Table 5.

Suggested interventions for physicians exhibiting disruptive behavior

1. Engage the physician one-on-one with data and examples of the behavior; keep the discussion focused on the behavior and try to avoid personality conflicts (7)

2. Refer to and make available the credentialing by-laws of the facility, including issues of due process

3. Consider and exclude potential medical reasons, including depression and drug dependence

4. If necessary, engage all who may oversee the functioning of the medical director, such as the governing body, company medical advisory board, chief medical officer and dialysis organization’s legal department

5. Suspend or terminate recalcitrant physicians. Dialysis providers must be vigilant and firm in this regard, even if it means the transfer of patients. The facilities’ quality of care must take precedence.

6. If necessary, report the disruptive behavior to the state medical society. This allows the medical society to adjudicate the appropriateness of the complaints and to recommend or mandate actions.