Watching an attending implode

[cranberrysnail]

We have a new (to us) attending who was hired into a senior position. The attending has a good pedigree and a great resume. Most of us already like her and she's enacting useful changes. If she does 1/3 of what she wants to do, we will all benefit.

The issue is she's...kind of a mess. She's obviously stressed, which makes her unpredictable and snappish. For someone who is supposed to be improving communication, that's not good. You can tell she's overextended, which manifests as being late or not helping us prepare. More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful. Someone needs to pull her aside and tell her to get some therapy and not use her junior residents to complain about her personal life. That person isn't me. I don't want to go to HR or our PD. I don't want her fired. I had enough of a corporate career prior to medicine that I know this is not okay for work.

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Do I say anything? Do I wait for it to rise to the level of an HR violation? Do I just roll my eyes?

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[gutonc]

I would go to your PD, or chair, or someone else in a position of authority to discuss your concerns. Maybe it's just you (unlikely) or maybe you're the 4th or 50th person to bring this up.

 

[Piebaldi]

We have a new (to us) attending who was hired into a senior position. The attending has a good pedigree and a great resume. Most of us already like her and she's enacting useful changes. If she does 1/3 of what she wants to do, we will all benefit.

The issue is she's...kind of a mess. She's obviously stressed, which makes her unpredictable and snappish. For someone who is supposed to be improving communication, that's not good. You can tell she's overextended, which manifests as being late or not helping us prepare. More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful. Someone needs to pull her aside and tell her to get some therapy and not use her junior residents to complain about her personal life. That person isn't me. I don't want to go to HR or our PD. I don't want her fired. I had enough of a corporate career prior to medicine that I know this is not okay for work.

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Do I say anything? Do I wait for it to rise to the level of an HR violation? Do I just roll my eyes?

Well a number of things here. First, we are ALL human beings and as such we ALL have personal problems. Some people deal with problems better than others. I have had my share of personal problems shortly after becoming an attending and luckily I was in private practice so less interaction with others. Certainly it's difficult if you have to interact with residents all the time - while I agree that oversharing is probably not the best idea, it's not uncommon. Attendings snap at times. Again we are all human. If you feel there is clearly an issue with her potentially endangering herself or anyone else perhaps that's reportable. But an attending, unless they are doing something extraordinarily egregious won't get fired - but you might. Unfair or not, that's typically how it is and I would be cautious about certainly going to HR. Is what's going on truly egregious, reportable, and dangerous to the residents or her? If so perhaps it's reportable. But essentially all attendings have their issues, and being quirky, or an oversharer, or saying things that you might deem inappropriate are unlikely to get her fired. If you truly have a concern for her safety then yes go to your higher up. But otherwise I'd be cautious.

 

[rokshana]

We have a new (to us) attending who was hired into a senior position. The attending has a good pedigree and a great resume. Most of us already like her and she's enacting useful changes. If she does 1/3 of what she wants to do, we will all benefit.

The issue is she's...kind of a mess. She's obviously stressed, which makes her unpredictable and snappish. For someone who is supposed to be improving communication, that's not good. You can tell she's overextended, which manifests as being late or not helping us prepare. More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful. Someone needs to pull her aside and tell her to get some therapy and not use her junior residents to complain about her personal life. That person isn't me. I don't want to go to HR or our PD. I don't want her fired. I had enough of a corporate career prior to medicine that I know this is not okay for work.

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Do I say anything? Do I wait for it to rise to the level of an HR violation? Do I just roll my eyes?

Talk to your chief if you don’t want to go to your PD

 

[cranberrysnail]

I would go to your PD, or chair, or someone else in a position of authority to discuss your concerns. Maybe it's just you (unlikely) or maybe you're the 4th or 50th person to bring this up.

I'm not the only person. A few of us went out tonight and the consensus was to stay away before she imploded and took anyone nearby with her. Not a good look.

 

[Mass Effect]

I don't understand a few things. You said she doesn't help you prepare. Prepare for what? Also, she's had issues, but where and how did suicide become part of the conversation? Are you basing this just on the other attending who committed suicide?

The bottom line is, is she abusive toward residents (and by abusive, I don't mean did she snap at someone one day, but more actually abusive)? Is she sexually or verbally harassing someone? Has she said or done anything that makes you think she might harm herself or harm others? If the answer to those questions is no, then I would stay out of it.

Anyone who's read my posts here knows that I am first and foremost a resident advocate and believe any and all abuse in medicine should be reported. As a psychiatrist, a former resident, former fellow, and now attending, I'm also a huge advocate for suicide intervention. But I also know that when a group of residents (or group of people in general, but especially residents/med students as they're toward the bottom of whatever "hierarchy" exists in training), they goad each other on and sometimes (read: not always), exaggerate or feed off each other's outrage and relatively minor things are blown up to be much more serious than they actually are through a more objective prism and before you know it, someone's reputation is on the line.

So again, I ask, is she abusive/harassing people? Is she at risk of harming herself or others?

 

[AMEHigh]

If several of you have the same concerns then I would talk to your chief about it and then they should talk to the appropriate person. That’s what the chief is there for.

Of course we all have personal lives but if it’s a reoccurring theme that this person is letting their personal life overshadow work duties then I think it’s absolutely appropriate to bring it to someone’s attention.

 

[EyeGuy15]

She is incompetent. A very important trait in successful people is knowing your own limits. Her pedigree means nothing. This is medicine. No one cares where you went to medical school or trained once you become an attending. How are you as an attending with real responsibilities is what matters. No one cares if you published 28 papers at "prestigious academic program". Can you take on real responsibility, handle complex cases, effectively educate fellows/residents/students, work well with your colleagues? That is all that matters. Anyone can have tons of ideas and goals, but can you effectively prioritize and implement the most important ones? She is incompetent for simply not being able to understand the importance of understanding her own own limitations.

