HeittC3 @JHospMedicine Absolutely - not only directly (patients/families witnessing disruptive behavior) but the "opportunity cost" to patient care from poor care delivery related to communication, safety culture, etc. #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @mahoneyr: @HeittC3 @JHospMedicine Absolutely - not only directly (patients/families witnessing disruptive behavior) but the "opportunity cost" to patient care from poor care delivery related to communication, safety culture, etc. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@preeti_john @TJCommission These passive activities are critically important and probably overlooked as "disruptive behavior", I'd imagine...#jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: @preeti_john @TJCommission These passive activities are critically important and probably overlooked as "disruptive behavior", I'd imagine...#jhmchat
Journal of Hospital Medicine @JHospMedicine
T2 coming up... #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @mahoneyr: @HeittC3 @JHospMedicine Absolutely - not only directly (patients/families witnessing disruptive behavior) but the "opportunity cost" to patient care from poor care delivery related to communication, safety culture, etc. #JHMChat
HeittC3 @HeittC3
@sanjaysaint @JHospMedicine Great point. There are times when raising one's voice is necessary in training, in the OR, or bedside. Like beauty, disruptive behavior often lies in the eye of the beholder. #JHMChat
Vinny Arora MD MAPP @FutureDocs
Welcome to an expert on #JHMChat ! https://t.co/QQoRhkhexk
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: @JHospMedicine T1. A physician who loses their temper and yells at a coworker or learner. When it is more of a 'snap' than a yell it's more gray #JHMChat
Journal of Hospital Medicine @JHospMedicine
T2: Given the multiple etiologies of DPB, are there ways we can recognize early on in one's career -- so as to mitigate its future effects? #JHMChat https://t.co/QBPfi6xuDO
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Working with a wide variety of individuals- trainees, colleagues, in different institutions over the years ,& witnessing behaviors that were "eyebrow raising" led me to wonder if physicians can have personality disorders, & I started to look up definitions #JHMChat https://t.co/6mz1kPrK9Z
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: @sanjaysaint @JHospMedicine Great point. There are times when raising one's voice is necessary in training, in the OR, or bedside. Like beauty, disruptive behavior often lies in the eye of the beholder. #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Working with a wide variety of individuals- trainees, colleagues, in different institutions over the years ,& witnessing behaviors that were "eyebrow raising" led me to wonder if physicians can have personality disorders, & I started to look up definitions #JHMChat https://t.co/6mz1kPrK9Z
Vinny Arora MD MAPP @FutureDocs
IMHO At the root of a lot of disruptive physician behavior is disturbances in personal well-being #JHMChat
Robert J. Mahoney, MD @mahoneyr
@HeittC3 @sanjaysaint @JHospMedicine We do sometimes confuse "speaking loudly" with yelling - the context and content sometimes help to distinguish. #JHMChat
Saima Chaudhry, MD @DrSaimaChaudhry
@JHospMedicine Yes I agree with @mahoneyr. DPB classified as he laid out makes sense #JHMChat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T2: T2: Given the multiple etiologies of DPB, are there ways we can recognize early on in one's career -- so as to mitigate its future effects? #JHMChat https://t.co/QBPfi6xuDO
HeittC3 @HeittC3
@FutureDocs “Although DPB can be [due to personality] or psychiatric disorders, it does not always stem from underlying psychopathology. Clarifying these distinctions is important for managing the problem & calls for expert professional evaluation in some cases” #JHMChat
Journal of Hospital Medicine @JHospMedicine
Great point, Vinny. While we might initially choose to blame the physician - it's likely that the training environment, stressors, etc that are leading to the disruptive behavior #jhmchat https://t.co/t1fi4uCJ7Z
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: @FutureDocs “Although DPB can be [due to personality] or psychiatric disorders, it does not always stem from underlying psychopathology. Clarifying these distinctions is important for managing the problem & calls for expert professional evaluation in some cases” #JHMChat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T2 Like so issues involving personality, it can be very hard for the one with the "disorder" to recognize it. Usually by identifying the impacts it is having on one's professional life. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@bruce_lambert Hence most.. #jhmchat
