The Program for Distressed Physicians
The CME program was designed as part of the ongoing mission of the Vanderbilt Center for Professional Healths commitment to physician well being. We have titled the course distressed instead of disruptive since the basic behavior of these physicians results from internal factors that is obvious from the experiences we have seen in the physicians attending the course.

The central theme for the course is to provide physicians with disruptive behavior a safe, confidential environment where they can learn with their peers about the origins and consequences of their actions. This environment must be conducive to open discussion in small groups with no more than seven and no less than five physicians in each group. The therapeutic modality is guided small group interaction. Each physician is given the opportunity to tell their story and confide their fears and hopes with other physicians in the group.

Physicians can be isolated, lonely, stressed and held in high esteem by their patients and their profession. We believe that most are technically skilled and cognitively able to practice medicine and their specialty. The subjective elements of behavior such as expressions of doubt, fear, sadness, ambiguity, and the elements of emotional intelligence (1) are unknown to these physicians. The course provides the opportunity to learn the value of expressing feelings appropriately and is emotionally healing for many of the physicians attending the course. This is a new way of behaving for some and they are slow to see the therapeutic value of the group. Most however, begin to open up and take advantage of the process early in the course.

A comprehensive understanding of each physicians behavior is critical to helping them learn new behaviors in the CME course. Collateral information about their acting out in the practice, hospital or medical school faculty is collected. We obtain written consent from the physician to contact colleagues, nurses, family members, and others who will comment on the physicians behavior. This information is provided to the faculty before the physician attends the course and helps individualize the experience.

We have found that small group experiential exercises such as the role play of problematic episodes are very effective educational and cathartic experiences. The genogram (family tree) of each physician is discussed in the group. This exercise attempts to help the physician and the group understand the antecedent family traits that contribute to disruptive behavior.