If you are noticing this, chances are everyone else is noticing this. She either doesn't understand her own limitations or she is trying to prove something by taking on so much responsibility. Either way she is failing miserable as an attending physician. She probably was a mess as a resident/fellow too, but was pushed along and graduated because that's just what happens these days. She will get bad evaluations from residents and the department will address her incompetence. It is very difficult to fire an attending physician, but the department heads will either address her issues with her and she will get her act together or they will make it very clear she is not wanted around and she will leave and blame everyone else for her own failure.

 

[cranberrysnail]

I don't understand a few things. You said she doesn't help you prepare. Prepare for what?

We're in a surgical specialty. We need to discuss patients and plans beforehand. She decided not to, leading to confusion on my part. The case after, she didn't show up until we had already rolled in. I am not the only resident this has happened to.

What you are saying about actual danger makes sense. I don't want to put my face where it doesn't belong and I absolutely don't want to ruin her rep. She's fantastic. I do respect her so much. The women residents all have the impression this is a ticking time bomb. The men? I don't know. I guess I'll have to wait until this either blows up or blows over. The suicide thing is based on pattern-matching, not actual threats.

 

[AdmiralChz]

I guess I'll have to wait until this either blows up or blows over.

What? Literally every reply has been to tell someone in a position of leadership about it. If you’re in a surgical sub, don’t bother with a chief - I’d go to a faculty member. It sounds like this is affecting patient care and you owe it to this attending you respect and your patients to bring it to someone’s attention.

 

[Frazier]

Not helping you prepare, in the sense you described, sounds like a patient safety risk.

 

[Dr.LeoSpaceman]

The case after, she didn't show up until we had already rolled in. I am not the only resident this has happened to.

This is not out of the realm of normal. At least in my experience. It's not uncommon for my attendings to come in while I'm prepping (or after I've draped).

I'll be honest, if you're going to go to a faculty member, you should have concrete examples. Not nebulous "things seem like a problem".

 

[Piebaldi]

This is not out of the realm of normal. At least in my experience. It's not uncommon for my attendings to come in while I'm prepping (or after I've draped).

I'll be honest, if you're going to go to a faculty member, you should have concrete examples. Not nebulous "things seem like a problem".

I would agree. even during my current fellowship, the attending comes in when everything is pretty much set up - the patient is on the table, essentially prepped and ready to go essentially.

 

[mvenus929]

We're in a surgical specialty. We need to discuss patients and plans beforehand. She decided not to, leading to confusion on my part. The case after, she didn't show up until we had already rolled in. I am not the only resident this has happened to.

What you are saying about actual danger makes sense. I don't want to put my face where it doesn't belong and I absolutely don't want to ruin her rep. She's fantastic. I do respect her so much. The women residents all have the impression this is a ticking time bomb. The men? I don't know. I guess I'll have to wait until this either blows up or blows over. The suicide thing is based on pattern-matching, not actual threats.

Is there someone in your residency program that you can informally go to to address concerns? For us, it was our program coordinator... she had been there forever and was amazing, so slyly sending her something when we thought it was worrisome would run it up the chain while keeping us anonymous.

 

[Mass Effect]

This is not out of the realm of normal. At least in my experience. It's not uncommon for my attendings to come in while I'm prepping (or after I've draped).

I'll be honest, if you're going to go to a faculty member, you should have concrete examples. Not nebulous "things seem like a problem".

This. Being concerned that she's going to get herself in trouble with HR is not a reason to report her. It's not your job to be her protector/rescuer. Unless she is harming patients, residents, students, or herself, what would you report her for -- being afraid she's going to get herself into trouble? I'm in favor of reporting people for abuse, patient care issues, bullying, or harassment (sexual or otherwise).

 

[Ironheme]

She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

This is the problem. If OP has a high tolerance, then can you imagine how it's making less tolerant people feel? Making sexist remarks causing people to feel uncomfortable IS harassment. It sounds like she's on her way to shooting herself in the foot for her own career. I'd steer clear.

You can also help her with @mvenus929's suggestion of the program coordinator (or PD) if they are trustworthy.

Sorry you're going through this. Your goal is to graduate. Keep it professional, head down, minimize interactions with her. She's in a higher position than you and can always ruin you, or at the very least make the last few years til graduation, miserable.

 

[Piebaldi]

This is the problem. If OP has a high tolerance, then can you imagine how it's making less tolerant people feel? Making sexist remarks causing people to feel uncomfortable IS harassment. It sounds like she's on her way to shooting herself in the foot for her own career. I'd steer clear.

You can also help her with @mvenus929's suggestion of the program coordinator (or PD) if they are trustworthy.

Sorry you're going through this. Your goal is to graduate. Keep it professional, head down, minimize interactions with her. She's in a higher position than you and can always ruin you, or at the very least make the last few years til graduation, miserable.

TONS of attendings make completely inappropriate comments, curse up a storm, and make sexist, comments, etc. Do i think it's right? nope. But no one will care. One of our attendings in residency who eventually got canned would tell us whether anyone wanted his job, etc.

 

[Mass Effect]

This is the problem. If OP has a high tolerance, then can you imagine how it's making less tolerant people feel? Making sexist remarks causing people to feel uncomfortable IS harassment. It sounds like she's on her way to shooting herself in the foot for her own career. I'd steer clear.

You can also help her with @mvenus929's suggestion of the program coordinator (or PD) if they are trustworthy.

