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Pediatrician and certified coach Jessie Mahoney discusses her article “Disruptive physician labeling: a symptom of systemic burnout.” Jessie argues that the rising number of “disruptive” labels slapped on highly skilled doctors is not a failure of character but a predictable response to a broken health care system. She explains how burnout and moral injury deplete emotional reserves, leading to reactivity that institutions punish rather than heal. The conversation advocates for replacing punitive measures with evidence-based coaching to restore physician well-being, improve retention, and ensure patient safety. Discover why supporting doctors before they break is essential for the stability of modern medicine.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome back Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Disruptive physician labeling: a symptom of systemic burnout.” Jessie, welcome back to the show.

Jessie Mahoney: Nice to be here.

Kevin Pho: All right, what is your latest article about?

Jessie Mahoney: So this article is about this phenomenon that I am seeing more and more of, and it makes me upset. This is about physicians being labeled as disruptive or poor communicators or bringing the wrong energy. Most of the time, and I will say not all of the time, but most of the time, these physicians are those who care tremendously and are exceptional physicians who are bearing the weight of the system and trying to make change. So they will be labeled as disruptive when really they are challenging the norms or they are saying this is a problem or that is a problem.

I want to bring up that conversation and also normalize it. In particular, I want to lessen that shame around it because a lot of people who reach out feel like it is a problem with them and they wonder what they have done and if maybe they have failed. So I want to empower people who potentially listen that if this happens to you, it doesn’t mean you are a bad doctor. There are things that can help, and it is often an opportunity to advocate for yourself.

I think one of the things that coaching helps with is to help you become a better advocate regarding the problems that you see. It helps you not just be a problem spotter, but be really strategic in how you bring these things up. You can work on making your own situation healthier so that you can show up in a way that works for the system and for you, but without giving up who you are and what you believe in in the process.

Kevin Pho: What are some specific examples you have heard of things physicians have done that had them being labeled as disruptive?

Jessie Mahoney: Well, they will often bring up problems with the system or unsafe patient situations, or complaints or things that need to be fixed. I think to be fair, and I am never in the moment where they actually said the thing, I am sure that the thing that they brought up could have been said more eloquently. I think when we are completely depleted, we are never particularly elegant. When we are reactive, we tend to have a shorter temper. That is expected in a system where we are pushed beyond our limits.

But these are things where physicians really feel like they are in a situation of moral injury or that patients aren’t getting quality care in particular. It may be that they usually could have handled it in a different way or been more strategic. Maybe they will bring up things to the wrong people or in the wrong language. Sometimes things are brought up in ways that actually are problematic, like maybe in the chart or maybe with nursing. It can create more problems rather than solve the problem.

Usually the points that they are making are really important. It is coming to a head, I think, because the pressure is so heavy in medicine. People who practice in medicine want good care and they want to do the right thing and they want the systems to work. We are, after all, trained as problem spotters, right? Yet, very often those people we are pointing the problems out to are not actually interested in us spotting the problems, or they don’t see it as our job. Or maybe there is no clear solution.

But what is happening is these physicians are then being put in a spot where they maybe have to defend their actions or do something in remediation. I think that there is learning here. No one ever taught us as physicians how to advocate effectively. When I went to medical school, the system was completely different. So none of this was an issue. We weren’t working in big business, and yet it is sort of a conflict between our inherent beliefs and a reaction to moral injury.

Kevin Pho: So how much of it do you think is that lack of eloquence, like you said, because a lot of physicians are not trained in being as diplomatic as we should be? We are not trained in politics. Right. And a lot of the administrators come from a business background where they have that formal training and negotiation. How much of it is really just a lack of polish on the part of physicians?

Jessie Mahoney: Well, that is an interesting question. A lot of it is a lack of polish. A lot of it is that we didn’t learn. A huge piece of it also is just depletion and the pressure. When we are not resourced internally, we don’t show up as our best selves. So if we are post-call, we are very likely not to advocate so well. No matter how well we have been trained, that is not our best moment in time, for example.

I think that a big piece of that is that we can learn and make it better. I find that through coaching it makes a big difference. People recognize pretty quickly what initially felt like a personal attack. They think: “Oh, I could be doing this better.” When you honor that physicians really care, and this comes from a place of wanting to provide exceptional patient care, and nobody wants to not be a good colleague or not be a team player. There are occasional people, but 99 percent of physicians are here for good reasons. Then there is relief in knowing that this is a learnable skill and that they can work on those things without just saying the system is fine because it is not right. It is about how to be eloquent. It is not all that, but I think there is a huge learnable piece of this.

Kevin Pho: Now, if a physician has been labeled disruptive, what are some of the ramifications of that?

Jessie Mahoney: Well, they can be really significant. I think that often what I see is they are being asked to do something in response. People come to me for coaching in response, which I think they are really looking for something that helps with communication or something that helps with reactivity. So mindfulness and specific professional development coaching is a solution for that.

Oftentimes people lose jobs over it and people end up on a performance improvement plan, which is just not a nice word. I heard at a conference once someone speak to this idea of what if it was a professional investment plan and that we were investing in our physicians to be able to make change in a way that works for these complex systems that we aren’t necessarily trained to advocate in.

I also see for many people, these are people who want to be leaders or who are leader types but don’t have a leadership role. So they are just advocating and asking, which may be seen as out of turn. But I think the ramifications can be huge. The ramification I worry most about is the shame, blame, guilt, and feeling like they have failed. They also feel really hopeless and helpless because their efforts are usually on behalf of making the system better. If they can’t do that, then they think: “Well, if I can’t make the system better and I am getting in trouble, what is the whole point?” To me, that is the highest stakes when people give up or hide because they feel bad.

What I really hope listeners hear is that it is usually not just a “you” problem and there are things you can do. It is what I would say is a natural reaction to working in a really difficult situation where a lot of things don’t make sense. If you point out that it doesn’t make sense, that puts other people on edge.

The other thing I think is really important is this idea of nervous system co-regulation. We are bringing stress as people who work in the system, but everybody else is too. Patients are stressed, the nursing staff is stressed, the hospital staff is stressed, and our colleagues are stressed. Even the administrators in health care today are also feeling incredible stress. So it is not just what we are bringing, it is in reaction to what other people are bringing. That is where working on how we show up, the emotional intelligence that we can bring to it, and specific advocacy strategies is really helpful, rather than just walking into the perfect storm without a raincoat.

Kevin Pho: And you wrote in your article that a lot of times these institutions treat systemic dysfunction and instead of addressing it, they blame that individual physician. Right?

Jessie Mahoney: Yeah. Yeah. And that feels terrible. I think that is where the hopelessness and extreme frustration comes from. When we are hopeless and frustrated, we don’t actually communicate even better. Right? It creates a spiral of frustration. What I see is most of these people desperately want to stay in medicine, actually love patient care, love their jobs, and feel a tremendous sense of purpose or are mission driven.

I think it is really hard to be mission driven in a system such as we have today. In some sense, I do want to say everybody is mission driven. But the functionality of it is such a quagmire and I just use the word broken right now. That makes it a little bit like stepping on landmines right and left.

Kevin Pho: So a lot of these times they are instigated by a physician seeing a patient care issue. Sometimes it is a whistleblower situation. So what kind of advice do you have for these physicians who do want to bring it up but don’t want to risk being labeled as disruptive?

Jessie Mahoney: Well, I would say one, don’t do it when you are tired or post-call or in the moment. Be thoughtful and be intentional. I think when we come at it not from a place of blame but from a place of suggestion, it works better. When we call people out and imply that they are doing harm, for example, we come at it from an injustice point. That is not usually our most effective advocacy strategy.

So really think about how you might motivate people or inspire people by thinking outside the box. I think thinking long term is helpful. We bring our urgency to it and think this has to be fixed today. Could we really look at it long term and say: “Well, this is something that we as a system could work on. These are some ideas out of the box that I have.” This works better rather than blame, anger, and frustration, which could a hundred percent be warranted but are not a strategy to having change.

I do think that getting some kind of communication, leadership development training, or business training is important. You want to understand and put yourself on the same playing field. I think that sometimes when we are the physician on the ground, we think that is not our job. In fact, we were told it is not our job. But in medicine today, it really is our job.

Thinking about how you can be strategic is key. Ask who is the person to bring this up with? Where is the most effective place where things could change rather than just lashing out or saying what you think? You want to set yourself up for success. That is not just pausing, but bringing it up when your nervous system is regulated, bringing it up when you have energy, and bringing it up in a thoughtful way about who you should be talking to and what you want to bring up.

