#JHMChat Transcript
Healthcare social media transcript of the #JHMChat hashtag.
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See #JHMChat Influencers/Analytics.
| Profile | Tweet |
|---|---|
 | 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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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) @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.