Dartmouth residency lawsuits

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anonperson said:
"Chronic insomnia":meanie:
Assbergers :laugh:

Some interesting cases. I do know that I would be pissed if a coresident pulled the chronic insomnia card and got a much more regular schedule.

Here is a link to what the resident Dr. Knapik was fired for:
http://www.vnews.com/news/3163344-95/knapik-dhmc-resident-letter
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Wow Dr. Knapik's case was so weird. I highly doubt she was motivated by her own ethical principles to send that letter to the fellowship program and the state medical board. If the other doctor sucked as a surgeon then it's her fellowship program's problem, and they'll likely figure that out sooner than later and deal with it. Not sure if sending that letter is worthy of being fired, but it's definitely a dick move.


As for the other stories, I agree with you that I'd be a little pissed if someone else got a special schedule because of something like Insomnia (I thought all residents had insomnia at some point, i.e. night float). I just don't get why people sue programs. It's a lose-lose situation in my opinion. If you lose you're in the same position you were in to begin with. But if you win, you get to go back to a program that already tried to fire you. It's like jumping into the ocean with meat pants on and hoping the sharks don't try to eat you AGAIN. But I guess you have to do something...
 
Not a resident, but a med student. Having just finished my psych rotation at Dartmouth I find the assertion that the psych department is malignant to be hard to believe. The psych residents and attendings I worked with were all the opposite of malignant. Almost all med students really like their psych rotations at Dartmouth, and much of that is because of how great the residents and faculty are to work with. I don't know anything about the situations of the two psych residents who are suing, but I find it really difficult to believe that the problem was with the department and not the residents who were fired.

As for the former surgery chief who is suing: I never met her. From what I heard, she very much deserved to get fired.

I know nothing about the rads resident and I haven't rotated in the department. That being said, if you can't take night call it's pretty difficult to do residency. I'm not sure a "reasonable accomodation" for insomnia would be to permanently excuse a resident from all overnight call, especially when that is an integral part of the job. Doing so also affects all the other residents who now have to take more call.

While I'm sure that some residents do get fired because of maliciousness on the part of their programs, some residents get fired for not being able to do the required job or because they are unprofessional.
 
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let me go ahead and cross Dartmouth off the list of places I'd do residency at. 2 residents fired for not using a stethoscope on a healthy patient? surely there is more to that story.
 
physicsnerd42 said:
Not a resident, but a med student. Having just finished my psych rotation at Dartmouth I find the assertion that the psych department is malignant to be hard to believe. The psych residents and attendings I worked with were all the opposite of malignant. Almost all med students really like their psych rotations at Dartmouth, and much of that is because of how great the residents and faculty are to work with. I don't know anything about the situations of the two psych residents who are suing, but I find it really difficult to believe that the problem was with the department and not the residents who were fired.

As for the former surgery chief who is suing: I never met her. From what I heard, she very much deserved to get fired.

I know nothing about the rads resident and I haven't rotated in the department. That being said, if you can't take night call it's pretty difficult to do residency. I'm not sure a "reasonable accomodation" for insomnia would be to permanently excuse a resident from all overnight call, especially when that is an integral part of the job. Doing so also affects all the other residents who now have to take more call.

While I'm sure that some residents do get fired because of maliciousness on the part of their programs, some residents get fired for not being able to do the required job or because they are unprofessional.
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I fixed your emphasis for you 🙂
 
This is sad for everyone involved. This resident who was fired will lose all that she has worked for (career-wise) in the past 9 or so years. The resident whose confidential letter (unofficial probation, it sounds like) she disclosed to others may also lose her fellowship spot. I think the resident who was fired was in the wrong - she is not the supervisor of this other resident, ultimately, and she is not responsible for evaluating her (fully). That is the job of the faculty and program director. And it looks like retaliation when 2 people get into a dispute and 1 of them grabs a letter from the other one and sends it the other person's future employer. The whole thing seems really bizarre, any way you slice it. It seems like this might have been a good resident (clinically/medically) but who had some troubles with dealing with other people. Firing someone 5 years into a surgical program is way harsh - not sure what this person will be able to do now - another surgery residency versus something else....very sad for everyone involved, and no winners here. Bad for both residents and the program.
 
