I want out

[meow1985]

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What risk is involved with midlevel supervision if they are billing and seeing patient independent on their schedule and if you didn't co-sign notes? What federal fraud we should be worried about? Thanks

I've perused licensing disciplinary actions and people get in trouble for things like pre-signing Rx sheets that the midlevels later fill in. That's not kosher. Also anything where you purport to supervise them but don't actually do what you say you did is problematic.

 

[meow1985]

Maybe it's time to try some psychodynamic and explore the source of all this?

I'm a bit skeptical of psychodynamic approaches, but you and @clausewitz2 may have a point.

But see, I think I already know the source of a lot of this. My childhood messed up. Lots of chaos, domestic violence, even being technically if not functionally homeless for a while. When things stabilized, a Tiger mother with BPD, bullying, and stunted social growth. I have a lot of insights about my past life, but that hasn't really done much for me... yet, anyway.

 

[meow1985]

The OP is struggling and the toxic culture of residency has little to do with it. Let's not hijack this thread.

Oh I am sorry that comment did not fit with your talking points. You can just let it sit and leave it there, if you are worried about the thread "being hijacked".

Well, I do feel somewhat unsupported in my residency because I feel like I can't talk to people there about it. Everyone in my residency was like, "wow, stinks that this lawsuit just HAD to happen to HER - she's already insecure as cr*p."

 

[downwithDTB]

The OP is struggling and the toxic culture of residency has little to do with it. Let's not hijack this thread.

Interestingly, my read of the original post was:
1) something kind of bad but not that bad happened.
2) now I'm generalizing a feared worst outcome to every kind of bad thing that happens with total catastrophic thinking
3) I want "perspective" (i.e. reassurance) because my last thread I got reassurance and it didn't stop the anxiety so I still want it

Training in pretty much every competitive career is bad: law, acting, science, physics, litterature, medicine, ect. Being in residency and having a constant, gripping fear of being sued is not the normal experience. What the OP described with an irrational fear of an extremely unlikely outcome is not the experience of any residents that I know. We're talking wanting to quit medicine to avoid the possibility of an outcome that happens to probably 1 in 1,000 physicians, most of whom were knowingly engaged in something blatently criminal like selling opioids for cash or billing Medicaid for patients they didn't see.

 

[Merovinge]

Interestingly, my read of the original post was:
1) something kind of bad but not that bad happened.
2) now I'm generalizing a feared worst outcome to every kind of bad thing that happens with total catastrophic thinking
3) I want "perspective" (i.e. reassurance) because my last thread I got reassurance and it didn't stop the anxiety so I still want it

Training in pretty much every competitive career is bad: law, acting, science, physics, litterature, medicine, ect. Being in residency and having a constant, gripping fear of being sued is not the normal experience. What the OP described with an irrational fear of an extremely unlikely outcome is not the experience of any residents that I know. We're talking wanting to quit medicine to avoid the possibility of an outcome that happens to probably 1 in 1,000 physicians, most of whom were knowingly engaged in something blatently criminal like selling opioids for cash or billing Medicaid for patients they didn't see.

In the world in which psychiatrists are literally the least sued doctors of any specialization. Even compared to pathology! We also have extreme demand for services, there's hardly a place on Earth that won't be interested in someone because they were named in a then dismissed or even settled lawsuit when they were a PGY1. I'm not sure Harvard would flinch at that, assuming the rest of your CV was up to snuff.

 

[watto]

You will come out of this with some great in vivo exposure to your core fear, if you can approach it in a positively-adaptive way. Consider those worst-case scenarios. Yes, you may end up doing more paperwork than 99% of your colleagues when you apply for licenses / insurance over the years. It will be a big drag. Assuming anything comes of the matter. Acknowledge the grimness of that paperwork. It could be an extra several hours of your time, each time. You may have to develop a stock answer for what happened that will help you save face. OK, another hour of your time. All of it extremely boring, but is any of it really that threatening? Are you really going to be out on the streets?

In another thread, NPs are being hired out as medical directors. You can survive. Remove some of the pressure to make bank early and consider that the job itself is not as intolerable as you think.

I always tell my patients who have grown up in chaos or witnessed trauma that they are the real survivors. It's a cruel joke the world plays that they THINK they are not capable survivors, when they are the ones I would follow in the event of giant disaster because they know the drill.

 

[meow1985]

You will come out of this with some great in vivo exposure to your core fear, if you can approach it in a positively-adaptive way. Consider those worst-case scenarios. Yes, you may end up doing more paperwork than 99% of your colleagues when you apply for licenses / insurance over the years. It will be a big drag. Assuming anything comes of the matter. Acknowledge the grimness of that paperwork. It could be an extra several hours of your time, each time. You may have to develop a stock answer for what happened that will help you save face. OK, another hour of your time. All of it extremely boring, but is any of it really that threatening? Are you really going to be out on the streets?

The paperwork is annoying but rationally, yes, it's just a few hours of my time.

 

[Fan_of_Meehl]

The paperwork is annoying but rationally, yes, it's just a few hours of my time.

But it's the case AND the fact that I took a mental health vacation for a month as a PGY3, AND the anxiety-driven mental illness that I have and the perennial impairment question. I know I've never been impaired in the workplace (though the quality of my personal life isn't always good), but would they wonder if lawsuit = she's impaired after all? And yes, both licensing bodies and insurance providers ask about all of those things so maybe they *will* decide to bar me from practice or sanction me for things a more "normal" person could get away with. 🙁

With all due respect...I don't think these hypothetical 'normal people' exist. They're just particularly good at hiding their catastrophes 🙂

 

[watto]

You end up spending the energy planning for all that, though, which is better than using it in unproductive hand-wringing. So you need to devote time to not only being the non-impaired physician you are, but you need to prove it. Saving letters of commendation, positive reports, etc, that other people take for granted. There's nothing wrong with creating the insurance. You may never need it but you will feel better if you plan for it. Takes you out of such a perceived helpless situation. You are probably a great planner.

