Advice?

[HopelessMS]

---

Members do not see this ad.

A resident appears to have an inability to control their temperament. They have had a couple of episodes of "blowing up" with complaints of a rotation and also of a misperceived wronged--->another resident went to the PD due to concerns the resident was not properly managing a patient and their medications. Then both were directed by residency head honchos to be professional so as to not create tension in the residency. However, the temperamental resident could not control themselves and became openly hostile to the resident who reported them to the PD during a meeting and now every other resident is aware of the "tension."

If the program leaders continue to brush off this blowhard's temper tantrums that continue to create an unprofessional and hostile work environment, what can residents do to encourage program leaders to finally take a stand and institute consequences?

 

[Apollyon]

The nearly nuclear option would be to call university police, or local PD, if the 'other resident' gets violent or makes people fear for their safety.

As far fetched as it sounds, I saw it happen 20 years ago. A junior surgical attending pushed a nurse in the OR. That nurse's husband was a police officer. She told him, and local PD came into the hospital, and took him out in handcuffs. I don't know the outcome of the case, but it was humiliating enough.

 

[wysdoc]

Let the PD handle it and stay away from the troublemaker. Or, if the one who is losing their temper is you, you need to get a handle on this before you are ejected.

 

[HopelessMS]

That’s the problem. The PD isn’t handling it. And staying away from the troublemaker is not a solution as attendance is required during didactics.

I need solutions not accusations.

 

[LucidSplash]

That’s the problem. The PD isn’t handling it. And staying away from the troublemaker is not a solution as attendance is required during didactics.

I need solutions not accusations.

If someone is being openly hostile still and you report to PD again with no results, you then go over PD to GME office.

But only if you feel you are actively being threatened/in a dangerous situation. Someone just not liking you and being angry at you is not a reason to do so.

Going to PD in the first place about management of a patient on a rotation probably was an overreach, should have discussed with the resident first in a non-confrontational manner ideally, or failing the ability to do that, then the senior resident on the rotation or the overseeing attending on rotation, not clear from your post if you did that first. Would have been the appropriate chain of command. Going to PD only after that if you feel patient is in danger. I’d probably bee annoyed at you too for going to PD without discussing with me or chain of command first.

Blowing up is not acceptable or professional I agree. Resident likely needs to be sent to anger management. But you should be cautious before going to GME about this.

 

[HopelessMS]

When the issue first arose, protocol was followed.

An attempt to reach out to the temperamental resident was done. There was no response. This lends credibility to the patients complaint that their messages about whether their scheduled two drug dose or frequency had changed were not being answered.

The second episode regards same patient and refilling of their scheduled two drug and if they did not get it filled they would have gone into withdrawal. Going to leadership about this was because of the nature of the drug, patient safety, and the initial failed attempt by the temperamental resident to not respond to the initial reach out attempt. There was no guarantee the resident would have responded in a timely manner to patients request.

The company code of conduct requires that managers knowing of harassment or hostile workplace environment are required to go to people services. This was not done during the first blow out. The resident also actively disregarded the directive from the associate director to not bring their displeasure out in the open during didactics regarding the refilling of patients medication.

 

[Saddleshoes]

That’s the problem. The PD isn’t handling it. And staying away from the troublemaker is not a solution as attendance is required during didactics.

I need solutions not accusations.

You don't know the PD's plan of attack.
One common way to handle cases like this is to give the problem child time and space BUT record everything.
Then, after the record is overwhelmingly clear, use the record to toss the problem case out of the program.

 

[NotAProgDirector]

Involve HR. They will take any unsafe working environment very seriously. However, understand that if you do this, the process can rapidly spiral out of your control. So I would start with a sit down with the PD, raise your concerns again, and tell them that if the behavior continues you'll need to file an official HR complaint.

 

[HopelessMS]

The hospital has let go or not renewed physicians contracts while I have been in residency for failure to adhere to hospital core values two of which are respect and professionalism towards colleagues and staff.

Blowing up twice, creating tension, and not following a directive from a supervisor, I would say show disrespect and unprofessionalism, violating the core principles of the hospital in addition to any ACGME principles.

 

[LucidSplash]

The hospital has let go or not renewed physicians contracts while I have been in residency for failure to adhere to hospital core values two of which are respect and professionalism towards colleagues and staff.

Blowing up twice, creating tension, and not following a directive from a supervisor, I would say show disrespect and unprofessionalism, violating the core principles of the hospital in addition to any ACGME principles.

