Interpersonal Failure in Residency: What to do?

[Divine Furor]

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I'll try not to be long-winded here, promise.

I'm having trouble figuring out how to deal with how I feel about a colleague--a co-intern. We started the year on friendly terms -- she is bright and insightful, and I knew from the start, also dysphoric and cynical. As time passed into this intern year, I've watched her get more and more unhappy, for reasons that I'm not entirely certain of--she gained weight, she withdrew, but as far as I knew her home life was stable. She was vocally resentful of the group of us that started on inpatient psych. She began ripping into residents on other specialties, venting about patients, mentioning her depression over and over--all of which I could tolerate and support, but I didn't enjoy it. Finally she turned her negativity on me--I found myself mocked, sarcastically, when I was trying to be earnest. When I asked questions of attendings in clinic or didactic, she would interrupt them to suggest, with little subtlety, that my education was deficient or my assumptions foolish. This went on for a month, and our friendship eroded. I definitely went through a stage in my life, in my late teens, when I alienated people close to me, sniped, played one-up-manship games.....when I was depressed. I can identify with her defense mechanisms but I don't like them.

I became quieter (not my usual MO), opting for nonconfrontation and found myself giving her the silent treatment, which didn't feel good. She detected this and upped the frequency of these semi-public "put-downs." Finally she texted me one night to ask if there was a problem, and I told her briefly that I didn't appreciate the way she had been treating me, and I wasn't feeling friendly toward her anymore. We haven't spoken since.

But of course we have to interact weekly, and soon, daily.

Half of me says to myself: "It's okay to be an adult and choose not to be friends with a person." Facile, right? The other half feels, "Okay, if you alienate her, she is going to make your professional life more difficult for at least 3 years, and what are you gonna do about it?" I'm trying not to care, but I find myself gritting my teeth before I see her in clinic. I've felt vengeful.

So internetz, what do I do about this? I'm a new doc with business professional experience, but that was hierarchical and easier to navigate, emotionally, than this situation seems to be. My other intern colleagues are aware we don't get along, and I fear I'm causing some group discomfort. Thanks for your thoughts.

 

[upright]

Bang her.

 

[Divine Furor]

Nice, but I didn't ask "What do I do if I meet Charlize Theron?"

 

[ghost dog]

I'll try not to be long-winded here, promise.

I'm having trouble figuring out how to deal with how I feel about a colleague--a co-intern. We started the year on friendly terms -- she is bright and insightful, and I knew from the start, also dysphoric and cynical. As time passed into this intern year, I've watched her get more and more unhappy, for reasons that I'm not entirely certain of. She was vocally resentful of the group of us that started on inpatient psych. She began ripping into residents on other specialties, venting about patients, mentioning her depression over and over--all of which I could tolerate and support, but I didn't enjoy it. Finally she turned her negativity on me--I found myself mocked, sarcastically, when I was trying to be earnest. When I asked questions of attendings in clinic or didactic, she would interrupt them to suggest, with little subtlety, that my education was deficient or my assumptions foolish. This went on for a month, and our friendship eroded.

I became quieter (not my usual MO), opting for nonconfrontation and found myself giving her the silent treatment, which didn't feel good. She detected this and upped the frequency of these semi-public "put-downs." Finally she texted me one night to ask if there was a problem, and I told her briefly that I didn't appreciate the way she had been treating me, and I wasn't feeling friendly toward her anymore. We haven't spoken since.

But of course we have to interact weekly, and soon, daily.

Half of me says to myself: "It's okay to be an adult and choose not to be friends with a person." Facile, right? The other half feels, "Okay, if you alienate her, she is going to make your professional life more difficult for at least 3 years, and what are you gonna do about it?"

So internetz, what do I do about this? I'm a new doc with business professional experience, but that was hierarchical and easier to navigate, emotionally, than this situation seems to be. My other intern colleagues are aware we don't get along, and I fear I'm causing some group discomfort. Thanks for your thoughts.

Personality disorder ? Substance abuse problem ? Who knows.

I would just avoid her; life's too short for people like her.

