Blindsided by new duties and need some perspective. Help!

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This is completely absurd... How is threatening to leave changing anything in the system? Wow. Lol I have to say though your response is not shocking. I guess that IS exactly why people who stay in big systems end up quote unquote abuse the system and induce your rage. People like should may be a poor culture fit for big institutions and I would I would certainly encourage you to quit as quickly as possible if I was your manager.

And yes institutionally it is a quote unquote white male privilege to be all on some moral high horse about not “abusing the system”. Are you seriously for real? Am I a welfare queen? What gives you the authority to adjudicate what is and isn’t an abuse of system? Maybe YOU are the abuser of the system. Maybe you should sit down and reflect on that for a bit. Though of course not all abuser of that whole institutional culture are limited to white males.
When did attendance get racial?

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This is completely absurd... How is threatening to leave changing anything in the system? Wow. Lol I have to say though your response is not shocking. I guess that IS exactly why people who stay in big systems end up quote unquote abuse the system and induce your rage. People like should may be a poor culture fit for big institutions and I would I would certainly encourage you to quit as quickly as possible if I was your manager.

And yes institutionally it is a quote unquote white male privilege to be all on some moral high horse about not “abusing the system”. Are you seriously for real? Am I a welfare queen? What gives you the authority to adjudicate what is and isn’t an abuse of system? Maybe YOU are the abuser of the system. Maybe you should sit down and reflect on that for a bit. Though of course not all abuser of that whole institutional culture are limited to white males.

Well-known fact: it's definitely more typical for men to work part-time or have more flexibility about being the primary wage-earner in a household. Yup. That's definitely how our society is organized and how patriarchy works.

I have to believe this is a persona a la Stephen Colbert. This persona is a slimeball. This persona watches Glengarry Glenross and wishes it focused more of that Alec Baldwin character because he's obviously the hero and doesn't understand why so much time is taken up with a bunch of losers.
 
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Well-known fact: it's definitely more typical for men to work part-time or have more flexibility about being the primary wage-earner in a household. Yup. That's definitely how our society is organized and how patriarchy works.

I have to believe this is a persona a la Stephen Colbert. This persona is a slimeball. This persona watches Glengarry Glenross and wishes it focused more of that Alec Baldwin character because he's obviously the hero and doesn't understand why so much time is taken up with a bunch of losers.

Huh? LOL YOU ARE the one who's all like there should be no flexibility regarding working night shifts while calling in on sick day OR YOUR COLLEAGUES WILL HATE YOU. YOU ARE THE SLIMEBALL. What in the world? Yeah keep up the personal attacks. That makes you look real good.
 
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Huh? LOL YOU ARE the one who's all like there should be no flexibility regarding working night shifts while calling in on sick day OR YOUR COLLEAGUES WILL HATE YOU. YOU ARE THE SLIMEBALL. What in the world? Yeah keep up the personal attacks. That makes you look real good.

Oh personally I think our system does a horrific job being accommodating, welcoming, or even not actively hostile to people with families and/or disabilities. There is a very strong case for urgent change. If someone actually had a condition that prevented then from working nights they absolutely should be accommodated. I would be all for making flex time as available as humanly possible and if it is unavoidable that people work terrible hours they should be paid more for it. I am sure we agree on that.

If however your employer is uninterested in accommodating you, we part company. I think, given the impacts on your colleagues of suddenly being pulled into fill your shifts and the general chaos of having someone not turn up last minute, you owe them at least some honesty about what is happening OR you need to quit OR you should file an ADA lawsuit/make use of whatever legal remedies you have OR organize a pressure campaign etc. Basically, take some ownership of the fact that you are not okay with what you are being asked to do and exert agency in doing something about it in a relatively direct manner. If you're not willing to do any of those things, maybe you actually aren't as outraged or upset as you thought you'd be OR the job is more important to you for whatever reason than your comfort/indignation/family.

You disagree. You say that if you don't like a situation, just lie and say you're ill in a systematic and deliberate way to escape your obligations, even though you are perfectly healthy. After all, "everybody" does it and really, your manager -wants- you to call off. Even more, you calling off is basically preserving your ability to work with your other patients who would be terribly harmed if you quit and aren't you just doing something that is basically civil disobedience? You're actually a hero.

The reservation I have with this (the biggest one ,anyway) is that it feels like you can justify doing almost anything that's not actively harmful to a patient with this kind of logic. It reeks of rationalizing to assuage a guilty conscience.

This is why I think this is a persona. I don't think you in fact don't believe in any ethics or morality. Although, if that is literally true, guess I better count the silverware after you leave my house and not leave any food in the breakroom fridge because you're gonna take it if you forgot to bring your own. After all, everybody does it...
 
The reservation I have with this (the biggest one ,anyway) is that it feels like you can justify doing almost anything that's not actively harmful to a patient with this kind of logic. It reeks of rationalizing to assuage a guilty conscience.

A does not automatically lead to B. Just because I think it's ethical (and perhaps at time even, in your words, heroic) for you to call in sick (when you are not) when your institution is hostile doesn't mean that you can do anything anytime. If this is somehow not obvious logically I don't really know what else to say. Go study logic before you have a serious ethical debate.

Secondarily, your stance is not just confused, it simply does not reflect the reality. Many people don't have the luxury to actively protest or leave their job, at least for a time. And it's extremely presumptuous for you to judge me or psychoanalyze me when I do that. My arguments have completely practical in nature. People don't have to do what I suggest. I'm just pointing out a path. You don't have to go there.
 

