Need help surviving a malignant program

[Floater102]

Need help

I'm at a malignant program which antagonizes constantly and is not afraid to punish

The chain of command is exhausted.

This makes me angry. Then I try to do something proactive i.e. involve myself in a project or whatever and I am met with more resistance or punishment. This makes me more angry.

Other residents in the program are able to cope and suck it up and shut up. But I'm having serious trouble.

I'm on psych meds and counseling and nothing is working. I've only a year and some to go so. Transferring is a last resort.

This is my last ditch effort to survive in this program and I don't know what to do.

I'm willing to take any (reasonable and mature) suggestions. This includes books...tapes...etc...

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[Janedoedoctor]

First of all, stop the anger. It drains your energy, makes you more likely to alienate others with whom you interact, and it serves no purpose. Try to accept the situation as it is.

A year is not very long. Your only goal should be to get through that year without getting kicked from the program. Nothing more. So stop taking initiatives or involving yourself in anything that isn't in your job description. You have nothing to gain and a residency position to lose.

Stop talking back. It gives you instant gratification but it WILL come back to bite you later. I understand from your post that you're not (yet) in danger of being fired from the program. It's imperative that you keep it that way.

See this as an exercise in humility and tolerance. You'll come out a wiser person.

 

[Law2Doc]

Need help

I'm at a malignant program which antagonizes constantly and is not afraid to punish

The chain of command is exhausted.

This makes me angry. Then I try to do something proactive i.e. involve myself in a project or whatever and I am met with more resistance or punishment. This makes me more angry.

Other residents in the program are able to cope and suck it up and shut up. But I'm having serious trouble.

I'm on psych meds and counseling and nothing is working. I've only a year and some to go so. Transferring is a last resort.

This is my last ditch effort to survive in this program and I don't know what to do.

I'm willing to take any (reasonable and mature) suggestions. This includes books...tapes...etc...

First, stop trying to do things proactive or exhausting the chain of command etc. Follow the lead of your co-residents who are keeping their heads down and plodding through. You can make it through a year. Step up the counseling if you need to but finish out the year without getting yourself kicked out and you should have plenty of opportunities to find a better situation. Basically you are like a marathon runner in the last mile of the race. You may decide you are feeling awful and tired and sore, and that it's not worth it and that there are better ways to live your life, but this is really the time to just focus on the finish line, and not let all these other things distract you.

 

[Floater102]

Thank you for the advice. You are right the program has told me that they do not want to fire me. But they will if I force them to...meaning shut up and go about my business.

I agree with that, but I'm having a very hard time with. Prior to this residency I have no record of un-manageable anger issues. None.

My anger stems from the fact I've (and others) have been antagonized repeatedly and thrown under the bus for whatever reason (especially me because I don't watch my back as well as I should).

With that said, I want to shut up, do what I'm told, not take any initiatives and finish the race without any major scratches.

My problem is a burning anger that I can't seem to control.

I'd really appreciate any help finding some self-help book or tapes or forum. The ones I've gone through don't really seem to work. Counseling is not really working. I'll try anything - which is sensible.

 

[Gordon Sims]

Thank you for the advice. You are right the program has told me that they do not want to fire me. But they will if I force them to...meaning shut up and go about my business.

I agree with that, but I'm having a very hard time with. Prior to this residency I have no record of un-manageable anger issues. None.

My anger stems from the fact I've (and others) have been antagonized repeatedly and thrown under the bus for whatever reason (especially me because I don't watch my back as well as I should).

With that said, I want to shut up, do what I'm told, not take any initiatives and finish the race without any major scratches.

My problem is a burning anger that I can't seem to control.

I'd really appreciate any help finding some self-help book or tapes or forum. The ones I've gone through don't really seem to work. Counseling is not really working. I'll try anything - which is sensible.

Try working out, hitting a heavy bag, etc. to help you destress.

 

[nitemagi]

Stop figuring out ways to push back or get pushed. Leave the 1-dimensionality.

Sidestep.

Put your mind somewhere else. Energy into that which you can control, and which you can succeed at.

Start a business. Start researching attending jobs and opportunities. Play video games.

 

[PharmaTope]

focus on it being over soon.

knowing you are not stuck there the rest of your life should make you so happy. focus on that goal of getting out of there.

document to yourself DAILY in emails (they maintain dates that cant be altered and can be used in court) any malignant behavior, bullying, who was present, who witnessed it, everything!!!!!!!!!!!!!!!

send yourself another email at the end of the day if it is having an effect on your emotional well being. this will allow you show there is damages to your well being from the work environment.

this is where you can put your effort into protecting yourself.

 

[bigDinLV]

Need help

I'm at a malignant program which antagonizes constantly and is not afraid to punish

The chain of command is exhausted.

