Rant: Shift Change Etiquette

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valianteffort

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Anyone else deal with colleagues that show up late to shifts consistently? It’s a guaranteed for some folks in my group and this has led to me staying late multiple times as a sickly patient would need intervention during their shift time. To make it worse, one of the people that does it is the medical director so there’s really no one to complain to. These guys are all great to work with other than this. The most beloved people are the ones that come 15 minutes early every time. Whether they’re a good clinician or not they are the favorites of the group. Ok rant over

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Have you just firmly but professionally voiced your displeasure to the offenders?

“This seems like it keeps happening and it’s really making me feel quite disrespected as a colleague.”

I know it’s hard, but like a toddler who is kicking your seat behind you on an airplane, it probs works best if you confront yourself rather than having “mommy” do it.
 
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I used to show up right at shift time but realized that wasn’t very professional so now I’m usually 5-10 min early.

Being late is all bad but how late we talking? There’s a pretty big difference between 5 minutes and 15 minutes in terms of annoyance. It seems to rise exponential.

Side story: I used to work with one of my best friends from residency. When we first started working at the same place my shift had changed from a day to AM and I forgot and didn’t wake up to relieve him for a night shift. One of my partner’s husband comes and wakes me up banging on our door. I drive in probably 1-2 hours late. I felt awful about it. Fast forward a couple years later and I am working night shift and he’s supposed to relieve me in the AM. He doesn’t show up and he’s always early. An hour or so later he finally wakes up and comes in. He comes in apologizing but honestly I couldn’t be happier. I got to finally tell him we’re even. That was the only time I was glad someone was over an hour late.
 
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This is from 15+ years ago. Guy in the group with the same first name as me: call him "Dave". He's working the overnight. Shift change is 7a. Relieving him is a woman that did IM and a crit care fellowship, but is the nicest, sweetest person, but always late. Well, this morning, she comes blowing in about 7:07, but my buddy Dave is pi$$ed, because he had to tube a pt at 7:02. He was livid, but, rightfully so.
 
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I have two of these that are always 5-10 minutes late.
They think they get to play the mommy-card.
"But my KID farted and it stank and I had to robbledy-robble-bobble-robble-robb-(trails off)."
I walked off mid-excuse from one of them once.
 
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I used to show up right at shift time but realized that wasn’t very professional so now I’m usually 5-10 min early.

Being late is all bad but how late we talking? There’s a pretty big difference between 5 minutes and 15 minutes in terms of annoyance. It seems to rise exponential.

Side story: I used to work with one of my best friends from residency. When we first started working at the same place my shift had changed from a day to AM and I forgot and didn’t wake up to relieve him for a night shift. One of my partner’s husband comes and wakes me up banging on our door. I drive in probably 1-2 hours late. I felt awful about it. Fast forward a couple years later and I am working night shift and he’s supposed to relieve me in the AM. He doesn’t show up and he’s always early. An hour or so later he finally wakes up and comes in. He comes in apologizing but honestly I couldn’t be happier. I got to finally tell him we’re even. That was the only time I was glad someone was over an hour late.

Detroit-boy with the glasses?
 
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I’m assuming this isn’t an SDG. You said these guys are great to work with but they’re not. They clearly don’t value anyone else’s time.
 
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Is your place RVU? Is it a single coverage place? Some of us come 5-10 min late due to traffic but we have overlap. It is also RVU so we leave 30 min early when things are slow so it all evens out.

When its a sickly patient I walk out of the room and say I performed a medical screening exam and the new doc will take over.
 
Sometimes a sarcastic but lighthearted comment can be a good first step. Nothing you can say to your medical director though.
 
most of the time I don't even know if they show up late because we huddle/cohort in different rooms.
I shouldn't talk though because I'm often late and it's a bad habit.
 
Yes! I hate this, at work and in the rest of life. People who are consistently late are just showing you that they have no respect for your time (and poor time management skills when it comes to their own time -- "time optimism," I heard someone call it -- as in, "I can definitely get this hour-long process done in the next 5 minutes before I leave for work!"). In my experience, they are known for it by the whole department, and they just laugh it off as if it's something they can't change.
 