Textbookversion said:
let me go ahead and cross Dartmouth off the list of places I'd do residency at. 2 residents fired for not using a stethoscope on a healthy patient? surely there is more to that story.
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I wondered about those two cases as well. Definitely more to it than that. I feel like getting fired for not doing an exam would only fly if the patient later on got sick (like an MI or something) that they claim should have been caught if they did the exam previously, or maybe they didn't do an exam but documented that they did. But who knows?

I interviewed at Dartmouth for IM this past cycle. I didn't get the impression from any of the residents there that it was a malignant place, but you never know until you start working there.
 
swifteagle43 said:
I think termination required a grievous offense and is quite damaging to a resident. S/he should be allowed to resign and allowed to find another place to work. This is scarring a resident for life. They will forever have to check the box on state licensing asking if they were ever terminated or lost privileges from an institution. Furthermore, it makes them liable for lawsuits in the future when cross questioned by lawyers. This is positive sign of a malignant program and I would never want to work for a program that terminates its resident(especially when they can be offered resignation).
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To tell you the truth, I really don't have a lot of sympathy for the resident who got fired. The PD was already handling the situation with the other resident. It was not her place to send a letter to the other resident's fellowship program, however incompetent the other resident may have been. She should have just kept her head down and gone about her business.
 
One thing to note is that Dartmouth can't make any comments about any of this, so it's really hard to know what actually happened. Having witnessed some resident terminations (long stories there), there's often a lot more to the story than the resident reveals.

And jeez, the insomnia person. I think being able to endure some sleep deprivation goes with the whole physician category. Can you imagine being this person's fellow resident?
 
Doctor Bagel said:
And jeez, the insomnia person. I think being able to endure some sleep deprivation goes with the whole physician category. Can you imagine being this person's fellow resident?
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Attitudes towards sleep and attention disorders are pretty negative. No matter how serious your disability, you'll always come across as either lazy or a whiner. Disabilities seem to only be permitted on soft factors. Someone with a obvious physical disability is permitted to work slower. But if it's a mental or neurological impairment that results in the person getting what others see as "perks" (more sleep, more time on test, less on duty responsibilities), they will become jealous and ostracize you because outwardly you appear normal and they will either assume you're lying or that you are weak. Even the NBME, who claim adherence to the ADA, are overwhelmingly unwilling to grant accommodation to people with non-physical disabilities (they have been sued over this), and if for some reason by the grace of god they allow it, they make sure everyone knows you weaseled around the system with a big asterisk next to your score. It's incredibly ironic how unwilling the medical profession is to accommodate for medical disabilities within its own ranks.
 
thefritz said:
Attitudes towards sleep and attention disorders are pretty negative. No matter how serious your disability, you'll always come across as either lazy or a whiner. Disabilities seem to only be permitted on soft factors. Someone with a obvious physical disability is permitted to work slower. But if it's a mental or neurological impairment that results in the person getting what others see as "perks" (more sleep, more time on test, less on duty responsibilities), they will become jealous and ostracize you because outwardly you appear normal and they will either assume you're lying or that you are weak. Even the NBME, who claim adherence to the ADA, are overwhelmingly unwilling to grant accommodation to people with non-physical disabilities (they have been sued over this), and if for some reason by the grace of god they allow it, they make sure everyone knows you weaseled around the system with a big asterisk next to your score. It's incredibly ironic how unwilling the medical profession is to accommodate for medical disabilities within its own ranks.
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Right but there is a fine line between disability and not being fit to perform a job.

If you can only work 7 hour days during the daytime you are not going to get the training needed nor be able the responsibilities of the job.

I don't know what side of the line this falls on...but that is the logic of a lot of people.
 
link2swim06 said:
Right but there is a fine line between disability and not being fit to perform a job.

If you can only work 7 hour days during the daytime you are not going to get the training needed nor be able the responsibilities of the job.

I don't know what side of the line this falls on...but that is the logic of a lot of people.
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7 hour days may be enough. Sometimes people work longer hours than those necessary to learn the job or get the job done. A fuss is made about how shorter hours will lead to the end of the world, but then a miracle happens and 60 hour weeks are found to be sufficient.

