Office gossip, power struggles, employee burnout, and short fuses are becoming more the rule than the exception in running a medical practice. The difficult conversation avoided today can turn into the lawsuit 15 years later. Managers often find it hard to confront high performers and authority figures in the workplace. In order to deal with disruptive behavior and incivility before it ruins the medical practice, practice managers should institute the four steps outlined in this article plus the Vow of Personal Responsibility to improve clarity, teamwork, and personal performance.