Should I RESIGN or be terminated & FIGHT?

[deleted480308]

I think part of the problem is that one person's definition of a clear warning may not be clear to another person.

For example...

E.g., We have received x number of complaints about unprofessional behavior and are informing you of these reports so that you can correct this behavior. Specific incidents include... Your actions deviate from the following policies... Based on these policies, it is the opinion of the program that you should be terminated for your behavior. However, per policy, except for severe infarctions, residents will not be terminated without warning so as to be informed of their behavior in order to allow the opportunity for improvement. This serves as an official warning that you have behavied in a manner deserving of termination. Per policy, you are required to undergo a psychological evaluation to retain employment at this time. Your signature below indicates understanding that this is your only warning and that any further unprofessional behavior will result in immediate termination.

Vs.

'Hey buddy, how are things going? Oh by the way, a couple of people have told me that they were offended by some of your jokes, can you please tone it down a bit? Oh and we got an email from a patient who was upset that you casually used profainty in front of him. Don't do it again, ok? If you need to talk to anyone, I'm always around.'

I think I get what aprogdirector was saying about being accused of being mean if direct. I have been called harsh a couple of times for telling guys that work for me, "this cannot happen again, it will get you fired, this is the last and only warning" etc.....I only got that direct though after past experiences where guys didn't process what I had thought were unmistakable warnings so I decided to be absurdly clear from then on out

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[foodle]

So in retrospective it seems like I didn't think the patient problems were that serious and that my relationships with my patients (in my opinion) were fine or had no issues. It's just too bad that a patient's opinion on a doctor can be so detrimental just coz that doc didn't smile in their face or didn't show enough empathy. It's really subjective and yes I'm not without fault but really this is a 1 way street and I have no way of defending myself.

You keep minimizing this problem with interaction with patients. Your view of this issue is clearly skewed since that was the primary reason that your PD gave for the termination, but you view it as "fine" with "no issues". Just reading your posts makes it clear that you have a condescending view of the patients. I'd suggest working on your actual attitude towards them, rather than just working on how to hide it better.

This wasn't just a single patient interaction. Anyone can have a single bad patient interaction for a variety of reasons. But this was a consistent pattern of behavior of a degree sufficient to get you fired.

 

[ruralsurg4now]

A common theme in threads like this is the resident/trainee not recognizing the seriousness of the situation when it first arises. Part of that is "my" fault, because I don't want to be a "bad guy", and hence I tend to use non-threatening language.

But that's the silly part of this all. A Program Director (and really anyone associated with a training program) is supposed to be involved in the training of a resident. And that's not just "medical knowledge" training, but all aspects of training. If the core competencies involve, for example, "professionalism" and someone isn't professional in your estimation, then it should fall to you to lead them. And probably nobody does. The conclusion is "well, I'll just call them into my office and tell them they're not professional and then suddenly they'll go home and realize how to do it." Even here you're talking about using "threatening" versus "non-threatening" language to them. How would either work? You can't "threaten" someone into becoming professional, nor can you politely and meekly tell them to be. If you recognize a problem, then you should move to help the person fix it, or you've failed in your own professional duties.

With regards to the OP, it doesn't really matter what you do at this point. The reason is because if you resign, you still have to indicate on every employment and license application that you were "fired" from residency. They all ask if you left "voluntarily," so you still have to explain what happened. When they tell you that this is a "better" way to do it, they're not actually being honest with you. It is "better" for them (not you) because it means you're going away without causing any problems. Additionally, once you voluntarily resign, that can be used by the residency program to say that you basically accepted the blame and chose not to fight. Being terminated, on the other hand, guarantees that you will get a poor recommendation if the program is ever contacted. However, if you do feel that you were "wronged" in termination, you at that point do have the option of suing them, at which point you may find them willing to negotiate the actual terms of your departure. For example, if the program has no documentation and is just trying to scare you, they could even go so far as to assist you in transfering to another program. That's been done before. However, you should realize that is a difficult road to take and not necessarily guaranteed to work. You should also discuss things with a lawyer and be completely open with them about what you think the case against you is, so they can inform you properly.

 

[Arcan57]

But that's the silly part of this all. A Program Director (and really anyone associated with a training program) is supposed to be involved in the training of a resident. And that's not just "medical knowledge" training, but all aspects of training. If the core competencies involve, for example, "professionalism" and someone isn't professional in your estimation, then it should fall to you to lead them. And probably nobody does. The conclusion is "well, I'll just call them into my office and tell them they're not professional and then suddenly they'll go home and realize how to do it." Even here you're talking about using "threatening" versus "non-threatening" language to them. How would either work? You can't "threaten" someone into becoming professional, nor can you politely and meekly tell them to be. If you recognize a problem, then you should move to help the person fix it, or you've failed in your own professional duties.

It's difficult to impossible to tell if someone will be professional to the patients during an interview. Most unprofessional conduct in medical school doesn't generate a paper trail visible to residencies. Without red flags in the packet, unless the applicant owns up to treating patients disrespectfully, it's extremely tough to tell from an 15 min interview that the applicant is unprofessional. Character traits that are associated with professionalism concerns are quite common in med students (especially arrogance), but the vast majority of students that shows these characteristics complete residency without any difficulty.

I'm not sure if you've ever tried to mentor someone who is exhibiting a pattern of unprofessional behavior, but it's extremely labor intensive and only works if the person
recognizes they have a problem that is internally generated and is willing to devote significant time and energy to breaking the habits they've fallen into. If multiple meetings addressing the behavior do not resolve in any significant change, it's unreasonable to expect the PD to become a psychologist and do deep-dive counseling to get at the root of the behavior.

Also, if you're an attending and are ever given the choice between voluntarily resigning hospital privileges or going through an investigation it's almost always a better choice to resign. Once the investigation starts if, you resign during or have hospital privileges revoked after it becomes reportable to the board.

 

[DrT2202]

I think part of the problem is that one person's definition of a clear warning may not be clear to another person.

For example...

E.g., We have received x number of complaints about unprofessional behavior and are informing you of these reports so that you can correct this behavior. Specific incidents include... Your actions deviate from the following policies... Based on these policies, it is the opinion of the program that you should be terminated for your behavior. However, per policy, except for severe infarctions, residents will not be terminated without warning so as to be informed of their behavior in order to allow the opportunity for improvement. This serves as an official warning that you have behavied in a manner deserving of termination. Per policy, you are required to undergo a psychological evaluation to retain employment at this time. Your signature below indicates understanding that this is your only warning and that any further unprofessional behavior will result in immediate termination.

