Love the sinner, hate the sin. They say that's how you tame a disruptive doctor, but have you ever tried sending love in the presence of an evil thrower of tantrums and scalpels?

It ain't easy, but that's what Kent E. Neff, MD, FAPA, a psychiatrist from Portland, Ore., who specializes in rehabilitating disruptive docs, says you must learn to do if you want to curb bad behavior.

Managing your troubled surgeons with an iron hand inside a velvet glove means "treating people with respect, but then getting really tough about their behavior," says Dr. Neff, widely regarded as the nation's foremost expert on troubled physicians. "Be hard on the behavior, but soft on the person."

A "good-doctor, bad-behavior" mindset is the key to exorcising your ORs of rude and crude physician behavior, says Dr. Neff, who last month led "The Disruptive Physician Workshop" at OR Excellence, Outpatient Surgery Magazine's annual conference. Surgical facility leaders dealing with difficult docs attended Dr. Neff's intensive, interactive, 2-day, 8-hour workshop. Some of what they learned:

• Disruptive behavior is a chronic condition that endangers your staff and your patients. At its core, it is an OR safety issue. "It is impossible to have a truly safe unit when disruptive, disrespectful behavior is present," says Dr. Neff, who once had a nurse confess to him that she knew the surgeon had cut an artery, but she was too afraid to tell him.
• Use the term "unacceptable" to address specific, observed behavior. If, for example, a surgeon yelled at a tech and called her "stupid," note the time and date of the behavior and address it with the doctor in non-judgmental terms. Nurse managers must lower their tolerance for harsh behavior and feel empowered to tell surgeons that their behavior is unacceptable, says Dr. Neff. Simply saying, "Doctor, that behavior is inappropriate and is not acceptable" is a powerful way to disarm a disruptive doc without ranting and raving yourself, he says. "Docs don't see their behaviors as you do."

• There must be consequences. Good intentions and insight don't work. "No consequences means no change," says Dr. Neff. "Most physicians with disruptive behavior have not had meaningful consequences." Whether it's rescinding their block time or suspending their privileges, you've got to have a hammer, and must not be afraid to swing it. Find out what really matters to your docs and hit them where it hurts.
• Many docs lack social skills and social maturity. They're not normally socialized or developed emotionally, says Dr. Neff. They're made to feel entitled at an early age, then subjected to abuse in medical school as they strive to become perfectionists. "The abused become the abusers," says Dr. Neff.
• Disruptive behavior is not about the stress that causes it. "That's never an adequate answer. It's how the person responds to the frustration," he says. "You're not paid to be abused. Is that respectful? If it isn't, then it's disruptive."

Say it again: Love the sinner, hate the sin.