Disruptive Behavior: A Sub-category of Ineffective Communication

Disruptive behavior prevents us from effectively communicating the issue that triggered the disruptive behavior.  A few years ago, as a Chief Medical Officer, I was working with one of our physicians.  He was accused of being disruptive and I was taking part in the review of the event.  From all reports, he was clearly acting in an inappropriate manner.  There was foul language, demeaning personal comments regarding our nurses, and charts being thrown around the nursing unit (back in the day of paper charts).  All of this was in front of patients, visitors, nurses and other medical staff.  I asked the physician if he recalled his actions.  He said he did, however he felt completely justified in his actions.  I asked him what the specific issue was.  He said it was over the fact that he ordered an antibiotic “stat” and there was a significant delay in the antibiotic being administered.  His concern was his patient was becoming sicker due to the delay.  During the course of our review with those who witnessed the event, not one person could specifically remember why he was so upset.  Only one nurse could recall it had to do with a medication, but could not recall the medication or the patient it involved.

From the physician’s perspective, he escalated his behavior to “disruptive” in the hopes of more effectively communicating the issue of the antibiotic delay.  It had the exact opposite effect.  It shut down communication.  His behavior now became the spectacle.  Everyone was too busy watching the train wreck to think about why the train came off the tracks in the first place.  He had a very legitimate concern.  Unfortunately, when he let his emotions get the better of him, he resorted to an extremely ineffective communication style.  Some might think his behavior will teach the nurses to listen to him when he gives orders in the future.  We never got to test that hypothesis.  He was a very good physician and he did what all good physicians do.  He learned from his mistake.  When issues would arise with his patients in the future, he took on a much more effective communication style.

It may be that using the term “disruptive” distracts from the real problem, which is behavior that results in ineffective communication.  What if that same physician wrote the order for the antibiotic and never told the nurse about the order or neglected to flag it for review.  It would have resulted in the same outcome, a delay in treatment for the patient.  By focusing on the “disruptive” component of the behavior, we are missing the real issue.  Disruptive people get all the attention, but what about all those with an ineffective communication style, who are not disruptive, and still have the same impact on patient care?  We have to think of disruptive behavior as a sub-category of ineffective communication.  That is the real problem.

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