Sometimes I do troll, but this is not one of those times. I've put up very clear arguments for my view point. They might not align with yours, but I'm not trolling. Feel free to disagree, but there's no need to judge me as a person and make snide remarks. And if you do obviously expect push back. That's not trolling.
 
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I'm not totally clear what has happened here (I haven't read every reply), but if the suggestion is to lie to get out of an assigned (even if ridiculous) duty, this is both silly and immature. There is no "gray area" here. This is kindergarten stuff. All health professionals should be prepared to work as a team member. And if you aren't, you can (or should) be in a solo private practice.

Whatever it is, for goodness sake's, be a man and do what is right! Sometimes you quit (or threaten to), sometimes you suck it up, sometimes there needs to be a mass protest or civil obedience. It all depends. But you can't honestly suggest doing something that I would admonish my 5 year-old for doing, right?
 
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Whatever it is, for goodness sake's, be a man and do what is right! Sometimes you quit (or threaten to), sometimes you suck it up, sometimes there needs to be a mass protest or civil obedience. It all depends. But you can't honestly suggest doing something that I would admonish my 5 year-old for doing, right?

See, notice this whole "be a man" thing? LOL

Being a "team member" very often means being able to appropriately handle (and generate) BS. I also don't need your career advice--doing very well managing a team AND make plenty of money doing a solo practice.

Wow, this is like seriously triggering people. Kudos to you for comparing me to your 5-year-old. Well done on the personal attacks. If I was more insecure I might get angry. Except I'm actually the one who's winning and you are the one who's getting screwed. Perhaps this is what is making you angry: corporate reality isn't going your way. In fact, in your heart of hearts, most of you know what I'm talking about and that I'm actually right about the reality of it all. That's the sad part. wolfvgang22, in particular, knows this probably all too well.

See: I can psychoanalyze too. Is this really meaningful as a way to discount a practical suggestion? I personally don't think so. But hey it's the internet, nobody cares. To each his own.
 
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For the medical students and residents reading, please take note that what Sluox is suggesting would be considered unprofessional by most Physician colleagues and is precisely what the extra professionalism courses your medical school and residency have been piling on are continually trying to reinforce against. What Sluox is describing is not what I or most would want in a Physician professional colleague.

If faced with a difficult work environment, strive to do what's best for the patients immediately and then for yourself professionally secondly. Real example, I worked a health system job, that was understaffed, didn't appropriately utilize my skill set for systems based care, disregarded elements of my contract, etc, etc. I expressed my grievances, as a professional, they were denied, I shored up my clinical duties and finished out my resignation period. Second example, I stumbled into a for profit inpatient hospital job, clinical aspects were not to my personal standard of professionalism. Staffing was quite concerning. Corporate culture was concerning, and Q2 call was also avoidable. I submitted my resignation and moved on.

Unsavory jobs are not the only option. Professionalism does, and can flourish, seek it out, or create it in your own private practice.

I feel like I have been trolled...
 
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I'm not going to weigh in here, I've been interested in both perspectives. Sloux's ideas called a particular The Last Psychiatrist (you may or may not have read the blog) opinion/post Pretty interesting discussion of the concept of "the grift."

 
Granted I'm a know-nothing med student but from my perspective: what's the big deal? One shift? Your org obviously needs help bridging the gap and they're willing to reduce other responsibilities in the mean time. Doesn't seem like a big deal to me.
 
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Granted I'm a know-nothing med student but from my perspective: what's the big deal? One shift? Your org obviously needs help bridging the gap and they're willing to reduce other responsibilities in the mean time. Doesn't seem like a big deal to me.

Wait until you are older. One shift per week is significant when it takes 2-3 days to recover. You do this every week and you’re hung over almost half the time. Shift work is also a cardiovascular risk factor. I get quoted $2-300/hour for similar moonlighting work and have declined for the above reasons. Doing it for free is a hard pass
 
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Wait until you are older. One shift per week is significant when it takes 2-3 days to recover. You do this every week and you’re hung over almost half the time. Shift work is also a cardiovascular risk factor. I get quoted $2-300/hour for similar moonlighting work and have declined for the above reasons. Doing it for free is a hard pass

Yea thats a fair point, I guess I was assuming OP would be able to work in a fair compensation if this were to be a longer term thing.
 
Yea thats a fair point, I guess I was assuming OP would be able to work in a fair compensation if this were to be a longer term thing.

For whatever reason OP doesn't want to and to roll over for rule changes when the game is in progress is a slippery slope.
Two pieces of advice I have found valuable:

1. Do not fall for the Team Player shaming strategy when it comes from admin
2. No good deed goes unpunished

As they say the hospital won't love you back.
 
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For the medical students and residents reading, please take note that what Sluox is suggesting would be considered unprofessional by most Physician colleagues and is precisely what the extra professionalism courses your medical school and residency have been piling on are continually trying to reinforce against. What Sluox is describing is not what I or most would want in a Physician professional colleague.

If faced with a difficult work environment, strive to do what's best for the patients immediately and then for yourself professionally secondly. Real example, I worked a health system job, that was understaffed, didn't appropriately utilize my skill set for systems based care, disregarded elements of my contract, etc, etc. I expressed my grievances, as a professional, they were denied, I shored up my clinical duties and finished out my resignation period. Second example, I stumbled into a for profit inpatient hospital job, clinical aspects were not to my personal standard of professionalism. Staffing was quite concerning. Corporate culture was concerning, and Q2 call was also avoidable. I submitted my resignation and moved on.