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Is your place RVU? Is it a single coverage place? Some of us come 5-10 min late due to traffic but we have overlap. It is also RVU so we leave 30 min early when things are slow so it all evens out.
I’ll take the other side of that. Overlap doesn’t make it any better. If there’s overlap it’s probably because it’s a busy place so the doc(s) already there are likely looking for a breather. Still unprofessional to habitually show up late no matter the excuse. In my experience, those who are chronically late always have excuses (such as traffic) that other people don’t seem to run into.
 
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I’ll take the other side of that. Overlap doesn’t make it any better. If there’s overlap it’s probably because it’s a busy place so the doc(s) already there are likely looking for a breather. Still unprofessional to habitually show up late no matter the excuse. In my experience, those who are chronically late always have excuses (such as traffic) that other people don’t seem to run into.

Yeah but it shouldn’t impact flow unless you are directly leaving most patients are not crashing and orders will not be done immediately anyway
 
We had a couple of these losers at my previous shop. Literally arriving 20 min late to relieve night shift single coverage guy, putting stuff down, saying "I'm gonna grab breakfast and then take your sign out."

There's a term for this: narcissistic personality disorder.
 
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Yes! I hate this, at work and in the rest of life. People who are consistently late are just showing you that they have no respect for your time (and poor time management skills when it comes to their own time -- "time optimism," I heard someone call it -- as in, "I can definitely get this hour-long process done in the next 5 minutes before I leave for work!"). In my experience, they are known for it by the whole department, and they just laugh it off as if it's something they can't change.
This is exactly my problem - time optimism - thank you for putting to words - I tend to be 5 minutes late. It’s a bad habit and I obviously just need to start my departure routine 5 minutes earlier. I’m inspired and will try to do better.
 
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Yeah but it shouldn’t impact flow unless you are directly leaving most patients are not crashing and orders will not be done immediately anyway
It shouldn’t but it could and it certainly won’t help flow. Regardless, nobody should be consistently late.
 
This is exactly my problem - time optimism - thank you for putting to words - I tend to be 5 minutes late. It’s a bad habit and I obviously just need to start my departure routine 5 minutes earlier. I’m inspired and will try to do better.

Start 15 minutes earlier because traffic, or you spilled coffee on your pants, etc.
 
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We have a fine in place in our policy manual for tardiness. It’s practically never enforced, but somewhat effective and occasionally enforced for egregious tardiness unrelated to illness, emergency, traffic accident, etc., such as for over sleeping.

We also have shift overlap, which helps.

We’re productivity based. You earn more if you stay a little later and work more. Our main site is well more than double covered during most hours. If someone coming to relieve your zone/pod is late and a critical patient rolls in, then someone else from another zone/pod is more than happy to take the higher acuity patient and billing so you don’t have to stay later if you don’t want the income.

Directly addressing tardiness in a polite manner is worthwhile. If people don’t know it’s an issue, then they certainly won’t change.
 
I think people who consistently run late are very much aware of it, but they might not be aware of how much it annoys people, even if no one says anything and everyone politely laughs about it with them. If this is you... the person you're relieving IS very much annoyed by it, whether they show it or not.

Just curious, for those who are chronically late, can you put your finger on why? Is it always "time optimism," as above? Do you just not realize it annoys other people? Do you not care if it does annoy people? And does it bother you when someone makes you wait? Do you just think of time as a more vague/fluid thing than other people?
 
Just be ready to go as soon as they get there. I stop picking up patients 1-1.5 hours before shift change. I will eyeball them and dump in orders to get things started but I don't document anything. It makes late comers much more tolerable because the only thing I have to worry about is finishing my own notes. If there is something very easy to dispo, I'll pick those up and punch out the note. If you've got overlap, then it's a non issue because you can just let the pt's pile up and it's their problem. If there's no overlap...although it can be annoying, with above pattern you should still be able to cleanly exit immediately upon their arrival.

As for escalating...you've got a pickle since the FMD is one of your main offenders. If you're in a CMG, one idea would be to edit the schedule and change your times to when you actually left and when it asks for reason...state "incoming doc late". That usually gets noticed by corporate scheduler and corporate brass. If that's not an option, I'd just deal with it unless you want to bring it up in a quarterly meeting which is a very reasonable request that most people should be on board about. Be careful about going out of your way to complain about your FMD or paint them in a bad light. In general, this is not a good policy for overall job security unless they are clearly on their way out.
 
I think people who consistently run late are very much aware of it, but they might not be aware of how much it annoys people, even if no one says anything and everyone politely laughs about it with them. If this is you... the person you're relieving IS very much annoyed by it, whether they show it or not.