Vs.

'Hey buddy, how are things going? Oh by the way, a couple of people have told me that they were offended by some of your jokes, can you please tone it down a bit? Oh and we got an email from a patient who was upset that you casually used profainty in front of him. Don't do it again, ok? If you need to talk to anyone, I'm always around.'

Very good point. Even though there was no profanities or jokes whatsoever but it was mainly the second example. No words such as warning or policy or official have been mentioned whatsoever. Thanks for your input.

 

[ruralsurg4now]

I'm not sure if you've ever tried to mentor someone who is exhibiting a pattern of unprofessional behavior, but it's extremely labor intensive and only works if the person recognizes they have a problem that is internally generated and is willing to devote significant time and energy to breaking the habits they've fallen into. If multiple meetings addressing the behavior do not resolve in any significant change, it's unreasonable to expect the PD to become a psychologist and do deep-dive counseling to get at the root of the behavior.

I actually have done that and it is labor intensive. But the fact that it is time-consuming doesn't mean it is not their responsibility. That's part of why they are being paid for the position and what you should ethically do if you care about residents. Instead, usually it's all about making a perfunctory effort like telling them they've been warned.

Oh, by the way, I did that on my own, not because I was told to. Every attending who interacts with a resident has that obligation. I'm not in a residency training program right now (hence my name), but every one of you who are attendings at such institutions have that obligation. And if you aren't doing it, you're being deficient.

 

[pgg]

Curious, have you lived in the US all of your life, or did you move here from another country (where)?

I ask because I've known a handful of physicians who were competent but had really significant communication difficulties with patients, staff, and colleagues, because they came from very different cultures, or places where doctor-patient relationships are very paternalistic and one-sided.

 

[DrT2202]

Curious, have you lived in the US all of your life, or did you move here from another country (where)?

I ask because I've known a handful of physicians who were competent but had really significant communication difficulties with patients, staff, and colleagues, because they came from very different cultures, or places where doctor-patient relationships are very paternalistic and one-sided.

I haven't lived in the US my whole life moved here permanently in the last 4 years. You can say that the doctor/patient relationship in my country could be one sided at times.

The PD is telling that I'm actually a nice person but I don't come out that way to patients. In the incident that hit the nail in my case: I was examining a lesion on a pt in the emergency dept and a family member/friend of the pt was asking a question or saying a comment and I didn't reply immediately and she took offense to that (if I'm remebering correctly) but when I mention if that justifies this drastic measure against me; I'm being told that it's a pattern not a single incident that resulted in that decision.

 

[ruralsurg4now]

when I mention if that justifies this drastic measure against me; I'm being told that it's a pattern not a single incident that resulted in that decision.

That's usually a stock answer that often indicates that they don't have any actual documentable proof. For example, a patient could call a nurse in and say "I just want to say that doctor was rude" and the nurse would pass it on but not actually know what was going on that was rude. That's not to say that there's not a problem, but it's basically at the level of "I know there's a lot of grumbling about this guy, but I don't have any specifics."

A caveat to that, however, is that I'm not saying they don't have any documentation. I have no idea. Generally, however, people who had proof will tell you what the issue is (e.g., "someone heard you screaming at Mr. Brown's wife in the hallway"), rather than "you didn't answer someone quickly enough and I've got a lot more, but not off the top of my head."

 

[NotAProgDirector]

I think part of the problem is that one person's definition of a clear warning may not be clear to another person.

For example...

E.g., We have received x number of complaints about unprofessional behavior and are informing you of these reports so that you can correct this behavior. Specific incidents include... Your actions deviate from the following policies... Based on these policies, it is the opinion of the program that you should be terminated for your behavior. However, per policy, except for severe infarctions, residents will not be terminated without warning so as to be informed of their behavior in order to allow the opportunity for improvement. This serves as an official warning that you have behavied in a manner deserving of termination. Per policy, you are required to undergo a psychological evaluation to retain employment at this time. Your signature below indicates understanding that this is your only warning and that any further unprofessional behavior will result in immediate termination.

Vs.

'Hey buddy, how are things going? Oh by the way, a couple of people have told me that they were offended by some of your jokes, can you please tone it down a bit? Oh and we got an email from a patient who was upset that you casually used profainty in front of him. Don't do it again, ok? If you need to talk to anyone, I'm always around.'

This, exactly. Except for the psychological evaluation part. That's not really legal -- but for a different thread.

 

[NotAProgDirector]

But that's the silly part of this all. A Program Director (and really anyone associated with a training program) is supposed to be involved in the training of a resident. And that's not just "medical knowledge" training, but all aspects of training. If the core competencies involve, for example, "professionalism" and someone isn't professional in your estimation, then it should fall to you to lead them. And probably nobody does. The conclusion is "well, I'll just call them into my office and tell them they're not professional and then suddenly they'll go home and realize how to do it." Even here you're talking about using "threatening" versus "non-threatening" language to them. How would either work? You can't "threaten" someone into becoming professional, nor can you politely and meekly tell them to be. If you recognize a problem, then you should move to help the person fix it, or you've failed in your own professional duties.

I agree, partially. I've discussed this with others, and been to several PD workshops on "how to fix residents with professionalism problems". Although there clearly isn't a one-size-fits-all solution (since professionalism problems come in all sorts of types), the basic solution is to show the resident the behavior/issue, inform them that it is unprofessional and must stop, and inform them that if it doesn't stop they will be terminated. I now add two extra elements -- I am clear that even if the rest of their performance is fine, this will lead to their termination; and I try to help them find the root cause of the problem, and refer them to someone who can help. So I don't "threaten" them exactly, but I'm honest with them about exactly what the consequences are if their behavior doesn't change.