1. in the example here, you literally wouldn't know if I didn't tell you, so there's nothing for you to resent me as a professional colleague.
2. the fact that you dropped 2 corporate jobs and ended up in PP actually is very good evidence of my point. if you want to survive in corporate for the long haul, you need to know how to not burn out. There's a separate point there which is perhaps people who end up in PP generally have a higher degree of "professionalism", as corporate culture is in many ways anti-professionalism. At the end of the day, being burnt out or quitting is not particularly good for patients either, so you pick your battles.

You haven't been trolled. It's just that I'm speaking on the side of the management that you dislike and just giving you a flavor of what that side is like and how they think. It's non-intuitive and almost paradoxical for a rank-and-file employee. But to a certain extent you and I both know that it is the reality. The reason you quit is that you didn't want to be that guy. I'm just spelling out exactly what being that guy means.
 
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1. in the example here, you literally wouldn't know if I didn't tell you, so there's nothing for you to resent me as a professional colleague.
2. the fact that you dropped 2 corporate jobs and ended up in PP actually is very good evidence of my point. if you want to survive in corporate for the long haul, you need to know how to not burn out. There's a separate point there which is perhaps people who end up in PP generally have a higher degree of "professionalism", as corporate culture is in many ways anti-professionalism. At the end of the day, being burnt out or quitting is not particularly good for patients either, so you pick your battles.

You haven't been trolled. It's just that I'm speaking on the side of the management that you dislike and just giving you a flavor of what that side is like and how they think. It's non-intuitive and almost paradoxical for a rank-and-file employee. But to a certain extent you and I both know that it is the reality. The reason you quit is that you didn't want to be that guy. I'm just spelling out exactly what being that guy means.

Ahh, why didn't you say you were just trying to present the viewpoint of management and educate us about the corporate perspective? It all makes sense now, the analogies with colonial independence movements, since they were all so famously corporate.

Who can forget the immortal words of Mohandas K Gandhi: "f*ck britches, get money"

Seriously though, the posts do help us understand what being that guy means. In this instance, it means being you.
 
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Seriously though, the posts do help us understand what being that guy means. In this instance, it means being you.

I don’t find the personal attacks helpful.

You don’t know me, I don’t know you. I am privy of certain kinds of institutional knowledge that you perhaps aren’t. I have a different perspective on what is and isn’t “ethical”. It’s best we leave it at that.

It is interesting that you are so trigged by a run of the mill HR topic. But hey I’m not your therapist—I hope you find it worth your while making snide and sarcastic remarks towards strangers on the internet. And kudos for perpetuating the idea that if you ever call out sick or do something else "unprofessional", and should your colleagues imagine that you might be "faking it", there'll be hell to pay.

For the trainees and junior attendings who are interested in organizational psychology and related topics, here are some worthwhile reading on related topics:


 
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I don’t find the personal attacks helpful.

You don’t know me, I don’t know you. I am privy of certain kinds of institutional knowledge that you perhaps aren’t. I have a different perspective on what is and isn’t “ethical”. It’s best we leave it at that.

It is interesting that you are so trigged by a run of the mill HR topic. But hey I’m not your therapist—I hope you find it worth your while making snide and sarcastic remarks towards strangers on the internet. And kudos for perpetuating the idea that if you ever call out sick, and should your colleagues imagine that you might be "faking it", there'll be hell to pay.

For the trainees and junior attendings who are interested in organizational psychology and related topics, here are some worthwhile reading on related topics:



I'll try one more time because maybe you are being sincere. I have no problem with people calling out sick, when they are sick. I don't even especially mind people calling out sick occasionally for miscellaneous other reasons. The system is inflexible in problematic ways, I get it. That's not what I think is objectionable and I think I've actually been pretty clear about that.

You are describing a deliberate attempt to evade a job responsibility via deception and passive-aggression that is otherwise falling on your colleagues. You advocate doing this not because of illness or some mitigating circumstance making it necessary, rather, because you are a chump if you do not (I think your words were "your naivete is showing" upthread). You justify this by citing heroic nonviolent resistance, stating that I am disagreeing because I am jealous of how much money you make, and then citing your experience in management as justifications for why it is actually laudable. We'll set aside the accusations of being triggered and needing a therapist for now, apparently because I disagree with you.

I believe you that the attitude that this is how you should handle these situations might be prevalent in HR. I have no intuition about that and certainly have never worked in HR. However, I don't see any reason for looking to a discipline that to a first approximation is based on organizational expediency and legal compliance for principled moral/ethical arguments. It's fundamentally orthogonal to the objection people are raising.

At the end of the day, @sluox , do you share the intuition that something is morally problematic about elevating yourself above your colleagues and securing special dispensations just because you are more willing to fabricate an illness?

Put aside everything else. Boiled down to the essentials, does that strike you as bad in any relevant way? This is not a gotcha, I am dead serious about trying to clarify our point of disagreement.

If you share that intuition at all, and sharing it does not mean that you are conceding anything beyond that, I think we can have a productive conversation about how we have reached so wildly different conclusions.