Dr. Brian Goldman @NightShiftMD
RT @JHospMedicine: T1: T1: What are the various manifestations of Disruptive Physician Behavior (DPB) you all have experienced in your own work environments? #JHMChat https://t.co/z43SSdt4Mt
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
"360 degree reviews" enable early identification- consists of feedback from coworkers: physicians, nurses, administrators; patient complaints & satisfaction surveys, peer assessments- gives a better assessment of individual than routine evaluations. #JHMChat https://t.co/Wuvs8PjiG2
Vinny Arora MD MAPP @FutureDocs
@DrPhilipVerhoef @mahoneyr @JHospMedicine @WrayCharles I’ll be there for the tantrum that ensues #JHMChat
Sanjay Saint @sanjaysaint
Wonder if 'definition' of disruptive behavior depends on specialty. Are there different thresholds for surgery vs medicine vs peds? #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @HeittC3: @sanjaysaint @JHospMedicine Great point. There are times when raising one's voice is necessary in training, in the OR, or bedside. Like beauty, disruptive behavior often lies in the eye of the beholder. #JHMChat
Aman Khanna MD, MBA @AmanKhanna
RT @sanjaysaint: Wonder if 'definition' of disruptive behavior depends on specialty. Are there different thresholds for surgery vs medicine vs peds? #JHMChat
HeittC3 @HeittC3
In my work with #DisruptivePhysicians I have found a high incidence of OCPD (aka Anankastic Personality Disorder). They often have very “high standards” ( #perfectionism ) for themselves …and others. #JHMChat
Journal of Hospital Medicine @JHospMedicine
Do we see a lot of 360 degree in #MedEd? #jhmchat https://t.co/aG8j3i7xGj
Robert J. Mahoney, MD @mahoneyr
@sanjaysaint Seems like two questions packed into this - 1) Are there different thresholds? 2) Should there be? #JHMChat
Rebecca Jaffe, MD @RJmdphilly
was pretty sure this as going to be about #assessment in the end. @boedudley #JHMChat https://t.co/T6WZnlMw5S
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine Some physicians in our division have started a 360 feedback system. I believe you'll hear more about it from them soon in Orlando. #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@sanjaysaint culture eats strategy culture is local sick cultures live in poor systems etc #JHMChat
Journal of Hospital Medicine @JHospMedicine
Great point, Sanjay. And if there are...is that ok? #jhmchat https://t.co/772eqIC5ci
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: In my work with #DisruptivePhysicians I have found a high incidence of OCPD (aka Anankastic Personality Disorder). They often have very “high standards” ( #perfectionism ) for themselves …and others. #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@mahoneyr @HeittC3 @sanjaysaint @JHospMedicine there are gender ramifications/implications here too... #JHMChat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine We also survey the nurses on the divisions we work on - and we receive the raw (but anonymous) ratings/comments. Very effective. #JHMChat
HeittC3 @HeittC3
@sanjaysaint The definitions that are being used by AMA and others are generic. But this is a very interesting point. Would a pediatrician in a clinic get away with the same behavior as a trauma surgeon during a trauma? #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Definition holds same-but @TJCommission Journal on Quality&PtSafety identifies #surgical specialties where disruptive events occur most often: GeneralSurgery, Neurosurgery, Cardiovascular Surgery. (Do certain types of personalities gravitate towards these specialties?) #JHMChat https://t.co/V4kK1o8VjO
Loren Academic Services, Inc. @LAS_Inc_
RT @FutureDocs: IMHO At the root of a lot of disruptive physician behavior is disturbances in personal well-being #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Definition holds same-but @TJCommission Journal on Quality&PtSafety identifies #surgical specialties where disruptive events occur most often: GeneralSurgery, Neurosurgery, Cardiovascular Surgery. (Do certain types of personalities gravitate towards these specialties?) #JHMChat https://t.co/V4kK1o8VjO
Journal of Hospital Medicine @JHospMedicine
My guess is no...any MedPeds folks out there that could chime in? #jhmchat https://t.co/x1tJPefInX
HeittC3 @HeittC3
