Conflict at work, how to deal?

[allycat0303]

Hey Everyone,

I've been having this 3 month+ conflict with a co-worker and it's really building up in me.

J and I were friends before, we would go out etc. Then this year, I was making the call schedule. It's a monthly schedule and quite hard to due as there are laws, requests to consider. In Septemeber I made the schedule, it was her responsibility to email me her requests but she didn't because she was on vacation. I made the schedule and sent a preliminary schedule 1 week before for PRE- APPROVAL. No one had an issue. Then I sent the final schedule. 1 week AFTER the schedule started J came back and felt it was unfair (she was scheduled for 9 days, which was the same as every resident had done in the 3 years previous to her.) I tried to get it changed for her, but as the other residents had already done their shifts, no one wanted to change with her.

The next month she complained that it was unfair etc., so I asked the other resident that had made scheduling if this was the way it was done. He said YES. I then asked the senior resident and he said NO. Due to the discrepancy, I emailed our program director asking him, "what are the norms?"" not mentioning the name or that J had an issue. He said I had done the schedule properly. At this point, I sent an email to the residents simply stating that these were the norms as per program director (to avoid future conflict).

The next day, she came to the nursing station, and screamed (and I mean SCREAMED) that I made her look bad etc. She was so loud, the nurses left the station. I did not say a word. And she stormed off. For the next three months we didn't speak. But the WORST part is she did not sign out patients to me at night, something which is her DUTY as a physician to do. So about 2 times a week, I would be on call and had no idea what was going on with the patients, something that is NOT right. Despite conflicts, we are obligated to put our patients first. With patients as sick as ours, it's dangerous, she put patients at risk. And before any of you ask, I've been in her situation, where one of the residents send me a text message threatening to spread rumors about me. Yes I hated his guts, but I called him every night to sign out. He was completely wrong, but that's not an excuse to endanger people's lives.

After much soul searching, I decided that this had to end, because I realized that she wasn't going to act professional. I kept hoping that she would do what she is supposed to do. In retrospect I could have gone to the program director and she would have been reprimanded quite harshly, but I didn't because the situation was so bad. So I spoke to her about it. She basically blamed it all on me, and thought it was AMUSING that she didn't sign out patients to me. I just get off the phone with her from now on, I'm very conflicted. I 100% feel I was right, but what really gets me is her attitude about patient care. I'm not sure how to act around her?????? Do I pretend all of this didn't happen? What is making me really uncomfortable is that next year I will be her senior and we'll have to work directly together. Frankly I don't want to be on call with her, because even if we've sort buried the hatchet, I don't feel like I can trust her. I don't want to work with someone that is willing to play games with people lives. Should I discuss this with the program director? I mean I spoke to her about it, saying it wasn't right for patient care, and she laughed. I don't think she gets it, and it's not acceptable.

 

[sonnyjane]

Has she at least agreed to sign out the patients to you? That's just not acceptable. That's not a friendship issue, it's a work issue. She's flat out not doing her job, and if you're above her, you need to bring that up. Where I work, we have a lot of conflicts, unfortunately, and the policy that we're urged to follow is to first bring an issue up with the person directly, but if the situation doesn't change, the second step is to have a meeting with your supervisor to discuss the issue. Usually, the third step is a meeting between you, the person with whom you're having the conflict, and your supervisor as a mediator. I think that's what you should do here. Putting people's health (or life!) at risk is not just socially uncomfortable. It's really negligent. You need to speak to your superiors about this. Someone that puts petty arguments over their duties and responsibilities to others doesn't deserve the position.

 

[movie zombie]

blunt: you are playing with peoples lives by not having already gone to the program director. i don't even begin to understand why you're asking us when you already know you should have done it already. if you don't do it now, well, next year you're in for double trouble and will never be "her senior". i would also say that the patients are getting a very raw deal from both of you. she obviously does not care about them and you are relegating them to 2nd class by making your relationship with her a priority. DO IT NOW.

sorry for the rant and for being so blunt. i think you're a very good and caring dr.....but it is impossible to be that if you allow this to continue. didn't you say at one time that your strength is medical but your weakness is "management"? i'm thinking that for your sake and that of your patients its time to consider some type of management class and/or assertiveness training.

again, i apologize for my blunt rant....... however, i'd certainly want "my" dr to put me first.

please go to the program director before a patient suffers because of childish behavior.

 

[allycat0303]

Movie_Zombie: Its been very difficult few months. The way I got around it was that I came in to see the patients every night and learnt about them one, by one. It was a big undertaking, and took me hours, but I didn't put the patients second. I've done what I could. I initially spoke to the Chief Resident (The boss on all of us) and he didn't think it was a big deal, granted, he's not really one to get involved, he just doesn't CARE. Literally, he's done things that are ethically shady. He just said, "Oh well, she should sign-out, but nothing bad has happened, and you're managing." When that didn't work, I spoke to her senior at the time, Z, who wasn't aware this was going on. He said he would speak to her. It didn't change anything. That's primarily the reason, I decided to just bury the hatchet a) Because of the patients b) although I was managing to learn about the patients, it was taking hours. This is not a completely altruistic decision. It's motivated also be my desire to be effective.

It's not as easy as it sounds to go to the Program Director and complain specifically about a resident. I don't know how to explain it. There's a strict hierarchy in surgery, with the Chief resident essentially responsible for us all. He brushed it off, but it's the nature of his attitude, he doesn't care. He's ordered residents NOT to treat patients, knowing they were dying, even if they had specifically EXPRESSED the desire for treatment.The reason I'm not going to the program director is because I'm managing it. And I don't want this to deteriorate further. Judging from her reaction to clarification about the work schedule, I don't know what she's going to do if I actually complain about her. It's annoying and disrespectful, but I'm compensating. I just don't want to work with her next year, because if she's not around, I'll handle all the patients on the service. If she's on call with me, protocol is nurses call her first, and me second if they disagree with her management. And from prior experience, the nurses never do that because of fear. It's going to be more work for me next year, but probably safer all around. I just don't trust her.