If you genuinely do not share that intuition at all, then a productive conversation is probably not possible and I am done engaging with you on this. Our ethical systems are just too remote from each other.

So what say you? Set aside the personal and try to figure out how we ended up disagreeing so violently?
 
At the end of the day, @sluox , do you share the intuition that something is morally problematic about elevating yourself above your colleagues and securing special dispensations just because you are more willing to fabricate an illness?

Put aside everything else. Boiled down to the essentials, does that strike you as bad in any relevant way? This is not a gotcha, I am dead serious about trying to clarify our point of disagreement.

Sure. Here's how I think about. I don't elevate myself above my colleagues morally who attempt to secure special dispensations for reasons that some others might be considered "nefarious". Just because I perhaps don't need to do it doesn't make me a better person. In particular, the point I am making is that it's very hard for me to make a judgement as to whether someone is "faking" or not, and no reason for me to make inferences one way or the other. If someone decides to "fake it", perhaps he or she has reasons to do so, and institutionally we should be more considerate of their circumstances, instead of expediently saying this is "morally problematic" or "abuse the system". I am pointing out sometimes there IS something laudable about people who, rather than throw a fuss, decide to "passively resist" in some shape or form that they feel comfortable, even though you might consider it "passive-aggressive". I also point out that these strategies have a longstanding history and the ethical justifications have also had many precedences, and Gandhi is an example of this.

In particular, as I said before, several of my patients needed me to help them do it, and I do not categorically refuse out of "moral principles", even when I sometimes don't think that telling them to go back to work as soon as possible is the right thing clinically. Of course, someone like you would be telling me that I'm helping them to "lie" and that's morally reprehensible. We disagree with that perspective. But as an addictionologist, I'm sure there are many such circumstances you might find my clinical practice morally reprehensible: for example, I often allow and sometimes even encourage my patients to lie to their parents about their drug use, if their parents, due to their ignorance, would make certain choices that would make it impossible for these patients to achieve long term recovery, etc. etc. I just don't have your way of seeing the world as this black and white thing and that lying to someone to get something means there's something automatically wrong and should be categorically forbidden.
 
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Sure. Here's how I think about. I don't elevate myself above my colleagues morally who attempt to secure special dispensations for reasons that some others might be considered "nefarious". Just because I perhaps don't need to do it doesn't make me a better person. In particular, the point I am making is that it's very hard for me to make a judgement as to whether someone is "faking" or not, and no reason for me to make inferences one way or the other. If someone decides to "fake it", perhaps he or she has reasons to do so, and institutionally we should be more considerate of their circumstances, instead of expediently saying this is "morally problematic". I am pointing out sometimes there IS something laudable about people who, rather than throw a fuss, decide to "passively resist" in some shape or form that they feel comfortable, even though you might consider it "passive-aggressive".

In particular, as I said before, several of my patients needed me to help them do it, and I do not categorically refuse out of "moral principles", even when I sometimes don't think that telling them to go back to work as soon as possible is the right thing clinically. Of course, someone like you would be telling me that I'm helping them to "lie" and that's morally reprehensible. We disagree with that perspective. But as an addictionologist, I'm sure there are many such circumstances you might find my clinical practice morally reprehensible: for example, I often allow and sometimes even encourage my patients to lie to their parents about their drug use, if their parents, due to their ignorance, would make certain choices that would make it impossible for these patients to achieve long term recovery, etc. etc. I just don't have your way of seeing the world as this black and white thing and that lying to someone to get something means there's something automatically wrong and should be categorically forbidden.

Okay, now we're getting somewhere. First, I should say I meant "passive-aggression" in the very strict technical sense. It was originally defined in basically this exact context - GIs shirking duties and systematically stalling as a way of not carrying out orders they objected to while not being openly insubordinate. In a context where you get shot for disobedience, I think it is much less blameworthy to do this than when the consequence is a couple months of inconvenience followed by a new job, which realistically is what happens when a psychiatrist quits in the current job climate.

I agree with you 100% that institutions should be more responsive to the needs of their staff. And again, we are in agreement that if there is a clear and compelling reason why someone cannot perform job duties otherwise expected of their closest comparable colleagues, something needs to be done to accomodate them. No daylight between us there; my sympathies are so not with the unreasonable demands of the institution.


The tricky part for me is when carrying out the duty will not in fact inflict greater harm on that person than on their colleagues being asked to do the same thing. Because when you secure special and unique accommodations for that reason, you are elevating yourself as more deserving than they are of special treatment. This is especially true in the case you outline because presumably if every attending starts calling out sick at the last minute and it is not part of some coordinated campaign of resistance, the institution is just going to crack down on use of sick leave with repercussions for everyone.

If the point is to resist an unfair or unjust policy, coordinate! Acting only for your own good in a way likely to bring down pain on your colleagues is objectionable for physicians more so than most jobs. We do difficult things that take a lot out of us and part of what makes the job bearable and doable is a certain level of trust and espírit d'corps with other physicians. In the role of physician you have moral obligations not present in other contexts. What you are proposing erodes that trust.

I'm not especially Kantian or categorical in my thinking. Lying is certainly not categorically wrong and for some people in some situations absolutely mandatory from an ethical standpoint. I can imagine lots of cases relevant to your drug use example where I'd find it totally unobjectionable. But when we are acting as physicians and lie to colleagues in the circumstances, with the consequences and for the reasons we have been talking about, it strikes me as far more vicious than virtuous.
 
