Mean colleagues, why are you guys like this?

[deleted1195964]

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Yes, I missed a critical diagnosis.

Could have just professionally let me know that I missed it. Instead I was called multiple times, literally screamed at by my colleagues, one of which I previously had a friendly professional relationship with. Another even hung up on me.

I initially felt terrible about missing the critical diagnosis, but now I'm actually just really pissed about how unprofessional my colleagues acted.

Seriously, just let me know professionally where I messed up instead of literally screaming at me. Why? Why do you guys do it? Why are you guys yelling?

**** medicine. Never experienced this level of unprofessional behavior before medicine.

 

[DrMetal]

Yes, I missed a critical diagnosis.

Could have just professionally let me know that I missed it. Instead I was called multiple times, literally screamed at by my colleagues, one of which I previously had a friendly professional relationship with. Another even hung up on me.

I initially felt terrible about missing the critical diagnosis, but now I'm actually just really pissed about how unprofessional my colleagues acted.

Seriously, just let me know professionally where I messed up instead of literally screaming at me. Why? Why do you guys do it? Why are you guys yelling?

**** medicine. Never experienced this level of unprofessional behavior before medicine.

To be fair, other professions also harbor very unprofessional behavior. It's not just medicine . . .

Many reasons for this in medicine:

1. We're always competitive, cut throat: premeds-->medical students-->residents. When we finally become an attending, when it's all said and done, we really don't know what to make of it all. We continue to be the ****hole premeds that we were 20 years ago.

2. Doctors are not very humanistic. We spend so much time studying and training, we really don't explore much else in life. Fun game, ask your doctor friends what their hobbies are? (do not accept working out, exercising, or spending time with family) Most don't have any. And if you tell them you have one, they're amazed.

3. Doctors are pretty stupid. Yeah, I said it. The way we're brought up in our education and training, memorize, regurgitate, take test . . . never really understanding anything, never questioning anything. And this goes on. We become great lemmings, creating constant hurdles for our selves (endless board certifications, MOC, other stupid admin requirements). It's one thing if you get crapped on by people outside of your profession . . .but it's especially stupid when the members of your own profession like to crap on themselves!

 

[HemeOncHopeful19]

Only reason I can imagine yelling at someone, which I've never done, is if they somehow dragged me into a medmal disaster.

When someone is obviously an asshat and giving me crap in the hospital though I do like to pretend I'm dumber than I am because usually they don't expect that response and it's fun to see how they react.

 

[anonperson]

Yes, I missed a critical diagnosis.

Could have just professionally let me know that I missed it. Instead I was called multiple times, literally screamed at by my colleagues, one of which I previously had a friendly professional relationship with. Another even hung up on me.

I initially felt terrible about missing the critical diagnosis, but now I'm actually just really pissed about how unprofessional my colleagues acted.

Seriously, just let me know professionally where I messed up instead of literally screaming at me. Why? Why do you guys do it? Why are you guys yelling?

**** medicine. Never experienced this level of unprofessional behavior before medicine.

What was the miss?

But plenty of professions have yelling/etc.

Not excusing the behavior but it can happen.

 

[glorifiedresident]

You're going to have to provide much more detail before this post makes any sense at all. I don't think I've ever seen a colleague yell at another colleague in the same department in 20 years of practice.

 

[dozitgetchahi]

You're going to have to provide much more detail before this post makes any sense at all. I don't think I've ever seen a colleague yell at another colleague in the same department in 20 years of practice.

If you’re at a toxic workplace, it can absolutely happen (witnessed it in fellowship). That said, I’d never tolerate being treated like that even if I committed some sort of major error. (It happens…everything has a failure rate, including you, me, “experts”, jet airplanes, the space shuttle, etc etc).

 

[glorifiedresident]

If you’re at a toxic workplace, it can absolutely happen (witnessed it in fellowship). That said, I’d never tolerate being treated like that even if I committed some sort of major error. (It happens…everything has a failure rate, including you, me, “experts”, jet airplanes, the space shuttle, etc etc).

that might be true, but we don't have any context that is provided in the post to make any sort of understanding. the behavior described in the post seems to me to be very unusual, and I would need to know more details to make any sort of judgment.