SonnyJane: No, she didn't actually agree to sign out patients to me. As I said, she laughed, and said "I know its pissing you off." By the same token, I can't beg her to sign-out, and can I even trust what she's saying? She can always hide behind the fact, that "As per her clinical judgement, she didn't think this part was important."

 

[movie zombie]

ally, you explained it very well. you're right. i don't understand the "rules"......but it does sound to me like you have followed them and gone to everyone that you possibly can w/o going to the director. question: if something does go wrong with a patient, will you be blamed? can you or are you keeping a record of everything "just in case"? what are your options? you don't trust her: do you think she's talking behind your back or do you not trust her to do right by the patients? how does she have so much power that the nurses are afraid of her? do you have to be paired with her next year....can you ask for a re-assignment?

admittedly, i'm asking more questions and not being of much help..........

 

[maplefemme]

Hey Everyone,

I've been having this 3 month+ conflict with a co-worker and it's really building up in me.

J and I were friends before, we would go out etc. Then this year, I was making the call schedule. It's a monthly schedule and quite hard to due as there are laws, requests to consider. In Septemeber I made the schedule, it was her responsibility to email me her requests but she didn't because she was on vacation. I made the schedule and sent a preliminary schedule 1 week before for PRE- APPROVAL. No one had an issue. Then I sent the final schedule. 1 week AFTER the schedule started J came back and felt it was unfair (she was scheduled for 9 days, which was the same as every resident had done in the 3 years previous to her.) I tried to get it changed for her, but as the other residents had already done their shifts, no one wanted to change with her.

The next month she complained that it was unfair etc., so I asked the other resident that had made scheduling if this was the way it was done. He said YES. I then asked the senior resident and he said NO. Due to the discrepancy, I emailed our program director asking him, "what are the norms?"" not mentioning the name or that J had an issue. He said I had done the schedule properly. At this point, I sent an email to the residents simply stating that these were the norms as per program director (to avoid future conflict).

The next day, she came to the nursing station, and screamed (and I mean SCREAMED) that I made her look bad etc. She was so loud, the nurses left the station. I did not say a word. And she stormed off. For the next three months we didn't speak. But the WORST part is she did not sign out patients to me at night, something which is her DUTY as a physician to do. So about 2 times a week, I would be on call and had no idea what was going on with the patients, something that is NOT right. Despite conflicts, we are obligated to put our patients first. With patients as sick as ours, it's dangerous, she put patients at risk. And before any of you ask, I've been in her situation, where one of the residents send me a text message threatening to spread rumors about me. Yes I hated his guts, but I called him every night to sign out. He was completely wrong, but that's not an excuse to endanger people's lives.

After much soul searching, I decided that this had to end, because I realized that she wasn't going to act professional. I kept hoping that she would do what she is supposed to do. In retrospect I could have gone to the program director and she would have been reprimanded quite harshly, but I didn't because the situation was so bad. So I spoke to her about it. She basically blamed it all on me, and thought it was AMUSING that she didn't sign out patients to me. I just get off the phone with her from now on, I'm very conflicted. I 100% feel I was right, but what really gets me is her attitude about patient care. I'm not sure how to act around her?????? Do I pretend all of this didn't happen? What is making me really uncomfortable is that next year I will be her senior and we'll have to work directly together. Frankly I don't want to be on call with her, because even if we've sort buried the hatchet, I don't feel like I can trust her. I don't want to work with someone that is willing to play games with people lives. Should I discuss this with the program director? I mean I spoke to her about it, saying it wasn't right for patient care, and she laughed. I don't think she gets it, and it's not acceptable.

As someone in the same profession who works with critically ill patients, I'd say she is BANG OUT OF ORDER.
She's neglecting her responsibilities and putting patients in danger, she acknowledges she's doing it and feels it's amusing.
I'd report her to the program director without hesitation.
If you pretend this all didn't happen and she does this again and a patient suffers as a result then YOU are on the hook for not reporting this earlier, you won't have a leg to stand on by covering for her.
I would not modify my duties and responsibilities in order to cater to someone's emotional problems. By reporting her you are letting her know you won't tolerate this behavior, right now you are in a sense covering for her (I know that's not at all your intent) and you have a responsibility to advocate for the patients.

I know how you feel, truly. I had a superior who was abusive to patients. She'd do it at night when there was only the three of us on the unit. I felt much trepidation about reporting her to our director because it appeared that they were good friends.
I finally reported her to our team leader and she was shocked. She said she felt that our director would not deal with it properly because she always tries to protect her but she would report it to her anyway.
Needless to say, the team leader relocated and never reported it to the director. I assumed this because the director never approached me and you'd think she would.
The abuse continued, I finally reported her to the director. The director told me that I just need to remind her "to be sweet and kind" WTF!?!?
I had no support from upper management on my unit.
The rest of the night staff know exactly how she is though and they'd back me up if need be but are scared to say anything themselves to her or management.

She was abusive and medically negligent once again to a patient, just before Christmas, and I stormed into the med room and asked her "who the hell does she think she is?!" She was stunned and I was furious. I told her that if she ever does that to a patient again I will report her directly to our Province's Health Services. It was a 30 minute back and forth argument and was very unpleasant but I let rip and told her exactly what she was doing and that I would not tolerate it.
This makes for a curt working relationship between us and we work very closely, however, she has altered her behavior, at least in my presence.
It's all business now, I don't need to be her friend, but I won't cover for her any longer.

I feel for you, I know how difficult your situation is and I hope you find resolution, you don't deserve to be treated like that and the patients deserve better too.