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So I don't get it sluox...you'd be cool if someone did this to you? Like you get pulled in to cover their shift (on top of your own) every other week just because they're trying to say "F the system"?

I have to agree with the other posters. Grow a backbone and just tell admin you're not doing it unless you get paid X much (or not at all) and vote with your feet. This seems like a super weird weasly passive aggressive roundabout way to try to get fired? Or protest without actually saying you're protesting?
 
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While you guys are yapping about picking up an extra emergency psych shift I’m over here preparing to run an ICU or medicine service, ha.
 
So I don't get it sluox...you'd be cool if someone did this to you? Like you get pulled in to cover their shift (on top of your own) every other week just because they're trying to say "F the system"?

I have to agree with the other posters. Grow a backbone and just tell admin you're not doing it unless you get paid X much (or not at all) and vote with your feet. This seems like a super weird weasly passive aggressive roundabout way to try to get fired? Or protest without actually saying you're protesting?


1. I've covered many shifts for others (maternity, impromptu vacation, parent/child conference, from the most legit to the least lgit you name it) and I've never felt slighted about that.
2. I have had good friends of my who called out sick but in private told me that it was for a "mental health day". Never bothered me. Sometimes I've covered it.
3. I've taken mental health "sick days" myself. No one cares. No one remembers. Maybe they secretly hate me, though I doubt it.
4. I know of people who take sick days to avoid certain services. I partially helped out. Unclear if the sickness is truly legit. Not my problem, never bothered by it.
5. As I said above, you almost NEVER get fired for calling out sick once a while. And if you can come up a logic for being "not able to carry out certain duties because of a legit disability", they must accommodate.
6. More openly confront about pay, job duties, etc. are much more likely to get you fired.
7. You may not believe me, but it's true.
8. Management knows if lots of people call out sick (or take personal days) at the same time it means something.


While you guys are yapping about picking up an extra emergency psych shift I’m over here preparing to run an ICU or medicine service, ha.

Psych is the new derm.
 
1. I've covered many shifts for others (maternity, impromptu vacation, parent/child conference, from the most legit to the least lgit you name it) and I've never felt slighted about that.
2. I have had good friends of my who called out sick but in private told me that it was for a "mental health day". Never bothered me. Sometimes I've covered it.
3. I've taken mental health "sick days" myself. No one cares. No one remembers. Maybe they secretly hate me, though I doubt it.
4. I know of people who take sick days to avoid certain services. I partially helped out. Unclear if the sickness is truly legit. Not my problem, never bothered by it.
5. As I said above, you almost NEVER get fired for calling out sick once a while. And if you can come up a logic for being "not able to carry out certain duties because of a legit disability", they must accommodate.
6. More openly confront about pay, job duties, etc. are much more likely to get you fired.
7. You may not believe me, but it's true.
8. Management knows if lots of people call out sick (or take personal days) at the same time it means something.

You're talking about two completely different things here. We all know people who have called in sick for whatever reason, some of us would think it's legit, some not. We all know people who have taken "mental health days" (some of the people on here probably have themselves). What you're proposing is not some occasional "call out sick once in a while". You were proposing that OP call out sick every single shift he/she is scheduled to work. Quite a bit different. I think it's weird if you don't realize it's different.

Just call in sick every shift. It's easier to do if you get a doctor's note. This is usually very easy if you see a psychiatrist yourself, for example for psychotherapy. Say you are unable to do nights for psychiatric reasons, and one can come up with a half dozen of them. By law, they MUST accommodate your request.

And yeah duh openly confronting people about pay/job duties or whatever is more likely to get you terminated. That's literally what you're saying to them...that's negotiations. "I want this thing, if I don't get this thing or you're not willing to meet me somewhere closer to this thing I walk". If you're not willing to walk you have no negotiating power.
 
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You're talking about two completely different things here. We all know people who have called in sick for whatever reason, some of us would think it's legit, some not. We all know people who have taken "mental health days" (some of the people on here probably have themselves). What you're proposing is not some occasional "call out sick once in a while". You were proposing that OP call out sick every single shift he/she is scheduled to work. Quite a bit different. I think it's weird if you don't realize it's different.

And yeah duh openly confronting people about pay/job duties or whatever is more likely to get you terminated. That's literally what you're saying to them...that's negotiations. "I want this thing, if I don't get this thing or you're not willing to meet me somewhere closer to this thing I walk". If you're not willing to walk you have no negotiating power.


That's a detail. Maybe not every shift, maybe once every other shift. Maybe work getting a doctor's note. Maybe take personal days. Who knows. Who cares. If you are interested in details we can sit down and strategize.

I have had colleagues who called out frequently for whatever reasons, sometimes take personal days, sometimes call out sick. Some had "real" mental health issues through the grape vine. Some never revealed it as such to people. They get covered by various people. All of them eventually came back or had their duties reassigned. Frankly I'm not even at a position that I can evaluate whether it's fair or unfair. I just do my job and cover it. No one cares. Some of them got promoted. Some left. None of this affected their later work performance and hence institutions (and their colleagues) never had a long memory about any of this.

With regard to the second point, exactly. That's literally exactly my point.
 
...if every attending starts calling out sick at the last minute and it is not part of some coordinated campaign of resistance, the institution is just going to crack down on use of sick leave with repercussions for everyone.

