The Danger of a Dysfunctional Medical Practice PDF Print E-mail
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Medical practice managementToxic offices take a toll on everyone, including your patients. Here's how to improve your practice's health.


In my job as a consultant for stressed-out physicians, I hear all kinds of stories about practices gone astray. Here are three recent ones:

  • Dr. Taylor's problems at work bothered him most at night, when he struggled to sleep. His colleagues, the doctor felt, were arrogant and consumed with greed. Dr. Taylor, in turn, was filled with resentment.

  •  On Dr. Garcia's first day at his new practice, another physician pulled him aside to talk about a colleague's clinical incompetence. This badmouthing, it turned out, was a typical conversation held with all new members.

  •  In Dr. Miller's office, the senior partner insulted anyone who praised others or even offered a hug after a partner survived a difficult call schedule.
All of these doctors, whose names have been changed, have two things in common: They were all part of dysfunctional practices, and they all came to my office at the Center for Professional Well-Being for help. With some coaching, they were able to improve their lives, and I wanted to share the solutions for family physicians who might be in similar situations.

A common problem

All of us at some point have encountered dysfunctional individuals. Everywhere they go, havoc follows. A dysfunctional practice is marked by that same chaos, and it comes with a human cost.

I define a dysfunctional practice as one that enables inconsistencies and interpersonal abuses, harming the emotional and professional health of those who work there. It is a toxic work environment.

Such an office can include poor organization, tyrannical or impotent leadership, and demoralizing attitudes. Conflict is the norm. Complaints pervade conversations. Gossip and unclear communication seem to be the rule. This behavior heightens turnover, undermines morale, reduces cooperative behavior, diminishes productivity and increases the risk of substandard care. Physicians and others leave prematurely or try to adapt, which usually generates enough stress to cause burnout. In extreme cases, I've seen it advance to the point of disability.

Causes of toxic practices

Toxic practices are the result of multiple converging factors (see "Causes and Consequences of Toxic Practices" ); however, three causes are most common:

First, no one is truly in charge of the practice. Toxic practices are fueled by ignorance and fear because their leaders don't know how to promote a mature, interdependent practice. Individuals' expectations for one another are not identified or validated. Ownership of a problem is usually pushed onto associates. Disruptive partners don't respect the manager, do not accept coaching and usually are not confronted because of their status.

Second, because no one is clearly in charge, the ambiguity takes over. Individuals with strong control issues see the practice as their personal fiefdom and use their power to intimidate others into an authoritarian model. These individuals may resist others' input because of cultural or personality reasons. These people may use toughness or tyranny to escape their own fear of being controlled by someone else. They are seen as despots who view all relationships as disclosing weaknesses. Their fears cause them to feel no sense of compassion for their co-workers (who are perceived as dangerous). Their co-workers, in turn, reflect no compassion and isolate one other.

Third, the practice has no sense of unity or purpose. The practice remains ineffective because the organizational teamwork that would produce a clear vision and realistic objectives is unknown. Any attempts at practice efficiency are sabotaged by those who control by maintaining disorganization. They view clarification, measurable objectives and ownership of responsibilities as a threat.

Dangers to your patients

A dysfunctional practice, like a dysfunctional family, breeds unhappiness. Disrespect and distrust fill the air. But while a dysfunctional family sometimes can hide its troubles from the world, a dysfunctional medical practice cannot.

Your patients will sense that something is wrong. In a worst-case scenario, their care could suffer, despite your best efforts to preserve your clinical integrity. Even if their health remains fine, your patients will transfer out of your practice or become hypercritical.

Some of the patient-related problems are easy to spot. Difficult patient requests become too troublesome and are ignored. Even routine patient requests may be neglected. When patients do hear from the practice, communications are often curt.

Less obvious problems might pose the most danger to your patients. They can suffer when positive feedback is missing or performance appraisals are put off. Observations or hunches that can sometimes solve a mystery illness are not swapped in a dysfunctional practice. Even the benefits of attending CME programs are not shared in partner meetings.
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Robyne Wilkerson
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