Sorry you're going through this. Your goal is to graduate. Keep it professional, head down, minimize interactions with her. She's in a higher position than you and can always ruin you, or at the very least make the last few years til graduation, miserable.

The troubling part for me is that the OP is all over the place. I get wanting to stay anonymous, but then we, as responders, need to consider that we don't have the story. What we have is someone saying:

More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

Then,

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful.

And,

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Followed by,

I don't want to put my face where it doesn't belong and I absolutely don't want to ruin her rep. She's fantastic. I do respect her so much.

So is the OP feeling this is a hostile or harassing work environment and THOSE are the reasons to report or is the OP trying to save an attending from herself? Those are two very different things with two very different motivations and warrant two very different types of advice.

Now, one part I did want to comment on is this:

The women residents all have the impression this is a ticking time bomb.

I want to say, first, that as I said earlier in this thread, people (especially women) tend to goad each other on sometimes when venting and I'm curious if that's what's going on here. If not, then this is concerning, but we still don't know the extent to which it's the OP's business. Ticking time bomb as in what? Danger to self or others? Or ticking time bomb in terms of getting herself in trouble with HR? The ticking time bomb bit is very melodramatic and makes me wonder exactly what's going on that anyone would say that. You really have to weigh these things out because going to the wrong person about a "ticking time bomb" can have lifelong career ramifications for the attending in question and could potentially lead to questions about her competence or mental health (see the PHP threads on this forum for more on this). All I'm saying is don't damage a person's career unless you're comfortable with why you're doing it.[/quote][/quote]

 

[Piebaldi]

The troubling part for me is that the OP is all over the place. I get wanting to stay anonymous, but then we, as responders, need to consider that we don't have the story. What we have is someone saying:



Then,



And,



Followed by,



So is the OP feeling this is a hostile or harassing work environment and THOSE are the reasons to report or is the OP trying to save an attending from herself? Those are two very different things with two very different motivations and warrant two very different types of advice.

Now, one part I did want to comment on is this:



I want to say, first, that as I said earlier in this thread, people (especially women) tend to goad each other on sometimes when venting and I'm curious if that's what's going on here. If not, then this is concerning, but we still don't know the extent to which it's the OP's business. Ticking time bomb as in what? Danger to self or others? Or ticking time bomb in terms of getting herself in trouble with HR? The ticking time bomb bit is very melodramatic and makes me wonder exactly what's going on that anyone would say that. You really have to weigh these things out because going to the wrong person about a "ticking time bomb" can have lifelong career ramifications for the attending in question and could potentially lead to questions about her competence or mental health (see the PHP threads on this forum for more on this). All I'm saying is don't damage a person's career unless you're comfortable with why you're doing it.

[/quote]
[/QUOTE]

Agreed. Also in Medicine in particular people tend to use vague random things as motivations when they don't like someone to make statements/claim that can lead to headaches and a great deal of nastiness and career ramifications. Ie - residents who are shy are "uninvolved", residents who are too go getter are "aggressive", sometimes mistakes are described as "oh this resident is a danger to patient safety" etc.

So I agree with you that OP is not clear about what the problem is.

Is the attending in question talking about committing suicide, ending her life, etc? Definitely report!

Is the attending at times moody or goes on rants? Well a lot of attendings and people do. Not a big deal.

Is attending not complying with academic requirements (not in surgery so no idea what requirements are in this case of attendings helping residents prep)- so if attending is not doing what she's supposed to do then definitely talk to PD, etc.

I agree with the ticking time bomb comment is very nebulous - is it that the attending, again, is a safety issue to herself? Or is she fiesty at times? Is this just a view that because she's female and sometimes goes on rants, and what not, that perhaps it's perceived differently? I know many attendings, male and female, that go on rants, that curse, that are completely inappropriate.

As a woman I also sadly agree regarding the comment of women going at each other. Not that uncommon so it's again unclear what the "female residents" are concerend about when you say this person is a ticking time bomb.

When making a complaint, you have to make sure it's specific - ie - attending is not showing up to OR cases on time or whatever is required in this case, or attending is talking about ending her life, or attending is sexually harassing residents, etc. Don't forget that making false or baseless claims that damage a person's reputation can not only lead to OP's career ending/getting in trouble, but certainly legal ramifications.

Being a jerk occasionally or a spazz or having personal problems (again we all have personal problems) - are not things that are "reportable" - have to maek sure that there are actual, problematic concerns present that can affect the person's individual safety, the residents and patients' safety, or is interfering with academic duties. Outside of that, you are in for a tough time OP if you happen to make claims that are inaccurate.

And if this person is an attending, well that won't bode well for you. AGain Medicine can be petty. I remember when I was a resident as a shy person I was told to "fake it" in terms of personality. I was like what BS. No different than a person of color being told to be more mainstream or something like that.

 

[YouMDbro101]

We have a new (to us) attending who was hired into a senior position. The attending has a good pedigree and a great resume. Most of us already like her and she's enacting useful changes. If she does 1/3 of what she wants to do, we will all benefit.

The issue is she's...kind of a mess. She's obviously stressed, which makes her unpredictable and snappish. For someone who is supposed to be improving communication, that's not good. You can tell she's overextended, which manifests as being late or not helping us prepare. More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful. Someone needs to pull her aside and tell her to get some therapy and not use her junior residents to complain about her personal life. That person isn't me. I don't want to go to HR or our PD. I don't want her fired. I had enough of a corporate career prior to medicine that I know this is not okay for work.

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Do I say anything? Do I wait for it to rise to the level of an HR violation? Do I just roll my eyes?

