Borderline Resident

[LemonCoke]

There is a borderline resident in my program who is also a compulsive liar. I am on the wrong side of the split. I try to be empathetic toward the behavior because my understanding is that BPD often results from a traumatic childhood, but it is very disheartening to (1) be the object of their splitting and (2) watch this resident lies almost daily to get they want/get out of trouble. Unfortunately I do have to work closely with this resident and I am finding it harder and harder to get out of bed in the morning...

Any advice would be greatly appreciated.

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[Leo Aquarius]

Can you share at least which region of the country you're in? Midwest? Pacific? Northeast? Thanks!

 

[Saluki]

You might find this thread helpful:

http://forums.studentdoctor.net/showthread.php?t=873441&highlight=interpersonal+residency

I've also heard from a few people that the book Stop Walking on Eggshells is good for this sort of thing, but I've never read it.

In general, though, I wish we wouldn't try to diagnose our colleagues... I think we lack the objectivity to do it effectively, especially since we mainly practice our skills on those colleagues that we have trouble getting along with, and it also fails the Golden Rule test (i.e. I wouldn't want someone doing it to me)

 

[BobA]

There is a borderline resident in my program who is also a compulsive liar. I am on the wrong side of the split. I try to be empathetic toward the behavior because my understanding is that BPD often results from a traumatic childhood, but it is very disheartening to (1) be the object of their splitting and (2) watch this resident lies almost daily to get they want/get out of trouble. Unfortunately I do have to work closely with this resident and I am finding it harder and harder to get out of bed in the morning...

Any advice would be greatly appreciated.

I think you should talk with your chief resident(s). That's what they are there for!

You can cover yourself by making the powers that be aware about this resident's behavior, and also get support for how to handle specific situations.

 

[billypilgrim37]

After warring with my borderline colleague for the first month of residency, I finally sat her down one day and said, look, we are going to be working together for the next 4 years. We can't keep doing this. I fed her narcissism and was self-deprecating a little bit, and I have been on the good side of the split ever since. She even stopped trying to sleep with me after a few months and moved on to my best friend, who became idiotically close to getting seduced before he figured out she was a death trap.

I'm not saying this should be a first-line approach, but hey, it worked. Going straight to your chief (especially this late in the year) probably makes more sense.

 

[kugel]

I began hearing we had such a resident in our class very early in year one, but I never saw it. In fact, I eventually overheard every single one of my classmates talking about the borderline in our midst, but no one ever said it to me directly.

Hey! Wait a minute. Do you think.....?


just kidding

 

[Doctor Bagel]

Can you share at least which region of the country you're in? Midwest? Pacific? Northeast? Thanks!

I find this an odd question. Are you trying to figure out where the OP is, so you can avoid this program? Lots of programs all over the place are going to have people with various personality disorders or just with personalities that don't mesh well with yours. It's not like it's something you should consider in your rank list.

Anyway, op, talking to your chiefs probably wouldn't be a bad thing to do, mainly just to talk about it. My guess is that there's not a lot they can do about it other than record your concerns if somehow this co-resident's attacks on you damage your reputation. Otherwise, how much longer are you working with this person? Avoidance might be the best answer.

Other thoughts, do you have a resident wellness program? Seeing somebody yourself might help because you probably can't get rid of the borderline or his/her behavior, but maybe you can find some better tools to deal with. Not wanting to get out of bed isn't a good thing.

 

[whopper]

Several with mental pathology are attracted to psychiatry. Never be surprised if you encounter someone in this field with issues.

As far as this resident is concerned, try to mind your own business, just do your thing, but if problems arise, bring it up with your superiors in a professional manner. Try to not get into an emotional and personal pissing match with this individual.

Residents with issues need to be held accountable for the responsibilities that anyone else would be. If they do their job, fine, so be it, if not, they should be held accountable.

 

[jettavr6]

Residents with issues need to be held accountable for the responsibilities that anyone else would be. If they do their job, fine, so be it, if not, they should be held accountable.

I couldn't agree more. One thing I might add is that it's not limited to psychiatry and I've seen it first hand in other specialties. It is best dealt with immediately, or else it will be harder to deal with later.

 

[whopper]

Agree. Every field attracts certain types. Every hospital I work had has had problems with the surgeons being irritable, narcissistic, etc. (Of course this is not every surgeon. My dad is one, he's a very nice guy though he's somewhat schizoid).

No one should be excused from not being able to do their responsibilities. If you can't do them--you shouldn't be in the field. Yes, of course, if someone is disabled, the institution has a responsibility to do what it can to make accommodations. E.g. a doctor in a wheelchair needs an elevator and ramp. Borderlines, however, even in therapy under DBT guidelines, are expected to do their responsbilities and be held accountable for mistakes they make.

I mentioned in other threads years ago that there was a severe borderline in my residency program. The program should've set objective guidelines to her that she needed to follow and clear boundaries, and if she didn't meet them, they could easily argue that she should be removed.

If a resident had borderline PD or a different one hurting their responsibilities, the biggest leeway I think I'd try to provide them if I were in the position would be for them to get therapy outside the institution, or tell them to take off time and get treatment, maybe some time off to get things in order, but never ever never never excuse them for poor work.