T2: Most DPB is not subtle or difficult to notice. It is best when DPB is addressed informally, in a supportive, educational, non-punitive manner, as early as possible, before it becomes a bigger problem. #JHMChat https://t.co/lUMdbD8XEd
Journal of Hospital Medicine @JHospMedicine
T3 coming up shortly...getting out that culture thing a little bit... #JHMChat
Loren Academic Services, Inc. @LAS_Inc_
@HeittC3 @sanjaysaint Almost definitely not—and they shouldn’t. Context is a critical component in judging whether behavior is appropriate/disruptive/etc. The more concerning question is—do we have the same standards for men/women, minorities, etc? #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@preeti_john @TJCommission this seems like a chicken and egg question, though maybe more utility in the answer - if personality gravitates to profession, design early (UME) interventions. If specialty creates the problem, fix the clinical depts and care environ. #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: T2: T2: Most DPB is not subtle or difficult to notice. It is best when DPB is addressed informally, in a supportive, educational, non-punitive manner, as early as possible, before it becomes a bigger problem. #JHMChat https://t.co/lUMdbD8XEd
Tobi Adu🇳🇫🇷🇴🇺🇸🇩🇪 @tobemcguire
RT @JHospMedicine: T1: T1: What are the various manifestations of Disruptive Physician Behavior (DPB) you all have experienced in your own work environments? #JHMChat https://t.co/z43SSdt4Mt
Robert J. Mahoney, MD @mahoneyr
@HeittC3 What are the typical responses when it is addressed? Do physicians typically answer "It's no big deal" or "I had no idea"? #JHMChat
Rebecca Jaffe, MD @RJmdphilly
RT @HeittC3: T2: T2: Most DPB is not subtle or difficult to notice. It is best when DPB is addressed informally, in a supportive, educational, non-punitive manner, as early as possible, before it becomes a bigger problem. #JHMChat https://t.co/lUMdbD8XEd
Journal of Hospital Medicine @JHospMedicine
T3: In your experiences, how has DPB contributed to #burnout or work satisfaction? #JHMChat https://t.co/ccNE6DgXSm
Rebecca Jaffe, MD @RJmdphilly
RT @LAS_Inc_: @HeittC3 @sanjaysaint Almost definitely not—and they shouldn’t. Context is a critical component in judging whether behavior is appropriate/disruptive/etc. The more concerning question is—do we have the same standards for men/women, minorities, etc? #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: T3: T3: In your experiences, how has DPB contributed to #burnout or work satisfaction? #JHMChat https://t.co/ccNE6DgXSm
Rebecca Jaffe, MD @RJmdphilly
@mahoneyr @HeittC3 even split? #JHMChat
Vinny Arora MD MAPP @FutureDocs
@JHospMedicine see work of Maxine Papdakis #jhmchat for T2
HeittC3 @HeittC3
I get both... and "I was just looking out my patient" or "I can't help it if others don't care as much as I do about safe patient care." It's a learning process to be able to receive and integrate critical feedback about one's behavior #JHMChat https://t.co/HPrbkkkCw8
Loren Academic Services, Inc. @LAS_Inc_
@mahoneyr @HeittC3 We work with learners (residents, fellows, etc) in difficulty, which often intersects with DPB. In our experience, some are clueless, some fail to assess the problem, and some just don’t know how to fix it #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @sanjaysaint: Wonder if 'definition' of disruptive behavior depends on specialty. Are there different thresholds for surgery vs medicine vs peds? #JHMChat
Saima Chaudhry, MD @DrSaimaChaudhry
@HeittC3 @FutureDocs this distinction is critical. Psychiatric disorders require more urgent evaluation/treatment. Personality disorders are more difficult to deal with. Do any of the experts here know which personality disorders are most prevalent among physicians? Loaded question - sorry! #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@JHospMedicine Or visa versa? as per @FutureDocs previous point, I think burnout is a driver of DPB as much as anything else. Loss of frontal lobe when your focus is on survival. #JHMChat
Robert J. Mahoney, MD @mahoneyr
@JHospMedicine T3 Anecdotally, DPB does seem to rank among top reasons for nursing turnover - after issues of staffing and salary, they often note that they don't feel like part of a team, that they are not listened to, or that their ideas are not taken seriously. #JHMChat
Journal of Hospital Medicine @JHospMedicine
Great example of how Disruptive Physician behavior can lead to patient safety concerns #jhmchat A central theme in @preeti_john & @HeittC3 paper? https://t.co/dASmiKZnoF
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Great point #JHMChat https://t.co/OFWsnfvW3B