Respect to you and your post, but this is what's wrong with communication in residency programs. I'm an intern and I've already been on the receiving end of vague feedback, gossip and hearsay. For everything that's drilled into us about effective communications, the hospital environment is often passive-aggressive, corporate and dehumanizing. People can either take one incident and blow it out of proportion or patently refuse to acknowledge major characters flaws and mistakes in individuals. There doesn't seem to be a middle ground.

Just reading your post, I genuinely have no clue what the actual problem is. I've met attendings that have been described as "snappish" that turned out to be rather stable and those that have been described as "kind and fun-loving" who were godawful, it's honestly subjective. At this point in my very short residency career, I'm already learning to distrust if not altogether dismiss rumors until I meet someone face to face. It's effing high school all over again.

I really don't know what "blindingly inappropriate" even means - it may just be that you need to reevaluate your threshold for what is and what isn't appropriate. Just approach her and ask if there's anything she'd like to talk about. I've had attendings who have had personal problems and I've offered to stay late to help them write notes and complete tasks, it helps and they will appreciate it, maybe even open up to you.

 

[Piebaldi]

Respect to you and your post, but this is what's wrong with communication in residency programs. I'm an intern and I've already been on the receiving end of vague feedback, gossip and hearsay. For everything that's drilled into us about effective communications, the hospital environment is often passive-aggressive, corporate and dehumanizing. People can either take one incident and blow it out of proportion or patently refuse to acknowledge major characters flaws and mistakes in individuals. There doesn't seem to be a middle ground.

Just reading your post, I genuinely have no clue what the actual problem is. I've met attendings that have been described as "snappish" that turned out to be rather stable and those that have been described as "kind and fun-loving" who were godawful, it's honestly subjective. At this point in my very short residency career, I'm already learning to distrust if not altogether dismiss rumors until I meet someone face to face. It's effing high school all over again.

I really don't know what "blindingly inappropriate" even means - it may just be that you need to reevaluate your threshold for what is and what isn't appropriate. Just approach her and ask if there's anything she'd like to talk about. I've had attendings who have had personal problems and I've offered to stay late to help them write notes and complete tasks, it helps and they will appreciate it, maybe even open up to you.

I would say you are correct that medicine is frequently high school all together, and vague, passive aggressive non sense if frequently used in a hierarchical way to get rid of those people those higher up on the ladder don't like. it's quite sad and totally agree, given how much it's entrenched on the whole let's make sure we communicate well. but i'd agree - many times vague feedback, and negative statements without actual basis are quite destructive.

I think OP needs to think about what truly is the issue and if there is an imminent problem address it.

 

[rokshana]

Just approach her and ask if there's anything she'd like to talk about.

No...just no

 

[keolu hills]

No...just no

I agree. In fact, from what I understand, the attending maybe opening up too much about her personal life during inappropriate times.

 

[WinslowPringle]

We're in a surgical specialty. We need to discuss patients and plans beforehand. She decided not to, leading to confusion on my part. The case after, she didn't show up until we had already rolled in. I am not the only resident this has happened to.

I'm interested by this....how does this work? Did she actively refuse to have a discussion with you about a patient? Does she have a different rounding pattern than other attendings or different expectations for communication?

It hasn't been routine for attendings to look for me (surgery resident) to say 'Here's the plan and details.' If outpt, I review the chart, available images, pre-op them, and prep. Specific questions about technique are discussed either if I initiate a verbal dry run as we're gowning ("We're starting with a chevron and you prefer the Thompson, then we'll...") or during the case ("Do you prefer the cruciate or linear incision here?"), but overall I had better know 'standard' surgical technique and several options for how to do it. If it's inpatient, I had better already know the patient and the plan.... In my neck of the woods, agree with FaytIND, pretty standard for attending to come in after prep/drape. But institutions have different protocols...Does she just have a different way of doing things if she's from a different institution recently?

 

[Mass Effect]

No...just no

Agree 100%. While I do agree with much of what @YouMDbro101 says regarding vague feedback and subjective criticisms in medicine, I also think it's important that there be boundaries, especially between teacher and trainee. Think of the attending as a professor in college or teacher when you were in high school. It's important that those lines be there and that you don't cross them by trying to be their "friend." You're not peers and you shouldn't pretend to be. They also should not be sharing personal things with you.

 

[YouMDbro101]

No...just no

On second thought.

No...just no

@cranberrysnail , this answer is precisely an example of what I'm talking about - vague, passive-aggressive and unhelpful. Many of those responding this way did residency in the 19th century, probably before xrays were even a thing . I also agree with @Mass Effect about boundaries, but these vary from person to person. There are some attendings that make the teacher-pupil relationship quite clear, and there are those attendings who send you football memes when your favorite team loses on Sundays. People are different. If your attending is sharing so much, it can be that she just wants someone to talk to. We're a younger generation: we're less formal and do things differently - and that's totally ok.

 

[rokshana]

On second thought.


@cranberrysnail , this answer is precisely an example of what I'm talking about - vague, passive-aggressive and unhelpful. Many of those responding this way did residency in the 19th century, probably before xrays were even a thing . I also agree with @Mass Effect about boundaries, but these vary from person to person. There are some attendings that make the teacher-pupil relationship quite clear, and there are those attendings who send you football memes when your favorite team loses on Sundays. People are different. If your attending is sharing so much, it can be that she just wants someone to talk to. We're a younger generation: we're less formal and do things differently - and that's totally ok.

How is “no” vague...it’s quite emphatic...do NOT do this...short, sweet, decisive.

You may be a younger generation...your attending is not.

