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  • Taking work home?

    My colleague recently told me that he’s had problems with excessively thinking/ruminating about cases he’s read from days before and whether he made the right call, or examined certain anatomy as part of his search pattern.  Sometimes he gets stuck at work and checks his work at home a second time.   He’s been out of training for years so I don’t think this is an experience issue.  I didn’t know what to say to him but not sure if this is normal since most physicians wouldn’t talk about stuff like this.  What do you guys think and is this part of the normal stress of being a physician for some, or does this cross the line?

  • #2
    I think it depends on how much time he's spending doing this and the level of distress it causes him. I'm a psychiatrist and I work with a fair number of docs so this could be nothing or it could be anxiety or OCD. I personally think about my patients and what they are doing or going through and what I can say to them or how I should approach a subject with them but this doesn't stress me out. I think it's actually helpful to me to be more thoughtful as I talk with them. And it doesn't keep me from being present with my family.

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    • #3
      It’s concerning for a radiologist because our work requires an ability to make a call and “move on.”

      Is he missing stuff? Has he had a bad miss recently?

      I saw a similar situation once with a radiologist colleague, who was being sued after a bad outcome, with questionable liability. Sent the person into a downward spiral that took a few years to come out of.

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      • #4
        Both great points above. Sounds like anxiety/ocd (not psych) but whats likely more important is if its new behavior and if so then what is the underlying driver? A miss, lawsuit, marital stress etc...could easily cause that kind of distress. Probably best it gets taken care of before it becomes more ingrained or debilitating.

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        • #5
          A lot of time I will follow patients that I admit that needed further testing out of curiosity but it isn't something I obsess over. Has he recently been sued or have a bad case come up on peer review?

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          • #6
            He is an employee in a competitive metro area.  He works in a hospital with a tough qa program and malignant culture.  He tells me this has been going on for years and fluctuates in severity.  No recent lawsuits.    Maybe he is prone to this problem and the job instability and malignant environment made it come out?  I’m no psychiatrist.

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            • #7
              The action is concerning, as is the fact that he seemingly brought it up to you. That would be difficult for a lot of people.

              Is the work he’s doing all well within his scope of competence? Or is he being asked to stretch his abilities?

              I don’t know what I’d do or say about it. But I wouldn’t ignore it.

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              • #8
                I think that second sentence may explain everything. If he doesn’t have tough skin (many people do not) and you place that personality into a malignant qa culture , I can understand why this is bothering him/her. It would certainly bother me I’m sure. I haven’t been in that situation as an attending, but I always think the malignant qa culture is counter productive and fuels defensive medicine.

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                • #9
                  He’s a real good safe doc who many others consult.  I bet no one suspects he has issues.  That’s why I asked here to see if this is a result of a stressful job in a stressful environment,  He did have some issues with productivity a while back but has gotten better and admin has left him alone now,   I’ve known him for many years so I think he feels safe with me.

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                  • #10
                    I think that would be a difficult thing to bring up with a colleague, so the fact that he did says something, and I would expect that it bothers him even more than he states.  He might not know who to tell and feels like he needs to at least let someone else know?  I'm also no psychiatrist, but I would suggest just listening, let him know that you really respect him and are thankful to have him as a colleague, and if as you listen you get the feeling  that he needs to talk to a professional, find a way to suggest that as a normal option that many physicians need to do to help with the stress of the job.

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                    • #11




                      I think that second sentence may explain everything. If he doesn’t have tough skin (many people do not) and you place that personality into a malignant qa culture , I can understand why this is bothering him/her. It would certainly bother me I’m sure. I haven’t been in that situation as an attending, but I always think the malignant qa culture is counter productive and fuels defensive medicine.
                      Click to expand...


                      As a younger attending, I've never understood the malignant QA/QI culture. It doesn't improve anything and most likely only makes things worse. We all make mistakes so there's no reason trying to rub somebody's nose in one that you would have possibly made yourself if it had been you as the treating physician in a particular scenario.

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                      • #12
                        Sometimes this can be s confidence issue. Mix that with some OCD, bad culture, and burnout and you probably have your friend. I would personally talk to him more to see if he'd open up more about the underlying issues and direct help where appropriate.

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                        • #13
                          Imposter syndrome, perhaps?

                          Combine that with mid-life crisis (it's real) and a malignant culture... a recipe for self-doubt and second-guessing.

                          The fact that you are asking if it crosses the line is highly concerning to me:  I think we all complain about our jobs or have down days, but obviously your gut is that this isn't ok or you wouldn't be asking.  I could very well be overreacting, but if I were in the situation, I'd clear my schedule STAT to sit down and talk with your friend to dig deeper.  It might be nothing, or you could save his life.

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                          • #14
                            As a pathologist, I completely understand your colleague. I'll think about cases at home occasionally too. Just part of the job for me, knowing that when certain things are taken out, my interpretation determines whether a patient will get chemo or be sent on their way. I understand that stress. Now before we all give him a clinical diagnosis, you need to know how much it interferes with his life outside of work. Is he relaxing on the couch, wondering if he checked the pancreas on that CT or is he at his kid's soccer game in a panic knowing he missed something?
                            What helps me is to follow a consistent routine. Know the clinical story, know what whoever took the biopsy (or radiograph in this case) is looking for, and do due diligence on every case. But as we say in path, it's not the case you worry about where you get sued... It's the ones you just blow by... Maybe don't tell him that though.

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                            • #15
                              I went into Emergency Medicine so that when the doors open and my first foot hits the ambulance ramp I can shut off my work brain and not turn it back on until the next shift.  If an experienced radiologist is still worrying about cases days later that can't be healthy.  A little OCD makes you thorough but there is no added value to that much worry.

                              The fact that your colleague opened up to you means he trusts you.  If you want him to open up even more you could consider talking to him about your stresses at work so that he feels like he's not alone.

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