 

[meow1985]

You end up spending the energy planning for all that, though, which is better than using it in unproductive hand-wringing. So you need to devote time to not only being the non-impaired physician you are, but you need to prove it. Saving letters of commendation, positive reports, etc, that other people take for granted. There's nothing wrong with creating the insurance. You may never need it but you will feel better if you plan for it. Takes you out of such a perceived helpless situation. You are probably a great planner.

Great, so my fears are real. That I'll be perceived as impaired. Since at least one person thinks said fears are worth planning for. You're right, all I do is plan for disasters. That's why my quality of life sucks - disaster planning takes up a huge amount of my time.

And don't you worry. I have a kudos folder or positive feedback I got over the years. I should probably look at it more.

 

[Fan_of_Meehl]

Great, so my fears are real. That I'll be perceived as impaired. Since at least one person thinks they're worth at least planning for

Nah. Not the way I see it. Your sensitivity is your superpower. As is your tendency to worry and your conscientiousness. The physician who doesn't worry is probably far more likely to be successfully sued.

 

[downwithDTB]

But it's the case AND the fact that I took a mental health vacation for a month as a PGY..

I know people who have had multiple unplanned psych hospitalizations during training, taken significant time off for ECT, ect, and continue to practice without anyone being the wiser or caring if they know. Some of the better shrinks I know, actually. You can always move to a state where they can't even ask about this stuff...

 

[meow1985]

I know people who have had multiple unplanned psych hospitalizations during training, taken significant time off for ECT, ect, and continue to practice without anyone being the wiser or caring if they know. Some of the better shrinks I know, actually. You can always move to a state where they can't even ask about this stuff...

Yeahhh, I guess I should've thought of that before I accepted a job. 🙁

 

[Fan_of_Meehl]

I know people who have had multiple unplanned psych hospitalizations during training, taken significant time off for ECT, ect, and continue to practice without anyone being the wiser or caring if they know. Some of the better shrinks I know, actually. You can always move to a state where they can't even ask about this stuff...

Right. Kay Redfield Jamison. Marsha Linehan. Probably countless others. It has been done. It seems like the critical thing is finding a way to make your experiences work for you rather than against you as a clinician. If a clinician has had particular real-life struggles in their lives, it seems that this could make them particularly adept at empathizing or finding an excellent hook into the therapeutic alliance at particularly challenging junctures. Where most people with 'perfect lives' (though I don't think they exist) would 'freeze,' the person with experience with tragedy would start to harmonize or 'jam' with the patient across from them who is having a rough time of it.

 

[meow1985]

Right. Kay Redfield Jamison. Marsha Linehan. Probably countless others. It has been done. It seems like the critical thing is finding a way to make your experiences work for you rather than against you as a clinician. If a clinician has had particular real-life struggles in their lives, it seems that this could make them particularly adept at empathizing or finding an excellent hook into the therapeutic alliance at particularly challenging junctures. Where most people with 'perfect lives' (though I don't think they exist) would 'freeze,' the person with experience with tragedy would start to harmonize or 'jam' with the patient across from them who is having a rough time of it.

Oh, you are preaching to the choir. My experiences definitely are an asset in my work.

My worry is about how I will be perceived by governing bodies, such as license boards and credentialing committees.

And yeah, I know no one will be able to definitively tell me it's ok. I just need to keep plodding forward and see what happens, and if it doesn't work out pursue plan B. Easy. But also so, so hard.

 

[Fan_of_Meehl]

Oh, you are preaching to the choir. My experiences definitely are an asset in my work.

My worry is about how I will be perceived by governing bodies, such as license boards and credentialing committees.

I hear ya. That's always a fear.

 

[meow1985]

I hear ya. That's always a fear.

Wake me up when it's all over, when I'm licensed and credentialed.

 

[Fan_of_Meehl]

LOL. The blessing is that time marches on without our intervention. The curse too.

 

[Fan_of_Meehl]

Wake me up when it's all over, when I'm licensed and credentialed.

You can do this...:

 

[Piebaldi]

Residency is horrible. Being an attending is better. If your jobs sucks you can just leave and get a new one. Anywhere.

Agreed. Residency is horrible, and some worse than others. It does get better - I'm not in Psych but I'm pretty sure that can be said for just about any field.
With time you can set up your own practice and see who you want.

 

[Tapepsi]

Hated as a resident being at the mercy of your attending’s personal preferences. Got into an argument while on consults one time because my attending (who thank the lord no longer works at that hospital) wanted me to order Klonopin 1 mg QID for a woman about to be discharged with confirmed pseudoseizures (keep in mind she demanded benzos her entire hospitalization). It was like a 2-3 week script too. Told him I felt uncomfortable as I didn’t think benzos were indicated in that situation and that he had to order it himself.
Once you’re an attending the responsibility falls on you and that can be scary but it feels liberating because every choice is your’s. That’s not to say you can’t talk to your colleagues to get outside input when you need help but for the most part no one is telling you what to do.

 

[nexus73]

Everything is going to be alright.

Lawsuits are slow things. Try not to worry about having to solve it today. You'll have a good lawyer to handle all of the difficult stuff.