But you have no idea how long it took the hospital to come to that plan of action, because as a resident you have a fairly short timespan to observe. So you saw people let go for unprofessionalism but that may have been years in the making. Hospitals will often try to rehabilitate first with anger management etc. especially for a full attending because it is expensive to recruit new docs.

So you should discuss with the PD again before doing anything else because you don’t know the PD’s plan and it is possible PD not aware of continued issues.

Despite what some people post on SDN, it is actually somewhat difficult to fire a resident as there are specific procedures and steps that have to be taken before getting to that point.

Talk to your PD then assess from there.

But I’m still not clear on what you mean by tension or temperamental in the aftermath of the initial incident and if this is truly a hostile/hazardous working environment or of this is a case where two people just don’t like each other and one is being a bit of a dick. No one here can really assess that without more granularity but you don’t have to provide that if you don’t feel comfortable. But recognize it does limit some of the ability to assess a situation and give advice.

 

[HopelessMS]

Appreciate the advice but just to clear up the definition of hostile work place environment. It is not narrowly tailored just to physical safety.

A hostile work environment is defined as a workplace where unwelcome conduct creates an intimidating, offensive or abusive atmosphere, violating legal standards set by the EEOC. This may include unwelcome conduct such as: Harassment.

There will be a meeting with residency leadership and I will bring up some of the solutions on this post and see what they have to say.

 

[comp1]

I'm still not clear on the OP's exact relationship to everyone else involved, but there are clearly some amazingly strong emotions involved. My advice, as others have put, is to stay the heck out of this drama. The OP does not need to get caught up in this and affect their own graduation. Residency is time limited and residents have extremely limited ability to affect change beyond reporting an issue to the program director, which was done. That should be the full extent of the OP's involvement in the situation described. There is not a physical risk of danger described anywhere here, there is no justification for going beyond the program director. Going beyond the program director for what are literal arguments does indeed risk extreme uncontrolled spiraling. A problem co-resident being in shared didactics does not prevent the OP from limiting engagement to the minimum possible amount, politely. Now that the program director has escalated this to some sort of residency meeting, my advice to the OP is to firmly limit comments to minimum extent possible there as well. No one has to like, appreciate or agree with every resident they work with. Now if there is a threat of physical violence, that is different, but that is not at all what was described here.

 

[wysdoc]

That’s the problem. The PD isn’t handling it. And staying away from the troublemaker is not a solution as attendance is required during didactics.

I need solutions not accusations.

You got in the middle of this: (quoting you) "to the patients complaint that their messages about whether their scheduled two drug dose or frequency had changed were not being answered."
Maybe the resident has a plan in place to taper this patient's "schedule 2 drug dose" and had reasons for not responding to the patient's request.
Not your patient, not your name on the prescription I assume, so not your problem.

 

[HopelessMS]

I didn’t get into the middle of it by choice. I was on call and patient called while I was in clinic. I had to answer the call.

Now she is messaging me not the temperamental resident because I was responsive to her original message while on call.

It’s moot now as patient has been reassigned to another resident.

 

[Goro]

That’s the problem. The PD isn’t handling it. And staying away from the troublemaker is not a solution as attendance is required during didactics.

I need solutions not accusations.

Tell HR? Just sounds like a hostile working environment

 

[operaman]

Seconding the advice to be careful. Never forget that HR or “people services” or whatever your shop calls it is not there to protect you. They’re there to protect the institution. Their goal is not to make your work environment less hostile, but rather minimizing the hospital’s risk of being sued for hostile work environment. There’s an important but subtle distinction in there. Sure, at times their protective nature may also benefit your interests, but they can just as easily turn on you if it seems like a safer way to go.

Nobody is going to like you for bringing in GME or HR. “Thank god someone called HR” said no one ever. If you talked to your PD and they’re handling it, then to go over their head implies you don’t trust or respect them. Just because you don’t like the way they’re handling it doesn’t mean it isn’t being handled. There may be extenuating circumstances that aren’t public knowledge.

If you’re going to go nuclear, better be certain you’re a stellar resident yourself. This kind of thing can land you under the proverbial microscope, and one need not read far down this forum to find stories of residents who got pushed out for less. And if they do that I’m sure you can litigate, claim it’s retaliatory, and if you’re lucky in 4-5 years after countless hours invested and no closer to board certification, you’ll “win” your suit when your hospital settles with your attorney who’s been working on contingency and tells you to accept the meager settlement or start paying the costs out of your own pocket.