This makes me angry. Then I try to do something proactive i.e. involve myself in a project or whatever and I am met with more resistance or punishment. This makes me more angry.

Other residents in the program are able to cope and suck it up and shut up. But I'm having serious trouble.

I'm on psych meds and counseling and nothing is working. I've only a year and some to go so. Transferring is a last resort.

This is my last ditch effort to survive in this program and I don't know what to do.

I'm willing to take any (reasonable and mature) suggestions. This includes books...tapes...etc...

Perhaps your perception of the program? Does everyone else seems to be getting along fine or does anyone else have the same complaints as you?

 

[residencycoord]

A program should not be that bad that you need to be put on medication, that is absurd, and to tell you to "suck it up" for the next year is poor advice, even though I understand the mentality of where that comes from. If the program is truly malignant and you are being verbally abused, then your institution should have an ombudsmen or some type of program through your GME office that you should be comfortable going to for help. You are there to be trained as a physician not to be used as a punching bag.

Good luck!

 

[turquoiseblue]

because i hate my situation right now, im listening to a library audiobook that is also in book form called 'Power Thoughts'. it helps in getting power to battle the negativity of the mind. Try positive thinking books like this. They could help, but not a guarantee. You should also try to meditate or yoga. that helps anger to dissipate. I used to be really angry at everything that happened to me, want to fight against things people said to me, but tried to numb myself and I have mellowed out over the years. things dont get to me as much as they used to. thoughts such as being thankful you even have a residency when many others cannot, or thinking of your work in a more positive way, able to handle whatever life throws at you, you may be able to get through with flying colors.

 

[phallusequinas]

Your situation is not that uncommon. I have known multiple residents who were normal before they entered residency and somehow ended up on psych meds during residency.

The situation here is very cloudy. There are several possibilities. One, you took the meds out of your own volition to cope with what is occurring at work, and the result of which is part of your own doing. This is legal and you will have no recourse. Two, you took these meds out of conduct by others who objectively should know that their conduct would lead to this predicament. Whether their conduct was reasonable is a question of fact for a jury. The last possibility is so called "disciplinary psychiatry" which the ACGME denies exists and is plainly tortious.

Thus the most likely scenarios are the first two.

There is not much you can do but suck it up until you are done.

But times are changing. Physicians who engage in the second and third possibilities do so at their own risk. The Supreme Court has recently recognized unanimously residents as employees in a tax context. But dicta in that case provides fodder for legal change in the future. Physicians who abuse their subordinates run the risk of being held out as examples in the litigation that I believe is certain to come.

 

[RespectResident]

Hey I am sorry to read about your situation. Besides all the suggestions above (good or bad) I will suggest a kickboxing class as well but mostly I want you read my thread and write to your ACGME. Your situation is not uncommon and there are a lot of people out there suffering the similar situation. Some got fired. Some got held back. Many on meds like you. This is not right. Take your frustration on being proactive and helping our community to figure out how to improve the situation. Perhaps that will help you. You don't need to enclose your name or anything or even name any particular program. What is important is that you email ACGME and let them be aware of the broken system. There are websites out there allowing anonymous emails out there. Do that!!! Perhaps by doing this you can stop internalizing your frustration that has led you to where you are right now. Be well.

 

[dragonfly99]

My advice is to stop being "proactive" and focus on the fact you will be done in <1.5 years. It's a good sign that the program says it doesn't want to fire you, but if you antagonize them they might make it harder for you to get a job later. There's not a ton that a resident can do to change the internal structure of a program, or correct deficiencies in a curriculum. You're kind of stuck with what you've got. People don't like to admit that sometimes, but from what I've seen the ACGME only steps in when there are egregious violations that are blatantly obvious, and that are there over several years. You could point out deficiencies on the exit survey they give you when you finish your program (they do still do this I think...). Most people (administrators, PD's) don't really want to hear what is wrong...some of it they can't personally change anyway (such as things that depend on money). There are definitely some programs that are more open to resident and/or fellow feedback than others (my current hospital is much more warm and fuzzy in this regard than either my med school or the hospital where I did residency). Chances are, if you were at one of those warm fuzzy places that DOES want the house staff to be happy and takes a lot of resident input, you'd already know that.

I know it is hard, but somehow you need to just learn to do the minimum of performing your job,and then go home and work out, get another hobby, etc. You can do yourself a world of hurt if you act p.o.'ed at work, whether it is or is not justified.

 

[Slowpoke]

Is there a way to know if a residency program is malignant before you apply to that place or is it something you only begin to understand once you're in the fray of things?

 

[Doctor Bagel]

Is there a way to know if a residency program is malignant before you apply to that place or is it something you only begin to understand once you're in the fray of things?