With regards to the OP, it doesn't really matter what you do at this point. The reason is because if you resign, you still have to indicate on every employment and license application that you were "fired" from residency. They all ask if you left "voluntarily," so you still have to explain what happened. When they tell you that this is a "better" way to do it, they're not actually being honest with you. It is "better" for them (not you) because it means you're going away without causing any problems. Additionally, once you voluntarily resign, that can be used by the residency program to say that you basically accepted the blame and chose not to fight. Being terminated, on the other hand, guarantees that you will get a poor recommendation if the program is ever contacted. However, if you do feel that you were "wronged" in termination, you at that point do have the option of suing them, at which point you may find them willing to negotiate the actual terms of your departure. For example, if the program has no documentation and is just trying to scare you, they could even go so far as to assist you in transfering to another program. That's been done before. However, you should realize that is a difficult road to take and not necessarily guaranteed to work. You should also discuss things with a lawyer and be completely open with them about what you think the case against you is, so they can inform you properly.

This is an excellent summary. If you resign, you might have the possibility of having a cordial relationship with your program and that might be helpful in the future. The best you can hope for would be an agreement that when future employers inquire about your performance, a standardized statement saying that you worked from XXX to YYY and resigned. People may (correctly) read problems into this, but some may not or some may not care.

If you fight it, you likely lose any good will, and your reference in the end will likely include the morbid details. Or, by fighting it you might be able to force them to report only your employment dates. Of note, if you fight it and are terminated, you might be able to claim unemployment -- if you resign you can't.

There's no perfect answer -- each option can end well or badly.

 

[DrT2202]

First of all, I'm really grateful to the presence of such a forum and the valuable input I'm getting from everybody. Feeling horrible as I am right now, the replies/messages really give me relief so thank you to everybody participating/sharing. Even though I'm trying to share as much as possible and not sugar coating anything but on the contrary using the language directed at me and citing all the mistakes/flaws that are seen in me. I had a few realizations:

(1) I can't live in the world alone being part of a group but antagonizing or having too much pride to play politics or try to appeal to others who don't like my views/opinions.

(2) I have to be very careful of every single word I say whether it's commenting on the shut down or telling a story or whatever that might remotely slightly offend somebody or come out as obnoxious.

(3) Patients are always right and they don't really appreciate your education/expertise that much. You have to be like a docile calm considerate eager to please doc to avoid any misunderstandings/ misinterpretations.

(4) Power belongs to whoever has power and it rotates so you just wish whoever has power would have mercy as well.

 

[Doctor Bagel]

Would get an attorney, b/c he/she can try to extract some sort of guarantee the program won't say a lot of blatantly bad stuff about you.
You should get a letter of reference/evaluation from them, if possible, that looks neutral/not too bad...not sure if this is possible.

I also agree that psychiatrist might not be the best person to be treating you if you don't have something like bipolar/schizophrenia/major depression where you would need meds. It might be helpful, but someone like a clinical psychologist, who is good at what he/she does, might be cheaper and able to spend more time with you and maybe more helpful. This seems more like a problem with interpersonal relationships and a difference between the way you intend to come across and the way you actually DO come across to other people. Right now, you are concerned with this bad thing that's happening to you in terms of residency, but this can continue to be an issue when you are in practice. Patients often will have a lot of high expectations of you, and even unreasonable ones, and you have to be able to step back and not let anybody push your buttons and also be reassuring at the same time.

Psychiatrists do actually do psychotherapy and can help people work on interpersonal conflicts and all that type of stuff. We're not just trained to do medication management, so if the op were seeing a psychiatrist, it could be perfectly appropriate. I agree that he would need something more than medication management, but it's not accurate to assume that is all he's getting if he is seeing a psychiatrist.

 

[DrT2202]

Psychiatrists do actually do psychotherapy and can help people work on interpersonal conflicts and all that type of stuff. We're not just trained to do medication management, so if the op were seeing a psychiatrist, it could be perfectly appropriate. I agree that he would need something more than medication management, but it's not accurate to assume that is all he's getting if he is seeing a psychiatrist.

Actually I've been seeing a therapist/psychologist and I confused both. No medication needed and didn't really "label" any conditions. No depression, no anxiety. i find myself mostly talking about my childhood and things in the past. Strangely enough, I was so fixated on my relationships with co-residents that I never tackled the issue of patients' communication which was detrimental.

 

[qxrt]

Patients are always right and they don't really appreciate your education/expertise that much. You have to be like a docile calm considerate eager to please doc to avoid any misunderstandings/ misinterpretations.

But you see, this attitude is precisely what your PD and others are referring to when they're referring to your condescending behavior. You can't generalize patients like this and then try to "fix" your interactions with patients by acting like a "docile...eager to please" physician because that is not what it means to be an empathetic professional. Patients are sometimes right, sometimes wrong, and it's your job as a healthcare professional to try to guide them on the right track in terms of managing their own healthcare. You're playing an advisor role, and it's a balance between making people trust you enough to listen to your advice and giving them the leeway to make their own decisions regarding their medical management.

 

[thefritz]

I'm not sure if you've ever tried to mentor someone who is exhibiting a pattern of unprofessional behavior, but it's extremely labor intensive and only works if the person
recognizes they have a problem that is internally generated and is willing to devote significant time and energy to breaking the habits they've fallen into. If multiple meetings addressing the behavior do not resolve in any significant change, it's unreasonable to expect the PD to become a psychologist and do deep-dive counseling to get at the root of the behavior.

Published data supports your experience. The 2008 APDIM survey indicates that of 7 resident deficiencies, professionalism was the least likely to be successifly remediated, with only 48.5% of residents correcting the problems vs. 85.8% correcting medical knowledge deficienies, the most likely deficiency to be successfully remediated.

 

[ruralsurg4now]

Published data supports your experience. The 2008 APDIM survey indicates that of 7 resident deficiencies, professionalism was the least likely to be successifly remediated, with only 48.5% of residents correcting the problems vs. 85.8% correcting medical knowledge deficienies, the most likely deficiency to be successfully remediated.

That's probably because you can actually quantify the one and not the other. In other words, anyone can teach someone else a fact. I mean, if I told you your job was on the line, I could get you to memorize and recite the entire ingredients list of a package of Oreos and Doritos. So what? But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham. We all know this, but we play along with it because some administrator told us to. We all know that a patient could belligerently complain about one person and we'd say "oh, that's a difficult patient" and the exact same patient could complain about another patient and we'd say "this physician is completely unprofessional." Similarly, there are lots of attendings who are unprofessional and, so long as it's not completely wildly out of control (and sometimes even then), everyone looks the other way. In fact, if you forced someone to actually tell you what was "unprofessional" about someone, chances are they'd be hard pressed to do it many times. It basically just means "I didn't like you."