 

[anonperson]

If you’re at a toxic workplace, it can absolutely happen (witnessed it in fellowship). That said, I’d never tolerate being treated like that even if I committed some sort of major error. (It happens…everything has a failure rate, including you, me, “experts”, jet airplanes, the space shuttle, etc etc).

Doesn't have to be a toxic workplace. Some people in the clinical realm do boneheaded things and need to be called out on it. Could be a nurse or another physician.

I have one example where I yelled at a colleague.

I had a full day of cases on my assigned block day ( 730am to 4pm, 3 or 4 cases in a row).

I get called by the on call OB at around 530am asking to bump me so they can do an "emergency" ectopic pregnancy case ( patient with severe pain, abnormal US etc). I refuse and tell them to bump someone else. I get called again 30 minutes later with the doc asking again to bump me because others were refusing as well.

I relent against my better judgment and am told by the charge nurse I'll probably be delayed by an hour. I go to the hospital around 8 and ask the charge nurse if they're almost done. She looks frustrated and tells me the case didn't happen because the on call doctor decided it was no longer an ectopic just now . I'm furious that I got delayed for no reason.

The anesthesiologist is even more p!ssed because he came in early to do the case as a courtesy and then do my cases to follow. He wasted his time.

I made sure the case gets brought up at our department meeting and rip into the colleague then.

Until I hear what the critical mistake is, I'm reserving judgement. Sometimes stuff needs to be called out.

 

[VA Hopeful Dr]

Doesn't have to be a toxic workplace. Some people in the clinical realm do boneheaded things and need to be called out on it. Could be a nurse or another physician.

I have one example where I yelled at a colleague.

I had a full day of cases on my assigned block day ( 730am to 4pm, 3 or 4 cases in a row).

I get called by the on call OB at around 530am asking to bump me so they can do an "emergency" ectopic pregnancy case ( patient with severe pain, abnormal US etc). I refuse and tell them to bump someone else. I get called again 30 minutes later with the doc asking again to bump me because others were refusing as well.

I relent against my better judgment and am told by the charge nurse I'll probably be delayed by an hour. I go to the hospital around 8 and ask the charge nurse if they're almost done. She looks frustrated and tells me the case didn't happen because the on call doctor decided it was no longer an ectopic just now . I'm furious that I got delayed for no reason.

The anesthesiologist is even more p!ssed because he came in early to do the case as a courtesy and then do my cases to follow. He wasted his time.

I made sure the case gets brought up at our department meeting and rip into the colleague then.

Until I hear what the critical mistake is, I'm reserving judgement. Sometimes stuff needs to be called out.

Called out is not the same as literally screaming.

 

[dozitgetchahi]

Called out is not the same as literally screaming.

Exactly.

I don’t care what the context is - openly screaming at colleagues is unprofessional (and I hate that word, but this is a time where it actually should be used) and not appropriate.

I had to cover patients for a colleague recently. After looking through charts and seeing a number of these patients, it was clear that this person was (to put it bluntly) not a competent physician. This doc had made a vast number of bad, stupid, and harmful management decisions. (And not just little things, either. Probably every other patient had some sort of “never event” that had happened at some point.) Untangling the problems this doctor created burned up a lot of my time. It was frustrating, and I resented that admin at my practice saddled me with cleaning up this doc’s messes. There were days where I saw 15+ of my own patients, and then up to 10 of his as well - it was an overload for sure, but a lot of these people really needed help. I did not want to turn patients away when undiscovered, potentially lethal management mistakes were lurking in the background. (His documentation was really crappy too, so I basically started over from scratch with each of his patients and did full workups, full HPI, etc.)

But did I scream at this doctor? No. Did I scream at admin? No. (And believe me, there are times where I would have liked to do so.) Screaming at this doc would have actually accomplished nothing. Instead, I brought this doctor’s incompetence to the attention of admin etc. That’s the professional way of handling this sort of issue.

(Also - in the modern era of medicine, the tolerance has gone way down for anything labeled “toxic” behavior. Scream at colleagues and staff enough, and admin may very well refer you to the state PHP, send you for anger management classes, etc. I’ve absolutely seen it happen. And you don’t want to be the person it happens to.)

