Approved by Council: November 2007
Reviewed and Updated: May 2016

Definitions

Disruptive behaviour: inappropriate words, actions, or inactions by a physician that interfere with (or may interfere with) the physician’s ability to collaborate, the delivery of quality health care, or the safety or perceived safety of others. Disruptive behaviour may be demonstrated through a single act, but will more commonly be identified through a pattern of events.

Policy

General

1. Physicians must take responsibility for their behaviour and meet the obligations and expectations set out in this policy, other College policies,¹ the Practice Guide, and applicable legislation,² along with the expectations set out in institutional Codes of Conduct, policies, or by-laws. Specifically:
   1. Physicians must uphold the standards of medical professionalism, conduct themselves in a professional manner, and not engage in disruptive behaviours.
   2. Physicians must act in a respectful, courteous, and civil manner towards their patients,³ colleagues,⁴ and others involved in the provision of health care.
2. If a physician is unable to control their behaviour on their own, they are advised to seek appropriate assistance to do so.
3. In addition to whatever resources may be available through their local setting (medical school, hospital, or other work environment), physicians and their colleagues are advised to contact the Ontario Medical Association’s Physician Health Program to explore the resources available for obtaining assistance.⁵

Responsibilities to Patients

4. Physicians must act in the best interests of the individual.⁶ This includes acting respectfully toward patients, their families, friends or visitors, and prospective patients, even under stressful situations.
5. Advocacy for patients, both individually and collectively, is an important component of the physician’s role. While advocacy may sometimes lead to disagreement or conflict with colleagues or the administration of the institution within which they work, physicians must meet the expectation for professional behaviour even in these contexts.⁷

Responsibilities to Other Health-Care Professionals

6. To ensure the safe and effective delivery of health care and a healthy working environment,⁸ physicians must work respectfully and collaboratively with other members of the health-care team, including all who are involved in the provision of health care.⁹

Responsibilities to the Profession

7. Physicians must uphold the standards of the medical profession by modelling appropriate behaviour for other members of the health-care team, in particular trainees, and fostering a culture of respect within their practice setting or workplace.

Disruptive Behaviour

Disruptive behaviour poses a threat to patients and outcomes by inhibiting the collegiality and collaboration essential to teamwork, impeding communication, undermining morale, and inhibiting compliance with and implementation of new practices.

8. Physicians must not engage in disruptive behaviours, because they undermine professionalism and a culture of safety. Disruptive behaviours may include, but are not limited to, the following:
   1. Rude, profane, disrespectful, insulting, demeaning, threatening, bullying, or abusive language, tone, innuendos, and behaviour;
   2. Arguments¹⁰ or outbursts of anger including throwing or breaking things;
   3. Use, attempted use, or threat of violence or physical force with patients, colleagues, and others involved in the provision of health care;¹¹
   4. Comments or actions that may be perceived as harassing or may contribute to a poisoned professional environment;
   5. Mocking, shaming, disparaging or censuring patients, colleagues, and others involved in the provision of health care;
   6. Repeated failure to promptly respond to calls or requests for information or assistance when on call or when expected to be available; and
   7. Failure to work collaboratively or cooperatively with others.
9. While there may be a myriad of reasons for disruptive behaviour – whether personal, professional, or situational – physicians must nevertheless demonstrate professional behaviour at all times.

Guidebook for Managing Disruptive Physician Behaviour

The Guidebook for Managing Disruptive Physician Behaviour, developed in association with the Ontario Hospital Association, may provide general helpful advice and tools for creating environments that foster medical professionalism, identifying disruptive behaviour, and effectively addressing disruptive behaviour.

Endnotes

^1. These include Maintaining Appropriate Boundaries and Preventing Sexual Abuse (regarding sexual abuse and misconduct) and Professional Obligations and Human Rights (regarding discriminatory behaviour).

^2. For example, the obligations set out in the Occupational Health and Safety Act, R.S.O. 1990, c.0.1 (hereinafter “OHSA”).

^3. This includes the family and friends of patients.

^4. Colleagues are considered all those who work with the physician, whether members of a health regulatory college or not. This includes other physicians, nurses, trainees, non-clinical staff, volunteers, and all other individuals who contribute to health-care delivery.

^5. More information on the Physician Health Program can be found here.

^6. Specifically, The Practice Guide: Medical Professionalism and College Policies notes that, “when providing care to a patient, a physician should always put that patient first.”

^7. For further information regarding physicians’ responsibility to advocate on behalf of patients, see The Practice Guide at pg. 8.

^8. Literature shows that unprofessional and/or disruptive behaviour can negatively impact both the delivery of quality health care and patient safety and outcomes by eroding the effective communication and collaboration that underpin good medical practice (Leape, L.L., Shore, M.F., Dienstag, J.L. et. al. (2012). Perspective: a culture of respect, part 1: the nature and causes of disrespectful behavior by physicians. Academic Medicine, 87(7), 845-852; Sanchez, L.T. (2014). Disruptive behaviors among physicians. Journal of the American Medical Association, 312(21), 2209-2210; Leape, L.L. & Fromson, J.A. (2006). Problem doctors: is there a system-level solution? Annals of Internal Medicine, 144(2), 107-115).

^9. Physicians may have other obligations under OHSA in regard to their own behaviour in the workplace, as well as specific obligations if they are employers as defined by OHSA.

^10. Respectful discussions, in which disagreement is expressed, are not arguments.

^11. The policy does not intend to capture circumstances where, for instance, force may be necessary to restrain a patient who poses a threat to themselves or those providing them with care.