All Branch Topic (ABT) Formally Counseled next actions to take

[Slevin]

Briefly a patient was eavesdropping on a conversation that I was having with another provider behind a closed door regarding their care/treatment plan. The soldier got upset because as they were eavesdropping they heard that I didn’t believe their chief complaint and decided they wanted to initiate an investigation claiming I violated their privacy resulting in a formal counseling. Commander initiated a investigation resulting in this formal counseling. The clinic on the other hand found no violation occurred and there was no suspension/loss of privileges.

I still wish to complete a military residency and I'm assuming a formal counseling would negatively impact my chances at a military residency. I'm about 1/2 though my payback. So what options do I have? Can I reject the counseling and request a court martial? Should I just accept the counseling?

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[Gastrapathy]

Get the details off the internet now. Way too specific about the patient. Formal counseling means a page 13, a plr, or a nplr? Was this njp?

 

[Slevin]

I'm not sure what the exact counseling will be all I know is that it'll be a formal counseling... I found out about this counseling around 1700 so it was late in the day and I couldn't do more investigation about it.

 

[Gastrapathy]

Counseling can be a letter that goes in the COs desk or something sent onward. I'm not sure of the Army particulars. You probably can't refuse counseling unless this is njp.

 

[Monty Python]

If policy allows, either have JAG with you when you're presented with something to sign, or tell the boss you wish to consult JAG before signing anything. Is there an Army reg which specifies the process and procedure for a formal counseling? Your military HR office might know.

 

[ArmyTiger]

Is the command considering article 15 action? Are they talking about a commander's letter of concern? Is it a commander's inquiry? Or does this commander just want to have a counselling session and fill out a DA 4856 as a prelude to further action? Your response is going to be different for each, but as the severity increases, and the likelihood of punishment increases, you should be quicker to ask for a lawyer.

That said, this sounds like a formal counseling statement that this commander wants a paper copy of. In that case, this is probably one of a number of things this commander doesn't like that you're doing, and he's building a formal case to go further with. Figure out how to appease the commander if possible. That's the easiest way to make this not happen again, or have the situation escalate.

 

[Ziehl-Neelsen]

Is the command considering article 15 action? Are they talking about a commander's letter of concern? Is it a commander's inquiry? Or does this commander just want to have a counselling session and fill out a DA 4856 as a prelude to further action? Your response is going to be different for each, but as the severity increases, and the likelihood of punishment increases, you should be quicker to ask for a lawyer.

That said, this sounds like a formal counseling statement that this commander wants a paper copy of. In that case, this is probably one of a number of things this commander doesn't like that you're doing, and he's building a formal case to go further with. Figure out how to appease the commander if possible. That's the easiest way to make this not happen again, or have the situation escalate.

Mostly agree with the above.

If it's a DA 4856 it represents a developmental counseling form that stays in your local personnel file and is destroyed when you PCS. Nobody except the company staff and the commander who delivered the counseling knows that it exists. This type of form is the first step in constructing a "paper trail" in case more severe, punitive actions are desired--in order to make NJP stick command needs a "paper trail" documenting deficiencies, warnigs, and attempted corrections. While it may mean that the commander doesn't like you, it's often done just to have something in the file in case someone becomes a problem later on and it needs to be used to justify more adverse actions. Sometimes it's the act of a benificent commander who has higher ups who want more severe punishment--it's an "adverse" action that satisfies those who want blood but has no real consequences. If its just a DA 4856, note your objection to the findings in the appropriate section, keep your nose clean, and move on.

If they are talking article 15, GOMOR, or commander's letter of concern I would advise having legal representation.

 

[Pannu86]

Briefly a patient was eavesdropping on a conversation that I was having with another provider behind a closed door regarding their care/treatment plan. The soldier got upset because as they were eavesdropping they heard that I didn’t believe their chief complaint and decided they wanted to initiate an investigation claiming I violated their privacy resulting in a formal counseling. Commander initiated a investigation resulting in this formal counseling. The clinic on the other hand found no violation occurred and there was no suspension/loss of privileges.

I still wish to complete a military residency and I'm assuming a formal counseling would negatively impact my chances at a military residency. I'm about 1/2 though my payback. So what options do I have? Can I reject the counseling and request a court martial? Should I just accept the counseling?

Does the provider you discussed with could have something to provide care to the patient? In other words can you establish a need to know base for the provider you discussed his case with? If yes, then you could say that you were contemplating referring this patient to him for his care or a second opinion or a consult. I am not suggesting you falsify anything but suggest you consider this if it could help.

 

[IlDestriero]

Sounds like a curbside consult, unless you were openly mocking the soldier or whining about your clinic full of malingerers.
It is not clear from your description.
Usually I wait until the patients and their families are no longer there before I openly mock them, and always out of potential earshot of patients.
Maybe it is a sign to get out and go with civilian training. .mil GME is often average at best. A GMO should be able to dazzle them with tales of your heroism and clinical acumen, scoring you a strong civilian residency slot.

 

[Gastrapathy]

Do you think what you did was inappropriate? Was the patient listening at the door because your skepticism was evident to the point where the insult had already occurred and then was confirmed? Do you believe your discussions about a patient should be protected from the patient? Have you seen so many malingering slugs that you lack empathy now? Were you right?