 

[deleted1195964]

It was a miss that led to an urgent surgery, which occurred at shift change. The oncoming physician thought I was dumping an unstable patient onto him right at shift change, chewed me out and then hung up on me, called admin, who also proceeded to chew me out. Both phone calls immediately started off very aggressive, didn't even let me explain the situation, barely even let me speak. I even tried to defend another colleague involved, but admin instead thought I was deflecting blame onto the other colleague. What??

I missed the diagnosis. Could have just told me that. Instead, they hounded me on my mistake and admin demanded I apologize to the oncoming physician. I've only been here 5 weeks, the admin and the other physician both have at least 10 years each, so I decided to suck it up and apologize. Previously had a friendly professional relationship with the admin, but I'm going to avoid her from now on unless it strictly involves work.

It's very unfortunate we hammer the concept of professionalism into med students and residents, but professionalism does not exist in real life.

 

[HemeOncHopeful19]

It was a miss that led to an urgent surgery, which occurred at shift change. The oncoming physician thought I was dumping an unstable patient onto him right at shift change, chewed me out and then hung up on me, called admin, who also proceeded to chew me out. Both phone calls immediately started off very aggressive, didn't even let me explain the situation, barely even let me speak. I even tried to defend another colleague involved, but admin instead thought I was deflecting blame onto the other colleague. What??

I missed the diagnosis. Could have just told me that. Instead, they hounded me on my mistake and admin demanded I apologize to the oncoming physician. I've only been here 5 weeks, the admin and the other physician both have at least 10 years each, so I decided to suck it up and apologize.

It's very unfortunate we hammer the concept of professionalism into med students and residents, but professionalism does not exist in real life.

Honesty I would probably stop posting about this since a missed dx leading to urgent surgery could come back to bite you.

But IMO, it's hard to say based on the context provided. If you missed a diagnosis and then realized it and left it for your oncoming colleague to clean up by calling surgery, talking to the patient etc., I'd say you're probably in the wrong. If you missed a diagnosed and then realized it, called surgery, let the patient know what was going on and had everything squared away then I don't really get what your colleague's problem was.

 

[dozitgetchahi]

Honesty I would probably stop posting about this since a missed dx leading to urgent surgery could come back to bite you.

But IMO, it's hard to say based on the context provided. If you missed a diagnosis and then realized it and left it for your oncoming colleague to clean up by calling surgery, talking to the patient etc., I'd say you're probably in the wrong. If you missed a diagnosed and then realized it, called surgery, let the patient know what was going on and had everything squared away then I don't really get what your colleague's problem was.

Yeah. Also, if the “colleague” is a long timer who’s been there for 10 years and their first move is to call admin (who is their buddy) about this…sounds like it could be a rocky place to work. Calling admin about an issue at a shift change wouldn’t be my first move for anything like this. Take care of the patient…

 

[glorifiedresident]

Still not enough information to make an informed judgment or opinion on this. If you have only been there five weeks, I think it would have to be something pretty bad to make someone "yell" at you. There is a certain leeway and understanding given to brand new colleagues, which makes me think you did indeed do something inappropriate.

 

[chessknt]

I am assuming the OP is an attending and not a resident. Getting reported to admin by someone on a first offense is a sign of a highly toxic work environment with nasty politics--save yourself a lot of stress and turn in your notice ASAP or at least start looking for a backup job then turn it in. I have worked in an environment like this--you are an outsider and will never be part of the 'in' crowd now. Just leave and find some place that isn't ****. You worked too hard to have to put up with this crap.

The yelling you can write off as a grumpy person, but the report to admin and then being yelled out by admin immediately is the hallmark of small town incestuous politics. Leave asap, do not let anything formal start happening that you will need to report forever.

 

[eyeeye_captain]

This reads like an AITA? Reddit thread. The answer is everybody sucks here.

There’s still some context to be ironed out for sure, including the communication with the colleague, so with what we’ve been told:

You suck. You admit you had a massive miss that I’m guessing was life/limb/organ threatening given the urgent surgery. You claim you didn’t dump an unstable patient on the next doctor, but for them to immediately recognize your error at shift change and send them to the OR, I’m not sure I believe you. I don’t know which is worse - actually dumping or actually being clueless. Errors happen. They make people upset. I’ve worked in some toxic places, and it still takes a lot to have multiple people get upset enough to yell. It concerns me that you are more upset about how you were treated than the significant error.