Doctivist 🏳️‍🌈 @jbcowartmd
RT @JHospMedicine: Great example of how Disruptive Physician behavior can lead to patient safety concerns #jhmchat A central theme in @preeti_john & @HeittC3 paper? https://t.co/dASmiKZnoF
HeittC3 @HeittC3
T3: #Burnout and DPB have a bidirectional causal relationship. #DisruptivePhysicians who are burned out are more at risk of engaging in DPB and DPB can surely lead to #burnout of the physician and surrounding colleagues. #JHMChat https://t.co/n293gB0mfq
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T3: T3: In your experiences, how has DPB contributed to #burnout or work satisfaction? #JHMChat https://t.co/ccNE6DgXSm
Loren Academic Services, Inc. @LAS_Inc_
RT @mahoneyr: @JHospMedicine T3 Anecdotally, DPB does seem to rank among top reasons for nursing turnover - after issues of staffing and salary, they often note that they don't feel like part of a team, that they are not listened to, or that their ideas are not taken seriously. #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@HeittC3 Can't help again but notice how some of this parallels ACGME milestones - ex learner ability to incorporate feedback. We need to teach this, observe this, and assess in learners. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@HeittC3 I am most afraid of when anyone who I don’t know well in my org asks me to have a conversation over “a cup of coffee” ever since hearing Gerry Hickson present #JHMChat
Journal of Hospital Medicine @JHospMedicine
@mahoneyr another great example of how this issue can lead to patient safety issues...#jhmchat
Vinny Arora MD MAPP @FutureDocs
RT @RJmdphilly: @JHospMedicine Or visa versa? as per @FutureDocs previous point, I think burnout is a driver of DPB as much as anything else. Loss of frontal lobe when your focus is on survival. #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: T3: T3: #Burnout and DPB have a bidirectional causal relationship. #DisruptivePhysicians who are burned out are more at risk of engaging in DPB and DPB can surely lead to #burnout of the physician and surrounding colleagues. #JHMChat https://t.co/n293gB0mfq
Robert J. Mahoney, MD @mahoneyr
@HeittC3 I would guess there are different approaches when physicians feel like their bad behavior is justified vs when they have no idea their behavior is inappropriate. #JHMChat
Loren Academic Services, Inc. @LAS_Inc_
@RJmdphilly @JHospMedicine @FutureDocs Absolutely—and people regularly report that with no time to eat/think/pause for a moment, empathy and compassion can be challenging. Systems running at their limits will fail. #JHMChat
Sanjay Saint @sanjaysaint
@preeti_john @TJCommission How do you address cultural differences? For example: doc from a country w a different normative communication style than in US? #JHMChat
HeittC3 @HeittC3
@DrSaimaChaudhry @FutureDocs Most of the literature focuses on Narcissistic and Antisocial PD. But as I noted before, I see quite a bit of Compulsive Personality Disorder (OCPD or Anankastic PD) among the #physicians I work with. #JHMChat
Loren Academic Services, Inc. @LAS_Inc_
RT @HeittC3: I get both... and "I was just looking out my patient" or "I can't help it if others don't care as much as I do about safe patient care." It's a learning process to be able to receive and integrate critical feedback about one's behavior #JHMChat https://t.co/HPrbkkkCw8
Journal of Hospital Medicine @JHospMedicine
RT @LAS_Inc_: @RJmdphilly @JHospMedicine @FutureDocs Absolutely—and people regularly report that with no time to eat/think/pause for a moment, empathy and compassion can be challenging. Systems running at their limits will fail. #JHMChat
Vinny Arora MD MAPP @FutureDocs
Some of you may have no idea what I’m talking about but just wait and you’ll see #jhmchat https://t.co/QYCAZkv3hd
Journal of Hospital Medicine @JHospMedicine
RT @sanjaysaint: @preeti_john @TJCommission How do you address cultural differences? For example: @preeti_john @TJCommission How do you address cultural differences? For example: doc from a country w a different normative communication style than in US? #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @DrSaimaChaudhry: @HeittC3 @FutureDocs this distinction is critical. Psychiatric disorders require more urgent evaluation/treatment. Personality disorders are more difficult to deal with. Do any of the experts here know which personality disorders are most prevalent among physicians? Loaded question - sorry! #JHMChat
Vinny Arora MD MAPP @FutureDocs
@DrSaimaChaudhry @HeittC3 Great to see you on #JHMChat Saima!!
