Abusive attending- what steps to take.

[3dtp]

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i am totally enamored with all of the statements of getting lawyers involved and gathering evidence. don't work through the given channels but let's work behind the scenes and make a video put it on youtube like lindsey lohan. that works very well on grey's anatomy and er, but not so much in real life.

there are pluses and minuses to everything that may be proposed. there are systems in place for you. the ACGME provides the guidelines of what to do in an anonymous way Complaint Procedures they have even made a statement to residents and medicals students about how they are in the process of rectifying situations Letter to Residents from the ACGME

i truly recommend that people work with the system in place to help your situation. the malignancy of the past is changing and not well tolerated today. i think that you may be surprised. http://www.acgme.org/acWebsite/resInfo/ri_complaint.asp

PediBoneDoc,

I suggest you re-read these procedures quoted. I have personally had conversations with David Leach in this arena. The ACGME will, in fact, not accept an anonymous complaint. They will not guarantee anonymity. They will not intervene on behalf of a resident aggrieved. This is very clear in the language of the documents you cite.

I call your attention to sentence number 2 in the complaint document: "The ACGME will not intervene on behalf of an individual complainant regarding matters of admission, appointment, credit, promotion, or dismissal of faculty, residents or fellows." This is a clear as a shotgun pointed at your head on a bright summer morning.

Concerning what they do with the complaint, I call your attention to paragraph 6. "During the period when the complaint is being processed, the Complaint Officer shall maintain the relevant correspondence in a case file that is separate from the official program file. When the case has been closed, the file shall not be retained." i.e, they throw it away.

Second, the resident has to go through the institutional channels, prior to contacting the ACGME. While this may work in a large university GME program, just how is this going to work in the 350 bed community hospital? They say they will attempt to maintain confidentiality, but after requiring you to go through those channels, what is the probability of that?

The second reference is Dave Leach's letter to residents concerning the 80 hour rule, which we all know is widely violated. This has been extensively published, and the departments have ways of subverting the surveys.

Chances are the DIO and the PDs go golfing on Saturdays. And you don't think they will circle the wagons? ChildNeuro is right. Forgive me for not being ready to sign onto your theories, but I've been around the block have seen lots and lots of bad stuff and I'm not buying it. The rules are there to provide the institutions a legal trail to reach the goal they wish. If they are evil, then they will retaliate and do so in such a way as to render it impossible to prove.

Unless and until this system has some fundamental checks and balances, and that means Congressional legislation and amendments to the CMS regulations governing GME, with teeth, the beatings will continue.

What is required? For honest institutions such as your, probably nothing.

For dishonest institutions and programs and those who run them, a strong Whistleblower protection regulation and an inspector general's office from CMS who will take the enforcement of regulations seriously.

It is in the public's best interest to provide an alternative protection. It is in the public's best interest to insure that those programs take their job of medical education seriously and that those who would protest abuse, waste and fraud would be protected.

While the ACGME may be able to squelch the most blatant abuses, they chose not to protect individual residents. Until there is an alternate protection, such as depriving an program of its IMEA or DMEA or both funds if it retailates, then you speak up at your personal peril.

 

[PediBoneDoc]

3dpt,

all of you points are valid.

as far as confidentiallity,

"If the complaint involves failure of a program or institution to provide due process, the name of the complainant must be used when a response to the allegation is requested from the Program Director or institutional official. In all other cases, the ACGME shall keep the name of the complainant confidential throughout its processing of the complaint, except when a complainant specifically waives the right to confidentiality."

i think that is the official statement.

truthfully, you have a better chance of working through the system than trying to build a case against one person who you work with on occasion. Most hospitals have stances on hostile work environments, your GME also has stances.

i believe you have a better case if you have official documentation of such grievances. this is not something that is only seen in the medical field, it is prevalent throughout society. my sister, a lawyer, had a hostile boss, also a female. everyone in the office knew. it was no secret. she tried what you are proposing. tape recorder in the bra, taping incidents of abuse or hostility. in the end, she ended up quiting.

i work though things in our hospital like this, resident issues with staff, the chief discusses with the chairman/PD, our chairman discusses with the involved parties. we try to keep hospital and ACGME out of our business as much as possible.