 

[ruralsurg4now]

But you see, this attitude is precisely what your PD and others are referring to when they're referring to your condescending behavior. You can't generalize patients like this and then try to "fix" your interactions with patients by acting like a "docile...eager to please" physician because that is not what it means to be an empathetic professional. Patients are sometimes right, sometimes wrong, and it's your job as a healthcare professional to try to guide them on the right track in terms of managing their own healthcare. You're playing an advisor role, and it's a balance between making people trust you enough to listen to your advice and giving them the leeway to make their own decisions regarding their medical management.

That's fine, however, I've met many a physician who has adopted his defensive strategy for dealing with patients (e.g., the patient wanted a CT and rather than arguing with him I ordered it). Often it is because it is felt that if you have that "good" relationship with the patient, they won't sue you. Similarly, he is thinking that if he creates a "good" relationship with the patient, he won't get written up any more. It is not unnatural for people to think in this manner.

 

[Shikima]

That's probably because you can actually quantify the one and not the other. In other words, anyone can teach someone else a fact. I mean, if I told you your job was on the line, I could get you to memorize and recite the entire ingredients list of a package of Oreos and Doritos. So what? But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham. We all know this, but we play along with it because some administrator told us to. We all know that a patient could belligerently complain about one person and we'd say "oh, that's a difficult patient" and the exact same patient could complain about another patient and we'd say "this physician is completely unprofessional." Similarly, there are lots of attendings who are unprofessional and, so long as it's not completely wildly out of control (and sometimes even then), everyone looks the other way. In fact, if you forced someone to actually tell you what was "unprofessional" about someone, chances are they'd be hard pressed to do it many times. It basically just means "I didn't like you."

This.

 

[wholeheartedly]

I actually just read a study on this very issue not too long ago. There were some very obvious things that everyone agreed on as unprofessional behavior, but beyond that quite a bit of variability on how pretty much everything else was viewed with respect to evaluating professionalism. There were some pretty big discrepancies among evaluators. The conclusion was that it would be a good idea to better define what they're looking for in evaluating professionalism before confusing the heck out of med students and residents.

That's probably because you can actually quantify the one and not the other. In other words, anyone can teach someone else a fact. I mean, if I told you your job was on the line, I could get you to memorize and recite the entire ingredients list of a package of Oreos and Doritos. So what? But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham. We all know this, but we play along with it because some administrator told us to. We all know that a patient could belligerently complain about one person and we'd say "oh, that's a difficult patient" and the exact same patient could complain about another patient and we'd say "this physician is completely unprofessional." Similarly, there are lots of attendings who are unprofessional and, so long as it's not completely wildly out of control (and sometimes even then), everyone looks the other way. In fact, if you forced someone to actually tell you what was "unprofessional" about someone, chances are they'd be hard pressed to do it many times. It basically just means "I didn't like you."

 

[pgg]

But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham.

That's ridiculous.

Shouting at other staff is unprofessional.
Throwing surgical instruments is unprofessional.
Being abusive to subordinates or other hospital staff is unprofessional.
Not showing up for work on time is unprofessional.
Not returning pages is unprofessional.
Having a relationship with a patient is unprofessional.
Cheating on in-training exams is unprofessional.
If you can imagine Dr. Cartman from South Park doing it, it's probably unprofessional.

There's an element of the pornography definition ("I know it when I see it") to the concept of professionalism, sure, but let's not go off the deep end here and pretend it's totally subjective, unquantifiable, and just a whimsical tool program directors use to screw residents they don't like.



It's probably less subjective than attendings' evaluation of clinical performance. There's a study from an anesthesiology residency that showed no correlation AT ALL between residents' eval scores (most everyone was rated as 'above average' by attendings in fund of knowledge) to their in-training exam scores (which ranged from something like the 2nd %ile to 98th %ile).

 

[ruralsurg4now]

That's ridiculous.

No, it's not. It's easy to say, for example, that punching a patient in the face is unprofessional. But that's not what people are getting fired for. You could be labeled "unprofessional" because a patient didn't like the expression on your face or the tone of your voice. Not that you were screaming at them or even had your voice raised, but merely that they personally felt that you were "disrespecting" them in some vague way and then reported that you were being rude. Now, if enough people report that, then that doesn't mean there isn't a problem, but to say "well, that was unprofessional" or even a fireable offense is really ridiculous.

In actuality, the subjectivity and vagueness of "professionalism" is what makes it so easy to abuse for disciplinary measures. It is not unheard of for nurses, for example, to decide to harrass a resident, either for real or fake reasons, and merely en mass start reporting everything they do as "unprofessional" or "rude." In those instances, it is actually the resident who is a victim and the staff that is being "unprofessional," yet they are doubly victimized by the system. You don't actually need any evidence of behavior, simply hearsay or opinion (e.g., I didn't like the tone of his voice when he spoke to me, she hung up on me too quickly, etc.). At that point, rather than deal with the staff, it's easier to "cut your losses" and just eliminate the resident. Staff at residency programs know that, as you could be an attending and be fairly rude to them and nothing will happen to you. They don't even make any real effort to take on the attendings in many instances, unless the behavior is extremely egregious.

 

[DrT2202]

That's probably because you can actually quantify the one and not the other. In other words, anyone can teach someone else a fact. I mean, if I told you your job was on the line, I could get you to memorize and recite the entire ingredients list of a package of Oreos and Doritos. So what? But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham. We all know this, but we play along with it because some administrator told us to. We all know that a patient could belligerently complain about one person and we'd say "oh, that's a difficult patient" and the exact same patient could complain about another patient and we'd say "this physician is completely unprofessional." Similarly, there are lots of attendings who are unprofessional and, so long as it's not completely wildly out of control (and sometimes even then), everyone looks the other way. In fact, if you forced someone to actually tell you what was "unprofessional" about someone, chances are they'd be hard pressed to do it many times. It basically just means "I didn't like you."

That's exactly it: I wasn't liked except by a few people not including the head attending or the influential residents. This issue being subjective is what really hurts me.

 

[DrT2202]

But you see, this attitude is precisely what your PD and others are referring to when they're referring to your condescending behavior. You can't generalize patients like this and then try to "fix" your interactions with patients by acting like a "docile...eager to please" physician because that is not what it means to be an empathetic professional. Patients are sometimes right, sometimes wrong, and it's your job as a healthcare professional to try to guide them on the right track in terms of managing their own healthcare. You're playing an advisor role, and it's a balance between making people trust you enough to listen to your advice and giving them the leeway to make their own decisions regarding their medical management.