Journal of Hospital Medicine @JHospMedicine
@FutureDocs you've got us all on pins and needles...#jhmchat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @HeittC3: @DrSaimaChaudhry @FutureDocs Most of the literature focuses on Narcissistic and Antisocial PD. But as I noted before, I see quite a bit of Compulsive Personality Disorder (OCPD or Anankastic PD) among the #physicians I work with. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@DrPhilipVerhoef @mahoneyr @JHospMedicine @WrayCharles I’ll definitely be there to watch this #enforcedhugging #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @sanjaysaint: @preeti_john @TJCommission How do you address cultural differences? For example: @preeti_john @TJCommission How do you address cultural differences? For example: doc from a country w a different normative communication style than in US? #JHMChat
HeittC3 @HeittC3
@sanjaysaint @preeti_john @TJCommission Great question, Sanjay. It's critically important to be sensitive to cultural norms of #physicians from other countries, but ultimately, the doc needs to comply with his/her institution's policies/culture. #JHMChat
Journal of Hospital Medicine @JHospMedicine
T4 coming up... #JHMChat
Vinny Arora MD MAPP @FutureDocs
You’d be surprised how far hot cocoa goes to improve wellbeing in residents and attendings in Chicago #JHMChat https://t.co/M9e305QIKN
Loren Academic Services, Inc. @LAS_Inc_
@mahoneyr @HeittC3 @HeittC3 may have a totally different response, but the work we do is relational, so in both those cases we work to develop a relationship between the MD/coach, and then look for common understanding & motion toward goal achievement. #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Cultural differences are challenging to address, but frequent & direct communication & feedback about what is acceptable (and what is not), is necessary #JHMChat https://t.co/z6G9sg6ciH
Journal of Hospital Medicine @JHospMedicine
T4: What strategies, both formal and informal, have you found effective in dealing with DPB? #JHMChat https://t.co/ZgmDeKXZEs
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Cultural differences are challenging to address, but frequent & direct communication & feedback about what is acceptable (and what is not), is necessary #JHMChat https://t.co/z6G9sg6ciH
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: T4: T4: What strategies, both formal and informal, have you found effective in dealing with DPB? #JHMChat https://t.co/ZgmDeKXZEs
Loren Academic Services, Inc. @LAS_Inc_
@DrPhilipVerhoef @mahoneyr @FutureDocs @JHospMedicine @WrayCharles (I know this was not totally serious but it might be true—medicine suffers from a real lack of human connection, and it’s much easier to be a jerk to your coworkers in that scenario than when you’re engaged/invested/care about the team & the people on it) #JHMChat
Vinny Arora MD MAPP @FutureDocs
I have learned #tweetiatricians aim to be disruptive but in a very positive way #JHMChat @freckledpedidoc @namd4kids @DrRemleyAAP https://t.co/tWGl5jw2ai
Society of Hospital Medicine @SocietyHospMed
Don't forget to claim #CME after tonight's #JHMChat: https://t.co/o8ek49Oczo
Loren Academic Services, Inc. @LAS_Inc_
RT @preeti_john: Cultural differences are challenging to address, but frequent & direct communication & feedback about what is acceptable (and what is not), is necessary #JHMChat https://t.co/z6G9sg6ciH
Journal of Hospital Medicine @JHospMedicine
RT @FutureDocs: I have learned #tweetiatricians aim to be disruptive but in a very positive way #JHMChat @freckledpedidoc @namd4kids @DrRemleyAAP https://t.co/tWGl5jw2ai
HeittC3 @HeittC3
When the docs I work with are attempting to repair damaged relationships with nursing staff, I frequently recommend that they bring #donuts to the nursing station. #JHMChat https://t.co/1HnQAoeoP8
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Interesting concept introduced by @FutureDocs "Enforced Hugging"- not sure if this would solve or create DisruptivePhysicianBehavior (!) #JHMChat https://t.co/zyOPzXEHjH
Journal of Hospital Medicine @JHospMedicine
You've put your time in, now get your credit! #jhmchat https://t.co/62PQRjaRqQ
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: When the docs I work with are attempting to repair damaged relationships with nursing staff, I frequently recommend that they bring #donuts to the nursing station. #JHMChat https://t.co/1HnQAoeoP8