Just curious, for those who are chronically late, can you put your finger on why? Is it always "time optimism," as above? Do you just not realize it annoys other people? Do you not care if it does annoy people? And does it bother you when someone makes you wait? Do you just think of time as a more vague/fluid thing than other people?
We have two hours overlap. I just figured people probably didn’t care. I’m never more than 10 minutes late unless the freeway is closed.

I will accept any signouts including “just saw ‘em, nothing is back” when it’s time for coworker to go home. I do not care in the morning if the am doc is late as I’m rarely ready to leave anyway.

I definitely just need to start earlier getting out the door and this thread has been eye opening.
 
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We have two hours overlap. I just figured people probably didn’t care. I’m never more than 10 minutes late unless the freeway is closed.

I will accept any signouts including “just saw ‘em, nothing is back” when it’s time for coworker to go home. I do not care in the morning if the am doc is late as I’m rarely ready to leave anyway.

I definitely just need to start earlier getting out the door and this thread has been eye opening.

Dude, people care. I leave my house so that I arrive 15 minutes before shift time in case there are rare road delays. We work shift work. Be on time.
 
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We have two hours overlap. I just figured people probably didn’t care. I’m never more than 10 minutes late unless the freeway is closed.

I will accept any signouts including “just saw ‘em, nothing is back” when it’s time for coworker to go home. I do not care in the morning if the am doc is late as I’m rarely ready to leave anyway.

I definitely just need to start earlier getting out the door and this thread has been eye opening.
100% you are the topic of many jokes/comments with regards to punctuality behind your back.
 
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We have two hours overlap. I just figured people probably didn’t care. I’m never more than 10 minutes late unless the freeway is closed.

I will accept any signouts including “just saw ‘em, nothing is back” when it’s time for coworker to go home. I do not care in the morning if the am doc is late as I’m rarely ready to leave anyway.

I definitely just need to start earlier getting out the door and this thread has been eye opening.

BRO.
Be on effing time.
 
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Dude, people care. I leave my house so that I arrive 15 minutes before shift time in case there are rare road delays. We work shift work. Be on time.
I understand and I hear all of you and I made sure to be on time yesterday and will make sure to be on time going forward.

Someone above asked, for late people, is time just more fluid? Maybe it is. I truly do not care AT ALL if my relief is 15 minutes late. A few times I have not noticed they aren’t there until the 30-45 minute mark because I was just going along getting folks dispo’ed.

I don’t want people to think that the late people think they or their time is more important than yours. My time is not particularly important. I guess I just don’t generally see time as that precise? Idk. I don’t particularly care if I leave on time either.

I’d encourage all of you to maybe one time say something to your work colleagues that annoy you by being late. It has made a big impact for me to read everyone’s comments and I would never want anyone to feel disrespected.. your colleagues (hopefully) may not either and may not realize the resentment they are causing.
 
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I understand and I hear all of you and I made sure to be on time yesterday and will make sure to be on time going forward.

Someone above asked, for late people, is time just more fluid? Maybe it is. I truly do not care AT ALL if my relief is 15 minutes late. A few times I have not noticed they aren’t there until the 30-45 minute mark because I was just going along getting folks dispo’ed.

I don’t want people to think that the late people think they or their time is more important than yours. My time is not particularly important. I guess I just don’t generally see time as that precise? Idk. I don’t particularly care if I leave on time either.

I’d encourage all of you to maybe one time say something to your work colleagues that annoy you by being late. It has made a big impact for me to read everyone’s comments and I would never want anyone to feel disrespected.. your colleagues (hopefully) may not either and may not realize the resentment they are causing.
I love this. It would have been really easy, especially on an anonymous forum, to dig in your heels and say the rest of us are just too uptight. Thank you, on behalf of your colleagues. :)
 
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I understand and I hear all of you and I made sure to be on time yesterday and will make sure to be on time going forward.

Someone above asked, for late people, is time just more fluid? Maybe it is. I truly do not care AT ALL if my relief is 15 minutes late. A few times I have not noticed they aren’t there until the 30-45 minute mark because I was just going along getting folks dispo’ed.

I don’t want people to think that the late people think they or their time is more important than yours. My time is not particularly important. I guess I just don’t generally see time as that precise? Idk. I don’t particularly care if I leave on time either.

