Sep 5, 2015
2
0
Status
Attending Physician
What is the proper protocol when a co physician within your department who outranks you starts to dump on you? Say they routinely ask you to see their follow up patients, or they dump their call patients on you, or try to dictate your treatment of your patients such as to use (medical product) reps that they prefer, etc. Do you stand up to them at risk of being insubordinate, or do you take their requests as orders?

Related to this, what if you know you are getting out at the end of your commitment, and you aren't worried about promoting, does this change the answer?

Thanks for any replies.
 

Gastrapathy

no longer apathetic
Lifetime Donor
10+ Year Member
Feb 27, 2007
5,060
4,169
Status
Attending Physician
There's no simple answer to this. Lazy senior physicians are the reality. They stayed in for a reason. That said, talk to your DH but don't expect any support. Explain the pharma rep concern. Decline to walk in anyone.

Other than that, they can make you work while they dodge deployment and go to meetings.

Welcome to the .mil.

There are nuclear options wrt the drug reps. (Legal, IG) but he will just deny it and you will probably lose.
 

jabreal00

10+ Year Member
Feb 20, 2009
595
99
USA
Status
Attending Physician
Easy, if you are a board certified and residency/fellowship trained physician you do not have to follow any orders regarding how to practice medicine. I don't care if it's an 07, I will not be ordered to prescribe a certain medication or use a certain device. Now if there are issues with substandard care or poor patient outcomes then there may be increased scrutiny and/or micromanaging.

The more challenging conundrum is trying to deal with dumps. That one would be more difficult to navigate. You likely won't get any support from your chain of command. However, you can always pull the card that your schedule is too full or just deflect as much as possible. It's inevitable that you will see some of their patients.
 

Gastrapathy

no longer apathetic
Lifetime Donor
10+ Year Member
Feb 27, 2007
5,060
4,169
Status
Attending Physician
Our old SL was in bed with Salix. Bethesda still has Moviprep and Apriso on formulary rather than Golyte and Lialda like everyone else.
 

jabreal00

10+ Year Member
Feb 20, 2009
595
99
USA
Status
Attending Physician
One can order both golyte and mesalamine ER (lialda) at Bethesda. Most are just use to moviprep and apriso because through the fellowship that is what they learn and the Salix reps are fairly aggressive about their presence.
 

d2305

SDN Gold Donor
Gold Donor
5+ Year Member
May 10, 2013
647
195
Pensacola FL
Status
Non-Student
I had never heard of Lialda until I wrote for it. Pt was willing to pay for it, so it must work. I thought drug reps were banned from base now.
 

Gastrapathy

no longer apathetic
Lifetime Donor
10+ Year Member
Feb 27, 2007
5,060
4,169
Status
Attending Physician
Right. And how did the "the fellows" learn that? Salix reps in power suits. Why were they special? Are you brave enough to withstand the subtle pressure from the guy with the billets? It's been long enough that people might not even remember why but that was the truth.

Moviprep is an incredible waste of taxpayer dollars. Is it better? Nowhere near enough to justify the cost.
 

HighPriest

Specialized in diseases of the head holes
10+ Year Member
Jan 1, 2008
2,077
2,454
Status
Attending Physician
More or less adding on to the above:

There is probably no way to come out unscathed from any confrontation, and so to an extent you'll have to decide if points won are worth the additional BS that anyone senior to you can dish out (true in the military and out). You can certainly refuse to do anything medically (prescribe medications, round on patients that aren't yours, what-have-you) with the argument that its not in the best interest of the patient. Obviously that has to be done within reason. What you'll get in return is micromanaging, scrutiny over everything that you do (the military - at least the Army - has a keen eye for turning known and expected complications into witch hunts, so unless you never have a complication you should expect at some point to have risk management "invited" to speak with you. I've even seen providers lose privelages for complications that were both known and statistically reasonable...) Additionally, your senior may elect to divert all the crap to your office door in terms of additional paperwork and the bottom-of-the-barrel patients.

If the guy is otherwise a decent provider, I think you're SOL unless he's asking you to do something that isn't good for the patient. For example, if someone senior to me expected me to see all of his post-op patients, I would argue that he needs to see his own post-ops unless he is actually unable, because that is best for the patient. If the guy is a crap provider, then you can always turn the risk management thing around on him. Just expect retaliation to the Nth degree, and make sure you go in extremely prepared.

The last option, of course, is to talk to the guy about your concerns. I'll assume that you have either done that already, or have a good reason to feel that he won't respond well.
 

j4pac

PM&R resident
10+ Year Member
Aug 22, 2005
2,509
2,416
www.med.navy.mil
Choose your battles wisely. As long as you aren't compromising patient care...I would probably just suck it up and try to outlive my attending or count the days to PCS.
 
OP
N
Sep 5, 2015
2
0
Status
Attending Physician
Thanks for the replies, I assume the answers are the same if you are not worried about promotion and will be getting out within a couple of years?
 

StevenRF

Senior Member
10+ Year Member
Mar 24, 2005
475
3
Status
I thought according to DODI 6000.13, physicians at Lt Col/CDR and above are federally mandated to see no more than 50 patients a year.

On a more serious note, it seems like for every doc seeing patients there is one that fills out paperwork/attends meetings all day. And then when they do have clinic scheduled its a 50/50 if they no show. Weird system.
 

HighPriest

Specialized in diseases of the head holes
10+ Year Member
Jan 1, 2008
2,077
2,454
Status
Attending Physician
Thanks for the replies, I assume the answers are the same if you are not worried about promotion and will be getting out within a couple of years?
Still the same. It just depends upon how much of a fight you want, and what kind of crap you're willing to eat. The only difference is that you won't have to care about a shoddy OER.
 

Apollyon

Screw the GST
Lifetime Donor
15+ Year Member
Nov 24, 2002
20,322
5,108
SCREW IT!

bustbones26

Senior Member
10+ Year Member
15+ Year Member
Jul 26, 2003
981
47
42
Visit site
Status
Attending Physician
Did you note that that was from 4 years ago? I'm just wondering, because the meat of the article is germane.
Yes, it is from a while back. Only dug this up as one of the many examples as to how doing what you think is the right thing can backfire! I think after a while, most of us will be able to list a few examples of where a doctor with all of the right intentions would have been better off keeping his/her mouth shut, smiling, waving, and then moving on.
 

pgg

Laugh at me, will they?
Administrator
10+ Year Member
Dec 15, 2005
12,210
8,305
Not home
Status
Attending Physician
Yes, it is from a while back. Only dug this up as one of the many examples as to how doing what you think is the right thing can backfire! I think after a while, most of us will be able to list a few examples of where a doctor with all of the right intentions would have been better off keeping his/her mouth shut, smiling, waving, and then moving on.
Is that not the case of any job in any industry?

Retaliation vs whistleblowers is shameful and evil, but hardly unique to milmed.
 
  • Like
Reactions: sb247