3dtp, you are right, in our program we are pretty honest. it comes from the top down. and as for the 80hr thing, i get tired of this, quoting an article whose data comes from 3yrs ago. not a current assessment of work hours. then again, i am biased because our residents that call once every 5 days.

 

[dutchman]

i am totally enamored with all of the statements of getting lawyers involved and gathering evidence. don't work through the given channels but let's work behind the scenes and make a video put it on youtube like lindsey lohan. that works very well on grey's anatomy and er, but not so much in real life.

there are pluses and minuses to everything that may be proposed. there are systems in place for you. the ACGME provides the guidelines of what to do in an anonymous way Complaint Procedures they have even made a statement to residents and medicals students about how they are in the process of rectifying situations Letter to Residents from the ACGME

i truly recommend that people work with the system in place to help your situation. the malignancy of the past is changing and not well tolerated today. i think that you may be surprised. http://www.acgme.org/acWebsite/resInfo/ri_complaint.asp

Completely unacceptable. The "system in place" is tilted heavily in favor of the supervisor and against the supervised. Why? well because some *******es decided to make everything in medicine revolve arround subjective evaluations. That has created an atmosphere of sheepish compliance in the midst of abuse. Not to mention that these programs are obviously harboring these terrorists even when they know there is a problem. Hidden videos and lawyers should fix the problem. Hell, if the program wants to jeopardize your career just because you refuse to take abuse from some idiot, then make sure they pay for you early retirement.

 

[PediBoneDoc]

dr. dutchman so i guess laws and rules mean nothing. yes, let be in favor of the vigilante. lets do a little V for vendetta. i enjoyed the movie.

problem is that many view the attending staff as somewhat untouchable. contrary to popular belief, bad behavior is less tolerated these days than in the past. i can attest to this in my own institution where an attending's contract was not renewed because of bad behavior. systems are not slanted, people are slanted.

if it is a bad situation or politics, it needs to be changed. a hostile work environment can be changed. i recommend against being a vigilante, you have now guarantees that this will work and no formal documentation that the hospital or program turned a blind eye to this person. yes, you will have tapes, video, youtube whatever. that is all against the one person. does it prove that the institution turned a blind eye or was aware. no. so the program fires the one person. will that change the culture, may be. one bad seed gone.

again, do what you will. you chances of improving the situation by formally documenting things is i think is better than yu chance of video taping or recording an altercation.

 

[dutchman]

dr. dutchman so i guess laws and rules mean nothing. yes, let be in favor of the vigilante. lets do a little V for vendetta. i enjoyed the movie.

problem is that many view the attending staff as somewhat untouchable. contrary to popular belief, bad behavior is less tolerated these days than in the past. i can attest to this in my own institution where an attending's contract was not renewed because of bad behavior. systems are not slanted, people are slanted.

if it is a bad situation or politics, it needs to be changed. a hostile work environment can be changed. i recommend against being a vigilante, you have now guarantees that this will work and no formal documentation that the hospital or program turned a blind eye to this person. yes, you will have tapes, video, youtube whatever. that is all against the one person. does it prove that the institution turned a blind eye or was aware. no. so the program fires the one person. will that change the culture, may be. one bad seed gone.

again, do what you will. you chances of improving the situation by formally documenting things is i think is better than yu chance of video taping or recording an altercation.

Point well taken. I am not a doctor BTW.

