How to help fellow resident

[Ironheme]

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One of my co-residents is struggling and has been placed on probation. He's a good guy and means well but is constantly late (5-15 minutes) to most things. The reason for probation, as per the resident, was running behind on clinic patients (so the last patient would be seen 1 hour later than scheduled), not finishing notes on time, being slow in general, and failure for agenda setting/prioritizing. What I have seen is not asking the right questions and struggling with preceptors (ie not asking all the SOCRATES questions), not investigating further (cough not improving for 2-3 weeks in a CHF + COPD patient - he diagnosed pt with URI with no lab work/CXR and sent pt home), etc.

I have offered to help, answering questions on how I do things, how I would manage, what resources I find helpful. Most of the time he says he's fine and that everything is going well, but I feel like I'm watching a sinking ship and would like to help him succeed.

The program seems to be trying their best to help him succeed with close mentoring and giving him feedback on every patient interaction on how to improve, and giving him a time frame in which to improve. However, he continues to be late to meetings (there seems to be conflict at home), and forgets to ask patients more information about symptoms (ie, only telling preceptor patient has chest pain for 2 weeks with no further information).

Any suggestions?

 

[NotAProgDirector]

I recommend you stay out of it. I know you want to help, but it doesn't sound like your colleague wants any help. He needs to prioritize his education and career, or take an LOA. Showing up on time is "easy", compared to improving his clinical skills. If he can't handle that, the writing is on the wall.

If you really can't help yourself, you could talk to the PD and offer to help. But your description suggests that he's not taking this seriously, so no amount of helping is going to fix it. Sometimes sinking ships sink, despite the crew manning the pumps.

 

[doc05]

Don't get involved.

 

[gutonc]

I'm going to agree with aPD here (as I do essentially every time he posts something). This resident/friend seems to have already dug his own grave, at least in the current program.

It sounds, by your description, that this program is being exemplary in terms of trying to help this dude out. And he's still not getting it. Whether he can't, or won't, get it, is kind of beside the point now.

Honestly, the best thing you can do to help your friend at this point is convince him to request a formal LOA and seek help for whatever med/psych/social issue is causing him to function the way he is right now. Obviously, he's smart enough to do this...something else is interfering at this point, and he needs to get that s*** sorted before he can move on.

 

[HomeSkool]

What you're describing here is a pervasive failure to meet acceptable norms of professional behavior. Chronic tardiness, failure to function as an adult learner, clinical incompetence...these are not inconsequential problems in a physician. By your own description, the program has gone out of its way to help him recover and you've reached out as a good friend. You may want him to succeed, but ultimately he has to make that happen.

I'd like to underscore a point that @aProgDirector made:

If you really can't help yourself, you could talk to the PD and offer to help.

Translation: "If you lack the self-mastery to keep your distance, going to the PD is the least inappropriate thing you can do." At least, that's how I read that. This guy's on probation and heading toward termination. You don't want to mix yourself up in that, especially without the knowledge and consent of your program.

I feel like I'm watching a sinking ship

You are. Don't be on it when it goes under. You can't help someone who doesn't want help, and you can't save people from themselves.

 

[gutonc]

One thing that I think that I should add to my advice above....

The absolute worst thing that you can do, for your friend, and yourself, is try to cover for him. Any other kind of help you try to offer (other than recommending an LOA and that he get some professional help) will likely be useless to him, but otherwise harmless to you.

But if you try to cover for him..."Hey Dr. Attending PD, Jim texted me and said he had an emergency at home this morning and won't be in to round for another half an hour"...that's going to ruin 2 careers.

 

[anonperson]

One of my co-residents is struggling and has been placed on probation. He's a good guy and means well but is constantly late (5-15 minutes) to most things. The reason for probation, as per the resident, was running behind on clinic patients (so the last patient would be seen 1 hour later than scheduled), not finishing notes on time, being slow in general, and failure for agenda setting/prioritizing. What I have seen is not asking the right questions and struggling with preceptors (ie not asking all the SOCRATES questions), not investigating further (cough not improving for 2-3 weeks in a CHF + COPD patient - he diagnosed pt with URI with no lab work/CXR and sent pt home), etc.

I have offered to help, answering questions on how I do things, how I would manage, what resources I find helpful. Most of the time he says he's fine and that everything is going well, but I feel like I'm watching a sinking ship and would like to help him succeed.

The program seems to be trying their best to help him succeed with close mentoring and giving him feedback on every patient interaction on how to improve, and giving him a time frame in which to improve. However, he continues to be late to meetings (there seems to be conflict at home), and forgets to ask patients more information about symptoms (ie, only telling preceptor patient has chest pain for 2 weeks with no further information).

Any suggestions?

Good guy?Why, because he makes a few jokes here or there?

Seems like a perpetual f$ck up.

Being late, not finishing notes, not being organized are all self inflicted wounds from sheer laziness. Nothing worse than rolling in 5-15 minutes late because it basically says "I don't care enough to leave/wake up/etc 15 minutes earlier to get here" which is pretty disrespectful.

Also, at a certain point, a resident has to realize that you are caring for actual human beings who can have negative outcomes/complications. You're not a medical student whose work doesn't count anymore. Yes, you are supervised to an extent but residents can inflict damage if not paying attention. This is not some test. These are actual people with real problems who are coming to see you for help. If that doesn't motivate your co resident to at least try to be competent, then there is no hope.

I've only been out in practice for 6 months but I have seen a few $hitty docs who dump patients and pass the buck at the expense of the patient because they are too lazy/too dumb/etc and it is infuriating.

 

[shopsteward]

The only thing that can be done for OP's colleague is for his colleague to himself understand the seriousness of his position and what he needs to do to put it right. If he can't acknowledge that there is nothing to be done.

Which raises a number of questions: what is causing these problems (there must be something: your colleague wouldn't have got this far without the basic skills of showing up on time, being able to learn and being able to correct problems when pointed out), why is your colleague unable to recognise it and why is he unable to deal with it? It must be something significant.

My quite possibly unfounded suspicion would be that the "conflict at home" that is mentioned is worse than anyone realises, possibly including the man himself. It may include violence or bullying: the way in which the colleague is "shutting down" could be an indicator of this. Perhaps what OP could do is create an opportunity away from work in which they can probe a bit about these problems and have contact details for some resources available to give to him.

 

[Ironheme]

Thank you for the suggestions. I will talk to him about LoA. As for not covering up - I haven't and don't plan to. Another colleague has but was caught by the program director 'yeah he's 30 minutes late because he's covering the floor' - turns out program director knew the attending that was solo covering the floor that day.

As for the home conflicts, I asked him about it and talked to him about the seriousness of everything. His spouse is upset they had to move for residency and has been actively working against him (hiding his car keys, picking fights before and after work, throwing away his white coat, trashing all his notes, etc.). My colleague says this has gotten better after spouse realized he was put on probation. I can't really explain why he is still continually late, doesn't know his patients well, and doesn't seem that stressed about the situation. He puts in more hours than all of us but is still struggling to finish notes on time. He is more than halfway through the probation period now.

I will stay out of it but suggest the LoA to him.

 

[anonperson]

As for the home conflicts, I asked him about it and talked to him about the seriousness of everything. His spouse is upset they had to move for residency and has been actively working against him (hiding his car keys, picking fights before and after work, throwing away his white coat, trashing all his notes, etc.). My colleague says this has gotten better after spouse realized he was put on probation. QUOTE]

Lol. I can't believe that's true. Sad but kinda funny.

Spouse should be really happy in a few months when he's fired and sitting his ass at home.

 

[deleted480308]

If I were him, I’d move out and be to work on time.....but he’s got to work out his own mess, poor guy

 

[shopsteward]

Yup, bullying and violence. He needs to leave the wife, but it'll probably take years for him to realise that.

 

[Psai]

Yup, bullying and violence. He needs to leave the wife, but it'll probably take years for him to realise that.

It can take years after the breakup to realize it. It's hard to let someone go even if they didn't treat you well and it's easy to spend a lot of time thinking about them years later

 

[AdmiralChz]

Another colleague has but was caught by the program director 'yeah he's 30 minutes late because he's covering the floor' - turns out program director knew the attending that was solo covering the floor that day.

Great example of exactly what NOT to do. Not only does this not help the resident, it puts another person in the crosshairs for lying. Dont be this person.

OP, as others have suggested all you can really do is be his friend, have a shoulder to lean on and listen and be supportive. Do not get insert yourself into the program conflicts.