echidna001

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I am writing on a friends behalf who is currently having a terrible time in her residency. It is about 10% female, with no female attendings. The male residents are not come down on as harshly by attendings, nor are they subject to the same standards. This woman has done well on all her exams, gotten good evaluations, and overall been a very good employee. The only thing going against her is about 5 complaints that have occured over the last 3 years about her being rude. These incidents have occured with patients and nurses. Her personality isn't that of bubblyness and smiles. She is very serious and matter-of-fact.....but when male residents behave the same way in the program they do not get in trouble.

Also her program doesn't take into account the context of the complaints. A patient complains she was rude: but was upset they couldn't get into surgery when they wanted and decided to kill the messenger. Beyond that, as soon as she walked into the room, as she was greeting them, the patient already expressed a dislike for her prior to interaction. The nurses sometimes refuse to do, or don't do what she asks them to. When she gets more stern and asks again, they write her up, saying she was rude. Not only does the same assertion from males garner respect from the nurses, but they don’t even have to ask twice.

Of course none of this matters. She constantly gets hung out to dry by her senior male residents, although they do look out for other male residents. Certain attendings tear only her apart at the end of her in house on call sessions, regardless of what she does. She’s tried everything to remedy the situation, and now she is facing the threat of going on probation (which in her department means it is only a matter of time before you’re fired). I wonder if she could put together a discrimination case, but she doesn’t want to do that unless she has to. But what should she do? Do any of you know someone, or have been yourself in this situation? Any feedback would be so appreciated.
 
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maybe she should try and transfer to a different program. For whatever reason (and I doubt it is because they don't like women) she is not getting along with the people at that program. In the meantime she should just try to lay as low as possible (getting into arguments with nurses seems to be one of her problems so she should avoid arguments at all costs, she can yell at them when she is an attending) , work extra hard, kiss ass or anything else to try to survive the remainder of her residency. She should also probably contact a lawyer (although from what I have heard it is very difficult for terminated residents to win in court.)
 

aProgDirector

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It usually impossible to separate "discrimination" from "poor performance" in situations like this. Perhaps she is being discriminated against. Perhaps she truly has a problem, and is blaming her failings on perceived discrimination.
 

jdh71

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It usually impossible to separate "discrimination" from "poor performance" in situations like this. Perhaps she is being discriminated against. Perhaps she truly has a problem, and is blaming her failings on perceived discrimination.
:thumbup:

I'm sorry, but every resident I've ever known who cried, "Why's everybody picking on me?!" wasn't such a great resident to begin with. The human ego defense mechanism isn't a pretty thing when it raises it ugly head.
 

EternalMD

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given all that you've reported, the problem probably lies with your "friend". Nurses, patients, attendings, fellow residents (who don't have her back either) all point to a problem with your friend. Let's say the nurses are just not happy taking orders from another woman, patients are just angry because of whatever reason, and attendings do what we all know attendings do. The one group that SHOULD have your back is your fellow residents. If they are constantly leaving you out to dry, they probably aren't all that fond of you and don't care to put themselves in harms way to look out for someone who they hardly have a relationship with (aside from Hi, bye). Makes me think the problem lies with your friend
 

dragonfly99

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It sounds like this person is probably a woman in some surgical residency that has a tiny number of female residents. I do think that sometimes nurses (particularly female nurses) do not like taking "orders" from female residents, and there isn't necessarily a great fix for this. And I agree that sometimes female residents get "written up" for behavior that is more often tolerated from men. However, your friend cannot change these facts. You also say that she doesn't have a "bubbly" personality, etc. Unfortunately this may be working against her. I think that realistically if she gets fired then it will be difficult, if not impossible, to find another residency in her chosen field. A lawsuit probably will not work, although seeking a legal opinion at this point might not be a bad idea, just to know what her options are. I think the best defense from this is to be super duper nice to the nurses, patients, and other residents, even if it seems "fake" to her. The reality is that hospital politics is real, and that you have to glad-handle people to some extent, and that once you are on the "bad side" of powerful people, you have to be very careful. I don't think we have all the facts here, to know what portion of this is the resident's fault versus some things that were/are totally out of her control. I can tell you from experience that certain hospitals, certain programs and certain attendings are a lot more accepting of female trainees than others. Also, it is a generalization but I think that assertive women are more socially acceptable in certain areas of the country versus others.

