They should make a TV show about this…oh wait

May 6, 2010 at 9:48 pm | Posted in Uncategorized | 2 Comments

Even though I’ve been preoccupied with other things outside of work, work itself is still pretty interesting. And my focus is much better, despite the fact that my life just got significantly more complicated. Somehow it’s much easier to handle the uncertainty of finding a solution to a problem, than the uncertainty of defining the problem that needs solving. But then again, that’s why I’m a surgeon and not an internist.

So my program just fired a mid-level resident. The resident in question had excellent surgical skills, but was pretty deficient in basic doctoring skills like establishing rapport with patients and team members, handling criticism (which admittedly is more of a challenge when the purpose is not constructive), making training-level-appropriate decisions, and self-education. There was definite improvement over the year, so clearly this resident is trainable, but I think there comes a point where people have just made up their minds, and they’re better off leaving voluntarily and finding another program.

On the one hand, there’s a palpable sense of relief that the situation has finally been resolved. Even though it means we all have to work that much harder, and take that much more call, we were all so tired of the drama that it almost doesn’t matter. I say almost because q2 call does indeed suck, and the juniors take the brunt of it. And now one of the other juniors is having an extended family emergency and is out for an unknown duration of time. So we’re down two people right now. But I don’t mind the first situation, and we’re all sympathetic to the second, so everyone’s pitching in to cover as needed.

However, the program is now without a scapegoat, and there’s a fascinating dynamic at work these days. Everyone is jockeying not to become the new scapegoat, and actively trying to ensure that the role falls on someone else. As the most junior person here, I am of course in the running. But it seems like everyone’s getting their turn in the hot seat, which is how it works in a generally functional group. Or at least one that’s not totally dysfunctional. Of course, the dysfunctional portion of this dynamic is the jockeying among the residents. In my view, we should present a unified front and contain the squabbling amongst ourselves. But that’s got to come from the chief down, not the other way around.

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I know I’ve said this before, but as someone who trains first-years in basic science and then sends them on their merry way towards the clinics, it is fascinating to read about what happens to them there.

Comment by Comrade PhysioProf— May 7, 2010 #

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When I was a resident, we were very strict about resident behavior. It was unacceptable to ever “complain” about another resident directly to the attending. All resident perceived issues were brought to the chief resident’s attention and swiftly dealt with by the chief resident. The issue died there if the resident knew what was good for them. If a resident ever did an end-around the chief resident, there was severe consequences.

It helped that the attendings bought into this system, not really wanting to deal with the squable issues and very much preferring the chief residents to insulate them from it. That meant the chiefs had real authority because what they said was law.

The job of the chief was to be fair and even-handed and not to pick favorites.

I remember having a resident who wasn’t performing up to the usual standard, don’t remember the details, he had been corrected several times already. We (myself and the other chief) finally threatened to send him home and suspend him for a week. He would be unwelcome on rounds, on call, and wouldn’t be assigned to any OR cases and would be expected not to be in the hospital. We also were very clear that all resident issues stayed with the residents and that we would not tell the chairman or other attendings that we had suspended him. But we also told him that eventually they would notice that he wasn’t around and would ask about it and since you can’t lie to the attendings it meant the attending would hear the whole issue leading up to and including the suspension.

It finally sunk in, and he turned it around, and performed much better after that. Fear sometimes works when nothing else will. Most importantly, there was no question on the resident’s part that the Chief resident had the authority to discipline in such a fashion.

Comment by RJ— May 7, 2010 #

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Hurricane Jill