The surest way to get in trouble on residency is the advice “you do you”...

And residency isn’t just some job...you lose it and you potentially kiss your career good bye...

It is great that the OP is concerned about the new attending, but risking his/her residency is not worth it.

The next thread could easily be... I was placed on probation for being unprofessional... plenty of threads scattered about that sound just like this ...

Though impressive that your imposter syndrome has given way to being an expert on how to deal with attending issues all in 2 short months!

 

[Mass Effect]

On second thought.


@cranberrysnail , this answer is precisely an example of what I'm talking about - vague, passive-aggressive and unhelpful. Many of those responding this way did residency in the 19th century, probably before xrays were even a thing . I also agree with @Mass Effect about boundaries, but these vary from person to person. There are some attendings that make the teacher-pupil relationship quite clear, and there are those attendings who send you football memes when your favorite team loses on Sundays. People are different. If your attending is sharing so much, it can be that she just wants someone to talk to. We're a younger generation: we're less formal and do things differently - and that's totally ok.

First, I'm a new attending, so more your generation than 19th Century. Second, you're an intern. If you don't soon realize that professional boundaries don't vary person to person, you're going to be in for a hell of a bumpy ride. This is a teacher-student/boss-employee relationship. There's very little gray where HR is concerned. Residents have gotten in trouble for chumming up to attendings and attendings have gotten in trouble for the same, though I predict to a lesser degree. This isn't Gray's Anatomy. When a trainee gets close to the person evaluating their performance and having a say in whether or not they're promoted to the next year, it gets noticed and not in a good way. Texts about a football game? No prob. Approaching an attending to ask about their personal life the way you would a BFF? That's a problem.

 

[Fatalis]

We have a new (to us) attending who was hired into a senior position. The attending has a good pedigree and a great resume. Most of us already like her and she's enacting useful changes. If she does 1/3 of what she wants to do, we will all benefit.

The issue is she's...kind of a mess. She's obviously stressed, which makes her unpredictable and snappish. For someone who is supposed to be improving communication, that's not good. You can tell she's overextended, which manifests as being late or not helping us prepare. More concerning is that she recently had a personal crisis that is overshadowing her accomplishments. She overshares. She makes comments about being miserable. She went on a man-hating tirade in the middle of a presentation. She has said some things that are blindingly inappropriate. It is making me uncomfortable and I have a high tolerance for social horror shows.

I worry that she'll burn out. I'm more worried that her inappropriateness is both making us lose respect for her and putting her in a precarious position HR-wise. If she says this stuff to the wrong people, it could make her life godawful. Someone needs to pull her aside and tell her to get some therapy and not use her junior residents to complain about her personal life. That person isn't me. I don't want to go to HR or our PD. I don't want her fired. I had enough of a corporate career prior to medicine that I know this is not okay for work.

The department had a suicide a few years ago. It was another up-and-coming attending with nebulous personal problems. She hid what was happening and no one knew the extent until she killed herself. I don't know if my attending is in that danger but ****, I could see it happening.

Do I say anything? Do I wait for it to rise to the level of an HR violation? Do I just roll my eyes?

roll eyes, avoid and move on. she obviously has crap that is going on. perhaps if a lot of people notice it, then can take it a step further

 

[YouMDbro101]

How is “no” vague...it’s quite emphatic...do NOT do this...short, sweet, decisive.

You may be a younger generation...your attending is not.

The surest way to get in trouble on residency is the advice “you do you”...

And residency isn’t just some job...you lose it and you potentially kiss your career good bye...

It is great that the OP is concerned about the new attending, but risking his/her residency is not worth it.

The next thread could easily be... I was placed on probation for being unprofessional... plenty of threads scattered about that sound just like this ...

Though impressive that your imposter syndrome has given way to being an expert on how to deal with attending issues all in 2 short months!

@cranberrysnail, this is what I'm talking about: passive-aggressive and dehumanizing. These are the kind of people we sometimes have to deal with. Everyone is different. The idea that asking someone how they are doing and offering help is "unprofessional" is bonkers, but it's something we can expect from generations of administrative abuse, neglect and mismanagement. It takes residents, not attendings, to make these changes. Part of the reason work-hour maximums and wellness requirements became a thing is because residents raised awareness and programs realized that there are legal/moral reprecautions for certain workplace behaviors.

This has less to do with medicine and more to do with interpersonal skills and creating a good working environment - you don't have to be a doctor, let alone an attending to recognize that.

 

[VA Hopeful Dr]

This has less to do with medicine and more to do with interpersonal skills and creating a good working environment - you don't have to be a doctor, let alone an attending to recognize that.

Yes you're exactly right. You don't go prying into the personal life of a superior in the workplace.

If you're concerned about the working environment, you take the established pathways for dealing with that.

 

[Merely]

No...just no

LOL

 

[Mass Effect]

@cranberrysnail, this is what I'm talking about: passive-aggressive and dehumanizing. These are the kind of people we sometimes have to deal with. Everyone is different. The idea that asking someone how they are doing and offering help is "unprofessional" is bonkers, but it's something we can expect from generations of administrative abuse, neglect and mismanagement. It takes residents, not attendings, to make these changes.

I predict you're going to have a very rough few years with this mindset in the third month of intern year.

Part of the reason work-hour maximums and wellness requirements became a thing is because residents raised awareness and programs realized that there are legal/moral reprecautions for certain workplace behaviors

Um, no. If you're going to lecture the rest of us, the least you can do is learn the history. It had nothing to do with residents raising awareness. Residents didn't even raise awareness. If anything, residents protested against humane work hours. It was the public, egged on by an outraged media, in a fight led by a prominent NYC journalist-turned-attorney whose daughter's death was blamed on fatigued residents that changed work hours.