I'm sorry for generalizing but I'm losing my residency because of a patient who I swear to this moment I'm not sure what i exactly did wrong to. It's not a patient, patient's family member who was sitting there. I'm palpating a swelling in the cheek and not sure how I upset the patient's friend/family. Was I too brief? I answered all questions. Was I not smiling? maybe. I need to improve my communication skills that's fine but this is a huge drastic step that will affect my whole career that hasn't even started.

 

[DrT2202]

No, it's not. It's easy to say, for example, that punching a patient in the face is unprofessional. But that's not what people are getting fired for. You could be labeled "unprofessional" because a patient didn't like the expression on your face or the tone of your voice. Not that you were screaming at them or even had your voice raised, but merely that they personally felt that you were "disrespecting" them in some vague way and then reported that you were being rude. Now, if enough people report that, then that doesn't mean there isn't a problem, but to say "well, that was unprofessional" or even a fireable offense is really ridiculous.

In actuality, the subjectivity and vagueness of "professionalism" is what makes it so easy to abuse for disciplinary measures. It is not unheard of for nurses, for example, to decide to harrass a resident, either for real or fake reasons, and merely en mass start reporting everything they do as "unprofessional" or "rude." In those instances, it is actually the resident who is a victim and the staff that is being "unprofessional," yet they are doubly victimized by the system. You don't actually need any evidence of behavior, simply hearsay or opinion (e.g., I didn't like the tone of his voice when he spoke to me, she hung up on me too quickly, etc.). At that point, rather than deal with the staff, it's easier to "cut your losses" and just eliminate the resident. Staff at residency programs know that, as you could be an attending and be fairly rude to them and nothing will happen to you. They don't even make any real effort to take on the attendings in many instances, unless the behavior is extremely egregious.

That's EXACTLY my case with patients. I was even told by the PD that it's not what you say or that you mean to be condescending but it's the way you come across. You can see some people without interacting with them and you would feel they rub you the wrong way.

I'm not saying I'm a saint but why not give me a written warning? Why not explicitly say you'll be fired in 1 of the 2 "friendly" meetings? I appreciate the responsibility on the PD and hospital administration but I really wish there was something I can do instead of losing all this work/studying in the past 4 months and the permanent 3 months failed residency in my CV.

 

[Shikima]

No, it's not. It's easy to say, for example, that punching a patient in the face is unprofessional. But that's not what people are getting fired for. You could be labeled "unprofessional" because a patient didn't like the expression on your face or the tone of your voice. Not that you were screaming at them or even had your voice raised, but merely that they personally felt that you were "disrespecting" them in some vague way and then reported that you were being rude. Now, if enough people report that, then that doesn't mean there isn't a problem, but to say "well, that was unprofessional" or even a fireable offense is really ridiculous.

In actuality, the subjectivity and vagueness of "professionalism" is what makes it so easy to abuse for disciplinary measures. It is not unheard of for nurses, for example, to decide to harrass a resident, either for real or fake reasons, and merely en mass start reporting everything they do as "unprofessional" or "rude." In those instances, it is actually the resident who is a victim and the staff that is being "unprofessional," yet they are doubly victimized by the system. You don't actually need any evidence of behavior, simply hearsay or opinion (e.g., I didn't like the tone of his voice when he spoke to me, she hung up on me too quickly, etc.). At that point, rather than deal with the staff, it's easier to "cut your losses" and just eliminate the resident. Staff at residency programs know that, as you could be an attending and be fairly rude to them and nothing will happen to you. They don't even make any real effort to take on the attendings in many instances, unless the behavior is extremely egregious.

Again, right on the money.
Programs and the ACGME don't care to correct this internal deficiency of a process either, it's easier to place labels on the weak and powerless.

--- Isn't this bullying?

 

[DrT2202]

Again, right on the money.
Programs and the ACGME don't care to correct this internal deficiency of a process either, it's easier to place labels on the weak and powerless.

--- Isn't this bullying?

Are there any laws I can read concerning this issue and is this state by state or a national legislation.

Thank you for your input, I really appreciate it.

 

[ruralsurg4now]

Isn't this bullying?

It absolutely is, but it comes down to the issue of whether people actually mean what they say. I am quite aware that a resident, for example, can be very rude to a nurse. I am also aware that a nurse can be very rude to a resident. If the institution actually cares about "rudeness," then both matters should hold an equal weight and both matters should be corrected. However, the fact is that they are not becasue it is easier to fire and replace a resident than a nurse, or even to discipline the one versus the other. It then becomes a game of politics (i.e., "which person has better standing in the hospital system") instead of actual concern over what is right or wrong. And that occurs even after residency, by the way. Hospital politics simply become more refined when you're an attending dealing with other attendings, rather than the "hammer will flatten the nail" type of brute force that you experience as a resident.

 

[Arcan57]

It absolutely is, but it comes down to the issue of whether people actually mean what they say. I am quite aware that a resident, for example, can be very rude to a nurse. I am also aware that a nurse can be very rude to a resident. If the institution actually cares about "rudeness," then both matters should hold an equal weight and both matters should be corrected. However, the fact is that they are not becasue it is easier to fire and replace a resident than a nurse, or even to discipline the one versus the other. It then becomes a game of politics (i.e., "which person has better standing in the hospital system") instead of actual concern over what is right or wrong. And that occurs even after residency, by the way. Hospital politics simply become more refined when you're an attending dealing with other attendings, rather than the "hammer will flatten the nail" type of brute force that you experience as a resident.

Being able to be tolerated by the people that you work for is a core competency.

 

[ruralsurg4now]

Being able to be tolerated by the people that you work for is a core competency.

Sure, but you're not getting fired in most cases because the PD (who is who you work for) can't tolerate you. It's also generally not because your co-residents hate you. It would be like if you worked for a corporate business and got fired because the lobby doormen hated you or the cleaning crew got angry at you for being arrogent. And, like I said, if "professionalism" is a core competency, then why are there attendings who don't act in that model-like behavior? Really, all you're doing is telling residents to suppress behavior until they graduate and then throw a party.