I think the friend should try to smile more, act more sweet and nice and outgoing even if it feels forced. Try to start up little conversations with the other residents about their families, etc. Nurses also. If she gets negative feedback from attendings, try to respond to whatever they are saying, do what they want even if she doesn't agree with all of it. Basically, I am saying to just suck it up and try to stay in the current program, at least unless she finds a better place to go.

She could look on Findaresident to see if there are any open spots at other programs, if things are looking really bad.

I think that 3 years in it may be less attractive for the program to fire her versus firing some intern, unless they really think there are patient care issues. If she can avoid formal probation at all costs, that would be good. She should emphasize to the program director that she really wants to succeed, wants to stay there and wants to do whatever it takes to do so.

I'm sorry and I'm sure this is a difficult situation. I haven't personally been through it but I know someone who has, and it's got to be hellish to deal with on top of the normal stresses of residency.
 

notinkansas

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There is probably a mix of both.

As a female myself, there have had complaints filed against me by nurses (claiming they are afraid of me) when I have witnessed my male counterparts behave much worse. There is some truth to the fact that female nurses sometimes have a problem with female doctors.

But for all categories of people to seem to have consistent problems with one person.... that is an indicator that your friend has at least in part, some sort of interpersonal problem. I imagine she's not deliberately trying to be difficult, but she is doing something (that she isn't aware of) that is turning people off. When people don't particularly like you, then they won't cut you any slack.

Sounds like there isn't a provable discrimination case....yet. She's not officlaly been denied anything yet. Doesn't hurt to consult a lawyer. I'd say she'd also be well served to improve people skills. That never hurts anybody.
 

Gastrapathy

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Its fine to go to a lawyer for advice but don't tell the program you did until there's real trouble. Nothing makes people start document subjective deficiencies faster than the threat of a suit.
 

exPCM

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Its fine to go to a lawyer for advice but don't tell the program you did until there's real trouble. Nothing makes people start document subjective deficiencies faster than the threat of a suit.
Yes - from what I have seen before this is true.
 

Integrity

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There is probably a mix of both.
.... that is an indicator that your friend has at least in part, some sort of interpersonal problem.
Interpersonal problems are massively aggravated in hospitals. When people have a preconceived opinion of what you are like, it makes a huge difference in how tone and content is interpreted. Seems to me like hospital relationships is like the stereotypical examples of chaos theory. Subtle variations in situational trait display produce huge variations in gossip and consequences. There are some really good books out there on the market, that ought to be standard lecture before residency.

I suppose the mixed responses here also stem from the same ore. We have all met the colleague who is stern, and females who are interpreted as stern, also have a tendency to be interpreted in a more negative way, as we are biologically biased. Stern people often command, without dishing out explanations, which quite often leads to hurt emotions, which again is the #1 rule why conflicts start building up, not because people are fundamentally evil.

Negotiators and good program directors can solve conflicts like this, by introducing external evals, and group interviewing. This is costly, but then again, not clearing up misunderstandings and providing for a learning environment where you can do mistakes both personally and professionally without facing harsh retaliation, results in a cynical culture where people choose to lay low, and let go of their enthusiasm and productive capabilities. I've seen it, and some specialities are more prone than others, due to high stress levels. You don't only hurt the resident, by letting go of her, you hurt the entire program.
 
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Interpersonal problems are massively aggravated in hospitals. When people have a preconceived opinion of what you are like, it makes a huge difference in how tone and content is interpreted. Seems to me like hospital relationships is like the stereotypical examples of chaos theory. Subtle variations in situational trait display produce huge variations in gossip and consequences. There are some really good books out there on the market, that ought to be standard lecture before residency.

I suppose the mixed responses here also stem from the same ore. We have all met the colleague who is stern, and females who are interpreted as stern, also have a tendency to be interpreted in a more negative way, as we are biologically biased. Stern people often command, without dishing out explanations, which quite often leads to hurt emotions, which again is the #1 rule why conflicts start building up, not because people are fundamentally evil.

Negotiators and good program directors can solve conflicts like this, by introducing external evals, and group interviewing. This is costly, but then again, not clearing up misunderstandings and providing for a learning environment where you can do mistakes both personally and professionally without facing harsh retaliation, results in a cynical culture where people choose to lay low, and let go of their enthusiasm and productive capabilities. I've seen it, and some specialities are more prone than others, due to high stress levels. You don't only hurt the resident, by letting go of her, you hurt the entire program.
out....
 
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alittlestory

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For the OP- I completely understand your friends situation... which sounds very eerily similar to mine (except for the proportion of male/female residents & attendings)

Other people who have replied have it spot on... there is a very delicate balance involved and the line between personality conflicts/perceived discrimination and "performance" problems is one that gets skewed far too frequently.

Unfortunately, the environment becomes tense and hostile... further catapulting the "problem" resident into a downward spiral... and inevitably their work does indeed begin to suffer because quite simply, they are not wanted and are cognisent of that fact... Not all of us are built of such strong character that we are able to survive and stay afloat in atmoshpheres like that.

The proper environment for residency is critical- you will either flourish or shrivel- it's that simple. In a place that is a "good fit"- you will feel accepted, comfortable and gain confidence in your clinical skills... and the opposite occurs when you are in a place where you are not welcome.

I'm one of those who wasn't able to suck it up and continue... at the time, I took that risk- it simply wasn't worth risking my sanity. True I'm struggling to get back on track now... and yes- it's always awkward to explain my perspective of things... I can only hope and pray that there ARE program directors out there that understand how vile some of these places can be.

My confidence was shattered- I began to doubt everything and questioned my commitment and my abilities in medicine. I hate that this happened to me, and on a daily basis I hate my old PD and the chief-residents... the whole place was akin to a freaking country-club... it's all politics there. and NO teaching. I used to be a talented, outgoing, confident and happy person-- and now, I'm trying to get back to being "me."

Please please please keep in mind, when it comes to residency programs- go where you are wanted... For example, if certain programs show enthusiasm towards you as a candidate- THIS MEANS SOMETHING!!!! THe grass is not always greener- and keep this in mind when doing your rank lists etc. Go where you are wanted... we do this in our social lives, why not when choosing a place for our training?
 

notinkansas

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Interpersonal problems are massively aggravated in hospitals.
Agreed. Stress levels can be much higher because constantly having to meet other people's needs (ie patients) without having time to get your own needs met (as many residents don't) can aggravate any interpersonal problems that may exist. Also the fatigue of being on call can contribute. Plus many attendings are used to just getting their way by bullying and so that is the role model they portray.

I recently decided to pursue emotional intelligence development. (I'm doing it - and paying for it- on my own without the knowledge of anybody in the workplace) It's an interesting field- the goal is to become more aware of both your own and other people's emotions and choose an effective response to get the outcome you want. Research shows that people who excel in the workplace score higher on measures of emotional intelligence than those who score low, and EQ scores are more predictive of career success that IQ. Some people dismiss it as "common sense" but there are many people who don't develop emotional intelligence as fully as others for a variety of reasons.

The development pathway I chose includes an initial assessment of the various components. My profile results indicated that it is likely that I will feel that people often misinterpret me. Which is exactly the case. It has also come to my awareness that I tend to focus only on negative interactions, tend to forget about positive interactions.

I've just started the process, but I can see that it has potential for improving the way I interact with others. Honestly, I never thought I'd wind up doing something like this. But I decided that I wanted to chart a different path for myself. I got to the point where I felt like I was walking on eggshells and being fake at work. I think there has got to be a more effective way. And I think that a lot of people in medicine could benefit from working on these skills.
 

Shikima

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Must not be a peds or family med residency. My guess: radiology or a surgical specialty. She needs to be candid with her program director.
I'll respectfully disagree. I've seen plenty of FM/Peds residencies/residents who were malignant.
Problem lies in the inverted power structure, poor manners, fragile egos and poor communication skills.

Best case situation for the girl who is the topic of discussion, change residencies. Also, engage in personal counseling asap too -- explore any possibility for personal growth.
 

DarthNeurology

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It usually impossible to separate "discrimination" from "poor performance" in situations like this. Perhaps she is being discriminated against. Perhaps she truly has a problem, and is blaming her failings on perceived discrimination.
Huh?

Well, if it went to trial then somebody, either a judge or a jury would make a decision whether it was "discrimination" or "poor performance." I think civil cases are basically more likely than not . . . she would have a good shot at trial.

