Acceptable behavior needs to be spelled out

One of our recommendations to a primary care group in Washington: "Create a Physician Code of Conduct for the group. This may seem unnecessary, but there were several anecdotes of physician behavior that apparently breach your assumptions of good conduct. When you have a code that is agreed on, it is easier to ask the question, 'How did your behavior fit the code or help the group?' You make assumptions about each others' motives, often erroneous, and resentment has built up among you. If behavior is unacceptable, make a motion to deal with it in some specific way. Record the vote, and if anyone votes no or refuses to vote, consider it an indication that you're dealing with a nonmember individual. And if you can't get a second, move on."

A group that continues to accept "unacceptable" behavior by not acting on it has a problem with definitions. Good groups create a culture of interdependence, trust, and friendship wherein no physician would countenance mistreating a practice, hospital employee, or colleague. Plenty of practices have just these kinds of malignantly narcissistic personalities among their physicians, however, and they do nothing about it beyond complaining (privately) or, maybe, calling a consultant. They're seeking the magic pill that will make Harry change or "go away" without having to actually do anything requiring gumption.

The first step in developing a code of conduct is to make clear what behavior is unacceptable. You can't deal with the problem fairly if you haven't put members of the group on record, defining terms and listing what can get a physician in hot water. Michael Josephson's Character Counts! Coalition ( http://charactercounts.org/) lists six key "pillars of character" that form a good place to start: trustworthiness, respect, responsibility, fairness, caring, and citizenship.

What follows are some examples of values and prescribed and proscribed behaviors that my associates and I have collected from groups we've visited. Practices adopted these lists preemptively in efforts to deal with problems physicians.

Values: