Anyone dealing with disruptive physicians at your facility. If so what's your approach. I ask b/c we have one that has a long history of poor behavior long b/4 our anesthesia group arrived. However, my partners and I are not the type to tolerate it like the past groups did. So we have petitioned administration and they have agreed to this point that something needs to be done. THe problem is that this physician makes some of my partners very leary of working with him b/c of malpractice issues. This physician points fingers at everyone but himself when things don't go well. For example, he did an AV fistula on a very sick pt that we cancelled 2 days earlier b/c she wasn't ready for surgery (it wasn't emergent). He stated that he needed a GA or very deep sedation on a pt with well documented gastroparesis due to DM. The anesthesiologist said that that meant a tube and that he needed to do it under local like the rest of the country. He got very upset as you can imagine and demanded a GA. Now I wasn't there but the case went well and the pt was extubated and was brought to PACU doing well after 2 hours of GA with 300 cc IVF. Shortly after arriving in PACu she had resp difficulties and hypotension. She was re-intubated and put on pressors eventually and admitted to the ICU. He blamed the anesthesia. Fine, maybe but maybe it was the AV fistula as well that put the pt in CHF. When this was brought up he stormed out and made a deragatory comment about the anesthesia. Well, we decided that enough is enough and have made a move to "fire" this surgeon from our services. I tell this story b/c many of you residents and early PP guys may never have seen this or much less had to deal with this. You have resources. Every facility must have a disruptive physician policy. If you document events and submit written complaints, the administrators must deal with the issue. It is JACHO mandated as of this year.