They suck. The situation was run up the flagpole immediately, which may not have been necessary. They may apparently have not listened to the situation. They may have raised their voices - what constitutes yelling etc. is in the ear of the beholder. They may have misinterpreted you. There is likely bad blood on both sides now, and there will be trust issues both ways. None of that is ideal.

Big picture, you screwed up and they didn’t handle it in a way which made you comfortable or was appropriate. I suspect if you folks aren’t able to be adults and talk things out, the relationship may be very tough going forward given your limited experience together. Checking on other job options isn’t a bad idea, and if you haven’t already spoken with risk management, you should.

 

[chessknt]

This reads like an AITA? Reddit thread. The answer is everybody sucks here.

There’s still some context to be ironed out for sure, including the communication with the colleague, so with what we’ve been told:

You suck. You admit you had a massive miss that I’m guessing was life/limb/organ threatening given the urgent surgery. You claim you didn’t dump an unstable patient on the next doctor, but for them to immediately recognize your error at shift change and send them to the OR, I’m not sure I believe you. I don’t know which is worse - actually dumping or actually being clueless. Errors happen. They make people upset. I’ve worked in some toxic places, and it still takes a lot to have multiple people get upset enough to yell. It concerns me that you are more upset about how you were treated than the significant error.

They suck. The situation was run up the flagpole immediately, which may not have been necessary. They may apparently have not listened to the situation. They may have raised their voices - what constitutes yelling etc. is in the ear of the beholder. They may have misinterpreted you. There is likely bad blood on both sides now, and there will be trust issues both ways. None of that is ideal.

Big picture, you screwed up and they didn’t handle it in a way which made you comfortable or was appropriate. I suspect if you folks aren’t able to be adults and talk things out, the relationship may be very tough going forward given your limited experience together. Checking on other job options isn’t a bad idea, and if you haven’t already spoken with risk management, you should.

Maybe this is a hospitalist thing but I couldn't give less of a **** if someone dumped an unstable mess on me at shift change. I'm there to work and if the other person was doing a crappy job I am glad a good doctor got there (but more likely it is because patients don't always clean up nice at shift change times). You think ER docs stay hours after their shift ends because someone isnt stable? The mentality that everything needs to have a pretty bow is something that reminds me of the laziest most toxic residents I worked with.

What I can't stand is when someone is unstable and someone is trying to slow roll their shift start and show up a few hours late leaving me stuck there for hours u paid because the patient actually needs someone around.

 

[SpoiledMilk]

My hospital had a GS who was the most experienced and longest tenured. They burned a lot of bridges throughout their time being a d*ck to most non surgical attendings., residents, nurses and other staff. Their contract was not renewed when it was time to renew, and they had an unforced early retirement. Karma finally got around to them.

 

[dozitgetchahi]

Maybe this is a hospitalist thing but I couldn't give less of a **** if someone dumped an unstable mess on me at shift change. I'm there to work and if the other person was doing a crappy job I am glad a good doctor got there (but more likely it is because patients don't always clean up nice at shift change times). You think ER docs stay hours after their shift ends because someone isnt stable? The mentality that everything needs to have a pretty bow is something that reminds me of the laziest most toxic residents I worked with.

What I can't stand is when someone is unstable and someone is trying to slow roll their shift start and show up a few hours late leaving me stuck there for hours u paid because the patient actually needs someone around.

I also found this confusing.

At least as an IM resident, I remember unstable patients being changed over all the time. Sometimes an admission shows up 15 minutes before changeover, and all the last shift could do was lay eyes, write a basic note and try to put in some basic orders. Sometimes a patient is super sick, and despite best efforts they’re still “unstable” when a changeover happens (in the ICU, this is a big fraction of patients!) Sometimes the last doctor sucked a big one. Ok, like you I’m happy to be there to make things right.

Pitching a fit and immediately calling admin because someone was unstable at changeover strikes me as petty, whiny, and a bit ridiculous. I get that it sounds like OP missed something, and that may be an issue, but if OP ultimately realized it and started to take the right steps (call surgery, etc)…I’m not sure what the big deal is?

