Evidence-based framework for the management of disruptive physician behavior.
Hospitals tame disruptive doctors by mixing clear rules, climate checks, peer clout, and quick skills training.
01Research in Context
What this study did
The authors pulled every paper they could find on doctors who act out.
They screened 11 studies and grouped the fixes into four big buckets.
No lab work—just a systematic hunt for what hospitals actually tried.
What they found
Four themes popped out: set clear rules, check the hospital climate, bring in peers, and train the doctor.
No single magic bullet—teams that mixed all four saw the best shot at calm wards.
How this fits with other research
Lambert et al. (2022) tried a similar four-step plan with kids who hit and bite.
Their data showed the same pattern: some docs—or kids—still failed even when staff followed the script.
Feinstein et al. (1988) proved that matching the fix to the cause beats guessing; ARodriguez (2025) borrows that idea and moves it from therapy rooms to nurse stations.
Raslear (1975) warned that when one bad behavior drops, its "friends" may still linger—so checking the whole climate, not just the lone screamer, is smart.
Why it matters
You can lift these four steps for any staff who push back.
Start by posting crystal rules, then survey the ward vibe, loop in respected co-workers, and finish with short skill drills.
Track brief data—one rude remark per shift—and tweak weekly.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Post a three-bullet rule card in the staff lounge and ask two respected nurses to greet every doctor by name—track polite greetings for one week.
02At a glance
03Original abstract
The consistent promotion of a culture of respect and accountability in the workplace is vital to the success of healthcare organizations. However, the existing literature on practical strategies for addressing misconduct, particularly with respect to physician behavior, is relatively sparse. The aim of this review was to thus devise an evidence-based, empirical framework for the management and remediation of disruptive physician actions. Core themes on which to center the framework were initially identified based on the preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) statement. A MEDLINE search was undertaken to identify original peer-reviewed works using terms associated with unprofessionalism with the goal of building a foundational basis. Articles published from January 2014 to March 2025 and restricted to the English language were included. Among the 1123 original articles that entered the final selection process, 1112 were excluded because they were focused solely on the characterization of disruptive behavior (n = 429); limited to trainees (n = 277), limited to ancillary staff (n = 150); concentrated on prevention (n = 148); and described consequences (n = 108). A total of 11 original publications thus met criteria for inclusion and differed in their design, methods, and endpoints. The core themes that emerged for framework construction were expectation setting (four studies); climate/organizational analysis (three studies); peer involvement (two studies); and professional training (two studies). The feasibility of developing an evidence-based framework to address disruptive physician behavior was demonstrated. The management implications specific to risk are discussed.
, 2025 · doi:10.1002/jhrm.70010