 

[deleted480308]

Sure, but you're not getting fired in most cases because the PD (who is who you work for) can't tolerate you. It's also generally not because your co-residents hate you. It would be like if you worked for a corporate business and got fired because the lobby doormen hated you or the cleaning crew got angry at you for being arrogent. And, like I said, if "professionalism" is a core competency, then why are there attendings who don't act in that model-like behavior? Really, all you're doing is telling residents to suppress behavior until they graduate and then throw a party.

part of every employee's role everywhere is to not create extra headache for their boss, it's part of every employment sector. If you create a significantly larger amount of hassle for your boss in terms of fielding complaints or needing to defend you from multiple accusations, you will eventually go home.

aside from medicine, that is a life lesson that all people need to learn if only for their own self-preservation

 

[ruralsurg4now]

part of every employee's role everywhere is to not create extra headache for their boss, it's part of every employment sector. If you create a significantly larger amount of hassle for your boss in terms of fielding complaints or needing to defend you from multiple accusations, you will eventually go home.

aside from medicine, that is a life lesson that all people need to learn if only for their own self-preservation

That's true, too, but keep in mind that as a pre-med you don't know how things work in a hospital. I''m not trying to be condescending, I'm just pointing out the fact. It's not a professional environment in many ways. In fact, many people act in a very immature way in the hospital. It's basically like grown-up high school.

 

[pgg]

No, it's not.

The fact that unethical or lousy program directors exist and abuse their power doesn't mean that "professionalism" can't or shouldn't be evaluated.

Your argument is equivalent to the (nonsense) declaration that because some people get speeding tickets when their cruise control is set to 55, that the police shouldn't be able to pull over reckless drivers. Because "reckless" is subjective, right? The system is broken, right? Scrap it all.



Program directors don't fire residents for fun. No PD wants the black mark and empty slot that comes with a resident leaving. No PD wants the headache, the legal tangles. They don't create these messes for the hell of it. PDs want residents to be wildly successful and go on to graduate, pursue fellowship training, and/or get great jobs so their program looks good and subsequently attracts great residents. Most PDs chose that job because they want to educate and teach.

There are easier ways for sociopaths to indulge hidden sadistic urges than by becoming a residency program director.


Here on SDN, we get one side of every story. I don't know DrT2202; he seems like a sincere guy who genuinely wants to do the right thing. I truly wish him the best. In general though, my first hand experience over the last 17 years of medical education, training, and practice is that each person I've observed get fired deserved to be fired, and if anything, should've been fired sooner.

I have seen residents that I thought were treated poorly. Malignant programs exist, of course. I knew one who quit and left a program because of it. But that resident wasn't fired and didn't get the 'resign or else' talk.



The take home message for casual observers:

Like it or not, in medicine and outside it, we are judged every day in everything we do by everybody we interact with. Our lives, our jobs, our relationships, everything is impacted by vague subjective encounters with other people. It's not always fair, so take care that what people perceive matches the reality of what you are.

If you can't seem to navigate through life without leaving a trail of pissed off people behind you, odds are the problem is you, not them, not The Man, not the system.

 

[ruralsurg4now]

The fact that unethical or lousy program directors exist and abuse their power doesn't mean that "professionalism" can't or shouldn't be evaluated.

Thanks, but that's not actually what I said, was it?

If you can't seem to navigate through life without leaving a trail of pissed off people behind you, odds are the problem is you, not them, not The Man, not the system.

That's true, but I would point out that the vast majority of these people did navigate their way through life up until residency without leaving this "trail of pissed off people behind them." True?

 

[deleted480308]

That's true, too, but keep in mind that as a pre-med you don't know how things work in a hospital. I''m not trying to be condescending, I'm just pointing out the fact. It's not a professional environment in many ways. In fact, many people act in a very immature way in the hospital. It's basically like grown-up high school.

I don't take offense to your statement, the hospital environment likely does have some peculiar facets that aren't seen in other places. You made a fair point

 

[gutonc]

Are there any laws I can read concerning this issue and is this state by state or a national legislation.

Thank you for your input, I really appreciate it.

It's not legislation. It's the ACGME which, I think pretty much everyone in this thread is forgetting, doesn't apply to you since you're not a physician.

 

[ruralsurg4now]

I don't take offense to your statement, the hospital environment likely does have some peculiar facets that aren't seen in other places. You made a fair point

Thanks. Basically, if you read SDN you will realize that the medical field is this well-controlled cauldron of hostility. Medical students often are angry at their residents and attendings. Residents are often angry at their medical students and attendings. Attendings are often angry at their medical students and residents. Nurses are often angry at everyone. It's really quite remarkable.

 

[deleted480308]

Thanks. Basically, if you read SDN you will realize that the medical field is this well-controlled cauldron of hostility. Medical students often are angry at their residents and attendings. Residents are often angry at their medical students and attendings. Attendings are often angry at their medical students and residents. Nurses are often angry at everyone. It's really quite remarkable.

haha I'm looking forward to it,

My wife got mad at me (vicariously on behalf of my nurse motherinlaw) because I said I had no intentions of mopping up vomit in the ER because a custodian could do it and the nurse could clean the patient. (I've been a custodian, no shame in it, but a doctor is too expensive to the hospital to run a mop and give sponge baths)

I got someone mad at me about a hypothetical situation years from occurring that didn't even involve the person who was mad at me.....such is the ridiculousness of medicine

 

[ruralsurg4now]

I'd say something about that, but it would only derail the thread, start a huge flame war between me and nurses, and probably end up in having the thread locked.

 

[thefritz]

That's probably because you can actually quantify the one and not the other. In other words, anyone can teach someone else a fact. I mean, if I told you your job was on the line, I could get you to memorize and recite the entire ingredients list of a package of Oreos and Doritos. So what? But "professionalism" is a very cloudy and almost completely subjective "core competency." It's really a sham. We all know this, but we play along with it because some administrator told us to. We all know that a patient could belligerently complain about one person and we'd say "oh, that's a difficult patient" and the exact same patient could complain about another patient and we'd say "this physician is completely unprofessional." Similarly, there are lots of attendings who are unprofessional and, so long as it's not completely wildly out of control (and sometimes even then), everyone looks the other way. In fact, if you forced someone to actually tell you what was "unprofessional" about someone, chances are they'd be hard pressed to do it many times. It basically just means "I didn't like you."

