Angry or Disruptive Physicians and Nurses

Out of respect for those who serve and protect the health of our
nation, let me first say that the use of the term disruptive referring
to nurses and doctors who present with anger management problems
oversimplify a much more complex problem that needs a deeper analysis.
William Bridges in his book Transitions, describes change as having
three distinct components -the end, neutral zone and the beginning. He
further purports that the neutral zone is the most difficult stage
where the person or system going through the change is in a kind of no
mans land, trying to find its place to a new beginning. Let me suggest
that our country's health care system is in that no mans lands. While
I will never excuse the abusive behavior that is displayed by some
doctors or nurses, it is helpful to determine the roots of this
emerging problem.

Anger management problems are always associated with problems managing
stress, not knowing how to communicate effectively and poor emotional
intelligence. My work with doctors, and the discussion with colleagues
who have also done extensive work with doctors, suggest that the
stress associated handling the changing face of health care is a major
contributor to anger management problems.

There was a time when the health care professional said they needed to
perform a procedure, they were not questioned. The resources were made
available to make this treatment a reality. Such power reinforced the
elevated view that was held of health care professions, especially the
medical doctor. Such supremacy was not to last forever, because the
advent of manage care limited the power of the doctor and placed some
of this power in the hands of insurance providers who ultimately may
determine care based on economics and medical necessity. Other
stressors include doctors whose skills suddenly become obsolete
because of technology, shortages of nursing staff, lower reimbursement
rates form insurance companies, the threat of lawsuits, rising
insurance premiums and the changing hospital culture that requires
doctors to display more restraint during periods of frustration.

Some medical professionals tend to have difficulty adapting to such
changes and fall victim to anger outbursts towards colleagues and even
patients. It may not be in the hands of doctors and nurses to change
the system, but it is their responsibly to have the skills to adapt.
Therefore seeking help to improve stress management, communication
skills and emotional intelligence may be one option to manage the
changes that plague the health care system.


Carlos Todd, LPC, NCC, CAMF
President of the American Association of Anger Management Providers
Anger Management/Executive Coaching of Charlotte, North Carolina
www.masteringmyanger.com
www.angeronmymind.com
www.aaamp.org

Disruptive Physicians and Abusive Physicians use Executive Anger Management Coaching

As a part of the medical training of all physicians, it is necessary
to rotate through all of the specialties in medicine. This means that
all physicians must rotate through a period of exposure in psychiatry
as well as all other areas of medicine. One of the obvious reasons for
this practice is to make sure that all physicians have enough
knowledge and experience to appropriately make use of all specialties
other than their own.

Unfortunately, psychiatry is an area of specialization which is often
viewed by surgeons, cardiologists, oncologists and neurologists as
somewhat soft as it relates to being scientific. Psychiatry is
considered to be highly subjective with questionable scientific
evidence. In addition, any mental health intervention carries with it
a stigma which may be damaging to a physician's professional career.

One of the first questions posed by physicians inquiring about
resources for abusive physicians is "Do I have to undergo a
psychiatric assessment?". This question is extremely important to any
practicing physician, as it will almost certainly affect his or her
entire career if there is anything in any file suggesting impairment
or even an assessment. Therefore, if the goal of a program is to help
abusive physicians who are not addicted to drugs/alcohol or
psychiatrically disturbed, it must not include a mandatory psychiatric
assessment.

Anderson & Anderson is the largest provider of Executive Coaching/
Anger Management for abusive physicians in the nation. We have many
case examples of physicians who purposely selected our program for its
lack of focus on psychopathology. This model uses an assessment
designed to determine the physician's level of functioning in
recognizing and managing stress, anger, assertive communication,
emotional intelligence and motivation to change. The Anderson &
Anderson Executive Coaching/Anger Management course provides skill
enhancement in the same four areas mentioned above: stress management,
anger management, assertive communication and emotional intelligence.
Participants who demonstrate a lack of motivation to change are not
accepted into the program.


George Anderson, MSW, BCD, CAMF, CEAP
Diplomate, American Association of Anger Management Providers

Physican and Nurse Conflicts Result in Policy Review

The worst kept secret in hospitals nationwide is the widespread
tension and conflict between physicians, nurses, physician assistants,
nurse practitioners, administrators and other ancillary staff such as
inhalation therapists and nurse anesticists.

Work stress is par for the course in almost all areas of inpatient
hospital care. It is not reasonable to expect an absence of stress in
Emergency Rooms, or among Cardiologists, Surgeons, Neurologists,
Gynecologists, Oncologists and most other critical care specialists.
However, medical staff, working in any of these areas of
specialization can and should be expected to be able to recognize and
manage their own stress rather than have it turn into anger, abuse or
person-directed aggression.