If longer hours are needed, then extra days should be added, either by reducing weekends/holidays or adding extra time at the end.

Just because it's not how things are usually done, doesn't mean it can't be done. A bit of creativity makes us a better, more inclusive and more productive society. And untill medicine reaches the state of grace where we all die in our sleep in old age with no previous health problems, we are doing ourselves, our friends and our children a favour by acknowledging that sometimes people have health issues that have to be managed rather than cured and that they are doing their best to deal with them and be productive members of society.
 
shopsteward said:
7 hour days may be enough. Sometimes people work longer hours than those necessary to learn the job or get the job done. A fuss is made about how shorter hours will lead to the end of the world, but then a miracle happens and 60 hour weeks are found to be sufficient.

If longer hours are needed, then extra days should be added, either by reducing weekends/holidays or adding extra time at the end.

Just because it's not how things are usually done, doesn't mean it can't be done. A bit of creativity makes us a better, more inclusive and more productive society. And untill medicine reaches the state of grace where we all die in our sleep in old age with no previous health problems, we are doing ourselves, our friends and our children a favour by acknowledging that sometimes people have health issues that have to be managed rather than cured and that they are doing their best to deal with them and be productive members of society.
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It's done in Europe. Residents have normal work weeks (usually). They have more supervision their first few years out of residency, but it shows that a slower paced system works fine.
 
thefritz said:
It's done in Europe. Residents have normal work weeks (usually). They have more supervision their first few years out of residency, but it shows that a slower paced system works fine.
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Don't know if that's true but even if it is, what I do know about their system is that you start medical school straight out of high school with med school being 6 years long.
We have to waste 4 years in college taking crap classes that do not really help us in any way & with the debt that we have, we have to be independent ASAP to start trying to pay back the loans
I don't think extra supervision beyond residency or fellowship will be well received
 
swifteagle43 said:
Two wrongs don't make a right. The punishment must fit the crime. Losing one year of residency equals $500,000 a year(the money she would have made as an attending). Asking her to resign would have let her save face and had a year to reflect on her costly mistake. Why is it that doctors have empathy for their patients but not for each other?

All this being said...she coulda just had borderline personality disorder and the institution may have feared branding her with their name.
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Surgical residencies require that you complete at least your 2 final years of residency in the same program so shed have lost more than one year. Regardless, I'm with Top Gun. This is a pretty big overstep on her part. Whether she resigned or was fired matters little. In any case I doubt any program would take her after this infraction.

And for those who are comparing our work hours to Europe, please keep in mind that their residencies are typically longer than those here and the endpoints frequently less defined in advance, so it's not just that their weekly hours are shorter. Personally, I think the 80-hour reduction was good but the other restrictions on shift lengths etc just get in the way of my training. I'd prefer they just limited it to 80 hours a week and let me train. Patients in my specialty don't get sick on a regular 8-5 schedule and in order to learn I need the flexibility to see them when they need us, not on some well intentioned but ill-conceived one size fits all (but doesn't) set of nearly arbitrary rules.
 
swifteagle43 said:
Two wrongs don't make a right. The punishment must fit the crime. Losing one year of residency equals $500,000 a year(the money she would have made as an attending). Asking her to resign would have let her save face and had a year to reflect on her costly mistake. Why is it that doctors have empathy for their patients but not for each other?
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Because patients are in miserable, oftentimes life-threatening situations that they don't ask for or deserve. No one deserves to be ill. Dr. Knapik, on the other hand, created her own problems. Sending a letter bashing your fellow resident behind his/her back is a douche move. It suggests that you are not a team player, and being a good resident means being a team player. The program was already addressing her fellow resident's incompetence, so there was no need for Dr. Knapik to send that letter in the first place. I will empathize with a competent, hard-working resident who truly did get screwed over by his/her program. Dr. Knapik, however, is not one of those residents.
 
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She probably should have thought about that million dollar pretax loss before she overstepped her bounds and did what she did. It really does suck for her, but I don't think the program is obligated to do her any favors.
 
Wow. Anonymously contacting the future program of a peer... How childish.

