CAN A CME COURSE HELP THE DISRUPTIVE PHYSICIAN?
Can you be taught to look before you lip, bite your tongue, button your lip, or things before you speak and get CME for it? You are listening to the ReachMD XM 157, the channel for medical professionals. Welcome to the clinician’s roundtable. I am Dr. Bill Rutenberg your host and with me today is Dr. Charles Samenow. Dr. Samenow is an instructor in the Department of Psychiatry and Behavioral Sciences at the George Washington University School of Medicine and Health Sciences in Washington DC. Dr. Samenow is a psychiatrist specializing in professional health and wellness. His research is focused on addressing professionalism in medical students, physicians, and other professionals. Today, we are discussing a unique CME course offered by the Center for Professional Health at Vanderbilt University aimed in addressing disruptive position behavior.
DR. BILL RUTENBERG:
Welcome Dr. Samenow. It is great to have you with us at the clinician roundtable.
DR. CHARLES SAMENOW:
Thank you. It is good to be here.
DR. BILL RUTENBERG:
I have heard of people wanting to tar and feather disruptive provider, but this is the first time I have heard of offering him or her CME. Why was it chosen to be a CME course.
DR. CHARLES SAMENOW:
Basically, what we noticed were that our state physician health program directors were in a real bond as well as many hospital executives. They would come across individual who had disruptive behaviors in the workplace and there really were no resources for them. They were not candidates to go for 6 months of inpatient residential treatment for drug and alcohol problems because those problems did not exist and many of the things that were in place for the impaired physician simply just did not apply to this individual who was clinically very competent, able to carry out their job, but was reeking havoc all over the workplace and so Vanderbilt had success with two other CME programs around physician behavior. The first one on misprescribing control substances and then the second course was on sexual boundary violations and so we decided to apply the model that we had used with those other physician behaviors towards this really important problem.
DR. BILL RUTENBERG:
How and when did the program get started?
DR. CHARLES SAMENOW:
The program has been existent now for, it must had been about three years that we had experience. Vanderbilt has been doing CME since the late 1990s and had had experience with those other two courses, but in 2004, the course faculty decided to develop a program around disruptive behavior and it was probably predominantly through the feedback they had gotten through their work, they had seen over a 1000 physicians from 50 states and Canada. So, our faculty has been in touch with health professionals, administrators, physician health program executives from around this country and so, through the feedback from that, then collaborating with psychiatry, behavioral medicine, social workers, addictionologist, we really worked to develop a curriculum that could address this problem.
DR. BILL RUTENBERG:
About how many physicians have come through the program in this time?
DR. CHARLES SAMENOW:
I think to date, we have had, I left Vanderbilt a year ago and at that point, we had had almost 40 physicians who had gone through and so I imagine the number is higher at this point.
DR. BILL RUTENBERG:
And how do the physicians get there, do they just set a call up and say I think I need a, you know, CME course?
DR. CHARLES SAMENOW:
We do have a few self referrals, but often times, are most likely source of referral is directly from a healthcare institution, originally many of more from Tennessee, but now again this has expanded nationally. Physician health programs refer and occasionally board licenses refer. We also will have sometimes treatment centers the physician may have drug and alcohol problems and they get successfully treated, but there are still behavioral issues that are identified and so our treatment center will send us a physician.
DR. BILL RUTENBERG:
Having been sent by someone else, do the physicians come in open minded or do you first have to get over that hurdle?
DR. CHARLES SAMENOW:
Most physicians come in very resentful. When you see the first day of our course, it often looks like a funeral. Physicians are guarded, very close, not talking, very paranoid about what will be reported back, <_____> often even legalistic. So, it is a huge challenge.
DR. BILL RUTENBERG:
And how many you are in the course of the given time?
DR. CHARLES SAMENOW:
We try to limit the course to no more than 10, but generally it is, you know, 6 to 8 core in the course, so there is always a small group.
DR. BILL RUTENBERG:
Do you think that model works better, I am just thinking if it was my situation, I would almost rather be one-on-one and not sharing it, but I know as a psychiatrist that some experience I have had in talking to people in groups that it could be very uplifting?
DR. CHARLES SAMENOW:
The small group format is a wonderful format and the reason for this is, the first thing we allow these physicians to do is tell their story and for many of them it is a first chance that they felt that anyone is really even listening to them. By the time they get to us as often, the disciplinary letters have gone out, the threats, you know then put on the defensive. So, they are able to tell their story and they have an audience there who can write because everyone has a story that is similar and so from that moment forward, there is a connection among the group, a cohesion that really helps fit the stage for the rest of the program.
DR. BILL RUTENBERG:
Tell us a little bit about the core program and you said day #1 starts out like a funeral, how many days are involved?
DR. CHARLES SAMENOW:
We do an extensive collateral information from before, so when we get a referral, we do not just take the person automatically. We obviously talk to the physician, but we ask to get information from family members, from their employer, we try to gather information up, want to make sure that the individual is an appropriate referral because we are not setup to do detox. So, this is really a substance abusing physician and that is a different issue. So, we first check for the appropriateness, but then second, we want the information because while the physician has his story or her story, there is often another very complex story out there and so we like to get as much data as possible. So, that is on the fine hand. Then, the program itself is a three-day program, basically full days from morning to afternoon, and we can talk later about each of the individual components, but you know, it is an interactive experiential process involving role playing, assertive training, relaxation techniques, a whole variety of skills, and then it is followed by three booster sessions over a six-month period, in which the physicians actually come back and for a half day, you know sort of share their progress and the change.
DR. BILL RUTENBERG:
I would like to welcome those who are just joining us at the clinician’s roundtable on ReachMD XM 157, the channel for medical professionals. I am Dr. Bill Rutenberg and with me today is Dr. Charles Samenow from George Washington University Medical Center. We are discussing a unique CME course for distressed physician.
Is there any additional monitoring system that takes place back where they are working?
DR. CHARLES SAMENOW:
