residency termination

[koh]

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[koh]

As the foo fighters said.."Its times like these you learn to live again.."

I am also working on my second chance at residency and medicine. My situation is a little different from yours. The only thing I can say to you is continue to follow your dreams. I know you probably feel like crap. There is probably alot of shame and anger at yourself too. Dont let anyone tell you that you cannot bounce back. Find a new path. Your path is still out there but youre gonna have to overcome your situation, find a new way and pursue it. For me that process took a long time. I can tell you from the outset alot of people told me I was done and there were alot (many more acutally)of people that told me what I im telling you..continue walking. It took me a while (almost a year) to take some self inventory, figure out what changes I needed to make with me and then figure out where I go from here.

Everybody makes mistakes. Anyone who tells you they are perfect and has lived a perfect life is either lying to themself or they havent lived long enough. There are people out there who realize this and will give you a second chance but they are not going to find you while your wallowing in your guilt and shame, you will have to do your own growing from this and then step out and find them. I started the match process this year thinking that no one would give me a second chance. Then the miracle happened..i got an interview. By the time it was all said and done I had way more than I could attend. My situation took a job from me but I gained so much personal growth that I almost shutter to think about where I would be if I had not had to endure it. There is hope.

I am new in this forum I was trying a coment to you but it didn't go through I don't know how to send it again.

 

[michaelrack]

I think that there is still right and wrong because at the end of the day, you're the one who has to look at yourself in the mirror. .

Some day after you become a physician you will realize that all physicians have blood on their hands and you will become less judgemental.

 

[dragonfly99]

all physicians have blood on their hands

Quite true.
This is particularly true if you do IM, fp or any type of surgery...

 

[Law2Doc]

Some day after you become a physician you will realize that all physicians have blood on their hands and you will become less judgemental.

I think making a mistake and then being dishonest about it are two very different things. Mistakes happen, they are forgivable if you are honest about them and learn from them. They are not forgivable if you compound them by lying about them. The person who forgets to measure FHR has made a mistake. The person who then goes and documents a result knowing he has not measured it is lying about it, falsifying medical records, and (assuming billing turns on this) committing a crime. Silas is totally correct about this.

Saying "everybody does it" or "you don't know because you aren't there yet" is really not a defense to this, it is a cop out. We had the exact same issues in law firms -- people padding their billing by saying they spent time researching things they didn't, etc. When they were caught, they were fired immediately. Didn't matter that this is widespread, it is illegal. It subjects the firm to indefensible liability, and nobody reasonable would ignore that risk in their employees. It really is that cut and dry. And is absolutely not something physicians have a monopoly in. Any profession is going to have documentation requirements, and the incentive (due to time, money, pressure, promotions) to falsify things, say you did things you didn't. But you don't go down this road. Even if "everybody" is doing it, or that this is the perceived culture.

Now, you can argue that attendings are allowed to rely on residents' work and I think this is fair. But then that puts more (not less) obligation on the resident to actually do all the measurements the attending is going to parrot. If nobody ever does the various parts of a physical exam then things will slip through. Somebody will be damaged because of it. And if the record says something was checked that wasn't, liability will ensue. A PD who knows his residents are making up stuff is just as liable as the resident who is screwing up. So he can't just sit by and ignore this stuff. It's his a$s on the line as well, for negligent supervision. So yes, discipline is going to happen, likely a probation/warning for the first instance and a firing for the second. Which is what aPD describes above, and basically sounds like what happened here.

 

[silas2642]

Some day after you become a physician you will realize that all physicians have blood on their hands and you will become less judgemental.

I understand that all physicians make mistakes-- I know that for sure. Where I think the problem in the system lies is when the person lies about or doesn't see their mistake to learn from it. I've had family members get hurt from physician error, and what you want to hear is the truth, not some sort of lie or cop out. We understand that doctors make mistakes, we just want to make sure that they didn't happen again.

 

[finished]

While all physicians may have blood on their hands and make mistakes, there is a difference between honest mistakes and willfully lying about having done a part of the exam. Patients are in a very vulnerable position and must rely on the trustworthiness of their doctors. There's a fundamental difference between a doctor who lies about something and one who accepts the scolding/punishment for not having checked a physical finding (and then tries to do better or work faster next time). Hopefully the OP will shift from being the former to being the latter before working with patients again.

 

[Doowai]

Regarding : doing the exam for real..... one learning moment for me was in a pulmonology rotation. MRI of a patients brain. The pulmonologist was in a hurry and had me go to radiology to find out about the imaging. I went, asked the radiologist who had recently dictated it - he looked up his report. His report was essentially negative.

I went back to the pulmonologist/critical care doctor. He asked me "Did YOU actually look at the film". I said NO.

So he took me and we went back down to radiology. He got the film. He clearly pointed out a lesion in the brain which was cocci to the brain. He told me "Always look at the films yourself". The radiologist missed it.

What I learned - even if the other people are not falsifying results, even if they REALLY did the exam.... always to it yourself too. ALWAYS. People make honest mistakes too. 3 people doing the same exam or reviewing the same exam make mistakes less likely.

 

[Bubb Rubb]

The confusing part for a rookie (read: 4th yr med student/intern) is to know how much is enough. If a particular exam seems pertinent, it is normally done. But it is not until one writes a note/dictates an H&P (possibly far-removed from the patient locale) that the rookie realizes s/he should have done this or that. Then the question becomes, go back and do it? Use someone else's findings? Make it up? How much time do you have? Are you already far behind? The temptation is there sometimes.

i never document an exam finding that i didn't perform myself or wasn't told about by a senior on my team. however, on stable, straightforward post-op patients with no complaints i will copy the neuromotor exam forward from previous notes if they are grossly moving on rounds. finally, if the exam for that day was "not seen on rounds today" or "RA, sleeping comfortably, not examined" then that's exactly what goes in the chart.

 

[DonStracci]

Bubb Rubb, I'm laughing at your name, and the Wooo Wooo! under it... obscure but very funny.

 

[missneurotic]

Well actually one of my residency mates in neurology had something similar happen to her. She showed up in one neuro program, had an abusive attending who made false allegations and was given warnings by the PD. The PD paged all attendings/seniors prior to his time starting service to say she had been given warnings - which in my mind is completely inappropriate because it puts someone under incredible pressure. This friend was an IMG btw and had a huge issue adjusting to the system despite being highly knowledgeable. So she corrected the deficiencies (improving order entry in the EMR and documentation) but the PD still said she was not able to progress to PGY-2 because she needed too much supervision and terminated her.

She came into my residency class the subsequent year and was very respected as a great resident. Her story was amazing and she did not give up despite being devastated. Not to mention her personality was so warm and she genuinely captured all our hearts as well as that of the faculty. Somehow she connected with our PD who is a wonderfully kind person who looked past all this and saw the potential she had.

So what I am saying is there are people out there who will look past these things. We had an amazing PD who brought the best in all of us and helped us where we were weak. But my friend said her biggest advice is keep trying, never bash any faculty or PD you worked with or program. Explain the situation and show commitment as well as that you learnt from your experience. Later on once she built confidence in our program, she told us about how her old PD disrespected her and did many things to sabotage her. Its hard to imagine someone like her could ever be treated like this but her vulnerability was taken advantage of there. She said in the end she was glad she got terminated for many reasons but most importantly she moved on to something more incredible.

I hope my classmate's story gives you all inspiration. We are all succesful physicians now and she went on to a top fellowship.

 

[highvoltage]

Well actually one of my residency mates in neurology had something similar happen to her. She showed up in one neuro program, had an abusive attending who made false allegations and was given warnings by the PD. The PD paged all attendings/seniors prior to his time starting service to say she had been given warnings - which in my mind is completely inappropriate because it puts someone under incredible pressure. This friend was an IMG btw and had a huge issue adjusting to the system despite being highly knowledgeable. So she corrected the deficiencies (improving order entry in the EMR and documentation) but the PD still said she was not able to progress to PGY-2 because she needed too much supervision and terminated her.

She came into my residency class the subsequent year and was very respected as a great resident. Her story was amazing and she did not give up despite being devastated. Not to mention her personality was so warm and she genuinely captured all our hearts as well as that of the faculty. Somehow she connected with our PD who is a wonderfully kind person who looked past all this and saw the potential she had.

So what I am saying is there are people out there who will look past these things. We had an amazing PD who brought the best in all of us and helped us where we were weak. But my friend said her biggest advice is keep trying, never bash any faculty or PD you worked with or program. Explain the situation and show commitment as well as that you learnt from your experience. Later on once she built confidence in our program, she told us about how her old PD disrespected her and did many things to sabotage her. Its hard to imagine someone like her could ever be treated like this but her vulnerability was taken advantage of there. She said in the end she was glad she got terminated for many reasons but most importantly she moved on to something more incredible.

I hope my classmate's story gives you all inspiration. We are all succesful physicians now and she went on to a top fellowship.

That is my philosophy. there is no need to destroy anyones career like what they did to the op. there are many many many programs who are more than happy to do it (destroy one's career) Fortunately for myself I have gone to programs that were malicious in my face but were not mailicious enough to throw m e out or sabotage me etc etc. But I feel for those who are in those programs in which there are many. If one has gone far enough to finish med school.. he/she can understand and appreciate re direction. Take him/ her aside and say dont do this again off of the record.

I have had comments put in my deans letter by the dean from my third year IM rotations. LOOKS bored on rounds all the time. Of course iscored 95th percentile on the shelf. I moved on and those comments never hurt me. WHy put those destructive comments in?. thumbs up for the above post. Everyone needs encouragement

 

[SouthernSurgeon]

I have had comments put in my deans letter by the dean from my third year IM rotations. LOOKS bored on rounds all the time. Of course iscored 95th percentile on the shelf. I moved on and those comments never hurt me. WHy put those destructive comments in?.

Because that is the point of the deans' letter - to be a compilation of your objective and subjective grades (good and bad). If you get a bad evaluation, expect that to be at least somewhat reflected in your dean's letter. Your issue should be with the grader who put that into your evaluation, not the dean's office for relaying said grade.

 

[missneurotic]

I am glad my post was liked and I hope it helps people who are suffering with these issues that above all there is hope. My friend and colleague is such an empowering person with a kind heart. The key is she learnt from the bad year she had but also had the courage to carry on and ability to convince our PD to take her in despite the negativity. She told him this: I move on from this bad year but yet it is a foundation for my career since I learnt more this year than I did in all of med school. I see that as powerful.

I also I think that negative comments etc. in things like dean's letters are inappropriate. I am not advocating that discipline and guidance are unimportant. They are vital to our success and god knows I too have received my share of criticisms. Luckily the people who told me these things did to make me grow so I'd be competent physician. Nobody should be made to feel inferior or undermined since most mistakes arise from ignorance. Its a tough career and educators need to recognize that malice amongst physicians/residents/medical students are inappropriate in the workplace.

 

[McGillGrad]

Where do you draw the line, then? If one cannot follow proper protocols (that were designed to preserve the quality of life of the patient) then what must one do to deserve negative criticism?

Protecting the patient is more important than allowing dangerous physicians to practice in order to preserve their precious feelings.

How dare you defend a dangerous physician by constructing a strawman argument that intentionally ignores the blatant truth: dangerous physicians should be identified and expelled by their peers before they drag all of us down.

I am glad my post was liked and I hope it helps people who are suffering with these issues that above all there is hope. My friend and colleague is such an empowering person with a kind heart. The key is she learnt from the bad year she had but also had the courage to carry on and ability to convince our PD to take her in despite the negativity. She told him this: I move on from this bad year but yet it is a foundation for my career since I learnt more this year than I did in all of med school. I see that as powerful.

I also I think that negative comments etc. in things like dean's letters are inappropriate. I am not advocating that discipline and guidance are unimportant. They are vital to our success and god knows I too have received my share of criticisms. Luckily the people who told me these things did to make me grow so I'd be competent physician. Nobody should be made to feel inferior or undermined since most mistakes arise from ignorance. Its a tough career and educators need to recognize that malice amongst physicians/residents/medical students are inappropriate in the workplace.

 

[highvoltage]

Because that is the point of the deans' letter - to be a compilation of your objective and subjective grades (good and bad). If you get a bad evaluation, expect that to be at least somewhat reflected in your dean's letter. Your issue should be with the grader who put that into your evaluation, not the dean's office for relaying said grade.

the point of the deans letter is to include petty stupid comments? I passed the rotation. .. if i was horrible fail me. Ill accept that, but dont put stupid comments in there. He constantly brought coffee to rounds after being told not to. That was in my friends deans letter.. CMON. you cant tell me thats appropriate. GOD Im so glad im not in that bull**** anymore. Actually its good that i didnt know better when i was a medical student because i would have had a sharper tongue and would have been thrown out.

 

[InfraMan]

the point of the deans letter is to include petty stupid comments? I passed the rotation. .. if i was horrible fail me. Ill accept that, but dont put stupid comments in there. He constantly brought coffee to rounds after being told not to. That was in my friends deans letter.. CMON. you cant tell me thats appropriate. GOD Im so glad im not in that bull**** anymore. Actually its good that i didnt know better when i was a medical student because i would have had a sharper tongue and would have been thrown out.

If you're saying your friend brought coffee after being told not to, and it was put into his dean's letter - then that is TOTALLY appropriate.

Your sense of entitlement is disgusting.

 

[SouthernSurgeon]

the point of the deans letter is to include petty stupid comments? I passed the rotation. .. if i was horrible fail me. Ill accept that, but dont put stupid comments in there. He constantly brought coffee to rounds after being told not to. That was in my friends deans letter.. CMON. you cant tell me thats appropriate. GOD Im so glad im not in that bull**** anymore. Actually its good that i didnt know better when i was a medical student because i would have had a sharper tongue and would have been thrown out.

The dean's letter is not a LOR - it is a MSPE (medical student performance evaluation). It is expected to contain good and bad evaluations.

While it is kind of weird to have an evaluation that mentions coffee consumption issues, the dean's letter doesn't just brush off any and all problems that students have during med school.

Again, the issue here is with the grader (and to some extent, the gradee); not the dean's letter.

 

[dragonfly99]

I think that bringing coffee to rounds after you have been told not to is disrespectful of the attending and patients you are seeing. I don't know that it needed to be in the Dean's letter, but it shows poor judgment. I think saying someone, "Looks bored on rounds" is in appropriate for a dean's letter because that's a totally subjective statement. Whether someone thinks a student "looks bored" is irrelevant to me. What is relevant is whether the student worked hard, took good care of the patients, showed knowledge, etc. and how the student did on the shelf exam. "Looks bored" is a meaningless, totally subjective comment. If I were the dean's office I would have edited that comment out. Just my 2 cents.

 

[dragonfly99]

How dare you defend a dangerous physician by constructing a strawman argument that intentionally ignores the blatant truth: dangerous physicians should be identified and expelled by their peers before they drag all of us down.

Spoken like a medical student who hasn't done residency yet. I don't think we have enough information here to know whether the person was a "dangerous physician" vs. not. More likely than not, the person was a typical intern who does some things well and also has some deficiencies. It sounds like the person perhaps had trouble with the extensive computer system/EMR in the first hospital, which would not be unusual, particularly for an IMG or FMG who wasn't used to those types of systems. I think the story was told to show that people do move on and have success after being terminated from programs...which is something I have also seen/observed. However, I think in order for this to happen the person has to make a realistic assessment of his/her difficulties in the prior program, and show that he/she has learned from the experience.

As you point out, there isn't a right to practice medicine and residents do have to perform. However, there just aren't a lot of checks and balances (or really any, in many cases) to protect residents in situations where a PD or some other faculty member might have developed an unreasonable dislike or targeted a certain resident. It does happen that sometimes a PD or someone else just doesn't like a certain person's personality or just makes a snap judgment about a person. There was a great resident in my IM program who had been booted from his previous program, and I just can't imagine why. This person was THE top person on all the in service exams, a great doctor clinically, etc. I think the previous program was just malignant (other residents had also left or been asked to leave there in the recent past). There are programs like that. It's not ALWAYS the resident, or JUST the resident. Some PD's are able to give constructive criticism, and others just throw interns out like garbage I think. I feel lucky that I was never in a program like that.

 

[McGillGrad]

The hypocrisy of your posts is almost palpable. On one hand, you feel free to 'authoritatively' post on the Caribbean boards without one ounce of experience or knowledge of the Caribbean system....and then have the gall to post that I cannot make an informed post because I haven't experienced residency.

Time to take a long look in the mirror and see the hypocrite staring back at you, hun.



In reference to your post, I do not need to be a resident to appreciate the legal aspects of lying on medical documents (which is a crime). The OP admitted doing it twice. There is nothing more black-and-white than a confession of falsifying medical record.

Spoken like a medical student who hasn't done residency yet. I don't think we have enough information here to know whether the person was a "dangerous physician" vs. not. More likely than not, the person was a typical intern who does some things well and also has some deficiencies. It sounds like the person perhaps had trouble with the extensive computer system/EMR in the first hospital, which would not be unusual, particularly for an IMG or FMG who wasn't used to those types of systems. I think the story was told to show that people do move on and have success after being terminated from programs...which is something I have also seen/observed. However, I think in order for this to happen the person has to make a realistic assessment of his/her difficulties in the prior program, and show that he/she has learned from the experience.

As you point out, there isn't a right to practice medicine and residents do have to perform. However, there just aren't a lot of checks and balances (or really any, in many cases) to protect residents in situations where a PD or some other faculty member might have developed an unreasonable dislike or targeted a certain resident. It does happen that sometimes a PD or someone else just doesn't like a certain person's personality or just makes a snap judgment about a person. There was a great resident in my IM program who had been booted from his previous program, and I just can't imagine why. This person was THE top person on all the in service exams, a great doctor clinically, etc. I think the previous program was just malignant (other residents had also left or been asked to leave there in the recent past). There are programs like that. It's not ALWAYS the resident, or JUST the resident. Some PD's are able to give constructive criticism, and others just throw interns out like garbage I think. I feel lucky that I was never in a program like that.

 

[dragonfly99]

I agree about the OP's post...clearly inappropriate not to check the fetal heart monitor and then say that he/she did. We agree on that.

I thought you were referring to the person who switched neuro residencies...I don't see any clear evidence of misconduct there...just usual intern stuff more likely.

Sorry that you have been offended by my posts in the Caribbean forum. I have worked with some Carib grads and think they are fine doctors. My only concern is that some of the students who go down there (Caribbean) are not well informed about what they are getting in to and may not do well, and also that some of the Carib schools (not the best ones) use shady recruiting tactics. Also, a lot of US students go down there thinking they are going to be able to go down there and then become a radiologist or ortho surgeon, and the vast majority will not be able to...it will be harder to get certain residencies from a Carib school vs. a US school, and some students are misinformed about this. I know of people who have gone down there, spent a ton of $$ and then not been able to get real clinical rotations, etc. and that is the fault of the schools taking the students, not just the students. I'm sure some students fail out because they weren't prepared, and they bear some responsibility for that, but also some of these schools are just for-profit, don't care about the students and just want to take their money. That doesn't mean all those schools, and certainly there are some great students down there, particularly from US states like New York, and from Canada, where it's notoriously difficult to get into med school.

Please don't call me "hon" because that's inappropriate and disrespectful. It also comes across as sexist.

 

[highvoltage]

If I were the dean's office I would have edited that comment out. Just my 2 cents.

well they didnt. and it went to all the programs that i applied to. Way to go top ten medical school.

 

[highvoltage]

In reference to your post, I do not need to be a resident to appreciate the legal aspects of lying on medical documents (which is a crime). The OP admitted doing it twice. There is nothing more black-and-white than a confession of falsifying medical record.

take it easy dude. You cant judge someone unless you are their peer, which you are not. Its not a crime and it wasnt a big deal. there are many things you will do in the future (ya gotta trust me on this one), that will be less than stellar and if scrutinized can be blown out of proportion. The lab you didnt check (and said you did) , the nurse you forgot to call back, the patient you forgot to see, the joke you made that got take out of context. You will make all of those mistakes and people will over look it and you will move on. chill out dude. we dont need it son.

 

[McGillGrad]

Welcome to the real world where people judge you all day long without being your peer...like, you know, um, A JUDGE IN COURT...lol

You people are so silly sometimes.

take it easy dude. You cant judge someone unless you are their peer, which you are not. Its not a crime and it wasnt a big deal. there are many things you will do in the future (ya gotta trust me on this one), that will be less than stellar and if scrutinized can be blown out of proportion. The lab you didnt check (and said you did) , the nurse you forgot to call back, the patient you forgot to see, the joke you made that got take out of context. You will make all of those mistakes and people will over look it and you will move on. chill out dude. we dont need it son.

 

[missneurotic]

I think there is a distinction between dangerous doc and someone who makes honest mistakes for whatever reason. The colleague I am talking about to clarify was basically underprepared to deal with the system of EMRs and documentation we do here in the states. She had great knowledge but her original program was unwilling to give her the help and compassion to get past the initial roadblocks so it escalated.

Anyway, so I guess the question is what constitutes someone as dangerous? Failing to record a fetal heart rate in my mind is something I would pull an OP out and give a stern warning even though it happened twice but does it warrant ruining a person's career? Did it kill the patient? I think that when you are the one being questioned, your view point will change...anyone can have oversights - especially on call 30 hrs or when you are sleep deprived..we beat each other up alot as MDs when its a career where compassion is important. We can show this to our patients but why not to ancillary staff and most importantly to colleagues.

I see the gamut of residents and students. I think someone should only take on an educator role in this career if they are ready to work with the weaker elements. Remember it took every resident and student alot to come to this point in terms of academic, emotional, financial so guidance is important. The path to success is one with so many roadblocks and difficult moments.

 

[Bill_Brasky]

Anyway, so I guess the question is what constitutes someone as dangerous? Failing to record a fetal heart rate in my mind is something I would pull an OP out and give a stern warning even though it happened twice but does it warrant ruining a person's career?

Failing to record a FHR is ok, but he lied about it (aka documented that he did it). He put his convenience above the health of a child, and is unsuitable for medicine. He knew what would happen if he got caught, he did it anyways. End of story.

 

[xanthines]

I'm happy for your colleague that she found a program and flourished.

Not to be too judgmental or anything, but is this really your litmus test for a physician's fitness for duty?

The OP's situation is basically that of the following concept: Fool me once, shame on you. Fool me twice, shame on me.

-X

... I would pull an OP out and give a stern warning even though it happened twice but does it warrant ruining a person's career? Did it kill the patient? I think that when you are the one being questioned, your view point will change...

 

[missneurotic]

I am not discounting the serious nature or that it was not ethical to fail to perform a FHR but record it...and more than that lying is the real issue..

What I am saying is, instead of termination and ending a persons career there are other avenues for remediation - stern warnings, counseling, probation, ethics courses etc. I just think that termination is going too far. You would be shocked at the amount of stuff people get away with in this profession and while not an excuse....if you observe it then it gives perspective.

For the record, my friend did not do anything wrong. She had a really bad program director and her situation was a lack of understanding of the system. Things happen. And also, I posted the story to give people hope who are in that position. While this career is not a bed of roses like we imagine as kids....there are "flowers for those who want to see them".

I hope I made my position clear.

 

[Winged Scapula]

I am not discounting the serious nature or that it was not ethical to fail to perform a FHR but record it...and more than that lying is the real issue..

What I am saying is, instead of termination and ending a persons career there are other avenues for remediation - stern warnings, counseling, probation, ethics courses etc. I just think that termination is going too far. You would be shocked at the amount of stuff people get away with in this profession and while not an excuse....if you observe it then it gives perspective.

But this was the SECOND time this resident had been caught lying. How much remediation does he need?

 

[maceo]

I am not discounting the serious nature or that it was not ethical to fail to perform a FHR but record it...and more than that lying is the real issue..

What I am saying is, instead of termination and ending a persons career there are other avenues for remediation - stern warnings, counseling, probation, ethics courses etc. I just think that termination is going too far. You would be shocked at the amount of stuff people get away with in this profession and while not an excuse....if you observe it then it gives perspective.

For the record, my friend did not do anything wrong. She had a really bad program director and her situation was a lack of understanding of the system. Things happen. And also, I posted the story to give people hope who are in that position. While this career is not a bed of roses like we imagine as kids....there are "flowers for those who want to see them".

I hope I made my position clear.

I agree with you.. There are so many finger pointing, holier than thou, self righteous people around here on this topic. Stern warning, move on with your life. No need to ruin someone's career over this.

 

[Saladin MD]

But this was the SECOND time this resident had been caught lying. How much remediation does he need?

Well, to be fair, in his original post he only said that the first time his PD thought that he made up a physical finding. The OP didn't actually say that he made it up. So it might be that he got accused of it unjustly in the first instance, but was guilty in the second instance. (Sure, it might be unlikely, but weird things do happen.)

If he did actually lie the first time, then I think that would be much more problematic. But if it was just once, then I think he should be given a second chance.

Failing to record a FHR is ok, but he lied about it (aka documented that he did it). He put his convenience above the health of a child, and is unsuitable for medicine. He knew what would happen if he got caught, he did it anyways. End of story.

See, the reason I don't agree with this 100% is that the OP says he did it "in the heat of the moment." C'mon, we can all understand that. There is surely a difference between "heat of the moment" lying and "pre-meditated" lying.

I'm not blindly defending the OP. I'm just saying that if he really didn't lie the first time around and if the second time around he did it "heat of the moment", then I think it could be forgiven. But like other posters, I tend to think that he must have had a bunch of other issues as well and they used this to fire him (which makes perfect sense and would not be wrong of them).