This has less to do with medicine and more to do with interpersonal skills and creating a good working environment - you don't have to be a doctor, let alone an attending to recognize that.

In ANY work environment, you maintain boundaries with your boss. You don't go around prying into other people's business.

 

[rokshana]

@cranberrysnail, this is what I'm talking about: passive-aggressive and dehumanizing. These are the kind of people we sometimes have to deal with. Everyone is different. The idea that asking someone how they are doing and offering help is "unprofessional" is bonkers, but it's something we can expect from generations of administrative abuse, neglect and mismanagement. It takes residents, not attendings, to make these changes. Part of the reason work-hour maximums and wellness requirements became a thing is because residents raised awareness and programs realized that there are legal/moral reprecautions for certain workplace behaviors.

This has less to do with medicine and more to do with interpersonal skills and creating a good working environment - you don't have to be a doctor, let alone an attending to recognize that.

Dunning -Kruger at its best!

 

[rokshana]

@cranberrysnail, this is what I'm talking about: passive-aggressive and dehumanizing. These are the kind of people we sometimes have to deal with. Everyone is different. The idea that asking someone how they are doing and offering help is "unprofessional" is bonkers, but it's something we can expect from generations of administrative abuse, neglect and mismanagement. It takes residents, not attendings, to make these changes. Part of the reason work-hour maximums and wellness requirements became a thing is because residents raised awareness and programs realized that there are legal/moral reprecautions for certain workplace behaviors.

This has less to do with medicine and more to do with interpersonal skills and creating a good working environment - you don't have to be a doctor, let alone an attending to recognize that.

You need to stop watching The Resident and Grays Anatomy...real life doesn’t work that way.

 

[nimbus]

Um, no. If you're going to lecture the rest of us, the least you can do is learn the history. It had nothing to do with residents raising awareness. Residents didn't even raise awareness. If anything, residents protested against humane work hours. It was the public, egged on by an outraged media, in a fight led by a prominent NYC journalist-turned-attorney whose daughter's death was blamed on fatigued residents that changed work

For those who are interested.

Libby Zion Law - Wikipedia

en.m.wikipedia.org

 

[Bacchus]

Go to your chief. Let your chief go to the PD. Don't just sit back if you feel this is going to devolve into a **** storm. If not for you, at least for her. Medicine can be a ****ty world and you should try to help her out (indirectly).

 

[cranberrysnail]

So is the OP feeling this is a hostile or harassing work environment and THOSE are the reasons to report or is the OP trying to save an attending from herself? Those are two very different things with two very different motivations and warrant two very different types of advice.

The latter. Attendings being wildly inappropriate and violating bounds has been the story of my career. I don't invite it. I try to show up and do my job. Her divulging the type of man she likes to sleep with and trashing her ex-husband are sort of par for the course on my end. It's still inappropriate.

Ticking time bomb as in what? Danger to self or others? Or ticking time bomb in terms of getting herself in trouble with HR? The ticking time bomb bit is very melodramatic and makes me wonder exactly what's going on that anyone would say that.

Our program has an interesting mix of women in it, several moms, multiple people from out of the country, ages from around 28 to over 40. Some high drama, most pretty low drama. Every one of us recognizes the signs of someone who is letting her personal life bleed into her professional life and someone who is under tremendous amounts of stress. We worry she'll go from being friendly and oversharing to realizing what she's done. At that point, she might try to regain the higher professional ground by lashing out and making our lives difficult. Or maybe she'll burn out so completely she leaves. Or starts drinking again - did I mention she told me all about that, too? Ugh. The guys also see it but I think they have a higher tolerance for people being crazy?

You really have to weigh these things out because going to the wrong person about a "ticking time bomb" can have lifelong career ramifications for the attending in question and could potentially lead to questions about her competence or mental health (see the PHP threads on this forum for more on this). All I'm saying is don't damage a person's career unless you're comfortable with why you're doing it.

That's why I'm being cautious and vague. She's on scheduled vacation for the next week or two. Maybe when she comes back she'll be better. If I end up hearing more about her sex life, I may have to determine who can professionally and subtly tell her to get her **** together.

 

[hallowmann]

The latter. Attendings being wildly inappropriate and violating bounds has been the story of my career. I don't invite it. I try to show up and do my job. Her divulging the type of man she likes to sleep with and trashing her ex-husband are sort of par for the course on my end. It's still inappropriate...

The bolded is concerning, because I don't know what situation results in people constantly just telling me stuff. Usually if people don't find others interested or aren't validated in some way, they just stop bringing stuff up, so I almost wonder if you are (possibly inadvertently or just to be nice) playing along when people talk about these things. Have you tried just not responding to a comment, or saying "that sucks. So this patient..."? And I don't just mean sometimes, I mean every time. That's kind of the only way to gently make it clear that hearing that stuff doesn't do much for you.

Inappropriate and inconsistent with the culture of the program/department are also 2 very different things. I hear crap like you describe all the time when I'm up on OB or in the surgical floors. I don't hear it when I'm on medicine, in clinic, or on psychiatry. Personally, it makes me uncomfortable, and I respond to it exactly like I described. People rarely keep going unless others in the room are playing along. The result is that when its mainly me and those residents/attendings, they tend not to bring stuff up.

It may be in your best interest to just ignore it. Alternatively, if you genuinely think the attending is risking their career/patient safety, sure you can talk to your chief. That said, be aware that your program's culture may be such that stuff you tell your chief goes into the same gossip factory as things your attending tells you. Safest thing is to leave it alone.