If the point is to resist an unfair or unjust policy, coordinate! ...what you are proposing erodes that trust...

There is where institutional knowledge which I mentioned would be helpful.

1. typically institutions don't respond to uncoordinated mass absence, medical or otherwise, with "crackdown", as there's no evidence as such that these things are "wrong". You can't really identify malingering for reasons I already listed: high cost of IMEs, inconsistent results, legal complications. Instead, absences lead to unstaffed slots, which need a larger budget to fill. Admins don't care why people don't show up--they just need slots filled.

2. doctors are actually legally barred from organized labor tactics, which I am sure you know.

3. even if you don't formally do organized labor tactics, it's very complicated to informally coordinate with fellow physicians in negotiating with hospital. not un-doable, but very complicated--as when you coordinate you may often find unsavory things that break things apart...the whole "erode the trust" thing...

I can give you many examples: e.g. very common that physician contracts have wildly different stipulations for the same salary, or wildly different salary for the same duties. You might find people who have less seniority over you are getting paid way more. People might lie to you about what offers admin might have given to them. They might say yes I'll tell admin no, but then actually they decide that they'll cover your shift, but for 5k a night instead--except, for 5k a night, you might want to do it yourself, childcare be damned!

Have you asked others about their salary at work? Do you 100% believe the numbers they tell you? Do you immediately believe everything everyone tells you whom you just started working with and have no basis of trust?

Do you see why I think all of this is "naive"?
 
There is where institutional knowledge which I mentioned would be helpful.

1. typically institutions don't respond to uncoordinated mass absence, medical or otherwise, with "crackdown", as there's no evidence as such that these things are "wrong". You can't really identify malingering for reasons I already listed: high cost of IMEs, inconsistent results, legal complications. Instead, absences lead to unstaffed slots, which need a larger budget to fill. Admins don't care why people don't show up--they just need slots filled.

2. doctors are actually legally barred from organized labor tactics, which I am sure you know.

3. even if you don't formally do organized labor tactics, it's very complicated to informally coordinate with fellow physicians in negotiating with hospital. not un-doable, but very complicated--as when you coordinate you may often find unsavory things that break things apart...the whole "erode the trust" thing...

I can give you many examples: e.g. very common that physician contracts have wildly different stipulations for the same salary, or wildly different salary for the same duties. You might find people who have less seniority over you are getting paid way more. People might lie to you about what offers admin might have given to them. They might say yes I'll tell admin no, but then actually they decide that they'll cover your shift, but for 5k a night instead--except, for 5k a night, you might want to do it yourself, childcare be damned!

Have you asked others about their salary at work? Do you 100% believe the numbers they tell you? Do you immediately believe everything everyone tells you whom you just started working with and have no basis of trust?

Do you see why I think all of this is "naive"?

Yeah, I am aware of restrictions on organizing for physicians. I suppose I had more in mind the informal collaboration or coordination of the kind specifically described in the first article you linked as a strategy for dealing with unreasonable organizational demands.

I think there is still kind of a disconnect here. You are raising a number of reasons why what you suggested would be effective tactically. That's probably true and I'm happy to concede it. I think it is more transparent to your co-workers than you think it is, having been in situations personally where something like this was obviously what was happening, but it probably would still be effective. I also think you may underestimate the incentive of admin to staunch a bleeding wound, especially in an environment like a psych ED where just having nobody present is a legal non-starter. I have worked in places that had very liberal sick leave with no formal limits that worked as long as it was being used judiciously, but when that no longer held true, guess what? Suddenly everyone has a finite number of days without having to do STD, and definitely lower than the previous average.

Ultimately, though, that's irrelevant. I'm more concerned with the effect on character of turning up to work in a situation where you have to lie about very basic aspects of your life every day. It's one thing if you have a stigmatized identity and it's the only way to avoid severe repercussions. But we are legitimately talking about leaving an academic environment to make more money as the major consequence. The major blow would be to ego and a certain kind of prestige. Those don't strike me as good reasons for routine deception as part of daily life.

Maybe you will say that that's the reality of the corporate world. Fine. So much the worse for the corporate world.

Morality is how you behave when nobody's looking.
 
It's actually very easy to dodge this kind of thing in a big system: sick days.

Just call in sick every shift.

We have a few residents like this in our program who often call in "sick". No one likes them, no one volunteers to cover for them, and we are disdainful of them. Arguably, it is somewhat understandable that this is their way to cope with being a powerless resident. However this shouldn't be what an attending should resort to because an attending does have some power.
 
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... what you suggested would be effective tactically. That's probably true and I'm happy to concede it...Maybe you will say that that's the reality of the corporate world. Fine. So much the worse for the corporate world...

Morality is how you behave when nobody's looking.

So you basically agree what I'm saying reflects the reality and is an effective strategy. Our moral framework basically differs in that I'm essentially a consequentialist. But that's a separate issue.

We have a few residents like this in our program who often call in "sick". No one likes them, no one volunteers to cover for them, and we are disdainful of them. Arguably, it is somewhat understandable that this is their way to cope with being a powerless resident. However this shouldn't be what an attending should resort to because an attending does have some power.