I totally understand that rules are rules, but if I was the PD, I'd have a hard time sleeping at night knowing I ended someone's career. Not that I am bashing the PD for doing that; I am just saying that me personally I'd feel bad about it, just because I tend to be a very forgiving guy (sometimes excessively so). At my med school, there were a bunch of guys who got kicked out for doing drugs; I really disliked those guys, but I felt bad for them that their careers were finished without a second chance. But I guess every school/hospital has a good cop and bad cop, and they all balance each other out. Too many good cops can spell disaster for a program.

 

[Winged Scapula]

Well, to be fair, in his original post he only said that the first time his PD thought that he made up a physical finding. The OP didn't actually say that he made it up. So it might be that he got accused of it unjustly in the first instance, but was guilty in the second instance. (Sure, it might be unlikely, but weird things do happen.)

If he did actually lie the first time, then I think that would be much more problematic. But if it was just once, then I think he should be given a second chance.

Fair enough.

But frankly it doesn't really matter whether he actually lied the first time or not because his PD thought he did. So in the PD's mind he exhibited a pattern of behavior and didn't learn from his "mistake".

For some reason residents think that residency is fair and that things are forgiven. As you note, the OP likely had multiple issues outside of lying about FHRs. Trumped up charges and outright falsehoods are not uncommon stories around here...if a resident is unliked, faculty and staff will find any excuse to get rid of them, even if means exaggerating the truth.

 

[Saladin MD]

Fair enough.

But frankly it doesn't really matter whether he actually lied the first time or not because his PD thought he did. So in the PD's mind he exhibited a pattern of behavior and didn't learn from his "mistake".

For some reason residents think that residency is fair and that things are forgiven. As you note, the OP likely had multiple issues outside of lying about FHRs. Trumped up charges and outright falsehoods are not uncommon stories around here...if a resident is unliked, faculty and staff will find any excuse to get rid of them, even if means exaggerating the truth.

Agreed.

I just hope that the OP triumphs in the end, but only if he changes his behavior, admits fault for past behavior, and works hard to improve himself. Good luck, OP.

 

[endreon]

 

[turquoiseblue]

I feel that it is a little harsh to suspend someone over that, even if it was the 2nd time. I understand the duty of a PD to let someone go who isn't trustworthy in a certain instance, but I think that destroying careers isn't the way to go. If it was falsified, maybe you should get a big lecture, a course in honesty, and a scare, but termination and ruining a career forever which someone has worked so hard for over a minute instance, isn't fair. Maybe you were in a hurry and went temporarily insane.

I wonder if the medical board would pardon this mistake if the OP has proven himself to be honest. I know that people lie all the time, even doctors. Just the other day I saw a doctor tell a lie, even though it had nothing to do with patient care. And yes it is true--some people don't wear stethoscopes and write "no murmurs rubs or clicks" on paper. I see it all the time. Maybe you were writing the estimate heart rate because you eyeballed her and she looked within normal limits and she was ready to go home anyways.That's the typical scenerio I see. Residency is busy and sometimes you have to be two places at once so maybe you had to write it quickly. I don't approve of termination of residency unless it was something like drug abuse or something more life endangering to the patient. Hopefully you should get pardoned by the medical board for that. If nothing else you can get licensed and work as a GP (or you may already have your license, so you can still work somewhere in the U.S). Also,
if you can prove yourself as someone who's not a liar, maybe you can get out of this mess.

 

[Neuronix]

I've been reading gen res recently to learn things for my upcoming residency...

Summary of things relevent to this thread:

Lying about hours on official time sheets. Ok.
Lying about checking a test value on official patient chart. Not Ok.

 

[mercaptovizadeh]

I've been reading gen res recently to learn things for my upcoming residency...

Summary of things relevent to this thread:

Lying about hours on official time sheets. Ok.
Lying about checking a test value on official patient chart. Not Ok.

You know how it goes: eat when you can, sleep when you can, lie when you can...

 

[sam1999]

I do have this limitation of low scores, but the LORs from my program are very strong. I appreciate everyone's $0.02 and will continue to look for fresh ideas and thoughts....on how to get a PD to keep the faith!

How can someone is willing to provide you strong LoR but not tell you that you should resign before you are fired in the gray area of suspension?

Q. To all others: What to do in the any situation where you did some thing bad and are suspended but don't know how it will turn up? Like resign or wait for the termination letter? How to tell or who to ask what is coming?

 

[InvitroDerm]

After all this, I still don't get if the OP made a mistake or if the falsification was willful. Did you in the heat of the moment write it down accidentally or did you say to yourself, "I am right now writing down something that I know to be erroneous to save time." If it is the latter, then why do you honestly think you should be given the right to stay in medicine?

 

[Top Gun]

would you relax? He didnt lie if you asked him if he cleaned the latrines and he said yes when he didnt

i once saw a optho in the icu write fundus normal disc sharp on a patient with a glass eye

i see nurses and doctors constantly write no murmurs rubs or gallops and they dont even have a stethoscope..

the point is, this is NOT a reason to terminate someone from a program thats for sure. especially if there was NO bad outcome.