 

[Ubba]

If I screw something up and I figure it out right before/at shift change, I'm staying and fixing things (medically, surgically, or socially) myself. Not dumping it on the oncoming doctor. Yes, hospitalists are paid to work whatever's on the list for their shift, but a miss requiring untangling is not the same as signing out an ACS with troponin f/u to the next shift.

It's not clear from the OP whether the issue was the miss or the fact that the incoming physician felt that (s)he was being handed a steaming pile of medical ____ just because the clock had struck 7. It's also not clear whether the oncoming physician was medical coverage (hospitalist) or the surgeon who had to operate. In the latter case, chewing you out would make a lot less sense.

 

[DrMetal]

Maybe this is a hospitalist thing but I couldn't give less of a **** if someone dumped an unstable mess on me at shift change. I'm there to work and if the other person was doing a crappy job I am glad a good doctor got there (but more likely it is because patients don't always clean up nice at shift change times). You think ER docs stay hours after their shift ends because someone isnt stable?

So true. If you work in a hospital with sick enough patients and a high census (try a border town hospital, where Mexico sends you all its train wrecks), then almost all of your patients are unstable, all the time. You'd never leave!

This complaint of "Hey! you signed out an 'unstable' patient to me!?" is very reminiscent of a low acuity facility. At a high acuity hospital, there's too many unstable patients to care.

ER docs? Forget about it. They admit patients to me that they haven't even seen.

 

[anonperson]

Maybe this is a hospitalist thing but I couldn't give less of a **** if someone dumped an unstable mess on me at shift change. I'm there to work and if the other person was doing a crappy job I am glad a good doctor got there (but more likely it is because patients don't always clean up nice at shift change times). You think ER docs stay hours after their shift ends because someone isnt stable? The mentality that everything needs to have a pretty bow is something that reminds me of the laziest most toxic residents I worked with.

What I can't stand is when someone is unstable and someone is trying to slow roll their shift start and show up a few hours late leaving me stuck there for hours u paid because the patient actually needs someone around.

This wasn't just an unstable patient this a missed diagnosis as well that apparently should have been caught.

OP is a bit vague ( and should probably keep it that way). Was this labs or imaging with critical findings that were ignored? Was a basic exam not done that could have uncovered something? Unsure based on the post.

Did the OP volunteer to stick around to clean up with mistake?

I'm willing to bet most of the fury is related to the possible litigation risk if there is not an ideal outcome on this case. This can easily spiral out of control

 

[chessknt]

This wasn't just an unstable patient this a missed diagnosis as well that apparently should have been caught.

OP is a bit vague ( and should probably keep it that way). Was this labs or imaging with critical findings that were ignored? Was a basic exam not done that could have uncovered something? Unsure based on the post.

Did the OP volunteer to stick around to clean up with mistake?

I'm willing to bet most of the fury is related to the possible litigation risk if there is not an ideal outcome on this case. This can easily spiral out of control

Meh I've seen missed **** all the time (wire left in a central line, CT surgeon who wouldn't fix a tension ptx from his own ****ing surgery, advancing septic shock on an inpatient treated with asa 81, etc etc list goes on forever) and I don't run to admin about it because that is a super hostile move that doesn't do anything to fix the situation. A missed diagnosis in a stable patient is generally not going to be a big deal on the order of a few hours--people are generally pretty hard to kill in a hospital, too many monitors and people around.

If it is a pattern it should be reported but generally I just grumble about it to myself or whoever happens to be around and move on with my life. Living in fear of litigation is a sign of insecurity--do a good job documenting and you will be ok (eg I assumed care 1800 and was informed patient was decompensating at 1900 and found XYZ etc).

 

[anonperson]

Meh I've seen missed **** all the time (wire left in a central line, CT surgeon who wouldn't fix a tension ptx from his own ****ing surgery, advancing septic shock on an inpatient treated with asa 81, etc etc list goes on forever) and I don't run to admin about it because that is a super hostile move that doesn't do anything to fix the situation. A missed diagnosis in a stable patient is generally not going to be a big deal on the order of a few hours--people are generally pretty hard to kill in a hospital, too many monitors and people around.

If it is a pattern it should be reported but generally I just grumble about it to myself or whoever happens to be around and move on with my life. Living in fear of litigation is a sign of insecurity--do a good job documenting and you will be ok (eg I assumed care 1800 and was informed patient was decompensating at 1900 and found XYZ etc).