 

[Merely]

The latter. Attendings being wildly inappropriate and violating bounds has been the story of my career. I don't invite it. I try to show up and do my job. Her divulging the type of man she likes to sleep with and trashing her ex-husband are sort of par for the course on my end. It's still inappropriate.



Our program has an interesting mix of women in it, several moms, multiple people from out of the country, ages from around 28 to over 40. Some high drama, most pretty low drama. Every one of us recognizes the signs of someone who is letting her personal life bleed into her professional life and someone who is under tremendous amounts of stress. We worry she'll go from being friendly and oversharing to realizing what she's done. At that point, she might try to regain the higher professional ground by lashing out and making our lives difficult. Or maybe she'll burn out so completely she leaves. Or starts drinking again - did I mention she told me all about that, too? Ugh. The guys also see it but I think they have a higher tolerance for people being crazy?



That's why I'm being cautious and vague. She's on scheduled vacation for the next week or two. Maybe when she comes back she'll be better. If I end up hearing more about her sex life, I may have to determine who can professionally and subtly tell her to get her **** together.

If she’s telling you the kind of man she wants to sleep with..become that man and **** her..why is this so complicated..she’s practically telling you too

 

[j4pac]

Two things:
1) nobody cares if this physician burns out and kills herself other than her family (who may not currently be close enough with her to see the problem) and her medical colleagues.
2) We medical professionals are experts at coping and suppressing stress/emotion. We’ve in a culture that the patient comes first and suffering is a known expectation. For all of those reasons, medical professionals tend to have absolutely horrible insight into their own mental health.

I’d talk to your chief and I’d EXPECT your chief to discuss it with your PD. If your chief is unwilling, do it yourself. There is more at stake than your medical education here.

 

[Dave1980]

Attendings being wildly inappropriate and violating bounds has been the story of my career. I don't invite it. I try to show up and do my job. Her divulging the type of man she likes to sleep with and trashing her ex-husband are sort of par for the course on my end. It's still inappropriate.

Sorry OP but it sounds like you are part of the problem...

 

[Mass Effect]

Two things:
1) nobody cares if this physician burns out and kills herself other than her family (who may not currently be close enough with her to see the problem) and her medical colleagues.
2) We medical professionals are experts at coping and suppressing stress/emotion. We’ve in a culture that the patient comes first and suffering is a known expectation. For all of those reasons, medical professionals tend to have absolutely horrible insight into their own mental health.

I’d talk to your chief and I’d EXPECT your chief to discuss it with your PD. If your chief is unwilling, do it yourself. There is more at stake than your medical education here.

Nowhere did the OP suggest the attending was at actual risk of self-harm. All of this is the OP's perception and might I add, it seems that the OP has a very tough time with boundaries. Attendings and others over-sharing about their sex lives doesn't become "the story of my career" without some fault on your end.

It's tough for any of us to know if this attending is at risk of self-harm or patient-harm because the OP has failed to identify and respect appropriate boundaries even in telling of the story. She admitted that she's trying to save the attending from herself and that she's concerned the attending will damage her career if she continues on this path. That is not a reason to report this. If it's as big a deal as she believes, the chief will likely see it/hear it without the need for anyone to report it.

Yes, we have to look out for each other, but that also means knowing when to speak up and when to mind your own business. If the attending is at risk of harm to self or others, speak up. If you're concerned she will damage her career, reporting her is only going to fast-track that outcome. Be cognizant of helping one another but also realize that by reporting behavior in order to "save" someone, you're stepping wildly out of bounds as a resident. They are not your responsibility and you cannot begin to appreciate the trouble you may cause in their life. The only time it's your responsibility to report is if there's genuine suicide risk or there's genuine harassment/hostile work environment (and the OP has already said that's not the reason she wants to report) or there's genuine patient care issues. Absent those three things, keep it moving.

 

[Piebaldi]

The bolded is concerning, because I don't know what situation results in people constantly just telling me stuff. Usually if people don't find others interested or aren't validated in some way, they just stop bringing stuff up, so I almost wonder if you are (possibly inadvertently or just to be nice) playing along when people talk about these things. Have you tried just not responding to a comment, or saying "that sucks. So this patient..."? And I don't just mean sometimes, I mean every time. That's kind of the only way to gently make it clear that hearing that stuff doesn't do much for you.

Inappropriate and inconsistent with the culture of the program/department are also 2 very different things. I hear crap like you describe all the time when I'm up on OB or in the surgical floors. I don't hear it when I'm on medicine, in clinic, or on psychiatry. Personally, it makes me uncomfortable, and I respond to it exactly like I described. People rarely keep going unless others in the room are playing along. The result is that when its mainly me and those residents/attendings, they tend not to bring stuff up.

It may be in your best interest to just ignore it. Alternatively, if you genuinely think the attending is risking their career/patient safety, sure you can talk to your chief. That said, be aware that your program's culture may be such that stuff you tell your chief goes into the same gossip factory as things your attending tells you. Safest thing is to leave it alone.

I'd agree. Attendings can be wildly inappropriate - I not infrequently look at my attending with horror with some things that he says, and at some points he says oh sorry .... Is it right? Not really. Unfortunately people can be inappropriate. On the other end I think my current attending is quite good procedurally and with patients. If I were to report certain things to someone no one would care, particularly with fellowship.