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Interesting concept introduced by @FutureDocs "Enforced Hugging"- not sure if this would solve or create DisruptivePhysicianBehavior (!) #JHMChat https://t.co/zyOPzXEHjH
Vinny Arora MD MAPP @FutureDocs
Let me be the first to say I am not a hugger as @jeannemfarnan @anitasamarth know but I’m open to trying #JHMChat https://t.co/KBMrrO2mCD
Vinny Arora MD MAPP @FutureDocs
RT @preeti_john: Interesting concept introduced by @FutureDocs "Enforced Hugging"- not sure if this would solve or create DisruptivePhysicianBehavior (!) #JHMChat https://t.co/zyOPzXEHjH
HeittC3 @HeittC3
T4: As previously mentioned (& as with most problems), the earlier you can intervene the better. Start with supportive & educational guidance, and if necessary, graduate up to formal documentation, discipline & referral for treatment. #JHMChat https://t.co/iuSsfDlX3C
Rebecca Jaffe, MD @RJmdphilly
@LAS_Inc_ @mahoneyr @HeittC3 important to note that this requires long term investment (time, energy), not just a cup of coffee. I feel like I have see either the cup o' coffee, or the formal/longitudinal HR or Chair process, without a lot of growth mindset/relational process living in between. #JHMChat
Vinny Arora MD MAPP @FutureDocs
@preeti_john We could do a fascinating RCT but the DSMB May be tricky #jhmchat 😂
Loren Academic Services, Inc. @LAS_Inc_
@JHospMedicine T4: coaching! one on one, relational model coaching with developed goals, steps for meeting those goals, and regular meetings for check-ins & ongoing support. #JHMChat
Journal of Hospital Medicine @JHospMedicine
@FutureDocs @jeannemfarnan @anitasamarth you can't #FistBump your way out of this one, Vinny #jhmchat
Vinny Arora MD MAPP @FutureDocs
Had a recent convo about the decline of doctors lounges which allowed for casual friendly dialogue and consultation -prevention for disruptive behavior? #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @RJmdphilly: @LAS_Inc_ @mahoneyr @HeittC3 important to note that this requires long term investment (time, energy), not just a cup of coffee. I feel like I have see either the cup o' coffee, or the formal/longitudinal HR or Chair process, without a lot of growth mindset/relational process living in between. #JHMChat
Saima Chaudhry, MD @DrSaimaChaudhry
@mahoneyr @HeittC3 unfortunately, from what I see, it's usually left unaddressed. I think most of us just don't know how to handle it when we see it. #JHMChat
Journal of Hospital Medicine @JHospMedicine
Fantastic discussion tonight with some wonderful insights and thoughts. We've got about 10 minutes left... Any final key points or thoughts @preeti_john or @HeittC3? #JHMChat
Sanjay Saint @sanjaysaint
@JHospMedicine T4: the culture of the hospital is heavily influenced by the worst behavior the leader allows. #JHMChat
HeittC3 @HeittC3
Indeed! I often describe my work as "remedial coaching," bridging enhancement of peak performance from executive coaching with pathology-fixing psychotherapy. #JHMChat https://t.co/QDJT0p9cUp
Loren Academic Services, Inc. @LAS_Inc_
@RJmdphilly @mahoneyr @HeittC3 It does—but the onus doesn’t have to fall on the MDs/admins. Outside coaches can be used with a lot of success! (And this can be nice because then suggesting that someone needs help/remediation doesn’t imply taking ON that work) #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Addressing DPB head on is key. Ignoring it enables continuation, and reinforces such behavior, esp. if it results in perceived gain. DPB can be learned & reinforced in hierarchical hospital culture. Residents learn to emulate attending behaviors. Address verbally first #JHMChat https://t.co/PgZNAhposU
Vinny Arora MD MAPP @FutureDocs
@bruce_lambert I think the question is disruptive behavior vs disruptive physician - events could be more common bc burnout vs patterns of behavior more due to personality issue #JHMChat
Rebecca Jaffe, MD @RJmdphilly
Can I get this without acting like an a^*h^%& first? #JHMChat https://t.co/0rVGDx8fOT
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Addressing DPB head on is key. Ignoring it enables continuation, and reinforces such behavior, esp. if it results in perceived gain. DPB can be learned & reinforced in hierarchical hospital culture. Residents learn to emulate attending behaviors. Address verbally first #JHMChat https://t.co/PgZNAhposU
Vinny Arora MD MAPP @FutureDocs