 

[BobA]

I'll try not to be long-winded here, promise.

I'm having trouble figuring out how to deal with how I feel about a colleague--a co-intern. We started the year on friendly terms -- she is bright and insightful, and I knew from the start, also dysphoric and cynical. As time passed into this intern year, I've watched her get more and more unhappy, for reasons that I'm not entirely certain of--she gained weight, she withdrew, but as far as I knew her home life was stable. She was vocally resentful of the group of us that started on inpatient psych. She began ripping into residents on other specialties, venting about patients, mentioning her depression over and over--all of which I could tolerate and support, but I didn't enjoy it. Finally she turned her negativity on me--I found myself mocked, sarcastically, when I was trying to be earnest. When I asked questions of attendings in clinic or didactic, she would interrupt them to suggest, with little subtlety, that my education was deficient or my assumptions foolish. This went on for a month, and our friendship eroded. I definitely went through a stage in my life, in my late teens, when I alienated people close to me, sniped, played one-up-manship games.....when I was depressed. I can identify with her defense mechanisms but I don't like them.

I became quieter (not my usual MO), opting for nonconfrontation and found myself giving her the silent treatment, which didn't feel good. She detected this and upped the frequency of these semi-public "put-downs." Finally she texted me one night to ask if there was a problem, and I told her briefly that I didn't appreciate the way she had been treating me, and I wasn't feeling friendly toward her anymore. We haven't spoken since.

But of course we have to interact weekly, and soon, daily.

Half of me says to myself: "It's okay to be an adult and choose not to be friends with a person." Facile, right? The other half feels, "Okay, if you alienate her, she is going to make your professional life more difficult for at least 3 years, and what are you gonna do about it?" I'm trying not to care, but I find myself gritting my teeth before I see her in clinic. I've felt vengeful.

So internetz, what do I do about this? I'm a new doc with business professional experience, but that was hierarchical and easier to navigate, emotionally, than this situation seems to be. My other intern colleagues are aware we don't get along, and I fear I'm causing some group discomfort. Thanks for your thoughts.

I don't think it's a good idea to communicate important emotional things via text. so much is lost without the nonverbal cues of body language, facial expression, etc. If something were having a big impact on my life (and a relationship with a colleague I'd see daily fits that bill) I would want to talk with them about it in person. May favorite way to do this is while going for a walk in a pleasant place since it's more private than a restaurant, and you're not stuck facing each other directly, but can turn if you want to. Plus, the exercise can lighten the mood.

 

[peppy]

How is the administration at your program?
At my program, I would feel comfortable telling the PD that I was concerned that the other intern seemed to be having trouble adjusting to residency (and I do feel the PD would take it seriously if someone felt an intern was depressed). Here, they would want to know if I felt someone was causing a hostile workplace for me.
At some programs, you might not be able to do that though. It really depends on the atmosphere at your particular place.

Being in the same residency class doesn't mean you have to be friends, but I do think it means you should treat each other professionally. If I felt like the admin wouldn't be sympathetic, I would probably just do my best to avoid her and when forced to interact with her would remain professional. Sort of like how if a patient was trying to provoke a reaction from me, I would just stay focused on being professional. 🙂

 

[splik]

I have had difficulties with residents being hostile towards me and trying to undermine me in the workplace. On one occasion that person was someone who I had considered a friend who completely turned on me. At first I ignored it because I liked her and wanted to believe she was a good person (and I still believe so) but it became hard to ignore and I found out she had been saying this behind my back and even telling frank lies! It turned out that she was struggling with some issues and she took it out on me. The difference between this situation and yours is she was a senior resident and I was an intern which put me in a difficult position. (I won't post here what happened in the end!)

