Are you disruptive or disruptive, doctor?

by Arlen Meyers

Are you disruptive or disruptive, doctor?

A friend and colleague physician entrepreneur was recently lamenting the fact that , in business, being disruptive is a good thing , but, in medicine, it can result in , among other bad things, losing your license to practice. Despite that, the AMA wants you to be disruptive.

In business, disruptive innovation, a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.

Medicine sees it a different way.Patients identify being confident, empathetic, humane, personal (ie, viewing the patient as a person, not a disease), forthright, respectful, and thorough as ideal physician behaviors. Valuing teamwork, handling stress, punctuality, and self-motivation to pursue professional and personal growth are also ideal physician behaviors. On the other hand, the American Medical Association, in its Code of Medical Ethics, states that “personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care constitutes disruptive [physician] behavior.” Such behaviors include inappropriate language, yelling, gossip, facial expressions and other mannerisms as well as physical boundary violations.

Unfortunately, the line between the two is not so clear and some doctors are branded as disruptive, not because they cause patients harm, but because, through their efforts and actions, they are disruptive to the existing sickcare business model. Those that dare to tell truth to authority are branded as provacateurs, naysayers, grenade-throwers and “just not team players”.

Those who threaten the status quo in any industry at any time are outsiders and run the risk of suffering from the full force of those seeking to resist change. Physician entrepreneurs are no different. Being disruptive in pin-stripes is one thing. Being disruptive in a white coat is another. Few vested interests tolerate either in the clinic, the bedside or the OR.

So, what differentiates a disruptive from a disruptive doctor? What’s the difference between a good rebel and a bad rebel? Here are the differences.

The disruption lexicon gets even more complicated. Do you want to know what else is disruptive in sickcare?

1. Alarm fatigue

2. Change fatigue

3. Cell phones in the OR

4. Music in the OR

5. Non-ergonomically designed surgical instruments and ORs

6. Shooters in the ER

7. Electronic medical records and workflow

8. Electronic medical records and the doctor-patient relationship

9. Meetings

10. Two words

Here are some tips on how to deal with rule breakers.

  • Let employees define their missions.
  • Tailor jobs to employees’ strengths.
  • Ask “Why?” and “What if?”
  • Stress that the company is not perfect.
  • Maximize variety.
  • Continually inject novelty into work.
  • Hire people with diverse perspectives.
  • Design processes to include dissent.

Ask, “What information suggests this might not be the right path to take?”

Part of doctors acting badly might be traced to loss of control or threatened masculinity.

Digital disruptors are making their mark in healthcare. The new triple threat is a doctor/technologist/entrepreneur. Many are outside of the industry, some are physician entrepreneurs and , increasingly, many are patients. As more a more doctors shift their attention from the practice of medicine to the business of medicine, the medical establishment will have a hard time distinguishing one disruptor from the other.

 
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Arlen MyersArlen Meyers, MD, MBA is the President and CEO of the Society of Physician Entrepreneurs at www.sopenet.org and co-editor of Digital Health Entrepreneurship

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