 

[maplefemme]

Movie_Zombie: Its been very difficult few months. The way I got around it was that I came in to see the patients every night and learnt about them one, by one. It was a big undertaking, and took me hours, but I didn't put the patients second. I've done what I could. I initially spoke to the Chief Resident (The boss on all of us) and he didn't think it was a big deal, granted, he's not really one to get involved, he just doesn't CARE. Literally, he's done things that are ethically shady. He just said, "Oh well, she should sign-out, but nothing bad has happened, and you're managing." When that didn't work, I spoke to her senior at the time, Z, who wasn't aware this was going on. He said he would speak to her. It didn't change anything. That's primarily the reason, I decided to just bury the hatchet a) Because of the patients b) although I was managing to learn about the patients, it was taking hours. This is not a completely altruistic decision. It's motivated also be my desire to be effective.

It's not as easy as it sounds to go to the Program Director and complain specifically about a resident. I don't know how to explain it. There's a strict hierarchy in surgery, with the Chief resident essentially responsible for us all. He brushed it off, but it's the nature of his attitude, he doesn't care. He's ordered residents NOT to treat patients, knowing they were dying, even if they had specifically EXPRESSED the desire for treatment.The reason I'm not going to the program director is because I'm managing it. And I don't want this to deteriorate further. Judging from her reaction to clarification about the work schedule, I don't know what she's going to do if I actually complain about her. It's annoying and disrespectful, but I'm compensating. I just don't want to work with her next year, because if she's not around, I'll handle all the patients on the service. If she's on call with me, protocol is nurses call her first, and me second if they disagree with her management. And from prior experience, the nurses never do that because of fear. It's going to be more work for me next year, but probably safer all around. I just don't trust her.

SonnyJane: No, she didn't actually agree to sign out patients to me. As I said, she laughed, and said "I know its pissing you off." By the same token, I can't beg her to sign-out, and can I even trust what she's saying? She can always hide behind the fact, that "As per her clinical judgement, she didn't think this part was important."

I don't understand this, please can you explain in more detail?

 

[allycat0303]

MZombie,

If something goes wrong with patient...well I don't think anyone will be blamed specifically. Rarely does anyone go back to retrace exactly where the mistake went wrong. Quebec is not like the United States. Legally doctors can be sued, but it's relatively small amounts (I think the most is about 150,000$? And the premiums are not like in the US. We have a non-profit insurance covered in part by the government, we pay insurance premiums, but for a resident it's like 50$ month, and it's capped).

It's a matter of conscience, ethics, and morals. For me at least, it's not as much medical legally, but what is RIGHT. I have a highly developed conscience, which beyond everything else, guides me. I'm really mad that the Chief resident doesn't care. He should care, and historically, the quality of the service is highly dependent on the quality of the Chief resident. It's up to him to run a tight ship, but he doesn't because he's morally, and ethically skewed.

She is the one that will make the call schedules next year. I'm not sure I can just say to her, "Don't put me on call with you." That would probably be like throwing a can gasoline on the fire. I don't really care if she's talking about me behind my back, that's minuscule to me. Typically, people that I don't respect, I don't care what they say, and to be honest, there's more bad residents in my program then good ones. We are 11 residents in the program. 4 of us are from Canada, while 7 are from Saudi Arabia (basically their government pays Mcgill 1 million$ to train them, and then they go back to Saudi Arabia.) They are not subject to the same rules as us. Of the 4 Canadian residents, the Chief resident has ORDERED me to let a patient die even though his family/him had expressively wanted FULL medical care. This was done because the patient had multiple strokes an no quality of life, but it's not up to US to decide. I disobeyed a direct order, and treated the patient anyway. He died, but the Chief nearly killed me for trying to save the patient. Medically legally, this is illegal, and ethically disgusting. The senior above me S, aside from sending me a threatening text message, has been cited by the director repeatedly for gross negligence. He refused to come in from home when a patient coded, leaving a junior who was incapable and too inexperience to deal with it. Among other things...he was nearly kicked out of the program. And now this thing with J, deciding that she's not going to give someone on call sign-out because she's *mad* at them. Part of me is very disappointed. I thought she was different and would bring some integrity to the program, but judging her by her actions, if she's willing to play games with patient's lives, there's something fundamentally untrustworthy about her too.

Part of what's making me so angry is that it's being swept under the rug. Because there's so little supervision in this program, they all get away with this stuff. I think there's something about this program that wears down on any sense of morality. Or maybe as they become surgeons, their arrogance takes over, and they no longer see patients as *people*. I don't know, I'm very conflicted and angry about this. It's difficult for me to get a grasp on exactly what is bothering me. I can tell you that in the last 2 months (I'm on research) I've stopped having any semblance of interactions with these people. I go to work. I do not say hello to them. I do not say goodbye. I only have strictly professional interactions with them. I purposely don't attend journal club which is technically required but *social*. I'm deliberately isolating myself. I think part of it is that I don't want to become like them. EVER. But it's hard, and sometimes I feel so alone that I feel like I'm going to break.

Well, writing that was incredibly cathartic, it's been a hard few months professionally. I'm just trying to make some sort of peace with the things I'm seeing.

MapleFemme: : This was the exact situation. Mr. C who was in his early 70's, had coronary artery bypass surgery and a valve replacement. In the post-operative period, he suffered several complications including multiple strokes, and aspiration pneumonia. He had been sent down to ICU 2-3 times. He was in the hospital with us for about 3 months. His family, particularly his daughter was very involved, but had limited medical knowledge. I was called, because he was hypotensive, confused, febrile. I knew he was in sepsis/septic shock. At that point, I checked on his code status which is a level 1, meaning full code, transfer to icu. The form was signed and dated by him and his family, and the wishes were CLEAR to all the nurses. I called the Chief resident and told him I was going to start early goal directed therapy: antibiotics (broad spectrum), fluid resuscitation, inotropes and call the ICU. He forbade me to do it. "Do not start antibiotics, don't do anything. Let him go. We should have let him go 2 months ago. He's a mess, and using up resources" At this point, I said, "G he's a full code, and he's not gone yet, I know you don't agree, but its antibiotics/fluid/medication, nothing too invasive. We need to give him a chance, its what he and his family want" He reiterated that I was not to do anything. Now this is not a normal infection, in septic shock, mortality is in the high 70's dependent on how fast you start therapy.