If someone you knew jumped off a bridge, does that mean you should do it too? It sounds to me like you're saying, "Oh, everybody I know falsifies medical records, its no big deal." Wrong. Its a very big deal. What if the actual fetal heart rate had been suggestive of fetal distress, but no one caught it because of the FHR written by the OP in the chart?
The OP basically opened himself, his attending, not to mention the hospital to major legal liability. If the OP had, instead of lying, admitted to his/her attending that he/she had forgotten to check the FHR, the attending, would, at worst, probably have yelled at him/her for a few minutes, advised him/her to check the FHR next time, and then moved on. Many attendings would probably skip the yelling unless they were particularly malignant, or the resident had made this mistake multiple times, which the OP has actually done. But no, the OP chose instead to falsify a record (a second time), and ended up getting terminated. Now the OP doesn't want to take responsibility for his/her mistake.

 

[Jason110]

I have been following this forum for quite sometime, and knew some input from experienced folks here would be vital in my quandary.

With a profile 85/77/pass/81(3 attempt), made it to Family Medicine residency in July 2005 on J1 visa. I did not realise how technical ObGyn was in this field, and with absolutely no experience I started having trouble in residency particularly in the Ob department. Once there was an instance where my PD thought I lied to him about a physical finding, but they decided to keep me on intense probation for 4 months to decide upon my internship year.

I performed well (with meek submission) and they were very happy to let me into second year, though extended my residency by 6 months saying I am raw and need more experience overall. Second year was without much issues in any department.

At the beginning of my third year, my PD being happy with my in-training scores and overall performance; gave me a good letter for my perspective job and j1 waiver application. That process even started with the USCIS.

Then I had to do my ObGyn rotation again. I was doing it after a 15 months gap, again faltered, and once in a heat of the moment, I wrote a fetal heart rate (FHR)value which I had not performed on a patient. Later on, the attending physician was called by the patient saying no one checked the FHR. Nonetheless, the patient and baby had an uneventful episode and they returned home.

My PD got vindictive, hell broke loose, and saying I had been warned about this event before in residency, suspended me. Within 2 weeks, I was terminated with nothing but 6 months of mere electives left.

The reason as they technically worded it was "falsification of medical records". I tried to avail any residency openings, but no one gave me an interview after reading my email where I openly declared my termination. Being on J1, I also had to leave the country in 30 days.

I do not want to stir emotions, but I kept asking the GME about trying to decrease the impact of punishment as it hits me for life, not just that particular moment. My PD told me we would be happy to recommend and say to others that give him a a second chance in IM... but not FP.

The main problem is that Pennsylvania medical board will not issue me a certificate of good standing, as I was terminated from residency. Had I voluntarily resigned during the 2 weeks i was suspended, i could retrieve my situation a mere bit, as my good standing would stay.

How can I alter my character assassination?? I am ready to take any path however hard or long to get back to the US and perhaps practise medicine, but how?? I heard of people practising without completing residency, I checked a couple of licensing boards in the US which give license with just internship completion, but I do not have the CERTIFICATE OF GOOD STANDING, which they require.

If anyone can spring up something that I have falsely assumed or do not know, you may help me get my life back. Its been the worst 9 months of my life post termination, and I do admit my mistake and believe that it is in my hands to turn it around, and all I need is an opportunity.

After reading your version of what happened during your residency, I tried to be empathetic to your loss of residency, but I could not. I do not know what happened during the first incident. Whether or not there was wrongdoing in the first incident, it obviously should have been a warning to you to follow the book to the letter from then on. You were warned! But there is no doubt what you did during the second incident (despite there not being an adverse outcome)... You admit that you falsified medical records!

I don't want to sugarcoat this. Your chances of practicing medicine in the United States again are pretty slim. I believe the only one who can give you a "certificate of good standing" is your prior residency program. It's pretty remote. And even if they do, your prior residency termination will follow you for the rest of your life. You will be asked about it if you try to get into another program. Most programs will not want to take chances on someone who was terminated, especially for a significant professionalism issue. Academic difficulty or deficiencies can many times be overlooked, but not professionalism. You will also be asked about it when applying for licensure in another state (if it gets that far). And another thing, a categorical IM position is much more difficult to come by than a categorical FP position. Sadly, this is the truth.

I know you worked hard and toiled for many years trying to get a residency in the United States. But once you reached that, your responsibility student does not end -- that's what residency is, in essence. But with more autonomy comes more responsibility. you did not live up to your responsibility in the professionalism.

And please don't use the phrase "character assassination." A character assassination generally involves manipulating facts or presenting untrue statements to damage your reputation. If your PD says you lied and did not look at the FHR, then how is that a character assassination if it's the truth? Falsifying medical records is a felony in most states (I'm not kidding).

 

[RegularNihilist]

Some day after you become a physician you will realize that all physicians have blood on their hands and you will become less judgemental.

+2

My sympathies to the OP. My OB/Gyn experience is subpar as well, and I could easily see myself pressured, in the same situation, and resorting to similar measurements to cover up. It's not just about making mistakes, it is about not coping with the pressure, and not thinking clearly in anxiety/panic. Am I right?

There are two discussions going on here, one full of ppl feeling compelled to point their finger at you, and one about your actual options. I wish I could have helped you out with the 2nd one, but I don't have a clue how things work in the US. I don't even know if the cause of termination is visible to every other residency you apply to?

I would apply broad, and lie to some, maybe you can forge some papers to get back in.

 

[RegularNihilist]

I agree about the OP's post...clearly inappropriate not to check the fetal heart monitor and then say that he/she did.