I'd do some introspection before you go meet the boss. If I were your boss, you can bet we would have a chat and the outcome would probably hang in the balance.

Given the intensely personal nature of the chief complaint, you're lucky you don't face a privileging action.

 

[bustbones26]

Do you think what you did was inappropriate? Was the patient listening at the door because your skepticism was evident to the point where the insult had already occurred and then was confirmed? Do you believe your discussions about a patient should be protected from the patient? Have you seen so many malingering slugs that you lack empathy now? Were you right?

I'd do some introspection before you go meet the boss. If I were your boss, you can bet we would have a chat and the outcome would probably hang in the balance.

Given the intensely personal nature of the chief complaint, you're lucky you don't face a privileging action.

Definitely learn from the lesson. We all complain about our patients to our colleagues. You don't need me or anybody else to lecture you, learn and move on.

But this is not the end. I agree with a previous poster. Just get out while you can. I believe that in the "real world" what would happen would be that the patient would file a formal complaint with your state medical board (at worst), you'd higher a lawyer that would take a willy nilly complaint behind the woodshed for a spanking and that would be it. It is not immoral, unethical, or malpractice to doubt the legitimacy of a patient's complaint. But again, take it as a lesson.

 

[Monty Python]

Regardless the final outcome of this particular event (and I wish you the best), a take-home lesson is that the walls EVERYWHERE have ears. Elevators, stairwells, parking lots, bathrooms, locker rooms, etc. And I've seen some incredibly thin clinic walls which essentially serve to transmit conversations through them. Carefully check six (and entire 360) before openly discussing xyz of a sensitive nature with someone else.

 

[Gastrapathy]

Didn't mean it as a lecture but rather some stuff he should think about and answers to prepare before he wanders into the command suite. Not all COs are hell-spawn but he risks significant pain here. BTW, doubting the legitimacy of a patient's complaint is not unethical in isolation, but the way that is communicated can certainly be deeply offensive (my wife was accused by a pediatric subspecialist of noncompliance with our child's care because the treatment always works and didn't, she had been compliant like clockwork and was really pissed). My concern would be how often the OP see's his patients in this light. We have to wade through so much BS to find the patient with the real disease that it can make cynics out of saints. This is particularly true in GMOs.

 

[Slevin]

Found out it's going to be a 4865 so not going in my record.

Gastrapathy totally understand your point of view and maybe I did appear skeptical with the soldier when he presented but this soldier is one of the 10% that make a GMO's job difficult. Multiple missed appointments with specialists, conflicting stories to not only myself but to other providers, comes to sick call and when I don't give them quarters they'll go to the local MedCen use the ER and to be placed on quarters, etc. and then there is the administrative issues that the company is dealing with so when looking at the whole picture it's easy to become a skeptic but I probably let that show during the appointment

 

[DrMetal]

Found out it's going to be a 4865 so not going in my record.

Gastrapathy totally understand your point of view and maybe I did appear skeptical with the soldier when he presented but this soldier is one of the 10% that make a GMO's job difficult. Multiple missed appointments with specialists, conflicting stories to not only myself but to other providers, comes to sick call and when I don't give them quarters they'll go to the local MedCen use the ER and to be placed on quarters, etc. and then there is the administrative issues that the company is dealing with so when looking at the whole picture it's easy to become a skeptic but I probably let that show during the appointment

Utterly ridiculous. I feel your GMO pain. Not only will this "4865" never make it to your record, but your superiors probably don't know how to get it into your record even if that was their intent. Getting something into someone's record usually requires at least an NJP and a good chunk of admin (something your supervisors probably aren't willing to do right now). This is just a scare tactic. The want to see you sweat. So my advice would be to act all concerned and worried when you talk to your supervisors about this, that reaction is really what they're looking for. Know in your mind though that this probably isn't going to affect you one bit, you'll promote just fine, you'll compete for your chosen residency all the same (unless your superiors involved now end up being future PDs). Oh and I'd refuse to help out that kid any more, let him seek his healthcare elsewhere. Enough already . . .

 

[orbitsurgMD]

Don't go into the particulars here, but make sure that you have detailed the train of facts that make you suspect this patient is malingering: the original complaints, the recommendations to see a specialist and the repeated failures to do so, everything relevant to the concern the patient isn't truthful. If you have to defend yourself in formal process, you should have recorded the facts that support you.

You may be correct and probably are. You may not have confronted the patient with your concerns, and I am not suggesting you have or should have. This complaint may be retaliatory for expressing your concern and to undermine your professional opinion by creating a likely insignificant privacy complaint. BTW, your patient is not entitled to expect you never to discuss a case with another provider and any professional discussions should be treated as privileged by both. Your patient sounds passive-aggressive, BTW.

The clinic response is typical bureaucratic cowardice and slavish "customer service" culture. Sorry to say, they aren't likely to be much help as their interest is to make the appearance that all issues of the "complaint" were explored and addressed and closed, and doing the "counseling" letter is the easiest way to do so. A braver and possibly fairer administrator could have closed out the complaint with a detailed report to the record detailing the facts and a conclusion that while the patient might have been unhappy with the doctor's suspicions, no breach of privacy occurred. That is uncommon in the military, with its habit of retaliatory investigations and incrimination.