Sure. I just find this silly that's all -- "not like them", what is this, second grade? This is actually "immature" (to recycle someone else's phraseology). If you think someone doesn't have a good work ethic and fakes being ill constantly, there are appropriate places you can say what you think and make it matter, like at a confidential peer-to-peer review. I actually find a lot of "lazy" people quite appealing on a personal level, but it's really for the best if you can separate work and personal feelings in a professional setting. Would it change your "not liking" if you become aware that this person who calls out sick is actually sick? What if it's a mental illness? What if it's a substance abuse issue? What if it's his or her family member who's actually sick a lot? Does any of that matter? Do you feel entitled to know this person's confidential medical history so that you can feel more or less entitled to "not like" this person?

On the flip side, I'm pretty sure those residents who call in fake sick a lot don't give a damn how the rest of you feel either. After training, you'll just part ways so it's irrelevant what you think. Let's be honest. It's not a matter of being a resident or an attending. It's just real life.
 
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So you basically agree what I'm saying reflects the reality and is an effective strategy. Our moral framework basically differs in that I'm essentially a consequentialist. But that's a separate issue.



Sure. I just find this silly that's all -- "not like them", what is this, second grade? This is actually "immature" (to recycle someone else's phraseology). If you think someone doesn't have a good work ethic and fakes being ill constantly, there are appropriate places you can say what you think and make it matter, like at a confidential peer-to-peer review. I actually find a lot of "lazy" people quite appealing on a personal level, but it's really for the best if you can separate work and personal feelings in a professional setting. Would it change your "not liking" if you become aware that this person who calls out sick is actually sick? What if it's a mental illness? What if it's a substance abuse issue? What if it's his or her family member who's actually sick a lot? Does any of that matter? Do you feel entitled to know this person's confidential medical history so that you can feel more or less entitled to "not like" this person?

On the flip side, I'm pretty sure those residents who call in fake sick a lot don't give a damn how the rest of you feel either. After training, you'll just part ways so it's irrelevant what you think. Let's be honest. It's not a matter of being a resident or an attending. It's just real life.

A morality centered around "will this materially benefit me?" is not consequentialism, it is sociopathy. All utilitarian frameworks involve summing utility across some relevant population larger than just the individual making the ethical choice. "Greatest good for the greatest number", not "how do I get paid?"

You're right that I'm not really a consequentialist, though.

People faking illnesses for personal gain not caring about the opinions of their peers on the matter is not really exculpatory. If anything it increases my estimate of the likelihood of a serious character flaw in the person in question. At least in my neck of the woods, a lot of residents stick around after graduation, and people get a reputation for all kinds of things. It definitely affects referral patterns and who years about what opportunities.
 
A morality centered around "will this materially benefit me?" is not consequentialism, it is sociopathy.

No. It's not a morality centered around "will this materially benefit me" [only]. It's a morality centered around what is the most pragmatic and practical solution that would benefit everyone involved. In this case, it is very clear what is good for me is also good for the system. As it's much worse for the system to leave than to stay and let someone else do something that I don't want to do. And it really doesn't hurt my colleague that much (if any), especially as they also basically don't participate, which then facilitates faster hiring and actually solves the systemic issue at hand.

You make lots of assumptions that I don't accept. For one thing, you make the assumption that there's some zero-sum that pursuit of self-interest is always in direct conflict with the greater good. In most systems of care, this is not the case. In particular, doctors who don't burn out, even if they work at a sub-optimal capacity, contribute much more than if they left or burn out.

It's very expedient for you to call others sociopaths without direct evidence and without consideration of the full circumstances. Which is fine, to each his own. If I were ever to manage someone like this, I'd certainly make sure that person's authority is circumscribed, as people like this are easy to spot and tend to create conflict because the tendency of everyone else as potentially morally inferior and sociopathic.

Yeh, one might wonder why it is that trainees are especially afraid of declaring illness, especially unreliable illnesses like mental illness. Because supposedly it would carry a "reputation" if you in fact become unreliable. Your rigid rules have very clear collateral damage, for which you decide to turn a blind eye. Thankfully, not everywhere is like where you live, and in many communities, your actual clinical skill and CV are clearly more important than amorphous backdoor "reputation", which oftentimes is unreliable and carries personal biases (if not overt malignant intent).
 
No. It's not a morality centered around "will this materially benefit me" [only]. It's a morality centered around what is the most pragmatic and practical solution that would benefit everyone involved. In this case, it is very clear what is good for me is also good for the system. As it's much worse for the system to leave than to stay and let someone else do something that I don't want to do. And it really doesn't hurt my colleague that much (if any), especially as they also basically don't participate, which then facilitates faster hiring and actually solves the systemic issue at hand.

You make lots of assumptions that I don't accept. For one thing, you make the assumption that there's some zero-sum that pursuit of self-interest is always in direct conflict with the greater good. In most systems of care, this is not the case. In particular, doctors who don't burn out, even if they work at a sub-optimal capacity, contribute much more than if they left or burn out.

It's very expedient for you to call others sociopaths without direct evidence and without consideration of the full circumstances. Which is fine, to each his own. If I were ever to manage someone like this, I'd certainly make sure that person's authority is circumscribed, as people like this are easy to spot and tend to create conflict because the tendency of everyone else as potentially morally inferior and sociopathic.

Yeh, one might wonder why it is that trainees are especially afraid of declaring illness, especially unreliable illnesses like mental illness. Because supposedly it would carry a "reputation" if you in fact become unreliable. Your rigid rules have very clear collateral damage, for which you decide to turn a blind eye. Thankfully, not everywhere is like where you live, and in many communities, your actual clinical skill and CV are clearly more important than amorphous backdoor "reputation", which oftentimes is unreliable and carries personal biases (if not overt malignant intent).