Not wanting to deal with malpractice litigation isn't a sign of insecurity. It's a fairly unpleasant situation that is professionally demeaning.

It's a freaking lotto system for patients and trial lawyers. Throw $hit to the wall and see what sticks. Can be completely random and it is not a pleasant experience.

You have enough of these and good luck finding a job in a half way decent area.

I'm currently involved in a case where my name is on the chart. Bad obstetric outcome didn't happen for over 16 hours after I saw the patient (wasn't even my patient, did something as a courtesy for another physician, and other physician delivered the patient well after my shift ended) but I still have to go through the deposition process etc.

I'm not losing sleep over this but it's definitely an annoyance.

Regardless, who is admin in OPs situation? The CMO? Chair of the department? Some non clinical VP?

 

[ReviewOfSystems]

You had every right to be chewed out. Not only missing the diagnosis, but not staying to clean up the situation when it was found out. This happened to me recently. I got one signout on a patient, pt came up to the floor unstable, I was informed, did further testing and patient had life threatening diagnosis completely different to the signout and was transferred patient to the ICU. Family was at bedside to boot. Patient remained stuck at our lower acuity hospital while I worked for hours trying to get patient transferred to a higher level of care during the winter holiday season, well beyond my shift. Yea you can guess how this has played out. This case is going for review and the doc who sent the patient up unstable and missed this diagnosis is under review. How badly I wanted to scream and yell at them but instead admin handled it. I hope they laid into them for me. We are not infalliable but humble yourself and learn from them.

 

[chessknt]

You had every right to be chewed out. Not only missing the diagnosis, but not staying to clean up the situation when it was found out. This happened to me recently. I got one signout on a patient, pt came up to the floor unstable, I was informed, did further testing and patient had life threatening diagnosis completely different to the signout and was transferred patient to the ICU. Family was at bedside to boot. Patient remained stuck at our lower acuity hospital while I worked for hours trying to get patient transferred to a higher level of care during the winter holiday season, well beyond my shift. Yea you can guess how this has played out. This case is going for review and the doc who sent the patient up unstable and missed this diagnosis is under review. How badly I wanted to scream and yell at them but instead admin handled it. I hope they laid into them for me. We are not infalliable but humble yourself and learn from them.

Well thank Christ you were there to call people on the phone for hours and still had time to notify administration. Or did you physically carry the patient to the other hospital and is that why it took more time than your shift?

 

[ReviewOfSystems]

Well thank Christ you were there to call people on the phone for hours and still had time to notify administration. Or did you physically carry the patient to the other hospital and is that why it took more time than your shift?

Yea thank Christ indeed. I'm sure you and OP would be 2 peas in a pod!

 

[eyeeye_captain]

Well thank Christ you were there to call people on the phone for hours and still had time to notify administration. Or did you physically carry the patient to the other hospital and is that why it took more time than your shift?

I will agree that there may be some pettiness and lack of professionalism in the original case.

But it looks like you’re doubling down on being ok with major medical errors, seemingly because the rock star hospitalist coming in the next shift will save the day every time. That dog don’t hunt in my eyes, but you’re free to play cowboy.

I despise admin at least as much as the next doctor, but there’s such a thing as both sides being wrong. If your stance is that keeping the suits out of your business is a bigger priority than practicing good medicine, I’m not on board with you. Errors will always happen, but I’m not a fan of brushing them off.

 

[dozitgetchahi]

Well thank Christ you were there to call people on the phone for hours and still had time to notify administration. Or did you physically carry the patient to the other hospital and is that why it took more time than your shift?

I was wondering this also (especially in OPs case)?

If the pt is that sick, how is there even time to call admin? And why is that the first thing you think of doing? Go to the bedside and get things sorted out. Calling admin is something to be done later, after the dust has settled. Not in the heat of the moment with super sick patients.

 

[dgdg]

1. Do right by your patient and take care of them at all times.
2. Consult your malpractice attorney before you say anything else to anyone. You have the right to legal counsel which should occur on the same day as your call. (The hospital and other involved parties are going to look to their liability as well, hence the screaming intimidation.).
3. Learn from your mistakes.
4. Mean people are everywhere.