If a trial jury says that it was discrimination then was it?? I am sure the PD or attendings would say that it wasn't until they died, and likewise the resident would believe that she was discriminated against. But in the end, the legal system will go one way or the other and won't conclude that it is impossible to figure out what it was.

Here's a scenario, a bright female surgical resident who does well on board exams, has a minor deficiency doing a certain procedure, is harrased frequently on rotations were said procedure is practiced, and subsequently doesn't get any teaching/experience/whatever with said procedure. Now the PD says "you suck at procedure x, fix it or I will fire you", resident complains about abuse and things get worse and she gets fired over this procedure and due to retaliation.

Uh, yeah I guess she sucked at the procedure so it was her but the environment inhibited her from learning well enough to be competent, and even more so it was worse for her than her male colleagues. Meaning, I think it is entirely possible in this case to have both gender discrimination as well as having a "poor work performance." I think the jury would find for gender discrimination/harassment/bad work environment as this colors and affects everything else downstream and makes any poor work performance eval suspect.

It is so true that if you are in a bad place then your performance will suffer, i.e. a bad fit for you, and if you are in a good fit place then you are golden. In bad situations you really forget why you are there and shift just into survival mode, so I don't think there is a pure "poor performance" as there is an interaction between environment and the trainee. Attendings would like to think that their evaluations and harsh comments/verbal abuse are just part of the "game" of training and are perfectly objective, but what else could they say? Fact is, evaluations are very subjective, more so as attendings progress in their career and use short-cuts, i.e. stereotypes and gut feelings to judge residents.

For anyone who is serious about gardening, you know that a myriad of factors affect plant growth, i.e. soil pH, soil consistency, geography, light exposure . . . if a plant dies you have to consider whether the plant was good for the environment, or if your soil and environment is mismatched. Usually you can figure it out, like if you plant something that won't grow in Maine under any conditions, or if the plant type/cultivar is OK, but you didn't allow for good drainage etc. . . Difference between gardeners and attendings is that attendings assume straight up that the environment is good, and that the resident is bad. Most of the time with plants the soil isn't good enough or other factors under control of the gardener. I think that most "problem" residents are OK docs, just that there are a lot of malignant residency programs out there.

Attendings are not all-fair, all-knowing gods, no way. Many are prejudiced, some are right wing nuts, and some are left wing nuts, and some hate men and some hate women. I have seen a lot who don't care to teach, stay up to date, or be nice to patients. They put on the same pants as anybody else and a lot of them are divorced, alcoholic or addicted to pain killers or other 'recreational drugs'. Most don't give a dam about teaching, but they do care if anyone questions what they are doing or ask for more teaching, and they often respond with really mean evaluations. Some hospitals are great and have support systems for teaching, others have lived out their glory days and are set up to collect high tuition while using med students as free labor.

I have seen so many residents/students get on the wrong side of the attending and then get slammed in bad evals. Sure, I have seen some incompetent residents, but most poorly evaluated residents are trying really hard and get beaten down and don't get the training they need to excel.

If there was discrimination then "they" i.e. the attendings and faculty, wouldn't say that there was and would find all the evidence in the world to blame the resident. Would the attendings even be consciously aware that they were being discriminatory?

Medicine fosters mediocrity and indifference. If you have a brain then you will critique the critique of your performance if warranted, and will question attendings more. If you are passive and don't care and just blindly follow attendings and put all your efforts into brown-nosing attendings then you will come out OK. People who get upset about crazy sadistic evaluations are people who care, if you don't care and just brush if off and take unwarranted abuse then you will be fine, but you will also have sold your soul.

I have faced significant problems myself in terms of harassment and abuse, but because on principle I don't believe in filing lawsuits I haven't done this. In the case of gender discrimination I would get legal help about how to peacefully resolve this before you get fired. Maybe a lawsuit is justified in the case of gender discrimination. I honestly think that if more lawsuits were filed by residents/students against attendings then this would be a checks and balances which would give sadistic attendings pause before doing mean things. Many attendings want to be king/queen of the hill and inappropriately exerting their power over subordinates is the major daily chore, lawsuits would discourage this behavior. Work place violence is a sad development in modern society, and as evaluations become more ludicrous/mean/impersonal in their wording then this may lead to some really upset residents/students. It is really scary reading all of the posts here and what I have heard from students rotating on our service, thre is a lot of hate out there now. . .
 
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