It was like 3 in the morning, so I just did it anyway, I gave him everything that I had. The patient died the next day of septic shock. The family was devastated that he passed, but G was furious when he found out what I had done, because he felt the patient was not viable. I took a lot of heat for disobeying the Chief, but medically-legally, if I hadn't done it, it was wrong. And morally, people have the right to decide how they want to live and die, we can't make that decision for them.

 

[movie zombie]

......If something goes wrong with patient...well I don't think anyone will be blamed specifically. Rarely does anyone go back to retrace exactly where the mistake went wrong. Quebec is not like the United States. Legally doctors can be sued, but it's relatively small amounts (I think the most is about 150,000$? And the premiums are not like in the US. We have a non-profit insurance covered in part by the government, we pay insurance premiums, but for a resident it's like 50$ month, and it's capped).......

ok, so drs are "protected" more or less.....but what is protecting these patients from her [and the system as well]? i know you can't change the system but i sure think these patients are not being well served by her [or the system in this particular hospital].

i know you're in research.....what type or which field of medical research?

is there no one within the hospital system that will advocate for these patients? no one deserves to receive the kind of treatment you are describing.

i know you are looking for advice on how to deal with this but it sounds like you have done everything you can and that the only thing left to do is go to the program director. or blow up on her like mapplefemme did in her situation. cold and distant/professional basis only is ok in my book.

 

[movie zombie]

dup post deleted

 

[maplefemme]

MZombie,

If something goes wrong with patient...well I don't think anyone will be blamed specifically. Rarely does anyone go back to retrace exactly where the mistake went wrong. Quebec is not like the United States. Legally doctors can be sued, but it's relatively small amounts (I think the most is about 150,000$? And the premiums are not like in the US. We have a non-profit insurance covered in part by the government, we pay insurance premiums, but for a resident it's like 50$ month, and it's capped).

It's a matter of conscience, ethics, and morals. For me at least, it's not as much medical legally, but what is RIGHT. I have a highly developed conscience, which beyond everything else, guides me. I'm really mad that the Chief resident doesn't care. He should care, and historically, the quality of the service is highly dependent on the quality of the Chief resident. It's up to him to run a tight ship, but he doesn't because he's morally, and ethically skewed.

She is the one that will make the call schedules next year. I'm not sure I can just say to her, "Don't put me on call with you." That would probably be like throwing a can gasoline on the fire. I don't really care if she's talking about me behind my back, that's minuscule to me. Typically, people that I don't respect, I don't care what they say, and to be honest, there's more bad residents in my program then good ones. We are 11 residents in the program. 4 of us are from Canada, while 7 are from Saudi Arabia (basically their government pays Mcgill 1 million$ to train them, and then they go back to Saudi Arabia.) They are not subject to the same rules as us. Of the 4 Canadian residents, the Chief resident has ORDERED me to let a patient die even though his family/him had expressively wanted FULL medical care. This was done because the patient had multiple strokes an no quality of life, but it's not up to US to decide. I disobeyed a direct order, and treated the patient anyway. He died, but the Chief nearly killed me for trying to save the patient. Medically legally, this is illegal, and ethically disgusting. The senior above me S, aside from sending me a threatening text message, has been cited by the director repeatedly for gross negligence. He refused to come in from home when a patient coded, leaving a junior who was incapable and too inexperience to deal with it. Among other things...he was nearly kicked out of the program. And now this thing with J, deciding that she's not going to give someone on call sign-out because she's *mad* at them. Part of me is very disappointed. I thought she was different and would bring some integrity to the program, but judging her by her actions, if she's willing to play games with patient's lives, there's something fundamentally untrustworthy about her too.

Part of what's making me so angry is that it's being swept under the rug. Because there's so little supervision in this program, they all get away with this stuff. I think there's something about this program that wears down on any sense of morality. Or maybe as they become surgeons, their arrogance takes over, and they no longer see patients as *people*. I don't know, I'm very conflicted and angry about this. It's difficult for me to get a grasp on exactly what is bothering me. I can tell you that in the last 2 months (I'm on research) I've stopped having any semblance of interactions with these people. I go to work. I do not say hello to them. I do not say goodbye. I only have strictly professional interactions with them. I purposely don't attend journal club which is technically required but *social*. I'm deliberately isolating myself. I think part of it is that I don't want to become like them. EVER. But it's hard, and sometimes I feel so alone that I feel like I'm going to break.

Well, writing that was incredibly cathartic, it's been a hard few months professionally. I'm just trying to make some sort of peace with the things I'm seeing.

This is horrifying, I feel very sorry for you. I have never been so disappointed in the Canadian medical system as I am reading this. It's an embarrassment. That's tantamount to murder.
Thank God my SO and I are both in the profession here, if anything happens to our loved ones we are very proactive advocates and nothing slips past us in their care, negligence does not go unmissed.
I'm thoroughly appalled...

 

[allycat0303]

MZombie,

In my program, there is a mandatory 1 year research, enrichment year. Right now I'm doing stem cell research to regenerate the heart. But I'm not a researcher by any means. It's part of the residency but in July I'm returning full time as a normal resident, and I'll eventually be a surgeon. You're right that Doctors are protected... It's up to the patient and family of the patient to get involved and be informed. If the family feels there is mismagement they can go to the Royal College and file a complaint, or initiate a lawsuit. Typically it's not in Quebec culture to sue. So it rarely happens, I've seen 2-3 cases of mismanagement where the patients could have sued for millions in the US but because of lack of knowledge etc, it's forgotten. The saying that "you are your own best advocate is true" and I'm not saying Quebec is horrible and we go around killing people. I'm saying that under the surface, there are sketchy things happening that are highly unethical. I did actually report a staff physician to DPS (director of professional service) who hires and fires doctors... But I did it anonymously. He did something atrocious, which the all the residents knew about, but the family never knew about. I would have gone to the Royal College but I did not have sufficient proof (the other residents were not willing to tell anyone what happened) and I thought at least he could be reprimanded.

