Defining unprofessional conduct or ‘gagging physicians’?

This story was published on June 27, 2002 on Page A9 in all editions of the Bangor Daily News

The Bangor Daily News recently published two front-page articles (June 11 and June 13) describing a proposed Eastern Maine Medical Center Staff bylaw change.

Phrases such as “gag rule,” “gag doctors” and “freedom of speech” were used in the headlines and bodies of those articles. These are attention-getting words and were used to do just that, attract your attention. Fortunately, the proposed bylaw changes have nothing to do with “gagging” physicians or limiting free speech. What the bylaw changes are focused on is defining unprofessional conduct.

Unprofessional conduct by members of a medical staff negatively impacts (either directly or by creating a hostile environment) patient safety and welfare, quality of care, the physician-patient relationship, collaborative relationships among providers and the orderly operation of a medical center.

Unprofessional conduct may have a deleterious impact on patient care and may result in errors in clinical judgment and performance. Additionally, the increased anxiety and intimidation associated with unprofessional conduct may severely compromise the effectiveness of the health care team providing patient care by increasing the level of workplace stress and creating an environment in which errors are more likely to occur.

The EMMC Medical Staff Bylaws Committee, after a number of its members attended a presentation on The Disruptive Physician, and read a report from the Federation of State Medical Boards Special Committee on Professional Conduct and Ethics, took up the challenge of adding clarity and substance to our bylaws regarding unprofessional conduct. Defining unprofessional conduct provides clarity for medical staff members as well as medical staff leadership who must deal with an allegation of unprofessional conduct. It was a tough challenge, but one the Bylaws Committee felt it needed to face.

The proposed bylaw changes include 18 examples of unprofessional conduct such as: profane or disruptive language, demeaning or intimidating behavior, outbursts of rage or violent behavior, throwing instruments, charts or other objects. The proposed example cited by some as a “gag order” reads as follows: “any communication that inappropriately undermines an individual’s trust in a practitioner or the hospital.” The intent of this example deals with physicians who make disparaging comments about the hospital or physicians who have previously or who are about to care for a patient. No patient awaiting treatment should be subjected to the disparaging (and thereby dispiriting) comments of a physician about the hospital or staff who have previously or who are about to care for that patient. This example has nothing to do with “gagging doctors” or impinging on “First Amendment rights,” nor was it ever intended to do so. If an error was made it was in not being more specific in the wording of the example.

The discussion of the proposed bylaws changes at the June 11 EMMC Medical Staff meeting was spirited, worthwhile, and appropriate. Medical staff meetings are the appropriate place for spirited discussions and expression of opinions. Medical staff members voted to return the proposed bylaw back to the Bylaws Committee for revisions and clarification. Any medical staff member is free to participate in that subsequent meeting of the bylaws committee, or to make their opinions on the proposals known to the committee via written communication or talking with a member of the committee.

This is exactly how the process is supposed to work. Bylaw revisions are reviewed at medical staff meetings and voted upon. If a bylaw is unacceptable to the membership or if it needs revision it is sent back to the Bylaws Committee for further consideration.

The June 13 Bangor Daily News article stated that at the June 11 EMMC Medical Staff Meeting Dr. Raczek “admonished” the medical staff member(s) who discussed the proposal with the BDN. Dr. Raczek did state that using emotional and visceral phrases like “gag orders” and “impingement of First Amendment rights” is sensational journalism at its worst. He also stated that a member of the EMMC Medical Staff talking to the BDN about concerns regarding bylaw changes before discussing them with the elected president of the medical staff or chair of the Bylaws Committee shows disrespect for those offices. We expect that communication about a concern with a proposed bylaw revision would occur with elected medical staff representatives prior to communication with a reporter for the BDN. If the individual(s) who chose to go to the BDN with a concern before discussing it with the elected representatives of the medical staff consider Dr. Raczek’s statements admonishment, so be it.

In both BDN articles there is an attempt to connect these bylaw discussions with the EMMC administration. At no time did any non-medical staff member of EMMC administration try to influence the Medical Staff Bylaws Committee or Executive Committee in its initial consideration and subsequent discussion of this bylaw change. The proposed bylaws changes were a medical staff initiative, not a hospital administration initiative.

Phrases such as “gag rules,” “impinging First Amendment rights,” plots by hospital administrators to “get doctors” certainly will get your attention and make for great reading over morning coffee. They also have nothing to do with this proposed bylaw change.

Why are these articles laced with attention-getting phrases that have nothing to do with the intent of the proposed bylaw revision? Why are medical staff concerns being published in the BDN before they are discussed with the elected medical staff leadership? Why is there an attempt to connect EMMC Medical Staff bylaw changes with EMMC administration, when they had nothing to do with the process? We will leave it to you the reader to come up with the answers to those questions!

James A. Raczek, M.D. is a board certified family physician. He is the elected president of the EMMC Medical Staff, chief of the EMMC Family Practice Service and is employed as the vice president for quality and care management. He maintains a medical practice at the EMMC Family Practice Center. Irwin Gross, M.D. is a board certified pathologist. He is the elected vice president of the EMMC Medical Staff and chair of the EMMC Medical Staff Bylaws Committee. He serves as chief of the EMMC Pathology Service and medical director of Affiliated Laboratory Inc.