We return once again to a really critical point. You weren't talking about someone with a mental illness. You are talking about just fabricating a medical excuse for your own purposes. Don't you think that plays some role in the negative reactions of others to any future claims of mental health related disability. This is really fundamental to our disagreement. I know you keep saying "other people can't reliably tell the difference", which, sure, that's true. But acts that are wrong are wrong regardless of whether or not they are detected by others. Even a Peter Singer-level consequentialist should be able to agree with that.

I appreciate you laying out your logic for why you feel this is beneficial for the system as a whole and why that is the grounds on which you base your assertions. Previously several of your arguments for why you were correct were that you personally were financially and professionally successful and that anyone saying otherwise was bitter that they were not ("I'm winning and you're mad about it") or because the strategy was very effective for the individual in practice. So you can perhaps understand why this sounded a lot like "this is okay because I got mine." The former is a principle argument, the later is still sociopathic or at the least very selfish.

For the record I don't think you're a sociopath, you wouldn't be engaging to this extent in this conversation if you were in all likelihood. It's the previous lines of reasoning that were troublingly close to completely lacking in any consideration for the values beyond increasing one's personal status and wealth.

I don't make any assumptions about zero-sum situations. I am generally all for making sure incentives for individual actors align with desired outcomes because I recognize self-interest tends to be a powerful motivator and needn't necessarily come in conflict with right action. As a virtue ethicist I do think that doing the right thing for the right reasons is ideal on a number of grounds, not the least of which is that doing it because you have cultivated a good character is a more reliable and consistent source for generating good behaviors than the calculus of "is this going to enrich me right now?" But acting rightly because you will get rewarded for it by the system is a start and good practice for actual virtue.

Similarly, calling out from time to time a la mental health days is not very troubling from my perspective. That strikes me as absolutely consistent with what you are talking about (correct me if I'm wrong) about having give or flexibility in the system to allow physicians with other demands or challenges to continue to function within it. In fact, I would say that embodies practical wisdom and is consistent with virtues like humaneness or compassion.

I know you say it's just a detail, but what everyone has been objecting to is a very different scenario that you outlined. Namely, you said that if someone received a work assignment they don't like, just keep calling out sick until you are reassigned instead or raising any objection or finding a new job. I am sure you have no truck with virtues like solidarity with peers that are obviously in conflict with this. You probably also don't believe in cowardice or mendacity as vices.

However, you say you are worried about stigma against mental health and invisible disabilities. A lot of that comes from the fact that it is often almost impossible for someone on the outside to be sure someone's report of their experience is veridicial or not. This leads to the usually unfounded suspicion of "faking" and a lot of grief for people are genuinely suffering. We agree this is bad and harmful to everyone involved, most especially the disabled person themselves. If we could snap our fingers and dispel that stigma tomorrow, I am sure even you and I could agree to snap away in unison.

Do you see how encouraging people to actively and deliberately fake an illness for instrumental reasons tends to increase rather than decrease stigma?

This is the opposite of not disclosing drug or mental health issues to parents or an employer. This is not concealing a weakness for perhaps justified fear of retribution or punishment. That's often simply wise. This is actively pretending to have a disability you do not have in order to secure preferential treatment (i.e. you are exempted from shifts your colleagues now have to work). Simulating weakness to get your way, for all it can obviously be effective in many situations, is the kind of thing we teach people not to do in DBT.

Maybe I can clarify the intuition. Say my local grocery store has some handicapped spaces that are never used. I notice this over the course of months and one day when it is snowing or raining heavily and miserably cold I decide I don't want to schlep across the parking lot. So I whip out my blue marker and gin up a handicapped parking tag on the spot and take one of those unused handicapped spaces.

Assuming arguendo that no one with a substantial impairment to mobility visits the grocery store that day, so we are not directly inconveniencing anyone, is your contention that there is nothing wrong with this?
 
IDK folks it seems way more complicated than it needs to be. I attempt to live an authentic existence regardless of the well known large institution admin smoke and mirrors. My goal is to deliver the best care I can, be a pleasant colleague and insist on appropriate treatment by administration. As with a playground bully it is amazing how effective firm boundaries and lack of fear can be. I keep my financial house such that if I need to walk I am able to which is rather liberating. The reality is that if I smell BS I share that information and its not as much about being self righteous as it is having a limited verbal filter and adversity to intentionally being taken advantage of.

A simple "no thank you" stops all discussion and tends to be extremely effective.
 
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IDK folks it seems way more complicated than it needs to be. I attempt to live an authentic existence regardless of the well known large institution admin smoke and mirrors. My goal is to deliver the best care I can, be a pleasant colleague and insist on appropriate treatment by administration. As with a playground bully it is amazing how effective firm boundaries and lack of fear can be. I keep my financial house such that if I need to walk I am able to which is rather liberating. The reality is that if I smell BS I share that information and its not as much about being self righteous as it is having a limited verbal filter and adversity to intentionally being taken advantage of.

A simple "no thank you" stops all discussion and tends to be extremely effective.

Good on you. I think what you are describing embodies several important virtues very well and would be good for more junior people to emulate. Having good character is about acting right, not being self-righteous.

An insufferable moralistic pr*ck or prig is just as vicious as the baldest-faced liar.
 
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