MapleFemme: the more I see of these people, the more I realize that there are some very bad doctors out there. But we are humans to, and nothing guarantees that just because you have a medical degree makes you an ethical person. It just makes you smart and a hardworker.

 

[movie zombie]

remind me to make sure to let you know when/if i'm ever in your city so you can look out for me. from what you're saying i would be loathe to be admitted to any medical facility there.

i've always told my husband that i need to know that he can "advocate" should the need arise.....we all know i could do it and he knows i'd do it for him...... sometimes i don't have faith that he'd be assertive enough....even aggressive if that's what it took.

eta: well, if i haven't been of any real help, at least i've helped with the catharic part. needs some sleep. its now 11p here in california which makes me wonder why you're still online!!!! get some rest dr!

 

[maplefemme]

MZombie,

If something goes wrong with patient...well I don't think anyone will be blamed specifically. Rarely does anyone go back to retrace exactly where the mistake went wrong. Quebec is not like the United States. Legally doctors can be sued, but it's relatively small amounts (I think the most is about 150,000$? And the premiums are not like in the US. We have a non-profit insurance covered in part by the government, we pay insurance premiums, but for a resident it's like 50$ month, and it's capped).

It's a matter of conscience, ethics, and morals. For me at least, it's not as much medical legally, but what is RIGHT. I have a highly developed conscience, which beyond everything else, guides me. I'm really mad that the Chief resident doesn't care. He should care, and historically, the quality of the service is highly dependent on the quality of the Chief resident. It's up to him to run a tight ship, but he doesn't because he's morally, and ethically skewed.

She is the one that will make the call schedules next year. I'm not sure I can just say to her, "Don't put me on call with you." That would probably be like throwing a can gasoline on the fire. I don't really care if she's talking about me behind my back, that's minuscule to me. Typically, people that I don't respect, I don't care what they say, and to be honest, there's more bad residents in my program then good ones. We are 11 residents in the program. 4 of us are from Canada, while 7 are from Saudi Arabia (basically their government pays Mcgill 1 million$ to train them, and then they go back to Saudi Arabia.) They are not subject to the same rules as us. Of the 4 Canadian residents, the Chief resident has ORDERED me to let a patient die even though his family/him had expressively wanted FULL medical care. This was done because the patient had multiple strokes an no quality of life, but it's not up to US to decide. I disobeyed a direct order, and treated the patient anyway. He died, but the Chief nearly killed me for trying to save the patient. Medically legally, this is illegal, and ethically disgusting. The senior above me S, aside from sending me a threatening text message, has been cited by the director repeatedly for gross negligence. He refused to come in from home when a patient coded, leaving a junior who was incapable and too inexperience to deal with it. Among other things...he was nearly kicked out of the program. And now this thing with J, deciding that she's not going to give someone on call sign-out because she's *mad* at them. Part of me is very disappointed. I thought she was different and would bring some integrity to the program, but judging her by her actions, if she's willing to play games with patient's lives, there's something fundamentally untrustworthy about her too.

Part of what's making me so angry is that it's being swept under the rug. Because there's so little supervision in this program, they all get away with this stuff. I think there's something about this program that wears down on any sense of morality. Or maybe as they become surgeons, their arrogance takes over, and they no longer see patients as *people*. I don't know, I'm very conflicted and angry about this. It's difficult for me to get a grasp on exactly what is bothering me. I can tell you that in the last 2 months (I'm on research) I've stopped having any semblance of interactions with these people. I go to work. I do not say hello to them. I do not say goodbye. I only have strictly professional interactions with them. I purposely don't attend journal club which is technically required but *social*. I'm deliberately isolating myself. I think part of it is that I don't want to become like them. EVER. But it's hard, and sometimes I feel so alone that I feel like I'm going to break.

Well, writing that was incredibly cathartic, it's been a hard few months professionally. I'm just trying to make some sort of peace with the things I'm seeing.

MapleFemme: : This was the exact situation. Mr. C who was in his early 70's, had coronary artery bypass surgery and a valve replacement. In the post-operative period, he suffered several complications including multiple strokes, and aspiration pneumonia. He had been sent down to ICU 2-3 times. He was in the hospital with us for about 3 months. His family, particularly his daughter was very involved, but had limited medical knowledge. I was called, because he was hypotensive, confused, febrile. I knew he was in sepsis/septic shock. At that point, I checked on his code status which is a level 1, meaning full code, transfer to icu. The form was signed and dated by him and his family, and the wishes were CLEAR to all the nurses. I called the Chief resident and told him I was going to start early goal directed therapy: antibiotics (broad spectrum), fluid resuscitation, inotropes and call the ICU. He forbade me to do it. "Do not start antibiotics, don't do anything. Let him go. We should have let him go 2 months ago. He's a mess, and using up resources" At this point, I said, "G he's a full code, and he's not gone yet, I know you don't agree, but its antibiotics/fluid/medication, nothing too invasive. We need to give him a chance, its what he and his family want" He reiterated that I was not to do anything. Now this is not a normal infection, in septic shock, mortality is in the high 70's dependent on how fast you start therapy.

It was like 3 in the morning, so I just did it anyway, I gave him everything that I had. The patient died the next day of septic shock. The family was devastated that he passed, but G was furious when he found out what I had done, because he felt the patient was not viable. I took a lot of heat for disobeying the Chief, but medically-legally, if I hadn't done it, it was wrong. And morally, people have the right to decide how they want to live and die, we can't make that decision for them.