Best thing to do is stay under the radar, be a good resident, and learn when to let things go. Make it your goal on your graduation day for your chairman to look you square in the eye and ask, “where did you train?”

Under. The. Radar.

Let the crazies self destruct.

 

[HopelessMS]

I appreciate the advice provided by all. True I don’t know what leadership has in mind to address the situation. I kept silent when the resident violated the ADs directive to keep everything on the low. It took all my effort to not respond in kind.

The resident is in a position that ensures they will be able to “bias” the newer residents against me with their “loose lips.” I am bound by the ADs directive to not say anything so I can’t give the other residents the context and nature of the situation.

I’m frustrated that I am honoring the directive while the temperamental one is “playing to their own set of rules” so to speak.

 

[Apollyon]

The resident is in a position that ensures they will be able to “bias” the newer residents against me with their “loose lips.” I am bound by the ADs directive to not say anything so I can’t give the other residents the context and nature of the situation.

I cannot parse how much of this is a "you" problem and how much is a "them" problem.

 

[comp1]

I cannot relate at all to the posters above who talk about going to HR and "hostile work environment." This reads very, very much like arguments between coworkers. There are no physical threats (yes, I fully get that HR definitions are broad so as to spread their influence as far as possible). Even based on the very limited information given, I genuinely believe HR could make this situation dramatically worse for everyone involved and the chance of them improving anything would be vanishingly small. I'm guessing the posters above who talk about "going to HR" haven't actually done that before or seen personally the outcomes from someone doing that. You are all indeed very fortunate.

 

[HemeOncHopeful19]

I cannot parse how much of this is a "you" problem and how much is a "them" problem.

Both OP and their coresident do not sound particularly fun to work with.

 

[shaggybill]

OP, sorry if I'm misreading but your posts make it sound like you are more interested in furthering your own agenda than you are in solving a problem. Are you in charge of this "temperamental" resident? If not, why are you so invested and involved? Just do your own work and avoid getting caught up in meaningless squabbles.

 

[HopelessMS]

I’ve been informed of leadership decision today.

 

[dozitgetchahi]

I'm still not clear on the OP's exact relationship to everyone else involved, but there are clearly some amazingly strong emotions involved. My advice, as others have put, is to stay the heck out of this drama. The OP does not need to get caught up in this and affect their own graduation. Residency is time limited and residents have extremely limited ability to affect change beyond reporting an issue to the program director, which was done. That should be the full extent of the OP's involvement in the situation described. There is not a physical risk of danger described anywhere here, there is no justification for going beyond the program director. Going beyond the program director for what are literal arguments does indeed risk extreme uncontrolled spiraling. A problem co-resident being in shared didactics does not prevent the OP from limiting engagement to the minimum possible amount, politely. Now that the program director has escalated this to some sort of residency meeting, my advice to the OP is to firmly limit comments to minimum extent possible there as well. No one has to like, appreciate or agree with every resident they work with. Now if there is a threat of physical violence, that is different, but that is not at all what was described here.

Yeah, this whole story seems incredibly bizarre to me.

OP, if this resident constitutes some sort of “clear and present danger” to *you* personally - especially if they are a physical threat - then yes, potentially go above the PD. (But even then, tread carefully, because HR involvement can become a major quagmire that can really blow back onto you.)

If this other resident is basically just acting like a douchebag - “anger management problems”, irresponsible, bad personality, whatever - then just stay away from this person and do not touch this issue with a 10 foot pole. You’re a resident, which means you are very vulnerable and have minimal power in this situation. It is not your job to police this person’s behavior.

 

[CopaceticOne]

I’ve been informed of leadership decision today.

And….?

 

[mistafab]

There are multiple sides to this:
1. The hot head will get what's coming to them. A PD will not necessarily inform you about their actions on the resident privately. Use appropriate methods and leave it in their hands.
2. The 'hall monitor' so to speak i.e. the resident who continues escalating the issues is out of line. Institutions DO NOT like to have people in their ranks who are frequently escalating things, they are labeled as a problem. Proceed with caution. If it is a Title IX problem, use the appropriate pathway. If it is a PD problem, use the appropriate problem. If it is a GME problem, use the appropriate pathway. Do not go above and beyond to make it your mission to get retribution when you are not privy to the repercussions they are facing (nor should you be).
3. The "tension" felt in the residency program - boo hoo. Learn to work with people you don't like. Use appropriate channels and keep it professional.