When Is It Finally Enough?

Three years after being hired to lead the oncology service line, Kiara was a champion for the physicians in her unit. While emphasizing high standards, she showed sensitivity to the unique characteristics of those on her clinical team. She reached out to us on multiple occasions — usually to enhance the leadership and interpersonal skills of promising young physicians. Under Kiara’s steady guidance, the service line made positive strides, and her team experienced growth and improved morale. Within this context, we were not surprised when Kiara asked us to work with Bren.

Like so many of the target physicians we have already discussed, Bren was a good physician with specialized expertise. In addition, she arrived with a solid research record that Kiara figured would spark the research of the unit as Bren collaborated with her colleagues.

After nearly two years, Bren never quite fit in with the team. Additionally, her curt tell-it-like-it-is style rankled nearly all her physician colleagues. Most refused to work with her on research projects — projects that Bren turned into stressful and contentious ventures. Through her interactions, Bren made it clear verbally and non-verbally that she was the smartest person in the room.

To her credit, Kiara met regularly with Bren. In most cases, Bren bristled at Kiara’s efforts, gave perfunctory agreement, dismissed the seriousness of her situation, and made little progress or changes in her behavior. Disciplinary actions followed, prompting a few short-term improvements followed by rapid regression to her old habits.

Now, Kiara reached out to us, hoping that our outside coaching might help Bren enact some needed behavioral changes. Granted wide latitude, we recognized that we were one piece (perhaps a final piece) in Kiara’s efforts to help Bren and salvage her career with the unit.

We met with Bren for about two months. She was defensive but polite and respectful. We discussed and practiced some interpersonal shifts — relatively minor changes. As we reviewed her progress in each meeting, she continued to focus on others’ problems rather than her own.

During our final check-in with Kiara, there was no discussion of the particulars of our interactions with Bren, which was consistent with our promised confidentiality. However, we all knew that appropriate and needed behavioral changes had not occurred.

Kiara thanked us for our work with Bren and reminded us of how much she appreciated our work with others in her unit. However, Kiara was adamant, “After nearly a year of trying to help her change, I must face the fact that it’s not getting better with Bren and the team. It’s best to move on.” When Kiara signaled to Bren that her upcoming contract would not be renewed, Bren decided to voluntarily leave, landing a promising position in another part of the country.

Even as a seasoned leader, Kiara shared her sense of frustration and disappointment. She had lost a talented clinician and lead researcher. From Kiara’s perspective, her ongoing efforts at remediation — efforts that consumed time, energy, and resources — had fundamentally failed. Intellectually, Kiara knew she was making the proper decision. However, from an emotional perspective, Kiara was struggling to get her arms around what had been a period of tension.

Excerpted from Working with Distressed Physicians: A Guide for Physician Leaders by Charles R. Stoner, DBA, and Jennifer Robin, PhD.