Watching an attending implode

[calvnandhobbs68]

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).

I'd agree to go to the chief first if it's just a "oversharing her sex life and I don't really want to hear about it/makes me uncomfortable" thing. If some of the other residents are getting bothered by this, then you can all talk to them together. The chief resident can then diffuse the complaint as a "some of the residents are getting a little uncomfortable with the amount of personal information you're sharing with them in the context of the attending/resident relationship" which is probably all this needs to end up being and doesn't single you out personally.

Is there the risk that she then makes all the residents she works with lives more difficult? Yeah but THEN you now have the sequence of events that you guys let the chiefs know about this, they let her know she's probably oversharing based on multiple resident reports and now she's being a pain in the ass. So now if multiple residents are complaining about her being a pain in the ass over time, the sequence of events is established and the temporality is pretty clear to everyone.

Again, complaints are taken more seriously if multiple people are complaining about the same thing, which is why it's best to gather up a few residents who all have the same concerns (also unlikely anybody is going to retaliate against 2+ residents because then you just end up f*cking the program over). Think about it if you're a resident...1 nurse complains about you? Whatever. 5 nurses complain about you about the same thing? You get to have a sitdown with the chiefs and the PD to talk about how you need to straighten up.

---

Members don't see this ad.

 

[j4pac]

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

Use to oversee mishap boards. It’s exceptionally rare to not come across the story of how someone thought or was hoping someone else would do something about a problem. Here’s the thing...nobody likes confrontation...even PDs.

 

[Mass Effect]

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.

Whoa, where was it said that this physician is "detrimental to their learning"? In fact, the OP said multiple times how much they like and respect this person and the OP admitted she was trying to "save" the attending from herself. Nowhere was it said that she was detrimental to their learning that I saw.

Also, take this:

"A few of us went out tonight and the consensus was to stay away before she imploded and took anyone nearby with her. "

Do I need to spell out what happens when a bunch of residents go out together and gossip about an attending? It's high school all over again and minor infractions are often exaggerated, dramatized, and emphasized for dramatic effect. The OP also said:

"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."

Any more evidence that the OP is having a problem with boundaries with no clear evidence of reason to intervene? This is all conjecture based on an attending who also has issues with boundaries.

And if that isn't enough, I also think the OP is all over the place and even contradicting herself. In one post she says that all the women are worried, but the men? She doesn't know. The next post she says the men also see it, but they have a higher tolerance for "crazy." What does that mean? Suddenly they know about it, so do they think the women are being melodramatic? Do they think there's a problem? Do they think this is just someone struggling with a personal problem and doesn't require professional reprimand? Who knows because the OP didn't specify. The OP is not coming across very well in this narrative, frankly.

Agree. Burnout heightens the risk of self harm greatly.

She's not burnt out. Per the OP's first post "I worry that she'll burn out." That's a direct quote. I think this is a case of an over-sharing attending likely going through a personal crisis and an over-involved resident who isn't respecting boundaries. Also, the fact that burnout heightens the risk of self-harm is, by itself, not a reason to report someone who is burned out to their professional superiors.

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.

Maybe, maybe, maybe. You can't advise someone to report an attending (or anyone) based on a bunch of maybes. The maybes make a difference and they should be specified before telling the OP to report this.

There is also no evidence that "something bad" will go down. All we have here is someone struggling with a personal matter. It literally happens every single day in every single field in every single city in every single state the U.S. The vast majority of people may lose themselves for a few weeks, but they get it together without suicide attempts, drinking, or making the lives of others hell. The OP wants to preemptively report this attending because she's afraid what will happen, that the attending might make her life hell in the future, might leave, might become burnt out, might turn to drinking. This whole conversation is crazy, imo.

 

[j4pac]

Whoa, where was it said that this physician is "detrimental to their learning"? In fact, the OP said multiple times how much they like and respect this person and the OP admitted she was trying to "save" the attending from herself. Nowhere was it said that she was detrimental to their learning that I saw.