 

[3dtp]

3dpt,

all of you points are valid.

as far as confidentiallity,

"If the complaint involves failure of a program or institution to provide due process, the name of the complainant must be used when a response to the allegation is requested from the Program Director or institutional official. In all other cases, the ACGME shall keep the name of the complainant confidential throughout its processing of the complaint, except when a complainant specifically waives the right to confidentiality."

i think that is the official statement.

truthfully, you have a better chance of working through the system than trying to build a case against one person who you work with on occasion. Most hospitals have stances on hostile work environments, your GME also has stances.

i believe you have a better case if you have official documentation of such grievances. this is not something that is only seen in the medical field, it is prevalent throughout society. my sister, a lawyer, had a hostile boss, also a female. everyone in the office knew. it was no secret. she tried what you are proposing. tape recorder in the bra, taping incidents of abuse or hostility. in the end, she ended up quiting.

i work though things in our hospital like this, resident issues with staff, the chief discusses with the chairman/PD, our chairman discusses with the involved parties. we try to keep hospital and ACGME out of our business as much as possible.

3dtp, you are right, in our program we are pretty honest. it comes from the top down. and as for the 80hr thing, i get tired of this, quoting an article whose data comes from 3yrs ago. not a current assessment of work hours. then again, i am biased because our residents that call once every 5 days.

I agree with you on most of this. As you are aware, evidence based medicine and decision making processes lag behind what is current. However, the more recent ACGME resident surveys have consistently and repeatedly demonstrated that residents at most programs do have a fear of retribution and retaliation. This is not true for my present program, but it was most assuredly true for my TY program. And from information drifting out of my TY program it continues to be true.

As for the study, it was a prospective study, which, as you know, do take time. Your questions of temporal validity cannot be answered without an addiitional follow on prospective study which will take an additional 3 years to complete and will be more difficult since many people have read the results of the first study and thus the Heisenberg Principle will be in play. If the known outcomes of the study reduces programmatic malfeasance, then so much the better.

Concerning your sister's situation, given a free market and free employment, this is precisely what the best outcome should be. One graduates from medical school, looks around for a post-graduate position and goes to work. If one does not like the position, one floats resumes on an open employment market, interviews and accepts a new position, gives reasonable notice and changes positions. Thus it is in law [and engineering and info-tech and ...].

Not so in medicine. There is a highly controlled and regulated employment environment, restricted and controlled by the COTH, LCME, ACGME and the ABMS. There are probably others as well. When it looked like Jung's antitrust suit would prevail, an 11th hour rider on a Senate appropriations bill added by Bill Frist who has close ties to a major hospital organization exempted the NRMP et al from the Sherman Act and ended the suit.

Hypothetical modification to OPs situation: law clerk 1 year post grad Harvard Law/Yale Law/Michigan Law/Stanford Law. Firm partner is abusive and creates hostile work environment. Managing partner says, tough luck kid, suck it up and you'll make partner on schedule, open your mouth again and it'll get worse.

Available options: a.) suck it up, b.) circulate cvs and find a new job. c.) quit, then find a new job.
Ramifications of a.) possibly partner, but possibly not (whiner, not a team player etc.) b.) new job highly likely in a similar line of work or specialty.
c.) new job very likely in a similar line of work or specialty.

Switching to Medicine and its arcane way of doing things the scenario changes dramatically.

Ramifications of a.) you likely will complete the program, be board eligible and find a practice without difficulty
b.) this will likely come to the attention of your program director, and even if it doesn't, you will need a letter of reference from the program director. If the program director desires your continuing services this letter will not be forthcoming, or worse, will begin a stream of harrassment. You *MUST* have permission to leave your present job!
c.) You are very likely to not find another position in your present or planned specialty. You will have gaps in your credentials which must be reported and explained not only to future prospective programs, but you will be unemployable in your trained line of work as you are not BC/BE, and possibly not licensable in your vocation in some of the several states, if not all.

Medicine is the only field that exists today in the United States where the draconian restrictions on change of position make the Soviets system appear progressive.

If it were as easy as quitting and finding a new position, then I submit that two things would happen: 1. Evil programs would improve....fast, and 2. Evil programs that did not improve...fast would soon find themselves with no residents at all or sub-optimal candidates.

Controlled markets are wonderful for those who control them. They are not so wonderful for those who must be controlled by them.