I also find the biggest preventive care measure is to decide really specifically what your intention in being at work is so that you can have these thoughts afterwards. Usually our intention is to provide exceptional care, connect with people, and find purpose, passion, and meaning in our work. So if we can focus on that in the moment, it doesn’t mean that you ignore all this. It just means that you are advocating from that energy.

The other energy that is super effective is to think how these people you are advocating to want the same thing as you. They want to save money. They don’t want these things. Being strategic in it rather than convincing or showing up with anger works best because anger is not usually our best convincing strategy.

Kevin Pho: And I know we have talked about this many, many times in our past conversations, that importance of the pause, right? Not acting out from a place of judgment or not acting out from a place of emotion. Having that pause so you can act in response strategically is important.

Jessie Mahoney: Yeah, and I think if you have been called out, this comes up a lot. Sometimes we have to lay low for a bit or grow a different reputation because you can’t just continue. Once people have decided that you are the one who is always bringing things up, they tend to not listen. So it is also being thoughtful about your strategy and the timing.

I love this word being strategic. And then I would say for institutions they can also make a difference. Rather than reprimanding or being punitive about it, how can they support physicians to get training and have systems for advocacy? This makes work for everybody honestly, and nobody really needs any extra work. How can we set up systems whereby we help physicians learn to advocate effectively?

I think in many ways we are set up in an adversarial setup right now, and that is not helping any of us. Sure, I have seen many institutions very clearly want to help their physicians. Nobody wants to lose a physician. Right? So when it comes to this, they are really looking at how they can support physicians and what will work. They are letting people think outside the box about what will work.

So far I think that everyone benefits from that. I mean, not so far, I think everyone will ultimately benefit from that. But I see it in action, so I don’t think organizations are against it. I think we just have these systems and it is like someone complains, so we have to respond in a certain way. Could we really look at it as a sign of needing support or a sign of burnout rather than a sign of a professionalism issue? It is a sign of needing support.

Kevin Pho: Once a physician is labeled as disruptive, and you alluded to this earlier, can they recover from that? Have you seen instances where they have recovered from that disruptive label?

Jessie Mahoney: I think so. I think it takes a very conscious intention and often a bit of a pause or a step back to be clearly showing up in a different way and beginning to lead. I often talk about leading as a lighthouse rather than being a rescue boat. If you can start not being the one that always speaks up in the meeting, but being the one who says something strategic or pointing out where you agree and where things are working, you can recover.

It takes of course more time than any of us would want. I think some people change settings because they have been labeled as that. But if you don’t work on yourself in between, you end up kind of labeled as that wherever you go. I do think people can respond from it and in fact it can be a pivotal moment where people recognize that actually this person is a leader and with some leadership support could actually be really helpful.

You might be even more effective in that role if an organization has the space and capacity. I think it depends on where you work. A more functional place would be open to this. I have seen people be able to get back to loving their work and not feeling like they have to hide in the corner, but it takes work on all sides.

Kevin Pho: We are talking to Jessie Mahoney, pediatrician and coach. Today’s KevinMD article is “Disruptive physician labeling: a symptom of systemic burnout.” Jessie, as always, let’s end with take-home messages that you want to leave with the KevinMD audience.

Jessie Mahoney: I would say two things. One is for the physicians to recognize that this isn’t a failure or a broken you and nothing to feel ashamed about, though that will be your natural response. How can you use it as a way to advocate for yourself and get extra training and make sure that you refill your own cup and learn how to advocate in an effective way? It can be a great career opportunity.

I think for the institutions, could we move away from this labeling and could we instead recognize that often these instances are calls for help or a need for support or a need for training? Ultimately maybe we could put that before these instances happened, but at least at this point, could we look at things a little bit differently? That being said, sometimes I think the labeling is what is required to get the financial support. Sometimes people will get financial support to get help or to help people recognize it as something that needs to be done. There is going to be a spot in between. But can we really work collaboratively given that I do think ultimately all of our goals are aligned, which are to have physicians continuing in medicine, enjoying it, and all working together on a system that works better.

Kevin Pho: Jessie, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.

Jessie Mahoney: My pleasure.