Honestly, this disturbs me beyond belief. The patient was R1 designation and the Chief treats him like a C2 - not his call!
The antibiotics may indeed not have saved him, no, but it was his right to try.
I have so many thoughts on this I could spill them out at length but I'll refrain and just say this; thank you alleycat, for being the person you are, you make a difference by your very nature. On days you feel alone, days you feel like you're fighting a loosing battle, please remember that it's people like you who make all the difference in the world and we need people like you, you are the difference amongst the apathetic.
I'd be honored to work with you.

 

[movie zombie]

can't resist one more post before going off to bed...

and i'd be pleased to be your patient! not that i want to be anyone's patient, but you know what i mean......

eta: yes, the world is a better place and Quebec especially is a better place because you are who you are and doing what you do.

 

[maplefemme]

can't resist one more post before going off to bed...

and i'd be pleased to be your patient! not that i want to be anyone's patient, but you know what i mean......

eta: yes, the world is a better place and Quebec especially is a better place because you are who you are and doing what you do.

Well I hope we never run into each other (in a professional capacity!) but if we do then I promise you this; I've got your back as if you were my own family
All of my patients are dying, I'm in hospice, but I don't care, if someone wants physio I'll get them physio, I don't care that it won't make a difference to their prognosis, it makes a difference to their emotional well being. If someone's diabetic but they want an ice cream sundae at 2am, that's their perogative and I'll make it the Mother of all sundaes!

Good night all

 

[smitcompton]

Hi,

I would talk to your past friend J again. I would state quite calmly that I wanted a truce.(Do it lightly, wave a white hankerchief. I have done this myself) I would let her know that you did not report her to the program director about the on call schedule. This seems to be the cause of her antics,(Yes I use that word) This is a case where she made an assumption that was untrue. Try convincing her it is true. Give a few examples of when you had good times together and say you have to work together, could you put the old wound behind you and start afresh. I would try that. Be your nice self, easy going. This should not be matter of pride for you for you know everyone is helped by this. If she laughs at you or isn't agreeable, well then you gave it your best shot. I really would do this. It might be a relief for her as well.

Don't you have nurses on staff who can give you the patients care. or case,history when she doesn't do the proper sign off to you?
I am more concerned that you are going to be a frazzled doctor worrying about every Drs actions. Medicine will continue to have ethical issues, such as you described, forever. I , unlike MZ, think the Drs call was right in saying no more treatment. Families would not agree, but if the prognosis is so bad, why prolong the agony for patients. You see, Allycat, we all want Drs like you, but you should learn that his error(the other DRS) was more precedural than negligent.IMO

MZ, you do need a strong advocate. Men usually fall a bit short. Always try to keep alert, and don't think they always do the right thing. Speak up even if you may feel you come off as an idiot. Try to get a female friend to help in case of medical mishaps, which happen more than people want to believe. Some are due to laziness, some are due to just negligience.

I really do know what I am talking about here. I have filed a malpractice suit against two doctors, which went to trial, and which I won. I am in wheelchair due to their negligence. Last yr a pharmacist gave me a prescription for a med I was alergic to. So sick. It was all on the form-they didn't bother to check it. Etc ect.

Allycat, try to eliminate your anxiety but starting with the truce with J. These all seem to be things you can forgive. Do the best you can, life cannot ask more of you.
Good Luck.

 

[maplefemme]

Hi,

I would talk to your past friend J again. I would state quite calmly that I wanted a truce.(Do it lightly, wave a white hankerchief. I have done this myself) I would let her know that you did not report her to the program director about the on call schedule. This seems to be the cause of her antics,(Yes I use that word) This is a case where she made an assumption that was untrue. Try convincing her it is true. Give a few examples of when you had good times together and say you have to work together, could you put the old wound behind you and start afresh. I would try that. Be your nice self, easy going. This should not be matter of pride for you for you know everyone is helped by this. If she laughs at you or isn't agreeable, well then you gave it your best shot. I really would do this. It might be a relief for her as well.

Don't you have nurses on staff who can give you the patients care. or case,history when she doesn't do the proper sign off to you?
I am more concerned that you are going to be a frazzled doctor worrying about every Drs actions. Medicine will continue to have ethical issues, such as you described, forever. I , unlike MZ, think the Drs call was right in saying no more treatment. Families would not agree, but if the prognosis is so bad, why prolong the agony for patients. You see, Allycat, we all want Drs like you, but you should learn that his error(the other DRS) was more precedural than negligent.IMO

MZ, you do need a strong advocate. Men usually fall a bit short. Always try to keep alert, and don't think they always do the right thing. Speak up even if you may feel you come off as an idiot. Try to get a female friend to help in case of medical mishaps, which happen more than people want to believe. Some are due to laziness, some are due to just negligience.

I really do know what I am talking about here. I have filed a malpractice suit against two doctors, which went to trial, and which I won. I am in wheelchair due to their negligence. Last yr a pharmacist gave me a prescription for a med I was alergic to. So sick. It was all on the form-they didn't bother to check it. Etc ect.

Allycat, try to eliminate your anxiety but starting with the truce with J. These all seem to be things you can forgive. Do the best you can, life cannot ask more of you.
Good Luck.

Very sound advice, though I respectfully disagree when you say "why prolong the patient's agony", because the patient's directives are R1 at the patient's request, it's their choice. Much the same as if they were C2 and I were to resuscitate them, I'd be violating their legal rights.

 

[movie zombie]

good a.m., all!

smit, the only reason i think the dr was wrong is that the patient and family directive were in writing and legally he was obligated to follow it. i have no problem when the patient and/or family make "the" decision to not prolong medical treatment.

my husband's father in AU had something similar but there the drs were up front and very clear about what they would do for him and what they would not do for him. his condition was such that there was never going to be a positive prognosis and everyone including my FIL knew it. didn't matter what his directive might have been because his medical plan was outlined and clear. they were not going to throw resources at someone that wasn't going to live long. no one had a problem with that. he did live longer than they predicted but it was still the right decision....and they did provide him with good care until his death.

alley and maple: if i'm ever in canada i want to know i can find you! wish there was a way to personally e-mail you. i do miss that function here on pricescope. i participate on other forums that offer it and i use it. i realize pricescope had "problems" but the other forum i am on do not seem to have experienced the same issue. i do hope that pricescope will revisit this and come up with a way to restore the private e-mail feature w/o compromising "security". if others can do it, i'm sure the pricescope administrative crew can do it, too.

maple: my dad tells the story of an old vet that he used to visit that was diabetic. one day he asked for his favorite sweet and everyone knew he was "ready". the joke in the family is that if my dad asks for "x", then we know he's ready to go....dad turns 88 march 4.