In your situation I don't believe your co-intern is a bad person or even that she was trying to alienate you with her behavior. If that were the case she wouldn't have reached out to you with a text asking if there was a problem. I think it is possible her sarcastic comments may have been misguidely well intended. You messed up by not addressing this in the first place, and then sending her a text saying you didn't want to be friends anymore. What you can do now is see whether you want to repair the friendship, try and establish whether she really is struggling with some issues or whether she may have untreated depression, and also to call her out on the way she has been treating you in public. All that is needed is for an attending to call her out on it (or you but this could go either way) and she will likely stop. If she really has been undermining you the way you say it won't have gone unnoticed. Quite frankly if she has been interrupting attendings to make snipes at you I am surprised no one has called her out on this already.

 

[nitemagi]

I could see 2 different approaches --

Both involve sitting down 1-1. One is make it about you relationship, rather than all the other things going on, and just try to connect personally. Just hang out 1-1. The other is to go the "I'm worried you're having problems and I want you to know you can talk to me about it."

You could also go the avoidance route but it's a long 4 years.

 

[F0nzie]

don't let her rent space in your head. keep it professional.

 

[whopper]

Well based on what you say there's several possible theories. I can tell you when I was an intern there certainly was a lot of dysfunction between some residents, and as I advanced and learned more, noticed there was a lot between attendings. I dropped the notion that because we were mental health professionals that we as a group would somehow be above this type of problem.

 

[Cinnameg]

Don't involve your administration -- "feedback" or "criticism" or "expressing concern" is always done best by the person who actually knows the details, the specific instances of overstepping bounds or making comments that either were intentionally mean or were intended one way and something got miscommunicated. As an adult professional, talk to her first. Have very specific examples of exactly what she has said and done that has made your worklife difficult. If you don't have specifics, it's hard for a person to change. I doubt she's thinking, in her head before she makes comments that hurt you, "wow, I bet I can really get him with this one." She probably does not know what she's doing to hurt you, and if you say something along the lines of "stop hurting me" or "stop insulting me" she might not be able to self-identify what, exactly, you're talking about. So give it a go, talk to her. And make it about you, not her; you are hurt, she hurt you, she's making your work environment difficult, and that is why you need to talk to her. The "I'm concerned about you" approach can too easily come across as condescending and un-genuine, when the underlying emotions you are feeling are actually anger and hurt.

 

[billypilgrim37]

i sat down our borderline before the end of July intern year and said, listen you batsh*t crazy daddy issue girl, we're going to have to work together for like 4 or 5 years. We can't keep doing this.

I said it a little nicer than that, and I have been on the right side of the split ever since. I'm just glad she stopped trying to sleep with me by the end of intern year.

 

[peppy]

The reasons I suggested bringing the administration into things:
1. You want a paper trail to show there was a problem if she does manage to make you look bad enough that it causes your evaluations to suffer and the administration starts wondering if YOU are the problem. Saying that she is trying to damage your reputation now holds more weight than if you don't bring it up until you have some negative evaluations from attendings who bought into what she was saying.
Yes, we would hope that attendings would be smart enough to recognize what she is doing and not play into it, but unfortunately attendings are not infallible. I was involved in an incident where a senior resident on another service was trying to bully me and would try to make me look bad on rounds in front of the attending...and instead of recognizing it for what it was, the attending commented negatively on my eval (even though the other attendings I worked with on that rotation didn't have a problem with me 🙄 )

2. Sometimes internship is enough of a stressor that it really does push people who are struggling to hold things together over the edge. While some programs are better than others at showing compassion for resident mental health, all programs should be interested in this for liability reasons if nothing else.
There are definitely cases of residents committing suicide or breaking down under pressure and not showing up to take care of patients.
It might be justified for the administration to take a look at if this is someone who needs some intervention before a bad outcome happens.

 

[nancysinatra]

How can interns be depressed nowadays? Don't they work like 4 hours a week and strategically nap the rest of the time?

In any case I don't really get what the problem is. So someone you work with isn't being nice? Welcome to the world. In life there are all sorts of situations where people say mean things to each other, talk badly behind each other's backs, complain, turn on each other and interrupt. It's not the kind of business to bring to your administration like some people have recommended. (If she was in a supervisory position above you it might be different but that's not the case here.) If this person isn't nice to you then is there really a "friendship" to worry about? I guess it's up to you to decide what you expect of your friends. Personally I would not waste my time providing "constructive feedback" to an adult co-worker who appears to lack basic interpersonal skills. Sure if I had a long past friendship with the person it might be different but you've only known each other a few months.