Agree 100%. The term 'unprofessional' gets thrown around and is really a blanket term for anything that upsets an administrator but can't logically be defended, so it is rationalized internally to the administrator and externally to everyone else as 'unprofessional' thereby avoiding the ego-conflict that would result if the administrator were to take a close look at himself and try to understand why this person bothers him so much,

For example, suppose you have a resident that wears blue jeans to work. Not ratty Levi's, but very nice, expensive, tasteful dark denim pants with clean, polished, fashionable leather shoes and belt, a neatly pressed dress shirt with conservative tie and either a blazer or white coat and is clean shaven every day with a sharp haircut and is always on time, treats patients well, and is an excellent resident physician. Of course, "blue jeans" are basically allowed in no american hospitals. Senior faculty often get away with deviating from dress code, but if a resident were to dress like I just described, it would either be ignored the first day, talked about extensively behind his back (did you see so and so's blue jeans?) and eventually if he continued to dress like that, he would be confronted and asked to change his dress, and if he wore them again, he would be terminated. Now there is very little doubt that this person is sharply and professionally dressed if you use your brain and think about it for just a second. Unfortunately people are closed minded and think that all denim is the same and think that this is the same as this

People in America, for whatever reason, are completely unwilling to even consider that some jeans may be professional and that after all, it is just a finish of cotton and it is totally unreasonable to group them all together. Deep down this manifests as "I'm not allowed to wear jeans and I don't have the balls to challenge the rules and here this guy is pulling it off wonderfully, and that offends me that someone underneath me is doing something that I cannot do." These thoughts aren't recognized conciously, and instead the attending labels this resident as 'UNPROFESSIONAL." Simply because this guy broke an incredibly illogical and conservative fashion rule, no matter how good he does anything else, he will be known as the 'jean guy,' and will be universally disliked and his ability questioned.

I use this as an example because I have seen it happen. Whereas it is totally acceptable to show up to rounds wearing lime green pants, sperry top-siders, a pink bow tie, and your white coat (I have seen this). Or, for a woman to wear 4" heels and a revealing skirt (seen this), or black leather hooker boots that come up to their knees (seen this practically every day. I am shocked at how common this is). Just god knows, if you have even a hint of denim anywhere, you're lazy and incompetent and are probably drunk. Definitely 'unprofessional.'

 

[thefritz]

It's basically like grown-up high school.

Lets see, in high school people would stand around gossiping most of the day, lie and cheat when it came time to get work done, constantly try to hook up (and sneak out to the parking lot or bathroom if successful), count the minutes until they could leave and get high (or were very good at hiding their intoxication), were most worried about their physical appearance and how they were dressed, were not allowed to leave or even go to the bathroom without permission, spent most of the day on their cellphone texting, were subjected to the most asinine rules and regulations enforced by the most incompetent administrators imagineable, and were constantly bullied by the upper classmen, leading them to then turn around and bully the freshmen.

Nah man, it's totally different

 

[ruralsurg4now]

Agree 100%. The term 'unprofessional' gets thrown around and is really a blanket term for anything that upsets an administrator but can't logically be defended

"Unprofessional" is on the same level as "unacceptable." You'd be amazed at how many people use that word to describe almost everything. News flash: it's not "unacceptable" just because you don't personally like it and nobody actually cares that someone finds something "unacceptable." These terms have been completely bastardized into words that are vague, nebulous, and almost meaningless. If I wore scrubs outside of the hospital (e.g., walking to my car as I'm going home) as a resident, someone could tell me that I'm being "unprofessional." What does that even mean? It's literally meaningless to me. And of course now that I'm an attending, I can wear scrubs anywhere I want and for some reason that's perfectly professional for the sole reason that they couldn't break me of the habit at some point during residency.

Or, for a woman to wear 4" heels and a revealing skirt (seen this), or black leather hooker boots that come up to their knees (seen this practically every day. I am shocked at how common this is).

There was a female physician at my hospital who was OLD AS DIRT who wore black hooker boots all the time. It was a little hysterical. It would be equivalent to some old guy coming in wearing a glittery muscle shirt.

 

[IlDestriero]

In actuality, the subjectivity and vagueness of "professionalism" is what makes it so easy to abuse for disciplinary measures. It is not unheard of for nurses, for example, to decide to harrass a resident, either for real or fake reasons, and merely en mass start reporting everything they do as "unprofessional" or "rude." In those instances, it is actually the resident who is a victim and the staff that is being "unprofessional," yet they are doubly victimized by the system. You don't actually need any evidence of behavior, simply hearsay or opinion (e.g., I didn't like the tone of his voice when he spoke to me, she hung up on me too quickly, etc.). At that point, rather than deal with the staff, it's easier to "cut your losses" and just eliminate the resident. Staff at residency programs know that, as you could be an attending and be fairly rude to them and nothing will happen to you. They don't even make any real effort to take on the attendings in many instances, unless the behavior is extremely egregious.

What kind of ridiculous places did you guys train at?

 

[DrT2202]

Thanks, but that's not actually what I said, was it?



That's true, but I would point out that the vast majority of these people did navigate their way through life up until residency without leaving this "trail of pissed off people behind them." True?

Not only that; I have also finished a similar residency in a university setting in a big city leaving with great relationships with the PD, his assistants and almost all attendings. Did they like everything I did, No. But they taught me a lot and saw me improve and I will never forget each and every one of them.

 

[DrT2202]

Agree 100%. The term 'unprofessional' gets thrown around and is really a blanket term for anything that upsets an administrator but can't logically be defended, so it is rationalized internally to the administrator and externally to everyone else as 'unprofessional' thereby avoiding the ego-conflict that would result if the administrator were to take a close look at himself and try to understand why this person bothers him so much,

For example, suppose you have a resident that wears blue jeans to work. Not ratty Levi's, but very nice, expensive, tasteful dark denim pants with clean, polished, fashionable leather shoes and belt, a neatly pressed dress shirt with conservative tie and either a blazer or white coat and is clean shaven every day with a sharp haircut and is always on time, treats patients well, and is an excellent resident physician. Of course, "blue jeans" are basically allowed in no american hospitals. Senior faculty often get away with deviating from dress code, but if a resident were to dress like I just described, it would either be ignored the first day, talked about extensively behind his back (did you see so and so's blue jeans?) and eventually if he continued to dress like that, he would be confronted and asked to change his dress, and if he wore them again, he would be terminated. Now there is very little doubt that this person is sharply and professionally dressed if you use your brain and think about it for just a second. Unfortunately people are closed minded and think that all denim is the same and think that this is the same as this

People in America, for whatever reason, are completely unwilling to even consider that some jeans may be professional and that after all, it is just a finish of cotton and it is totally unreasonable to group them all together. Deep down this manifests as "I'm not allowed to wear jeans and I don't have the balls to challenge the rules and here this guy is pulling it off wonderfully, and that offends me that someone underneath me is doing something that I cannot do." These thoughts aren't recognized conciously, and instead the attending labels this resident as 'UNPROFESSIONAL." Simply because this guy broke an incredibly illogical and conservative fashion rule, no matter how good he does anything else, he will be known as the 'jean guy,' and will be universally disliked and his ability questioned.