Good point #JHMChat solution breeds that more disruptive behavior and I don’t need to try - great https://t.co/DpAFvlx5RX
Journal of Hospital Medicine @JHospMedicine
Winding down now...We've got a great chat scheduled on Monday, May 21 with @CAPCpalliative's @DianeEMeier on the intersection of Palliative Care (#hpm) and hospital medicine #JHMChat
Rebecca Jaffe, MD @RJmdphilly
@LAS_Inc_ @mahoneyr @HeittC3 yes but there needs to be time/incentive to engage. Maybe that is the stick (institution creates accountability after episodes of DPB)...or a carrot (foot the bill, as you say, or create time/reduce RVUs, etc) #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
@FutureDocs @jeannemfarnan @anitasamarth A surgery chief resident first told me about existence of 'professional huggers' (I didn't know they existed, but they do) Personally I would rather hug a furry animal than a human stranger #pettherapy #JHMChat
HeittC3 @HeittC3
These are incredibly difficult conversations to have, regardless of what your relationship is with the #disruptivephysician This is why so often #disruptivebehavior is left unaddressed. #JHMChat https://t.co/OnEbyxZ2EB
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: Winding down now...We've got a great chat scheduled on Monday, May 21 with @CAPCpalliative's @DianeEMeier on the intersection of Palliative Care (#hpm) and hospital medicine #JHMChat
Vinny Arora MD MAPP @FutureDocs
@preeti_john @jeannemfarnan @anitasamarth I’m alarmed already #JHMChat
Loren Academic Services, Inc. @LAS_Inc_
@HeittC3 So interesting to hear others describe what is (I imagine) similar work—we started in educational therapy, which may have informed some of the difference in descriptions. #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @FutureDocs: @bruce_lambert I think the question is disruptive behavior vs disruptive physician - events could be more common bc burnout vs patterns of behavior more due to personality issue #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @HeittC3: These are incredibly difficult conversations to have, regardless of what your relationship is with the #disruptivephysician This is why so often #disruptivebehavior is left unaddressed. #JHMChat https://t.co/OnEbyxZ2EB
Loren Academic Services, Inc. @LAS_Inc_
@RJmdphilly @mahoneyr @HeittC3 Precisely—people are often meeting with us and it’s paid for by their program, which creates some accountability. Those in more trouble may have meetings mandated as part of a plan for remediation, which poses some relational challenges! #JHMChat
Rebecca Jaffe, MD @RJmdphilly
RT @sanjaysaint: @JHospMedicine T4: @JHospMedicine T4: the culture of the hospital is heavily influenced by the worst behavior the leader allows. #JHMChat
Robert J. Mahoney, MD @mahoneyr
Thanks @JHospMedicine @HeittC3 and @preeti_john for a great #JHMChat! https://t.co/jYkchDgTyk
Loren Academic Services, Inc. @LAS_Inc_
@RJmdphilly @mahoneyr @HeittC3 And time is critical—institutions must protect time for these types of activities if they want to see utilization/improvement #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @mahoneyr: Thanks @JHospMedicine @HeittC3 and @preeti_john for a great #JHMChat! https://t.co/jYkchDgTyk
Vinny Arora MD MAPP @FutureDocs
Hence my fear over a cup of coffee conversation his flagship intervention! That is also patient reports of disruptive. Lots of behavior not reported #JHMChat https://t.co/zFYprP4wDy
Loren Academic Services, Inc. @LAS_Inc_
@FutureDocs @preeti_john @jeannemfarnan @anitasamarth Pets instead of humans for sure 😂 #JHMChat
Rebecca Jaffe, MD @RJmdphilly
I still really struggle with the role of the institution here. No time for this question - but how "bomb proof" does the institutional professionalism process need to be in order to succeed in individual cases? Seems necessary, not sufficient? #JHMChat
HeittC3 @HeittC3
I'm a clinical #psychologist by training (and I do plenty of #psychotherapy), but early in my career I was supervised someone who literally wrote the book on executive coaching, and thus integrated much of that #positivepsychology work into my work #JHMChat https://t.co/0TrHdDvzRZ
Saima Chaudhry, MD @DrSaimaChaudhry
@HeittC3 @JHospMedicine @preeti_john wow. i'd love to know how many of your docs get better with remedial coaching. #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
Leaders need to foster a culture of respect. Combination of individual attention, psycho-educational coaching, systems approach, aftercare program with feedback and evaluation following intervention #JHMChat https://t.co/ZPjo5mnmjF