I wonder how she was linked to the anonymous letter.
 
swifteagle43 said:
Once again, letting people save face is what separates a good program from a malignant one(and a good PD from a potentially malignant one) IMO. It is like dumping someone, there is a classy way to do it and a unclassy way.
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How do you know she wasn't offered resignation and refused? Regardless, I don't believe it makes a difference. I don't think any other surgery program would have taken her even if she had resigned. Leaving at such an advanced place in a surgical residency is almost unheard of unless you are leaving the specialty. HUGE red flag for any other surgery program she applied to no matter how it was termed. She wasn't going to get back into surgery.
 
swifteagle43 said:
Not true, they are NOT equal. That is why they make it a check box for termination or lost privileges on every transfer application. Bigger red flags get triggered when applicants check the box "have you ever been terminated." Resignation is a big question mark and something the candidate can explain in a neutral light(e.g clash of personalities).

If she was offered resignation and didn't take it, she deserves it. She may be borderline or cluster b personality disorder, but I doubt she is stupid.
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You think she should have been given the chance to "explain in a neutral light" after she took that option away from her co-resident? The punishment fits the crime but I still say that no surgery program would have taken her after leaving her program at the advanced stage of training. You can talk about check boxes all you want but any program that thought about taking her would have gotten on the phone to get the real story from the PD and there's no way they want someone like that. She wasn't going to get another surgery residency period. You seem to think that no one ever deserves to be fired from residency but that simply isn't the case. This was an egregious lapse of professionalism and IMHO I think termination was appropriate.
 
If the breach of professionalism is egregious enough to have the resident resign or be terminated, why do you think they should get another chance in a different program? Why would a program pass off their soiled goods to another program? If the program thought the resident can be rehabilitated for the lapse in judgement, they can do so in their own program, but if the offense is enough to warrant leaving the program, they have no business passing that person off to anyone else. The resident's statements in connection with the lawsuit show that she failed to take responsibility for her actions or admit her error; if she doesn't believe she did anything wrong, you can't rehabilitate her.

I don't understand why you keep talking about 2 years and a million dollars, unless you just refuse to believe that she would not have found another surgery program after resignation.
 
swifteagle43 said:
1) Who says she couldn't have matched at another program? Maybe as a 3rd year? 2nd year?

2) who says she couldn't have matched in a lesser ranked surgery program?

3) who says she could have matched into a different specialty?

4) it is a lawsuit not a meeting- the plaintiff is not going to give their cards away. She may have a personality disorder but she isn't stupid. If they had let her resign she would have had a job and Dartmouth wouldn't have a lawsuit on their hands.
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Being in surgery, I can tell you that the likelihood of a surgery program, even a "lower ranked" one, of taking someone who had been a chief and taking them as a 2nd or 3rd or 4th year is essentially nil. This is not how the mindset of surgery works.

Maybe she could have gone into another specialty, but as she used up her funding eligibility, that would also be a stretch. It happens, but it is uncommon.

You and I are at an impasse. I simply do not believe it is ethical for a program to pass off a resident whom they believe is too ethically challenged to continue in their own program to another program. You appear to have a different view of the ethics involved and I think we've each stated our perspectives clearly enough for the discussion at hand, so my participation in this current exchange has drawn to a close.
 
shopsteward said:
7 hour days may be enough. Sometimes people work longer hours than those necessary to learn the job or get the job done. A fuss is made about how shorter hours will lead to the end of the world, but then a miracle happens and 60 hour weeks are found to be sufficient.

If longer hours are needed, then extra days should be added, either by reducing weekends/holidays or adding extra time at the end.

Just because it's not how things are usually done, doesn't mean it can't be done. A bit of creativity makes us a better, more inclusive and more productive society. And untill medicine reaches the state of grace where we all die in our sleep in old age with no previous health problems, we are doing ourselves, our friends and our children a favour by acknowledging that sometimes people have health issues that have to be managed rather than cured and that they are doing their best to deal with them and be productive members of society.
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I already work a majority of weekends and plenty of holidays. If you gave me a 7-hour day (which is just over half of my usual day), you'd just have to turn my residency into a 10-year program. You won't be able to get funding for that, which would make it an unreasonable accommodation. So it wouldn't happen, and that's really all there is to that...