 

[wildcat03]

Very sound advice, though I respectfully disagree when you say "why prolong the patient's agony", because the patient's directives are R1 at the patient's request, it's their choice. Much the same as if they were C2 and I were to resuscitate them, I'd be violating their legal rights.

It sounds like the directive was R1 (or what we call "full code" at my institution) at the FAMILY'S request, as the patient was not capable of making requests.

I agree that the chief's management of this patient's code status was horrendous and wrong, but on some level it was probably the right thing to do, even if he went around it the complete wrong way. I've taken care of two patients in the medical ICU who were full code who should not have been. If we, as physicians, deem efforts "medically futile" we can change the code status and can refuse in good conscience to run a code on these patients. I don't know if the same applies to making a patient CMO (comfort measures only, or what you call C2), but I don't think I'd ever feel comfortable doing that.

Alley - I hate to say it, but your program sounds like a mess. There are 51 of us in my program and I think we have less drama (despite our program director being fired, our elective time being usurped and shifts being sneakily added to our schedules).

 

[iugurl]

MZ, you do need a strong advocate. Men usually fall a bit short. Always try to keep alert, and don't think they always do the right thing. Speak up even if you may feel you come off as an idiot. Try to get a female friend to help in case of medical mishaps, which happen more than people want to believe. Some are due to laziness, some are due to just negligience.

Are you serious?

 

[movie zombie]

i agree that men often fall short of being assertive in medical situations.
i see it with my own father.
i know my husband is not nearly as assertive as i am in these situations.
the good news is that i think i've impressed upon my husband my expectations and that i want from him what he knows i would do for him.

i research everything. drs try to prescribe meds and i discuss the side effects. i'm not a medical pushover. the drs i have now realize this and actually treat me well....i will admit they are younger female drs and seem to appreciate a proactive patient. i have had issues in the past with the "you patient, me dr" personalities that expect that see themselves as the "father" who knows best. no surprise, right?!

it is the medical emergency situation, one in which i would be unconscious that i would be concerned about....or drugged to the point of thinking.

 

[allycat0303]

Wildcat: the patient could express himself, clearly actually. The strokes although many (3) were not incapacitating. He had a facial droop and left sided weakness, which at 3 months, with physio could have improved, he was a dialysis patient. The family and patient had a family meeting with the attending the week before, and the decision was for a full code. I actually don't have an opinion on whether or not this was the appropriate code status. I can tell you that even before he was septic, it was a 50/50 of full recovery. We take care of patients that are MUCH sicker. We have someone in CHF, 80 years old, EF:15%, trached, pegged, indwelling catheter with FUNGAL endocarditis, who weighs 55 pounds, that we have been transferring in and out of icu for the last 8 months. but his family are aggressive 24/7 so this would never happen. Trust me, the chief HIMSELF would have run a full 60 minute code on this man. The issue is that this was clearly his wish. We can't make that decision for them. We can guide, suggest, etc, but not impose our will on them. I also thought at the very least, some iv antibiotics, some levo, and fluid for sepsis is pretty much benign considering he had open heart surgery 3 months ago. Intubation, I would have called the family and discussed it with them if I thought it was necessary (once septic he was confused, where previously he was with it.) My program is ridiculous. During a sleepless night, I realized its also the nature of the personality of CT surgeons. They are all egotistical, arrogant carbon copies of one another. It's more exhausting dealing with the residents then the actual work load.

MZ, Smit: honestly, the thought of dealing with her is making anxious. I actually wrote the post AFTER I had waved the flag. I explained that I didn't rat her out, that the call schedule was unfortunate and that it wouldn't happen again. This was said in a nice, apologetic way, which at this point, I'm embarrassed that I had no pride. She laughed that she had yelled at me, and again when I asked for sign out. Basically I begged fit forgiveness and she laughed in my face. That's what is bothering me last night, I had no self respect because she WAS wrong. AND I bent on my stance, and it got me nothing, except a feeling of self loathing.

MZ it is super scary sometimes. I always assumed it was different in the US because it's a litigious structure. I assumed because its easy to sue, Doctors would have an external check preventing them from acting badly. But it's important to know, and important to ask questions. You should never blindly trust.

maplefemme: thanks for the kind words. Last night I was really sad, but better this morning. Your work is hard, there are not many people that can do hospice for extended periods of time, it takes a special courage to do that on a daily basis.

 

[maplefemme]

good a.m., all!

smit, the only reason i think the dr was wrong is that the patient and family directive were in writing and legally he was obligated to follow it. i have no problem when the patient and/or family make "the" decision to not prolong medical treatment.

my husband's father in AU had something similar but there the drs were up front and very clear about what they would do for him and what they would not do for him. his condition was such that there was never going to be a positive prognosis and everyone including my FIL knew it. didn't matter what his directive might have been because his medical plan was outlined and clear. they were not going to throw resources at someone that wasn't going to live long. no one had a problem with that. he did live longer than they predicted but it was still the right decision....and they did provide him with good care until his death.

alley and maple: if i'm ever in canada i want to know i can find you! wish there was a way to personally e-mail you. i do miss that function here on pricescope. i participate on other forums that offer it and i use it. i realize pricescope had "problems" but the other forum i am on do not seem to have experienced the same issue. i do hope that pricescope will revisit this and come up with a way to restore the private e-mail feature w/o compromising "security". if others can do it, i'm sure the pricescope administrative crew can do it, too.

maple: my dad tells the story of an old vet that he used to visit that was diabetic. one day he asked for his favorite sweet and everyone knew he was "ready". the joke in the family is that if my dad asks for "x", then we know he's ready to go....dad turns 88 march 4.

