In our practice we have a seriously dysfunctional physician. The stress level this causes is poisoning the work environment for everybody. What can or should we do?

The dysfunctional physician presents an insidious cost to any practice or health care organization. He or she increases the stress in the work environment and the accompanying loss of efficiency.

In a stressful workplace morale and team spirit suffer, which results in an increased turnover of staff and a dysfunctional team. If the problem is severe, retaliation may occur, and this may take many forms: failure to properly assist, the initiation of lawsuits, the support of the plaintiff in a malpractice suit against the physician, or even malicious sabotage of the practice. When a confrontation is necessary, a team approach should be used, and if possible, a member of the team should be a close acquaintance of the individual, setting up a “good cop-bad cop” scenario. If only one person is involved, the physician may view the intervention as a personal confrontation instead of a peer-related issue. Specific incidents should be documented, and the focus should be on behavior, not personality. Empathy should be expressed but change must be demanded, with a delineation of the consequences if behavior is not improved. The communication should be direct and clear, with the subject not given an opportunity to respond until the end of the  dissertation. However, individuals who have a destructive effect on the workforce should be asked to leave before they cause harm.