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs @bruce_lambert agree that this is a central issue. #JHMChat
Loren Academic Services, Inc. @LAS_Inc_
RT @preeti_john: Leaders need to foster a culture of respect. Combination of individual attention, psycho-educational coaching, systems approach, aftercare program with feedback and evaluation following intervention #JHMChat https://t.co/ZPjo5mnmjF
Journal of Hospital Medicine @JHospMedicine
That's a wrap..Enjoyed the lively conversation on tonight's #JHMChat chat! Thanks everyone for participating! Looking forward to catching up with everyone at #HM2018
Vinny Arora MD MAPP @FutureDocs
RT @preeti_john: Leaders need to foster a culture of respect. Combination of individual attention, psycho-educational coaching, systems approach, aftercare program with feedback and evaluation following intervention #JHMChat https://t.co/ZPjo5mnmjF
Vinny Arora MD MAPP @FutureDocs
RT @DrSaimaChaudhry: @HeittC3 @JHospMedicine @preeti_john wow. i'd love to know how many of your docs get better with remedial coaching. #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @mahoneyr: Thanks @JHospMedicine @HeittC3 and @preeti_john for a great #JHMChat! https://t.co/jYkchDgTyk
Journal of Hospital Medicine @JHospMedicine
RT @FutureDocs: Hence my fear over a cup of coffee conversation his flagship intervention! That is also patient reports of disruptive. Lots of behavior not reported #JHMChat https://t.co/zFYprP4wDy
Vinny Arora MD MAPP @FutureDocs
RT @JHospMedicine: Great example of how Disruptive Physician behavior can lead to patient safety concerns #jhmchat A central theme in @preeti_john & @HeittC3 paper? https://t.co/dASmiKZnoF
Rebecca Jaffe, MD @RJmdphilly
@FutureDocs win win #JHMChat
Journal of Hospital Medicine @JHospMedicine
RT @preeti_john: Leaders need to foster a culture of respect. Combination of individual attention, psycho-educational coaching, systems approach, aftercare program with feedback and evaluation following intervention #JHMChat https://t.co/ZPjo5mnmjF
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
@mahoneyr @JHospMedicine @HeittC3 Thank you for your participation #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @HeittC3: These are incredibly difficult conversations to have, regardless of what your relationship is with the #disruptivephysician This is why so often #disruptivebehavior is left unaddressed. #JHMChat https://t.co/OnEbyxZ2EB
HeittC3 @HeittC3
First time on a Twitter Chat. Had a lot of fun. Thanks for everyone's participation. #jhmchat
Society of Hospital Medicine @SocietyHospMed
RT @JHospMedicine: That's a wrap..Enjoyed the lively conversation on tonight's #JHMChat chat! Thanks everyone for participating! Looking forward to catching up with everyone at #HM2018
Loren Academic Services, Inc. @LAS_Inc_
Thank you so much to @JHospMedicine @HeittC3 @preeti_john for an extremely topical and interesting chat! Glad I happened to see a tweet in my feed and follow it here. #JHMChat
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
@DrSaimaChaudhry @HeittC3 @JHospMedicine Interesting question - psychologist @HeittC3 would be best person to answer since he has worked with physicians over the years #JHMChat
Vinny Arora MD MAPP @FutureDocs
RT @SHMLive: Don't forget to claim #CME after tonight's #JHMChat: Don't forget to claim #CME after tonight's #JHMChat: https://t.co/o8ek49Oczo
Vinny Arora MD MAPP @FutureDocs
@JHospMedicine Thx for amazing #JHMChat and lots of casual drop ins on this topic speaks volumes @preeti_john @WrayCharles
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
@LAS_Inc_ @JHospMedicine @HeittC3 Thank you for participating #JHMChat
HeittC3 @HeittC3
Unfortunately, in my private practice, I don't keep stats. Even if I did, defining "better" would be difficult. That said, after a few months of working with folks, it is usually pretty clear who is likely to "get in trouble" again, and who isn't. #JHMChat https://t.co/9GYx6tpSiL
Preeti R. John MD, MPH, FACS, FCCM, CPE, HEC-C @preeti_john
RT @HeittC3: T3: T3: #Burnout and DPB have a bidirectional causal relationship. #DisruptivePhysicians who are burned out are more at risk of engaging in DPB and DPB can surely lead to #burnout of the physician and surrounding colleagues. #JHMChat https://t.co/n293gB0mfq
#JHMChat content from Twitter.