Also, take this:

"A few of us went out tonight and the consensus was to stay away before she imploded and took anyone nearby with her. "

Do I need to spell out what happens when a bunch of residents go out together and gossip about an attending? It's high school all over again and minor infractions are often exaggerated, dramatized, and emphasized for dramatic effect. The OP also said:

"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."

Any more evidence that the OP is having a problem with boundaries with no clear evidence of reason to intervene? This is all conjecture based on an attending who also has issues with boundaries.

And if that isn't enough, I also think the OP is all over the place and even contradicting herself. In one post she says that all the women are worried, but the men? She doesn't know. The next post she says the men also see it, but they have a higher tolerance for "crazy." What does that mean? Suddenly they know about it, so do they think the women are being melodramatic? Do they think there's a problem? Do they think this is just someone struggling with a personal problem and doesn't require professional reprimand? Who knows because the OP didn't specify. The OP is not coming across very well in this narrative, frankly.



She's not burnt out. Per the OP's first post "I worry that she'll burn out." That's a direct quote. I think this is a case of an over-sharing attending likely going through a personal crisis and an over-involved resident who isn't respecting boundaries. Also, the fact that burnout heightens the risk of self-harm is, by itself, not a reason to report someone who is burned out to their professional superiors.



Maybe, maybe, maybe. You can't advise someone to report an attending (or anyone) based on a bunch of maybes. The maybes make a difference and they should be specified before telling the OP to report this.

There is also no evidence that "something bad" will go down. All we have here is someone struggling with a personal matter. It literally happens every single day in every single field in every single city in every single state the U.S. The vast majority of people may lose themselves for a few weeks, but they get it together without suicide attempts, drinking, or making the lives of others hell. The OP wants to preemptively report this attending because she's afraid what will happen, that the attending might make her life hell in the future, might leave, might become burnt out, might turn to drinking. This whole conversation is crazy, imo.

Residents should have the ability to voice concerns to their chief. And if their chief is unwilling to do their job they can go up the chain of command.

 

[Mass Effect]

Residents should have the ability to voice concerns to their chief

No one said otherwise. The OP asked whether or not she should. We're allowed to tell them what we think.

And if their chief is unwilling to do their job they can go up the chain of command.

What is the chief's job in this circumstance?

 

[Dr.LeoSpaceman]

What is the chief's job in this circumstance?

I'd say talking to a chief is reasonable. But if I was the chief being consulted, I would say (as I have in similar circumstances when I was a chief) that people need to check themselves. And if someone went over my head after I gave recommendations, they're on their own related to the consequences. I don't want to hear about how what I suggested may happen is now happening.

 

[j4pac]

No one said otherwise. The OP asked whether or not she should. We're allowed to tell them what we think.



What is the chief's job in this circumstance?

I trust myself enough to know when to talk about concerns about a fellow resident or attending to a chief resident. The answer to the OP’s question is to do what they think is right, understanding that there are risks and consequences of something or doing nothing.

It’s a Chiefs job to hear the concerns of those below them (the residents), and if there is enough concern to voice those concerns to the PD. There are good chiefs and there are crap Chiefs. The chain of command is only relevant if you don’t have a chief who is just there to pad their resume. That’s how the chain of command works universally.

 

[Piebaldi]

I trust myself enough to know when to talk about concerns about a fellow resident or attending to a chief resident. The answer to the OP’s question is to do what they think is right, understanding that there are risks and consequences of something or doing nothing.

It’s a Chiefs job to hear the concerns of those below them (the residents), and if there is enough concern to voice those concerns to the PD. There are good chiefs and there are crap Chiefs. The chain of command is only relevant if you don’t have a chief who is just there to pad their resume. That’s how the chain of command works universally.

Typically though most chiefs ARE there to pad their resumes. Few residents have their life mission be the take of care other residents. Come now!

 

[rokshana]

Typically though most chiefs ARE there to pad their resumes. Few residents have their life mission be the take of care other residents. Come now!