Also, I agree with the above that it was completely out of line to send a letter to a colleague's future fellowship program. Residents are not charged with evaluating their peers, and she did not pursue the appropriate channels to have this dealt with.
 
swifteagle43 said:
I think a million dollars and 2 years of not practicing medicine is harsh enough of a punishment. Do you think we should just shoot people like this? There are limits, but this cruelty to fellow physicians is part of the medicine culture at malignant places. In some ways these places are built to breed it.

Once again, a PD that prevents a former resident from getting a job is not a good PD IMHO. Once again this is unclassy and malicious. As I stated earlier, the only reason to fire a resident is if there is purposefully harming of patients. Otherwise the option to resign should be offered first.
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I would argue that what she did was unclassy and malicious, no matter how incompetent the other resident was. She certainly didn't show mercy toward her colleague. Why should she expect any from the program?
 
swifteagle43 said:
Am I the only one who has broken up with a crazy girlfriend or boyfriend in a nice way? I am out.
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Sorry, disagree. First of all, medicine is a career, not a relationship. It's almost apples and oranges. Secondly, just because so much goes into a medical career, doesn't mean some sort of objective due process should be expected for terminating (resignation) of residents. It is up to a program director to decide how someone should be let go. If you do want to use relationships as a metaphor, it's like me saying the only way a significant other could break up with someone is because they were unfaithful. For any other reason, one should give the other person a chance to break it off first so they 'can feel better' about it.

If sucks that the life of the resident is in the hands of the PD, but we just have to hope PDs are neutral and as objective as possible since they do have to make subjective decisions about their residents.

We are not sure of all of the big picture circumstances nor day to day occurrences in that particular resident's time at Dartmouth. There may very well be good reasons for termination of which we are unaware. I believe designating intentional patient care infractions as an only metric for termination unrealistic. Residency is a job. There are numerous things that go into performing that job effectively. Numerous acts that point to the potential for poor patient care, even if by accident, should be valid grounds for dismissal in my opinion.

If she truly is fit for medicine, I feel bad that happened to her. However, if you want to talk about the unspoken rules of medicine, let's talk about the one concerning not ever throwing your fellow physicians under the bus...
 
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While I agree that what she did wasn't classy in the slightest (and probably indicates a serious personality problem/personality disorder), I also agree with the idea that blowing up her entire career seems...a bit much. Imagine if both of these residents had been attendings, and one was in the process of switching jobs after having been sanctioned somehow at some hospital. The attending sending the letter might have been 'disciplined' somehow - hell, he/she could/should/would have been canned - but it probably wouldn't have been a career-ending act. We 'rehabilitate' doctors who IMHO have done far worse things (operating on patients drunk, DUIs, serious errors/demonstrations of incompetence, etc). Hell, it's not hard to imagine that in the right circumstances this resident's actions could have been hailed as 'upholding the profession' or whatever (the state boards seem to really like the idea of physicians anonymously squealing on other physicians, don't they).

As far as personality disorders go...yes we have a massive problem with this in medicine, and I agree something needs to be done about it. However, if we just tossed out every doc with a personality disorder/'personality problems' etc, I think we'd be left with a lot fewer docs than everyone seems to think there'd be. I guarantee Dartmouth has a gaggle of unpleasant cluster B types in high places - probably even in the surgery department.
 
dozitgetchahi said:
While I agree that what she did wasn't classy in the slightest (and probably indicates a serious personality problem/personality disorder), I also agree with the idea that blowing up her entire career seems...a bit much. Imagine if both of these residents had been attendings, and one was in the process of switching jobs after having been sanctioned somehow at some hospital. The attending sending the letter might have been 'disciplined' somehow - hell, he/she could/should/would have been canned - but it probably wouldn't have been a career-ending act. We 'rehabilitate' doctors who IMHO have done far worse things (operating on patients drunk, DUIs, serious errors/demonstrations of incompetence, etc). Hell, it's not hard to imagine that in the right circumstances this resident's actions could have been hailed as 'upholding the profession' or whatever (the state boards seem to really like the idea of physicians anonymously squealing on other physicians, don't they).