The nature of the work in all of the areas mentioned is, in itself
stressful. There are however, additional stressors which until
recently, have not been adequately addressed.
These include the debilitating stresses placed on all hospitals by the
constraints of Managed Health Care. Physicians are no longer able to
provide the level of care to their patients which are needed. Rather,
they must seek/beg for permission from some non-physician (MBA) at the
end of an 800 line to approve or disapprove of each procedure based on
cost. Therefore, doctors tend to displace their frustration, anger and
stress on to nurses and other members of the treatment team including
technicians and ancillary staff.
Hospitals are being forced to close Emergency Rooms because a lack of
adequate funding which adds to staff stress and patient distress.

Patient care is no longer based on the needs of the patient but
instead on the cost of the procedure. This is demeaning to physicians
and life threatening to patients. Unfortunately, patients are angry at
the physicians for not providing the care needed without recognizing
the current limitation placed on physicians by the patients' own
health care plan.

In an attempt to address at least part of this quiet crisis in
healthcare, the Joint Commission on Hospitals Accreditation issued a
directive to all hospitals requiring written policies to be in place
effective April 1, 2007 to address the issue of "disruptive
physicians". Disruptive physician is defined as those physicians whose
"aggressive, abusive behavior" impact patient care and treatment team
effectiveness.

Simply put, nurses, physicians and other treatment staff can now
formally complain about unfair treatment/abuse from physicians in the
course of their hospital work.

Enlightened Hospital Administrators, Physician Well-Being Committees
and Hospital Admitting Staff Credential Committees have begun to move
quickly to require that doctors who are defined as "disruptive" are
required to complete an Executive Coaching/anger Management Class to
enhance skills in recognizing and managing stress, anger, enhancing
assertive communication and increasing emotional intelligence.

Nurses and ancillary staff are now being required to participate in
Organizational Training Courses in which the same topics along with an
assessment is given with the option of small group anger management
classes for those who score in the deficit range in managing stress,
anger, communication or emotional intelligence.

In summary, previously ignored behavior which impacts patient care and
staff morale are being address by using anger management and executive
coaching for physicians and ancillary staff in most hospitals. This
will likely have the impact of reducing litigation and increasing
staff morale as well as increasing effective patient care nationwide.

George Anderson, MSW, CAMF, BCD.
http://www.linkedin.com/in/geoanderson
www.andersonservices.com
www.aaamp.org
www.anger-management-resources.org

Myth of Fact

Ten Myths about Anger Management

A person who has problems managing anger is mentally ill.

Fact: Anger is a normal human emotion which becomes a problem when it it too intense, lasts too long, occurs too frequently, damages interpersonal relationships, or leads to aggression o violence.

Anger management is covered by Managed Health Care.

Fact: Since anger is not a mental or nervous disorder, it is not covered by helth insurance including Managed Health Care.

Anger management is counseling or psychotherapy.

Fact: Anger management is neither counseling nor psychotherapy. Anger Management is a class which teaches skills in manging anger and stress while enhancing assertive communication and emotional intelligence.

Psychiatrists can perscribe medication to treat problems in managing anger.

Fact: Since anger is not an illness, it can not be treated by psychotropic medication.

Psychologists, Psychiatrists, Clinical Social Workers, Licensed Professional Couselors and Marriage Counselors are routinely trained to provide anger management.

Fact: None of the above professionals are required to take anger management neither in their professional training nor in their licensing exams.

Anger management does not work.

Fact: Research from Canada, Australia, and the University of South Florida has demonstrated that anger management classes are effective when taught by facilitators training in anger management, stress management, emotional intelligence and assertive communication. Participants must be motivated to change in order to be successful in anger management classes.

Anger management classes can teach participants how not to get angry.

Fact: Anger is a normal human emotion. The goals in anger management classes are to teach skills for managing unhealthy anger.

People get angry because their buttons are pushed.

Fact: Anger is a secondary emotion which generally triggered by frustration, fatigue, stress or unfullfilled needs.

Counting to ten backwards and deep breathing are the best solutions to controlling anger.

Fact: In order to learn to manage one’s anger, you must begin with an assessment to determine that person’s level of recognizing and managing anger, stress, typical styles of communication and the degree of empathy or emotional intelligene exhibited by the person in question.

All anger management curricula are created equal!

Fact: Only anger management curriculums which include assessments, workbooks, DVDs as well as Pre and Posts tests are effective.

George Anderson, BCD,CAMF

www.angertrends.blogspot.com

www.andersonservices.com