I'm only an intern (and I'm not saying I'm at a "malignant" program), but it's really hard to know how a program really works until you're there. There's always going to be surprises, and misreading a program is a pretty easy thing to do

 

[buckley]

I'm only an intern (and I'm not saying I'm at a "malignant" program), but it's really hard to know how a program really works until you're there. There's always going to be surprises, and misreading a program is a pretty easy thing to do

I agree!!!

Do not blame yourself if you did not see SOME things during the interview process that is so blatant now. I think that was a great difficulty, admitting you were deceived and your intuition was wrong.

The hatred and the anger I sense is not just to the program but directed to yourself as well.

Things happen for a reason...that's what has always kept me sane.

 

[emanlaer]

Need help

I'm at a malignant program which antagonizes constantly and is not afraid to punish

I am interested in what things you think are malignant? Do they yell at you, throw things at you, strike you, force you to do push ups, belittle you and call you names, ....what?

 

[latte01]

I am interested in what things you think are malignant? Do they yell at you, throw things at you, strike you, force you to do push ups, belittle you and call you names, ....what?

MALIGNANCY DEFINITION

I'm glad you inquired. This is how I define "malignancy".

Despite how hardworking and pleasing that a resident might be, the faculty member(s) who write your evaluation(s) essentially disparages your integrity, intelligence, and/or work ethic. Who cares about a person's mannerisms or interactions? What matters most is what words were written about you.

It's far more hurtful/traumatizing to have harsh words that follow you for the rest of your life than of a person who publicly berates you. To me, malignancy used to imply that a faculty member had rude mannerisms and he/she could care less about your well-being. But oh no. Nowadays, malignancy means what "very damaging" words were documented as part of your official evaluation record.

And there's a difference between what is professional constructive criticism versus assassination of a person's character. With professional criticism, you recognize the problem and make efforts to improve yourself. With personal attacks, you feel helpless because you realize you can't do anything to please this person no matter how hard you try. The worse part about it is that you dare not speak up because you fear the wrath of retribution.

 

[Slowpoke]

MALIGNANCY DEFINITION

I'm glad you inquired. This is how I define "malignancy".

Despite how hardworking and pleasing that a resident might be, the faculty member(s) who write your evaluation(s) essentially disparages your integrity, intelligence, and/or work ethic. Who cares about a person's mannerisms or interactions? What matters most is what words were written about you.

It's far more hurtful/traumatizing to have harsh words that follow you for the rest of your life than of a person who publicly berates you. To me, malignancy used to imply that a faculty member had rude mannerisms and he/she could care less about your well-being. But oh no. Nowadays, malignancy means what "very damaging" words were documented as part of your official evaluation record.

And there's a difference between what is professional constructive criticism versus assassination of a person's character. With professional criticism, you recognize the problem and make efforts to improve yourself. With personal attacks, you feel helpless because you realize you can't do anything to please this person no matter how hard you try. The worse part about it is that you dare not speak up because you fear the wrath of retribution.

wow this sounds really depressing...

 

[LADoc00]

Need help

I'm at a malignant program which antagonizes constantly and is not afraid to punish

The chain of command is exhausted.

This makes me angry. Then I try to do something proactive i.e. involve myself in a project or whatever and I am met with more resistance or punishment. This makes me more angry.

Other residents in the program are able to cope and suck it up and shut up. But I'm having serious trouble.

I'm on psych meds and counseling and nothing is working. I've only a year and some to go so. Transferring is a last resort.

This is my last ditch effort to survive in this program and I don't know what to do.

I'm willing to take any (reasonable and mature) suggestions. This includes books...tapes...etc...

Hmmm.

This is a perfect example of why every future doctor should have some type of public service when they are young to get the crap pounded out of them: military, slaving in the jungles for the Peace corps, something...I fear the day when all bullying is outlawed leaving a pitiful soft underbelly of a nation.

Unless they are completely depriving you of all sleep and/or food/drink and physically torturing you, you CAN survive.

Christ, you arent in a tiger cage in North Vietnam. Dont be so dramatic.

Man up.

 

[lipomas]

Hmmm.

This is a perfect example of why every future doctor should have some type of public service when they are young to get the crap pounded out of them: military, slaving in the jungles for the Peace corps, something...I fear the day when all bullying is outlawed leaving a pitiful soft underbelly of a nation.

Unless they are completely depriving you of all sleep and/or food/drink and physically torturing you, you CAN survive.

Christ, you arent in a tiger cage in North Vietnam. Dont be so dramatic.

Man up.

lol. I fear it won't just be bullying that will be outlawed, it will be all types of criticism. Did you see the youtube video of the kid in australia who was getting bullied and decided to fight back. http://deadspin.com/5781702/the-ult...sa-kid-fights-back-with-devastating-body-slam

If every other resident is able to suck it up and cope, then perhaps the problem is not the program! If you read these forums you would think there is an unending army of evil attendings who pick out otherwise competent but sensitive residents from their training program to single out and harass until they are broken.