So I wonder if OP is a little tad sensitive. Many times particularly as residents we think our attendings are jerks - and many times they are. But unless there is factual, objective patient harm being done, actual objective sexual harassment or serious concerns for lack of patient safety, you have a short straw here OP. No one is going to care if this attending is trashing her ex-husband or talking about the man she likes to sleep with. Is it appropriate? No. Would I do it? No.
But it's probably no different than all the disgusting trash talk that dudes do in surgery, or like the Orthopedic surgeons in my training program going with residents to strip clubs, etc. Again, as mentioned before, is her behavior really that out of hand or is it that she's a woman and talking about these things? Because male attendings particularly in surgical specialties do this all the darn time and it's sickening.
Unlikely that it'd go anywhere.

The whole statement about burning out - well as a starting resident, OP really is not in the best position to talk about that, not to mention that we are all somewhat burned out to some extent - one of the biggest problems in medicine, so this attending wouldn't be the only person who is burning out.

The only way that I'd report behavior would be:
1- Objective danger to patients (if in surgery, does she not know procedural protocols? Is she not following her patients? Is she having bad outcomes? Those are objective markers)
2- Is she sexually harassing residents? Inappropriately touching, making uncomfortable suggestions, etc?
3- Is she stating that she'd harm herself or others?

If any of the above, I'd definitely talk to your PD. Otherwise I'd thread carefully. Again residents (and as a former resident I did too) - frequently complain about their attendings. Sometimes rightfully so, always remember that attendings are also human beings - they are not immune to personal problems. If she's going through a divorce, that's tough too.

Perhaps when she starts talking about personal stuff jokingly say oh the less I know about these things the better! or something like that and she'll get the point eventually.

But be cautious about reporting things that cannot be proved - that could be career ending for you. If I had an overly sensitive resident who made false statements about me, I wouldn't be happy. I'm sure most other attendings wouldn't either.

 

[j4pac]

Nowhere did the OP suggest the attending was at actual risk of self-harm. All of this is the OP's perception and might I add, it seems that the OP has a very tough time with boundaries. Attendings and others over-sharing about their sex lives doesn't become "the story of my career" without some fault on your end.

It's tough for any of us to know if this attending is at risk of self-harm or patient-harm because the OP has failed to identify and respect appropriate boundaries even in telling of the story. She admitted that she's trying to save the attending from herself and that she's concerned the attending will damage her career if she continues on this path. That is not a reason to report this. If it's as big a deal as she believes, the chief will likely see it/hear it without the need for anyone to report it.

Yes, we have to look out for each other, but that also means knowing when to speak up and when to mind your own business. If the attending is at risk of harm to self or others, speak up. If you're concerned she will damage her career, reporting her is only going to fast-track that outcome. Be cognizant of helping one another but also realize that by reporting behavior in order to "save" someone, you're stepping wildly out of bounds as a resident. They are not your responsibility and you cannot begin to appreciate the trouble you may cause in their life. The only time it's your responsibility to report is if there's genuine suicide risk or there's genuine harassment/hostile work environment (and the OP has already said that's not the reason she wants to report) or there's genuine patient care issues. Absent those three things, keep it moving.

If everyone says that the physician is detrimental to their learning and is “burnt out” and is a loose cannon...I think that’s enough reason to talk to the PD. I don’t think that most make it through medical training and show up as a weirdo without something being wrong. Certainly doing nothing is an option but I personally wouldn’t stay in my lane out of respect of my co-residents and the colleague.

 

[Bacchus]

If everyone says that the physician is detrimental to their learning and is “burnt out” and is a loose cannon...I think that’s enough reason to talk to the PD. I don’t think that most make it through medical training and show up as a weirdo without something being wrong. Certainly doing nothing is an option but I personally wouldn’t stay in my lane out of respect of my co-residents and the colleague.

Agree. Burnout heightens the risk of self harm greatly.

 

[nimbus]

Because male attendings particularly in surgical specialties do this all the darn time and it's sickening.

That’s quite an exaggeration. It happens almost never. I’ve spent over 25 years in the OR with male and female attending surgeons. Never have I personally witnessed a conversation about someone’s sex life. Most conversations are about current events, kids, family, hobbies, sports, travel, restaurants, movies, music, cars, cycling, running, golf, etc. Stuff that’s appropriate to talk about at work. No sex. No religion. Rarely politics. OP’s attending is crazy....probably borderline. I would personally keep a low profile and get through the month.

 

[Dr.LeoSpaceman]

If everyone says that the physician is detrimental to their learning and is “burnt out” and is a loose cannon..

Everyone "saying this" is different that it actually being true. As multiple people in this thread have said, what the OP or his/her co-residents "feel" isn't going to be relevant.

Is the attending taking care of her patients? Are her outcomes appropriate? Is she fulfilling administrative duties? Are her senior partners happy with her performance? These are the only questions that the PD and leadership are going to find relevant.

 

[j4pac]

Everyone "saying this" is different that it actually being true. As multiple people in this thread have said, what the OP or his/her co-residents "feel" isn't going to be relevant.

Is the attending taking care of her patients? Are her outcomes appropriate? Is she fulfilling administrative duties? Are her senior partners happy with her performance? These are the only questions that the PD and leadership are going to find relevant.

Maybe she isn’t meeting her responsibilities. Maybe the PD has seen the same issues but never said anything because he/she didn’t think it was affecting the education of his/her residents. There is often a Swiss cheese model of effects...and when people keep their mouth shut or overlook problems...that’s when mishaps occur. There are just about always warning signs before something bad goes down and if I was a PD I hope to have enough confidence in my residents to talk to me if they felt there was a problem.

 

[Dr.LeoSpaceman]

Maybe she isn’t meeting her responsibilities. Maybe the PD has seen the same issues but never said anything because he/she didn’t think it was affecting the education of his/her residents.

If the PD/administration has noted issues and not acted, the program has problems larger than one oversharing attending.