Wow...you really are quite jaded...I’m so sorry that your experiences in residency were so bad...hopefully fellowship is better.

 

[keolu hills]

What if you told her, "I am uncomfortable about hearing about your sex life." If saying that is too uncomfortable, you can always change the subject to a discussion about a patient or another work related type of issue. And have the other residents do the same. And, whoever you speak to may ask you if you had tried any of this.

 

[Medstudent9]

As a new intern, I had to do a 3 month block of a rotation I didn't care for with (some) attendings I didn't care for either. My co-residents and I took every opportunity to get together to kvetch like "this block sucks" "this attending is crazy CAN YOU BELIEVE IT??" You know what really sucked? My performance (not actual patient danger but I wasn't at my best or most compassionate dealing with the patients) and my attitude. I'm not saying this is exactly what is going on with OP because I can't know but the gossiping and lack of boundaries is unhealthy.

I would say that OP should try to make every interaction with this attending (and with all attendings, frankly) about learning and patient care. And keep it bland bland bland. If the attending starts talking about her personal life, redirect "Oh, hmmm, sorry to hear that. So about Mr. X's gallbladder? I think we should get XY radiology study and then blah blah..."

And stop gossiping with your fellow residents. I hate to say "studies have shown..." because I have no citations but I'm pretty sure there is workplace psychology literature that the more time you spend gossiping and kvetching at your job, the worse you will like your job and do at your job.

OP needs to focus on the work until and unless this attending becomes a danger to patients or expresses a concrete plan of self-harm.

 

[Mass Effect]

I trust myself enough to know when to talk about concerns about a fellow resident or attending to a chief resident. The answer to the OP’s question is to do what they think is right, understanding that there are risks and consequences of something or doing nothing.

Most people do not post to this forum for wishy-washy answers like "do what you think is right, understanding the risks and consequences of doing something or doing nothing." Pretty sure the OP already went through that in his/her mind and wasn't here to hear the obvious.

It’s a Chiefs job to hear the concerns of those below them (the residents), and if there is enough concern to voice those concerns to the PD. There are good chiefs and there are crap Chiefs. The chain of command is only relevant if you don’t have a chief who is just there to pad their resume. That’s how the chain of command works universally.

Having been a Chief, I'm quite aware of the job duties.

Typically though most chiefs ARE there to pad their resumes. Few residents have their life mission be the take of care other residents. Come now!

This is absolutely false. Most people are Chiefs because they're interested in administration/education. Being chief is one of the toughest jobs one can do during training and it's primarily because of attitudes like the above.

As a new intern, I had to do a 3 month block of a rotation I didn't care for with (some) attendings I didn't care for either. My co-residents and I took every opportunity to get together to kvetch like "this block sucks" "this attending is crazy CAN YOU BELIEVE IT??" You know what really sucked? My performance (not actual patient danger but I wasn't at my best or most compassionate dealing with the patients) and my attitude. I'm not saying this is exactly what is going on with OP because I can't know but the gossiping and lack of boundaries is unhealthy.

I would say that OP should try to make every interaction with this attending (and with all attendings, frankly) about learning and patient care. And keep it bland bland bland. If the attending starts talking about her personal life, redirect "Oh, hmmm, sorry to hear that. So about Mr. X's gallbladder? I think we should get XY radiology study and then blah blah..."

And stop gossiping with your fellow residents. I hate to say "studies have shown..." because I have no citations but I'm pretty sure there is workplace psychology literature that the more time you spend gossiping and kvetching at your job, the worse you will like your job and do at your job.

OP needs to focus on the work until and unless this attending becomes a danger to patients or expresses a concrete plan of self-harm.

This. Thank you, @Medstudent9 for a decent and healthy perspective.

 

[Piebaldi]

Wow...you really are quite jaded...I’m so sorry that your experiences in residency were so bad...hopefully fellowship is better.

