The Disruptive Physician: Righteous Maverick or Dangerous Pariah?

"Disruptive physician" is a term appearing more frequently in many hospital bylaws. It has significant negative implications that can lead to loss of privileges for plastic surgeons. Exploring the various definitions of disruptive physician reveals palpable differences between those of the Joint Commission and the American Medical Association. These discrepancies expose plastic surgeons to potential harm when actively addressing quality issues in the hospital environment. The disruptive label can be inappropriately leveraged by hospital administrators against plastic surgeons who confront quality issues. Moreover, the term disruptive is open to subjective interpretation. Challenging the disruptive label in court reveals only that the justice system is concerned that the actual process leading to the disruptive charge is followed appropriately as outlined within the organizational bylaws; the courts are not interested in the actual quality issues and generally will not second-guess the judgment of peer review panels or hospital administrators. Plastic surgeons would benefit from familiarizing themselves with these issues. Hospitals should be required to use root cause analysis when dealing with quality issues raised by members of the medical staff. Furthermore, findings from root cause analysis should be privileged from legal discovery in all jurisdictions to permit honest exploration of quality issues. When a conflict does arise, consideration of mediation should be given to resolve disputes.