And furthermore, your co-residents are not your patients. If you weren't working in psychiatry, would you be so concerned about her seeming depressed? If she has a problem that is interfering in her work, then her attendings will notice and she will find out. But if you're not friends anymore, then unless you are alarmingly worried about her, how is it your place to address?

Honestly it really bugs me when psych people scrutinize the "defense mechanisms" or mental statuses of all the people around them. It's what gives our profession the reputation of being weird.

 

[notdeadyet]

I'm with those suggesting the issue be resolved 1:1 with the problem child. While going to the administration to start a papertrail sounds like a good idea, it should be done after you've shown you've taken all steps to resolve the problem yourself. Running to the boss any earlier ends up reflecting poorly on both the complainer and the complainee alike. At the end of the day, what you're describing here is a pretty common workplace problem of co-workers not getting along.

Honestly it really bugs me when psych people scrutinize the "defense mechanisms" or mental statuses of all the people around them. It's what gives our profession the reputation of being weird.

I'm with Nancy on this score. Co-residents are co-workers, not patients. I love psychiatry but when I encounter psychiatrists who aren't able to take off the work hat, I tend to walk the other way and doubt I'm alone in that.

 

[Divine Furor]

Thanks for the variety of inputs -- I'm not "analyzing" my colleague in this, I'm just on the receiving end of bad behavior and she has vocally stated, "I am depressed." I don't care to take it further than that...

I guess I felt nervous about a 1:1 confrontation, because I didn't trust that I wouldn't snark back and sound whiny while I was still mad about the particular dis-in-question. But I think I will try that approach before I go to the PD, as you're right and it's better to at least try handling it myself first. She hasn't done anything overt to jeopardize my standing with the program, but if it goes there I will move quickly to involve administration.

Right now I don't want to be friends, persay, and I'm okay with that. But we do have to set the ground rules for professional conduct.

 

[flash]

ditto with above 2 posts.

 

[Doctor Bagel]

Is there enough damage here where you'd actually need a paper trail? It sounds like she's obnoxious and maybe she sometimes make you look a little less on the ball than you are, which might maybe result in some less than stellar evals, which certainly sucks. But even that isn't really a big enough to deal to officially involve the administration. The bigger issue is that you're having difficulty getting along due to interpersonal conflict, which isn't an official paper-trail triggering type of deal.

Personally I'd probably just shrug her off, remain somewhat annoyed and occasionally bitch about her to other people (not attendings), but I've got some avoidant traits, so I'm not sure that's the best way to deal with it. 😉 If doing anything proactive, the 1:1 route is definitely the way to go, and I agree that focusing specifically on what she said that you perceived as mean would be the best information to give out.

Also, I'm the queen of lack of discretion online, but you've commented on where you train, so she might be reading here and even know that you're talking about her. We've got lots of lurkers out here.

 

[ShrunkenHeads]

Also, I'm the queen of lack of discretion online, but you've commented on where you train, so she might be reading here and even know that you're talking about her. We've got lots of lurkers out here.

Even more of a reason to try and peace things out?

You don't necessarily have to LIKE her and be best friends with her, but it might be a good idea to show her (as opposed to telling her) that you don't have anything against her, that way she may ease up a bit with the hostility. Try to find good aspects about her or what she does. If she continuously tries to be hostile towards you and you ignore it (the behavior, not her) by not reacting, others may take notice and/or she will eventually feel stupid and stop.

Maybe you can go out for coffee/lunch?

I'd say try to be warm and non confrontational while still being real - tough, I know, but give it a shot. Actually, not too unlike the tone of your OP. A quick text like the one you sent comes off as dismissive and distant, it probably frustrated/concerned her even more. She's probably going through some things and doesn't have anyone to speak to about it.

 

[PETRAN]

This thread probably exceeds the maximum touchy/feely capacity, even of mental health services