Not jaded at all, but some residency programs are clearly better than others in terms of malignancy. But I don't believe any resident just wants to be chief for the sake of goodness. Most residents who are chiefs typically want to get into a competitive fellowship of some sort. Taht's been my experience - you certainly don't have to agree.

 

[Mass Effect]

Not jaded at all, but some residency programs are clearly better than others in terms of malignancy. But I don't believe any resident just wants to be chief for the sake of goodness. Most residents who are chiefs typically want to get into a competitive fellowship of some sort. Taht's been my experience - you certainly don't have to agree.

Quite presumptuous of you to assume that your experience with the few chiefs you've known is universal. Regardless, even if a resident wants to be chief to get into fellowship, that doesn't mean their motives are bad any more than the motives of someone wanting leadership roles in college to get into a good med school or those wanting a leadership role in med school to get into a good residency.

 

[evilbooyaa]

Not jaded at all, but some residency programs are clearly better than others in terms of malignancy. But I don't believe any resident just wants to be chief for the sake of goodness. Most residents who are chiefs typically want to get into a competitive fellowship of some sort. Taht's been my experience - you certainly don't have to agree.

I believe your experience is with IM, right? Where Chief is somebody taking a pay-cut for a year? Most residencies that is NOT the model. One or a few of the about to graduate residents gets tagged as the Chief, leading to a bunch of admin and scheduling issues on top of the clinical responsibilities of that year.

Maybe in IM the chief resident position is more for resume padding, but OP is in a surgical sub-specialty where this definitely is NOT a thing.

 

[Piebaldi]

Quite presumptuous of you to assume that your experience with the few chiefs you've known is universal. Regardless, even if a resident wants to be chief to get into fellowship, that doesn't mean their motives are bad any more than the motives of someone wanting leadership roles in college to get into a good med school or those wanting a leadership role in med school to get into a good residency.

I can only speak from experience, and my beliefs are what they are. Again I don't expect others to necessarily agree and can respect other people having their thoughts. There is nothing wrong with being chief - but I don't think that most people who want to be chiefs do so because they care so much about residency. I believe the vast majority of chiefs are gunning for a competitive fellowship.

 

[Piebaldi]

I believe your experience is with IM, right? Where Chief is somebody taking a pay-cut for a year? Most residencies that is NOT the model. One or a few of the about to graduate residents gets tagged as the Chief, leading to a bunch of admin and scheduling issues on top of the clinical responsibilities of that year.

Maybe in IM the chief resident position is more for resume padding, but OP is in a surgical sub-specialty where this definitely is NOT a thing.

I'm not in IM, PM&R so our chiefs dont take a pay cut, they are 4th year residents as you describe. In my year, 2/2 chiefs wanted fellowships - one did not match into pain as she wanted, and the other did something less competitive. During the switch when 3rd years become chiefs a few months before one was gunning for pain since i believe before even starting residency and got pain, and the other wanted a power trip - she felt especially great about talking down to other residents, and had to be "talked to" and event went on a crazy rampage when we had a meeting with the dean when our program had some issues - she wanted to "talk for us" which was a disaster.

 

[evilbooyaa]

Oh, my mistake. Interesting that was your experience. That has not what I have seen routinely FWIW.

Regardless, I don't think it's a majority as you state, but there likely is some significant minority that 'gun' for chief as a 'distinguishing' feature on their resume. The group that go for chief in order to go on a power trip are likely a small fraction though.

 

[IlDestriero]

Keep your head down and don’t get involved in her crazy. Finish the month and be happy to move on.
If she’s a crappy attending, put her on blast in your evaluations.
If she’s a wreck on rounds, the other attendings are seeing this as well in the break room, etc.
Not your problem.
I wouldn’t bring it up to anyone until they are a threat to patient care, themselves (with an unambiguous threat of harm), or are going so far over the line that HR needs to be involved.
You have to protect yourself from this Looney Toon, not the other way around.
It’s very easy for her to damage your career, it’s much harder for you to damage hers when things all go sideways, as they often do with people that are unstable or with a personality disorder.