As far as personality disorders go...yes we have a massive problem with this in medicine, and I agree something needs to be done about it. However, if we just tossed out every doc with a personality disorder/'personality problems' etc, I think we'd be left with a lot fewer docs than everyone seems to think there'd be. I guarantee Dartmouth has a gaggle of unpleasant cluster B types in high places - probably even in the surgery department.
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Trainees are typically held to higher standards then those in a profession. In most cases, things that would result in letters of censure to someone finished with training will result in dismissal for a trainee. Part of a trainee's job is to assimilate into the culture of their chosen vocation, at least enough to be able to finish training. The ability to do so (usually) is part of being successful in that profession.
 
I have bipolar disorder. Going without sleep is detrimental to me. However- medicine does have certain physical and emotional requirements. Not everyone should be a doctor. Just like not everyone should be a race car driver- you can't argue that someone's discriminating against blind people cause you're not allowed to drive.

Sure- I struggle. But so does everyone. I have ways to adapt that are not obvious to others. And- I purposely chose a residency program with a night float system to avoid 24 hour calls (although intern year- to my dismay- I had to do 24 hour call while in the ICU- I got through it in one piece).

People need to suck it up! Nobody wants extra work dumped on them. We chose this life.
 
Arcan57 said:
Trainees are typically held to higher standards then those in a profession. In most cases, things that would result in letters of censure to someone finished with training will result in dismissal for a trainee. Part of a trainee's job is to assimilate into the culture of their chosen vocation, at least enough to be able to finish training. The ability to do so (usually) is part of being successful in that profession.
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Are you saying "Trainees", not yet professionals and part of a formal education program, should have higher standards than the "professionals" themselves?

So after completing training and thereby becoming a professional, you should suddenly have lower standards required of you?

You dont see anything wrong with that point of view
 
ferning said:
Are you saying "Trainees", not yet professionals and part of a formal education program, should have higher standards than the "professionals" themselves?

So after completing training and thereby becoming a professional, you should suddenly have lower standards required of you?

You dont see anything wrong with that point of view
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I was imprecise. I was referring to trainees being held to a higher standard of ethical conduct. Trainees, of course are, not held to the same standards for work quality. Once someone has made it through training and is a member of an organization, the thinking changes from weeding out problem members to salvaging the time and training that went into the member. It may not be fair from the trainee's POV, especially if they are unaware of the rules they are violating. On the other hand, trainees by definition lack the skills to practice the profession independently and in the early stages ability to conform to organizational norms is one of the few available proxies the organization has for suitability.
 
Arcan57 said:
I was imprecise. I was referring to trainees being held to a higher standard of ethical conduct. Trainees, of course are, not held to the same standards for work quality. Once someone has made it through training and is a member of an organization, the thinking changes from weeding out problem members to salvaging the time and training that went into the member. It may not be fair from the trainee's POV, especially if they are unaware of the rules they are violating. On the other hand, trainees by definition lack the skills to practice the profession independently and in the early stages ability to conform to organizational norms is one of the few available proxies the organization has for suitability.
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More precise, but I disagree with higher ethical code of conduct which should be unanimously held at the same standard for all medical professionals and trainees.

I think professionals have more opportunities to veer from ethical conduct, which requires more vigilance in maintaining the same standard as a trainee

I also dont understand why you have to educating a trainee as "weeding out process" and then recouping this from them as professionals. Alot of people dehumanize people like this and probably mean nothing by it, but its a toxic attitude and in different work and training places I've been its definately contagious or at least social conformation that leads to the worst healthcare and work environments

But freedom of speech trumps
 
Haven't read every word of the thread, and I won't.

You can't accomodate everyone's issues in some jobs. Don't have 20/20 vision? You can't fly a a military aircraft for insatnce. If you can't walk, you can't be a fire-fighter. If you lack the spatial reasoning and mathematical skills, you can't be a theoretical physicist.

Part of the job of medicine is working long freaking hours and too often at night. For better or worse this has been mitigated some with the new work hours, but when you're out of training and it's your call, your hospital, ED, group, etc, will expect you to handle whatever business needs to be handled for patients who acutely need a physicians skill set, and that means nights.

I can't say I feel too sorry of these folks. What next, sue neurosurgery because they accomodate your lack of hands or sue radiology because they won't accomodate your lack of sight?!

No one is keeping these people from working. They have simply demonstrated they cannot work in medicine in the field they initially chose. Done.
 
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