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Developing a doctor’s code of conduct
Ten general guidelines offer a starting point for reining in behaviors that may harm your company.
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“On my honor I will do my best to do my duty to God and my country and to obey the Scout Law; to help other people at all times; to keep myself physically strong, mentally awake and morally straight.” – The Boy Scout Oath
In some countries, littering brings a $1,000 fine or even a “corrective work order” in the case of Singapore — you wear an orange jumpsuit in public while you pick up people’s trash for a day. In other countries, littering is overlooked, along with graffiti scribbling, spitting and general mayhem.
It is the same in ophthalmology, in which each practice is like a tiny country, with laws and customs all their own. Some are tight, some loose.
Small practices, and administratively neglected larger ones, are typically informal about boorish doctor behavior. They overlook tardiness, grumpiness and rudeness. They ignore poor grooming, sloppy patient care and late paperwork. Or they write rules and wag fingers, but do not really establish a consequential environment.
But largish practices, and those more formally (and effectively) led, have developed an evolving code of conduct and a fair set of consequences to help providers keep their darker tendencies at bay.
This small vs. large practice difference is understandable. A practice with two doctors has lower odds of loutish behavior in a given month than a practice with 20 doctors.
Some physicians, especially practice owners, consider such codes of conduct to be another intrusion on their autonomy, and they are correct. While a majority of eye practices are still mom-and-pop scaled, the average practice size is growing. In more settings, autonomy and anything-goes have to yield to that which is best for the group (which, conveniently enough, is often what is best for patients and staff, too).
If your practice is on the verge of (or beyond) needing a behavioral statute book, here is a starter kit of 10 general guidelines. Even if you only adopt some of these, they will provide your managing partner and administrator with a starting point for reining in behaviors that may be harming your company today.
Beyond these common-sense sample items, you can also look to your local hospital’s bylaws, the AMA’s comprehensive and widely adopted ethical cannons, and within your own four walls, where adverse behavior unique to one of your very own doctors might suggest a customized approach.
1. Show up (and stay) on time. An efficient ophthalmological practice is a study in industrial engineering, with all of the work stations humming together. When you arrive late or get lost reading your email between patients, the factory floor grinds to a halt at great expense. Timeliness also applies to inside and outside business meetings and promised phone calls. As the old man used to say, “Early is on time and on time is late.”
2. Respect your practice’s governance model. Boards, managing partners and administrators have the unpleasant task of saying “no” more often than they say “yes.” This is difficult for iconoclastic surgeons to accept. As each issue arises in the boardroom, say your peace, contribute your thinking, then vote in your practice’s best interests. And then publicly support every vote, even the ones that do not go your way.
3. Work to establish and preserve trust. This is fundamental to all healthy relationships, with patients, staff and partners alike. The best-cared-for patients trust their doctor. The most effective staff trust their boss. And the highest-functioning doctors trust their partners. Scan often and work hard to bridge any trust gaps.
4. Be equally effective as a leader and as a follower. For most eye surgeons, leading comes more naturally than following. But both are important in a group practice. The key to success with either role is to put the interests of others first.
5. Accept and follow through on your agreements. Volunteer for projects. Take your fair share of call responsively. Accept work-ins without protest. Strive to do more for others than they do for you.
6. Practice only within your sphere of competence. Accept that even with continuing education it can be hard to be all things to all patients in a professional world trending to ever-greater subspecialty focus. If you are uncertain about your appropriate scope of care or care pathway, talk to your partners or respected colleagues outside of the practice.
7. Do everything in your power to grow the entire practice, not just your part of it. When speaking with referral sources, mention your partners and their respective subspecialty interests. Ask them to support the entire practice, not just your surgical volumes. Take internal referral seriously, and strive to provide better care by letting your patients know what your colleagues might be able to help them with.
8. The patient is always right, even when he is wrong. Convey clearly to every patient through your actions and tone that you have their best interests at heart. With a belligerent or unreasonable patient, this can be much harder to do than to rescue a surgical complication, but it is as core to your life as a professional as any other skill. Learn to let go of hurt feelings.
9. Be open and non-defensive. When challenged by a patient, staffer or peer, say, “You know, you may be right. Tell me more.” Then hang in there and listen patiently and actively, without rolling your eyes, while the other person lets you have it.
10. Be physically and financially productive. Ophthalmology does not require the brute strength of orthopedics or an OB/GYN’s tolerance for sleep deprivation, but it is a physically and mentally taxing profession. You owe it to your partners and staff to be work-hardened and capable of taking on the peak patient loads that are increasingly obliged to be financially effective in private practice.
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- John B. Pinto is president of J. Pinto & Associates Inc., an ophthalmic practice management consulting firm established in 1979. John is the country’s most-published author on ophthalmology management topics. He is the author of John Pinto’s Little Green Book of Ophthalmology, Turnaround: 21 Weeks to Ophthalmic Practice Survival and Permanent Improvement, Cashflow: The Practical Art of Earning More From Your Ophthalmology Practice, The Efficient Ophthalmologist, The Women of Ophthalmology, Legal Issues in Ophthalmology, Ophthalmic Leadership: A Practical Guide for Physicians, Administrators and Teams and a new book, Simple: The Inner Game of Ophthalmic Practice Success. He can be reached at 619-223-2233; email: pintoinc@aol.com; website: www.pintoinc.com.