It was inappropriate, because he/she didn't get away with it. Turn it the other way round. OP could have gotten fired for not doing an adequate exam. This damned if you do- damned if you don't situation is caused by factors outside the OP as well, something you all seem to forget. Some medical students are trained worse than others, and your skills directly affect the "moral" dilemmas you are shoved into. You could just as well have said, the program is to blame, for not giving adequate support, and assisting in ironing out the OP's deficits. There are more sinners in this story.

People have an easier time sympathizing with ppl put in situations you could see yourself in. Those of you not sympathizing argue that the OP should have acted against his own perceived interests and fear of being fired for not doing proper exams, due to a god-given set of rights and wrongs. However, self-crucifications are not common, and not any more common among those on a high horse than others. This makes you all huge gigantic hypocrites. Most would never crucify themselves, and if, then purely due to the egotistical wish of being able to live up to conditioned standards, to feel worthy of human contact and love.

comes across as sexist.

So?

 

[Jason110]

It was inappropriate, because he/she didn't get away with it. Turn it the other way round. OP could have gotten fired for not doing an adequate exam. This damned if you do- damned if you don't situation is caused by factors outside the OP as well, something you all seem to forget. Some medical students are trained worse than others, and your skills directly affect the "moral" dilemmas you are shoved into. You could just as well have said, the program is to blame, for not giving adequate support, and assisting in ironing out the OP's deficits. There are more sinners in this story.

I don't agree with the 'damned if you, damned if you don't' statement.

There really is a big difference between skill deficiencies (i.e., forgetting or not knowing to do a specific exam) versus falsifying a physical exam finding. If the OP had just owned up and said he didn't do the exam, it would look bad, but it would not blow up in his face like it did.

 

[RegularNihilist]

I don't agree with the 'damned if you, damned if you don't' statement.

There really is a big difference between skill deficiencies (i.e., forgetting or not knowing to do a specific exam) versus falsifying a physical exam finding. If the OP had just owned up and said he didn't do the exam, it would look bad, but it would not blow up in his face like it did.

How do you know what would've happened? Psychic?

If the OP didn't fear the consequences, why would the OP have falsified anything? You don't falsify records for fun. You falsify records to save your sorry bum (am I gonna get banned for saying bum, or is that kosher in US English?). You falsify records, because of a personality trait seeking the pathway of least resistance. You falsify, because you fear being yelled at. I can feel that.

 

[Winged Scapula]

I wish I could have helped you out with the 2nd one, but I don't have a clue how things work in the US. I don't even know if the cause of termination is visible to every other residency you apply to?

He/she would have to provide a letter of reference in any application to residency. Undoubtedly the reason for termination will be listed accurately there and visible to every program he/she applies to.

I would apply broad, and lie to some, maybe you can forge some papers to get back in.

Please tell me you're joking. That's an extremely bad idea, one which will ruin any chances of ever practicing medicine in the US. Perhaps this is common in your country, but it is not in the US.

 

[dragonfly99]

I'm not without any sympathy for the OP,and I certainly DO understand how trainees can feel pressure to be perfect and appear infallible. I do agree that some of the onus is also on programs and attendings not to create that type of atmosphere where trainees fear to make any mistakes, and I have been in similar types of situations to. I have been yelled at or "dressed down", as you might say, for real or perceived deficiencies. Sometimes being a trainee sucks and it can be unfair.

It is true that nobody is perfect. However, the lie that the OP put in the medical records was potentially a big deal because the baby could have died...so it's really not a "white lie". That's part of why the OP got in such hot water. But I definitely agree that sometimes med schools and residencies teach inadequately and don't provide support, and then they expect trainees to perform at a high level anyway, and without necessarily being taught everything they need to know. This is a dilemma faced by a lot of trainees, and it does suck. However, the patients come before us and even if they, or the attendings, are being "mean", have unreasonable expectations, etc. we still have to try and give them our best, like we would our own relatives.

 

[dragonfly99]

I don't think it's a good idea for the OP to falsify documents. Pretty much inevitably, the new program will find out and then you he/she won't be able to get a job anywhere, ever, in the US. It seems like a better strategy would be to try to get LOR's from attending(s) who worked with the OP and seem supportive, and do his/her best to overcome what will probably be a lousy evaluation letter from the program director. He/she can try to explain the incident by saying a mistake was made under a high pressure/anxiety situation, and what would be different in the future (new program needs to feel secure such things won't happen again). Switching specialties also might help (if not doing OB, then some of the same pressures won't exist, and different skills would be needed).

 

[motoo]

if we strictly apply the rule that one should not write down an exam finding that one did not do, then I bet you the vast majority of residents and attendings would be terminated. Especially with an EMR system like ours that has a template for physical exam, everyone just clicks on through and writes "normal" for stuff they haven't done. 75% of the time ROS is negative (as in negative because it wasn't even asked). The only difference between the OP and the rest of us is that the OP got caught. to try to make a distinction and and say that you only make up stuff for things that are not important (e.g. eye exam for a person with foot trauma) is ridiculous. it's still lying and all you're doing is playing the odds that nothing truly is wrong with the eye. but if there is some undiagnosed pathology in the eye and it is caught later, you would be just as liable. lying is lying.