I use this as an example because I have seen it happen. Whereas it is totally acceptable to show up to rounds wearing lime green pants, sperry top-siders, a pink bow tie, and your white coat (I have seen this). Or, for a woman to wear 4" heels and a revealing skirt (seen this), or black leather hooker boots that come up to their knees (seen this practically every day. I am shocked at how common this is). Just god knows, if you have even a hint of denim anywhere, you're lazy and incompetent and are probably drunk. Definitely 'unprofessional.'

Drawing on the subconscious issue. I should've laid low and not shown much pride in the procedures I've done at a previous residency. There are plenty of lessons to be learned from this and would've helped a lot if I was more liked and more humble.

 

[thefritz]

There was a female physician at my hospital who was OLD AS DIRT who wore black hooker boots all the time. It was a little hysterical. It would be equivalent to some old guy coming in wearing a glittery muscle shirt.

Same thing here. It's mostly 40 year old women attending wearing the hooker boots. Were they really popular 20 years ago or something and now these women are trying to relive their wild youth? Did they not see pretty woman or understand (1) how hideously ugly they are or (2) the image they convey? I know promiscuity is rampant among middle aged physcians, but why broadcast it like that at work?

"Unprofessional" is on the same level as "unacceptable." You'd be amazed at how many people use that word to describe almost everything. News flash: it's not "unacceptable" just because you don't personally like it and nobody actually cares that someone finds something "unacceptable." These terms have been completely bastardized into words that are vague, nebulous, and almost meaningless. If I wore scrubs outside of the hospital (e.g., walking to my car as I'm going home) as a resident, someone could tell me that I'm being "unprofessional." What does that even mean? It's literally meaningless to me. And of course now that I'm an attending, I can wear scrubs anywhere I want and for some reason that's perfectly professional for the sole reason that they couldn't break me of the habit at some point during residency.

As a medical student, the term "unprofessional" was used ad nausem by the administration.

Having your computers open during lecture was "unprofessional."
Arguing with faculty about grades was "unprofessional."
Not wearing a tie and white coat was "unprofessional."
Making a personal phone call during the day was "unprofessional."
Expressing disagreement with a policy decision was "unprofessional."
Asking for an exception to policy is "unprofessional."
Emailing faculty about a problem with a test is "unprofessional," and therefore grades were not displayed after taking the test in order to prevent "unprofessional" contacting of faculty.
Publically expressing dissatisfaction with the medical school is "unprofessional" (i.e., if you are unhappy or disagree with policy, you must keep it to yourself or else you are "unprofessional").
Being late for any reason is "unprofessional." (isn't late a negative term in and of itself?)
Submitting mandatory evaluations anonmyously is "unprofessional." (i.e., you must use your real name so as to prevent "unprofessional" feedback comments.)
Etc. Etc. Etc.

I have really come to dispise that word. It truly is a totally meaningless blanket term that is used for one single purpose: threatening noncompliance.

Look at the definition:
unprofessional [ˌʌnprəˈfɛʃənəl] adj
1. contrary to the accepted code of conduct of a profession
2. amateur
3. not belonging to or having the required qualifications for a profession
unprofessionally

First of all, where's our accepted code of conduct? Second of all, wouldn't this mean violating the accepted methods of actually conducting our profession (e.g., not wearing gloves, using non-standard surgical methods, operating outside your scope of training, incorrectly documenting procedures, mis-coding, deviating from your required uniform, etc.)? Instead the term is used for deviations in personal character and actions that occur not related to our line of work. For instance, a doctor seen smoking a cigarette at a restaurant on a Saturday can be considered "unprofessional." This has nothing to do with the accepted code of how that doctor is supposed to do his job. Instead it's being trasnferred to the image that he conveys as being a member of that profession.

 

[thefritz]

double posted

 

[shopsteward]

There was a female physician at my hospital who was OLD AS DIRT who wore black hooker boots all the time. It was a little hysterical. It would be equivalent to some old guy coming in wearing a glittery muscle shirt.

Same thing here. It's mostly 40 year old women attending wearing the hooker boots. Were they really popular 20 years ago or something and now these women are trying to relive their wild youth? Did they not see pretty woman or understand (1) how hideously ugly they are or (2) the image they convey? I know promiscuity is rampant among middle aged physcians, but why broadcast it like that at work?

Please note that describing a female attending as "OLD AS DIRT", equating the age of 40 to "OLD AS DIRT" and describing a work colleague as "broadcasting promiscuity" because of the boots she wears is unprofessional.

 

[thefritz]

Please note that describing a female attending as "OLD AS DIRT", equating the age of 40 to "OLD AS DIRT" and describing a work colleague as "broadcasting promiscuity" because of the boots she wears is unprofessional.

So it is unprofessional to call someone unprofessional. Got it. Love our system.

Thanks, this made me laugh.

 

[ruralsurg4now]

Same thing here. It's mostly 40 year old women attending wearing the hooker boots. Were they really popular 20 years ago or something and now these women are trying to relive their wild youth? Did they not see pretty woman or understand (1) how hideously ugly they are or (2) the image they convey? I know promiscuity is rampant among middle aged physcians, but why broadcast it like that at work?

I presume they want to call attention to themselves, only they think that people are looking at them because they're "hot" or "look good in these boots," when the reality is people are looking at them and going "what?"

Please note that describing a female attending as "OLD AS DIRT", equating the age of 40 to "OLD AS DIRT" and describing a work colleague as "broadcasting promiscuity" because of the boots she wears is unprofessional.

You'd better let someone know that cares.