I’d encourage all of you to maybe one time say something to your work colleagues that annoy you by being late. It has made a big impact for me to read everyone’s comments and I would never want anyone to feel disrespected.. your colleagues (hopefully) may not either and may not realize the resentment they are causing.

See, that's the thing. time isn't "fluid". A minute is sixty seconds. An hour is sixty minutes. These are fixed and discrete values; not "whatever you want it to be". This is at least in part emblematic of what's wrong with society today; people think that whatever they "feel" is the way it is.
 
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I thought being on time and time management were skills we learned in high school.
You’re getting paid to be there. Routine tardiness is unprofessional. How did these people get through med school and residency?
 
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I understand and I hear all of you and I made sure to be on time yesterday and will make sure to be on time going forward.

Someone above asked, for late people, is time just more fluid? Maybe it is. I truly do not care AT ALL if my relief is 15 minutes late. A few times I have not noticed they aren’t there until the 30-45 minute mark because I was just going along getting folks dispo’ed.

I don’t want people to think that the late people think they or their time is more important than yours. My time is not particularly important. I guess I just don’t generally see time as that precise? Idk. I don’t particularly care if I leave on time either.

I’d encourage all of you to maybe one time say something to your work colleagues that annoy you by being late. It has made a big impact for me to read everyone’s comments and I would never want anyone to feel disrespected.. your colleagues (hopefully) may not either and may not realize the resentment they are causing.
I agree that some people live life that way and I would hope I could see time as fluid as you one day in some aspects. I just think if you are professionally paid to do the job at a certain minute to minute you should be there at that minute or before. Truly if you are right on time, you are late. Although reading your side makes me think I am uptight which I never saw myself as before this thread:unsure:

You must also be the type to get to the airport 30 minutes before boarding. I need my 2 hour + buffer. Just two types of people. Acceptable when it is your own personal time. However, If I have 0 patients at shift change (which especially turning over night to day is very common where I work), I don't want to sit there waiting twiddling my thumbs and on the same side, I would never make my colleagues do the same so i consistently come in early.

At times, even the nurses will throw a little insult to the oncoming doc when I am waiting. They'll say 'Oh Dr. X is coming in for your relief? He won't be here till 6:15'. Although it doesn't effect the nurses in anyway who comes in when, they notice these things to. You will be talked about when you're not there for one reason or another, just wouldn't want 'the late doc' being one of them
 
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What should have been handwriting on the wall for me at my last job was when I had an MRI scheduled for 8am. Our shifts ended at 8. My FMD was my relief. I told him the day before that I had to get out right at 8. He showed up at 8:07, no excuse, no apology, no call ahead.

That's a GREAT way to treat your docs like crap.
 
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What should have been handwriting on the wall for me at my last job was when I had an MRI scheduled for 8am. Our shifts ended at 8. My FMD was my relief. I told him the day before that I had to get out right at 8. He showed up at 8:07, no excuse, no apology, no call ahead.

That's a GREAT way to treat your docs like crap.
See if someone told me that I would have been there at 7:40. That’s terrible.

At my place about 1/2 of the docs are typically 5-10 minutes late. When I started there we were 100% rvu and people would get feisty if someone was 10 minutes early, so I just kind of slid into that culture. I was always on time for everything prior to starting this job. Time to get back on track.
 
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I think this is job dependent. Where I work, there is an hour of overlap at one shop and the other shop there is not, but both have true sign outs. If someone is 10 min late, they just get sign out when they get there while I am wrapping up charts. I may have started a workup or a patient may need a procedure, but I will sign out the procedures if the patient came in right at sign out. We don't stay late, we just sign out, so it isn't a big deal. There are a couple of people who are not great at taking sign outs and they also get the shortest leash when it comes to tolerance of tardiness and their own sign outs. Most people are a few min early, but sometimes life happens and people are rarely ready to sign out on time where I work anyway. Sticklers over 5 min must be angry at a lot of people all the time...
 
I don’t want people to think that the late people think they or their time is more important than yours. My time is not particularly important. I guess I just don’t generally see time as that precise? Idk. I don’t particularly care if I leave on time either.

I think there's a misconception here about what people mean by the implication of the statement "my time is more important than yours." Speaking as someone who used to fall into the category of "late" (not at work), on introspection I don't think that it was ever the feeling of "look at me, I'm more important than you therefore my time is more valuable," but more of a "I don't really care about my time or how it flows so why does everyone else care so much"? Which is fine and good when you're on your own terms, but other people do care and it tends to be how the workplace and society operate, so stick "timeliness" in the "things I grumble about but I guess I just have to do it" facet of life.
 
I think there's a misconception here about what people mean by the implication of the statement "my time is more important than yours." Speaking as someone who used to fall into the category of "late" (not at work), on introspection I don't think that it was ever the feeling of "look at me, I'm more important than you therefore my time is more valuable," but more of a "I don't really care about my time or how it flows so why does everyone else care so much"? Which is fine and good when you're on your own terms, but other people do care and it tends to be how the workplace and society operate, so stick "timeliness" in the "things I grumble about but I guess I just have to do it" facet of life.
The "my time is more important that yours" basically becomes the default when you can't see how you being late affects other people. I don't think most people are late on purpose but when they can't see how them being late affects other people then it basically becomes them caring more about their time than yours although that isn't exactly what they're thinking.
 
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The "my time is more important that yours" basically becomes the default when you can't see how you being late affects other people. I don't think most people are late on purpose but when they can't see how them being late affects other people then it basically becomes them caring more about their time than yours although that isn't exactly what they're thinking.

Right, which is why I was basically saying if you're one of those people that rationalizes being late, suck it up and figure out a way to not be late.
 
The fact that people don't account for an occasional traffic jam or slowdown is crazy to me. I leave home typically at a time that I know will get me to work 15 minutes early. I usually go get coffee, snack, whatever, then log into my computer 5 minutes or so before shift start. Even if there's a traffic slowdown or some other event I can usually make it on time or early. One would think highly intelligent, educated, and motivated people could figure out time management skills. That so many physicians are routinely late for shift is insanity.
 
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The only organized religion I subscribe to at work is The Church of Going Home on Time.

Chronically late coworkers directly threaten that. Do better. Be better.

Chronic tardiness makes you look like a self-centered donkey.

No one likes receiving a train wreck CPR in progress at 7:03 because your relief is late, AGAIN.
 
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The only organized religion I subscribe to at work is The Church of Going Home on Time.

Chronically late coworkers directly threaten that. Do better. Be better.

Chronic tardiness makes you look like a self-centered donkey.

No one likes receiving a train wreck CPR in progress at 7:03 because your relief is late, AGAIN.

This is the thing. If I'm not perched on the edge of my chair, ready for signout at 07:00:00, I'm wrapping things up as quickly as possible and definitely do not want to take on someone else's project because they failed to arrive on time. I've even had it in a double coverage shop when the overlapping guy went to the cafeteria during what should have been my shift change. And it's not just the codes -- it's the EKGs shoved under your nose, etc. because you're still physically there.
 
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We have two people in our shop who are consistently late 10-15 minutes. When I say consistent, I mean 100% of the time. The bizarre thing is, they are both in the building before the shift change. It's not like they hit the traffic and are frantically parking around the corner to rush in. In their minds, there is nothing wrong with this behavior. Multiple people complained, even brought it up to the medical director. The director doesn't give a crap because he doesn't work any clinical shifts and it doesn't affect him.
 
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We have two people in our shop who are consistently late 10-15 minutes. When I say consistent, I mean 100% of the time. The bizarre thing is, they are both in the building before the shift change. It's not like they hit the traffic and are frantically parking around the corner to rush in. In their minds, there is nothing wrong with this behavior. Multiple people complained, even brought it up to the medical director. The director doesn't give a crap because he doesn't work any clinical shifts and it doesn't affect him.

So what's their "excuse" if they're physically in the building?
 
I don't like to be late. I don't like when others are late. But at the end of the day, it doesn't really bother me. As I get older, I don't let the small things bother me and I know I can't change the world or even people for that matter.

Plus it always fixes itself because I have a much higher tolerance for most stuff and typically other docs would have fought this battle before it hits my radar.
 
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See if someone told me that I would have been there at 7:40. That’s terrible.

At my place about 1/2 of the docs are typically 5-10 minutes late. When I started there we were 100% rvu and people would get feisty if someone was 10 minutes early, so I just kind of slid into that culture. I was always on time for everything prior to starting this job. Time to get back on track.
Damn. There is something wrong with the culture b/c someone came 10 min early for loss of RVUs. When you are sitting in your rocking chair, those 10 lost minutes of RVU will mean NOTHING.

I remember when we had an all RVU site, and docs would get mad at others for being "fast" and taking all of the charts. This was my signal to go get coffee and relax.

I am probably the fastest guy in all of my jobs, and many times I would look up at the board and I have 80% of my name surfing the internet. 2 people waiting to be seen and I would not touch them even if I had nothing to do waiting for the other doc to pick them up. Only when there were 3+ would I pick some up.

RVUs always have meant little to me in my career and my goal was to have a clear waiting room. The small amount of money fighting over patients is really inconsequential.
 
The fact that people don't account for an occasional traffic jam or slowdown is crazy to me. I leave home typically at a time that I know will get me to work 15 minutes early. I usually go get coffee, snack, whatever, then log into my computer 5 minutes or so before shift start. Even if there's a traffic slowdown or some other event I can usually make it on time or early. One would think highly intelligent, educated, and motivated people could figure out time management skills. That so many physicians are routinely late for shift is insanity.

I get the frustration with the chronically late but I don't see how expecting people to waste 2 hours a month at work drinking coffee to avoid ever being late is more respectful of their time than occasionally being late and extending people some grace when they are also late. The majority of the interpersonal drama in emergency medicine always seems to just be people holding themselves to different, equally reasonable standards.
 
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Damn. There is something wrong with the culture b/c someone came 10 min early for loss of RVUs. When you are sitting in your rocking chair, those 10 lost minutes of RVU will mean NOTHING.

I remember when we had an all RVU site, and docs would get mad at others for being "fast" and taking all of the charts. This was my signal to go get coffee and relax.

I am probably the fastest guy in all of my jobs, and many times I would look up at the board and I have 80% of my name surfing the internet. 2 people waiting to be seen and I would not touch them even if I had nothing to do waiting for the other doc to pick them up. Only when there were 3+ would I pick some up.

RVUs always have meant little to me in my career and my goal was to have a clear waiting room. The small amount of money fighting over patients is really inconsequential.
When I started at my job, there were a few of us new and a dozen docs that had been there more than a decade. The shifts were staggered and unless someone was stuck in a critical case it was assumed that the patients between x and y time were “my patients,” then the patients between y and z time were “my reliefs patients,” etc. I’ve had people take my name off charts if it wasn’t “my time” yet. I had someone pull me aside maybe 6 weeks in to tell me I was getting to work too early. I was never on the floor more than 15 minutes early. It was pretty odd tbh but I’d rather be at my house than sit in the crappy lounge doing nothing. Things have changed now, most of those docs have moved on.
 
When I started at my job, there were a few of us new and a dozen docs that had been there more than a decade. The shifts were staggered and unless someone was stuck in a critical case it was assumed that the patients between x and y time were “my patients,” then the patients between y and z time were “my reliefs patients,” etc. I’ve had people take my name off charts if it wasn’t “my time” yet. I had someone pull me aside maybe 6 weeks in to tell me I was getting to work too early. I was never on the floor more than 15 minutes early. It was pretty odd tbh but I’d rather be at my house than sit in the crappy lounge doing nothing. Things have changed now, most of those docs have moved on.

In that case, the system was perfectly designed to get the results it got.
 
I get the frustration with the chronically late but I don't see how expecting people to waste 2 hours a month at work drinking coffee to avoid ever being late is more respectful of their time than occasionally being late and extending people some grace when they are also late. The majority of the interpersonal drama in emergency medicine always seems to just be people holding themselves to different, equally reasonable standards.

Counterpoint: when you're single coverage, it blows staying over for an hour+ dealing with an ICU train wreck admission that rolled in at 7:06 because your relief is late, again, and you had to spend time with lines/tubes/labs/calling consultants/charting and then dealing with worsening traffic on the way home isn't fair so your colleagues can avoid "drinking coffee to avoid ever being late show up at their scheduled times like an adult with a professional job" (there, I took those rose-colored glasses off for you).

One of our noctors is routinely 20-30 minutes late because of "muh traffic" while the department is melting down. Somehow this is just accepted, and the powers that be don't ask her to stay late to make up the difference in scheduled hours.

In the grand scheme of cosmic karma, show up to your damn job on time. Why is this so hard? You had to do it in med school, you had to do it in residency. It's not cute, it's not cool. You can get a pass once in a while. Don't make being late a habit.
 
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