Are You Disruptive or Disruptive, doctor?

A friend and colleague physician entrepreneur was recently lamenting the fact that, in business, being disruptive is a good thing , but, in medicine, it can result in, among other bad things, losing your license to practice.

In business, “disruptive innovation,” a term of art coined by Clayton Christensen, describes a process by which a product or service takes root initially in simple applications at the bottom of a market and then relentlessly moves up market, eventually displacing established competitors.

Medicine sees it a different way. Patients identify being confident, empathetic, humane, personal (ie, viewing the patient as a person, not a disease), forthright, respectful, and thorough as ideal physician behaviors. Valuing teamwork, handling stress, punctuality, and self-motivation to pursue professional and personal growth are also ideal physician behaviors. On the other hand, the American Medical Association, in its Code of Medical Ethics, states that “personal conduct, whether verbal or physical, that negatively affects or that potentially may negatively affect patient care constitutes disruptive [physician] behavior.” Such behaviors include inappropriate language, yelling, gossip, facial expressions, and other mannerisms as well as physical boundary violations.

Unfortunately, the line between the 2 is not so clear and some doctors are branded as disruptive, not because they cause patients harm, but because, through their efforts and actions, they are disruptive to the existing sickcare business model. Those that dare to tell truth to authority are branded as provocateurs, naysayers, grenade-throwers, and "just not team players".

Those who threaten the status quo in any industry at any time are outsiders and run the risk of suffering from the full force of those seeking to resist change. Physician entrepreneurs are no different. Being disruptive in pin-stripes is one thing. Being disruptive in a white coat is another. Few vested interests tolerate either in the clinic, the bedside or the OR.