Dear editor. (Reader Feedback).

The insights expressed in Drs. Alan Rosenstein, Henry Russell and Richard Lauve's article, "Disruptive Physician Behavior Contributes to Nursing Shortage," and the guidance on the issue presented in Dr. Michael Youssi's article on JCAHO standards, (The Physician Executive, November/December, 2002) remind physician executives that this problem has true repercussions on health care delivery and must be addressed systematically.

As in previous articles on the topic that have appeared in The Physician Executive, however, this work suffers from its failure to identify and deal with the fundamental cause of disruptive physician behavior: mental illness.

By labeling physicians as, "...individuals who are unable or unwilling to improve their behavior," and regarding this as, "recalcitrance," the authors ignore the simple fact that most disruptive behavior results from genetic illness that is aggravated or encouraged by the occupational hazards of the modern medical work place with its easy access to drugs, the stress brought about by managed care squabbles, tort reform issues, increasingly demanding work loads and plummeting job satisfaction.

By ruling out mental illness and substance abuse through formal evaluations, hospitals stand to preserve the natural resource that is our clinical physician population while placing the medical staff on firmer footing should more severe measures such as suspension of privileges become necessary. Approached without such objective clinical evidence, the process becomes a politicized game of "he said, she said." In my experience, when the physician is given the chance to identify and address the source of his or her problem behavior such rancor gives way to gratitude and the improved performance physician executives hope for and should come to expect.

Joseph Molea, MD, CAP, CHE

Executive Director

HealthCare Connection of Tampa, Inc.

Tampa, Fla.