Movie zombie, I think it all boils down to dying with dignity, if there's absolutely no hope for quality of life or life at all. Sounds like your Dad is holding strong and I'm sure at 88 he has a plethora of storįes!
If you're on Facebook, Move zombie, and have Good Old Gold as a friend, you can find me on there, I just commented on Rhino's latest fancy colored AVC picture (what a beauty it is!) I'm Naomi

 

[Kaleigh]

I will start by saying I didn't read the whole thread. Just your initial post. I have been an advocate for many family members, and have a lot of medical knowledge, not my choice, just circumstances have made me learn a lot.

I think she is out of line. Behaved very badly. Peoples lives are at stake. Follow the rules period. She took an oathe so she needs to revisit that.

You can't sort out personal issues w/her. Being a Doc means you put that stuff aside and do the job that you are entrusted to do....

Oh I feel for you. I have many friends that are docs, I know the scheduling is hard to do but..... You sign up for this by being a Doc , so shame on her.

 

[wyndham]

Hi Ally,
My husband is an attending now but I vividly remember his residency, and I don't envy you right now. It's a tough job...and unfortunately it only gets more difficult when you're a fellow / attending!

This situation is ridiculous and unprofessional...on BOTH sides. I would address J again (either in person or via email) and tell her that under no uncertain terms will you be doing hours of extra work so that she can shirk her professional responsibilities by not giving you signout. You are enabling her behavior by not paging / calling / texting / emailing her repeatedly when you need to obtain signout from her...you need to stop avoiding the situation and address it head-on. My husband would never page someone once and then say "oh well, they didn't call me back...let me go round on my own." Absolutely not! He would page and call them again...and again...and again. It is HER responsibility to transition her patient list to you (just as it is YOURS to get it from her), and by not doing that you are both complicit in allowing important components of patient care to fall between the cracks.

If she refuses to give you signout even after you page / call her repeatedly, you need to write her an email saying "I have paged you XX times and called you XX times this evening; I need signout ASAP. Please call me immediately." If that doesn't get a response from her, reply again and cc your chief resident. I know you said that he's ambivalent, but he can't be ambivalent when you send him a written record of her misbehavior. If that doesn't get her to comply, you need to involve your program director. You're right that he or she probably won't want to get involved in petty politics, but your emails will serve as proof that this is a recurring and pressing issue that needs to be escalated beyond just you and the chief resident. Imagine if something goes wrong with one of your patients -- really wrong -- and you get hauled into your program director's office. Can you imagine what his / her response would be if you tried to say, "oh it's not my fault, J didn't give me signout"? You're in charge of the patients on your service, period. You need to get the information from her for continuity of care...doing your own rounding is a waste of time, and even then things can STILL fall between the cracks if the doctors have not discussed a patient's action plan.

Good luck with the situation -- I don't envy you, but unfortunately getting signout is not optional, so you need to make her cooperate. Hope she sees the light when you confront her!

 

[allycat0303]

Wyndham,

When this all began, I did page her/text. So much so that the operator eventually told me to stop paging her. That was before I spoke to the chief. At this point I don't even think its worth it. Her sign out will undoubtedly consist of, "everything is fine" no one can regulate what she says. If anything I would go to the resident federation they take complaints on ethical conduct, but I doubt it will come to much. We had a resident 2 years ago, who refused to write any notes on his patients (including an or note). He was reprimanded by program director, the DPS and the federation, and guess what? He graduated without EVER writing a single note. Most our checks don't have any teeth. Probably the only one that could do something is the Director of the Service. Theoretically he can kick her out of the program but that has NEVER happened (even to the guy who stole drugs from anesthesia and passed out cold in the OR as they were prepping the patient. He'd nearly OD and spent 2-3 days in ICU.

Did you hear about the cardiologist who murdered his two kids in Quebec? He was found innocent by insanity.... Fine... Miscarriage of justice. But he's going to petition to get his liscence back, and he probably WILL succeed. He's insane enough that he can murder his two children and not be responsible, but he should be taking care of patients.

 

[allycat0303]

http://www.nationalpost.com/related/topics/index.html?subject=Guy+Turcotte&type=Person

Doctors getting away with murder....literally. Not the case, but shows the kind of mentality here in Quebec

 

[movie zombie]

maple/naomi, i don't FB.....one of the disadvantages is in this instance. sigh.

i don't trust the pharmaceutical companies and i don't trust their control over drs.
i'm allergic to EDTA and its in my medical records. despite that i've had drs order medication for me with it in it.
i have to quiz pharmacists and even then i go online and research.
paranoid?! no, just very very cautious.

my FIL understood why the drs in AU put the limits. the entire family understood.

with my dad, well, he's a stubborn WWII veteran Marine....with bullets still in his body. he won't let my mother go into the room with him because she's a bulldog for getting info. you should see the two of us when my dad has been hospitalized and a dr walks into the room.....between my mother and i the dr doesn't have a chance..

eta: geez, alley, i thought things were screwy here....that blows my mind!

 

[wyndham]

Wow, Ally...sounds like things are pretty different where you are! I can't imagine any of those scenarios happening here and that person still being allowed to remotely practice medicine. That's really tragic about the doctor who murdered his two kids.

I realized after I responded that your question was about how to deal with J as a person, not as a colleague. My answer to that is pretty simple: ignore her unless you have to interact with her for professional reasons, and then keep your interactions courteous but professional. This person has made it abundantly clear that she's not your friend, and I can't imagine you'd want her in your life seeing as what a bad friend and colleague she is. Unfortunately you can't control the schedule for next year, but given how she's treating you I think it would be a fair assumption that she's not going to try to spend any more time with you than is necessary...something that should make you both happy!

Good luck to you!