Surprise mtg w/ chief of service and admin. Should I have lawyer present?

[OSman]

I'm the chair of my dept and I would find it very unusual if one of my medical staff brought a lawyer in to a meeting I requested to just discuss a dept concern. Look at it as an informational meeting, you don't have to commit to anything. If they are asking for some sort of concession ask for some time to think it over. Bringing a lawyer would be viewed as an inappropriate and aggressive move.

Would you also refuse to say what the meeting is about though? It is clear they are not going to give me specifics so I have no way to prepare or try and recollect the events. That is what seems so shady to me. Not the meeting itself.

[Larry Ragman]

Supporting K82 here, a lawyer would escalate in ways the OP made not be made aware of until later. It also doesn't matter much. This isn't a legal meeting, it is an administrative one. That said, I agree with those who say to listen respectfully and admit no fault. The thing that I find vexing about these sorts of situations, from either side, is that there is a lot of implications and inference. If there is a complaint, ask for a copy. Even if not, make them spell out any issues clearly. Maybe the concerns here are all overblown. (Maybe not.) If they ask you to sign something, politely ask for time to have it reviewed.

[fatlittlepig]

i'm in the camp that you're doing something wrong whether you want to acknowledge it yourself or not.

[K82]

Would you also refuse to say what the meeting is about though? It is clear they are not going to give me specifics so I have no way to prepare or try and recollect the events. That is what seems so shady to me. Not the meeting itself.

It depends on the Doc I'm interacting with and my previous experiences with them. I may just say "there has been a concern raised that we need to talk about". At the meeting I will go into detail of the problem and evaluate appropriate courses of action. I wouldn't pressure a Doc to make any significant decisions at that first meeting.

[Zaphod]

This is a reasonable thing to ask me to consider. And believe me, I am always looking inwardly and take as much responsibility as I can. However, the practice of medicine in the hospital setting now is not compatible with a provider who demands care for patients equivalent to that which they'd like to receive themselves. At least that's the case where I work. When those demands for excellent care are perceived as creating "hostile" working environments and no attempt is made by administration to accommodate the providers... all in the name of "Just Culture", not much else one can do other than have these meetings every so often. Obviously an exit is in the works but I need to protect my name/interests while still employed.

You can tell yourself this, or you can fix the situation.

You either work within the bounds of the system you're in, providing as excellent of care as possible, or you quit. Or, you do the job without being rude or unnecessary inflammatory towards people that probably cant change anything. This is a recipe for disaster.

Even if your comments are true, I cannot express how true two separate but linked things are. You will not change them by complaining at all, and especially if theyre true, you are annoying people that will find a way to deal with you and you will have little recourse.

Accept the game on its terms or make your own.

Please dont take this as an accusation that "you did something", its just the situation makes no sense from a personal standpoint.

The rhetoric about pt care is the first grasp of someone that is either complaining and generally in a bad mood all the time or that has acted inappropriately. At best its simply a misunderstanding of the system you're in and its limitations.

You can accept them, get yourself into issues, or move on from it. 2/3 of those are good situations, one makes you miserable. I am personally a complainer, I see all kinds of inefficiencies and dumb stuff done. Amount of things I've said, zero. I go to work at these places, find the best way to give my patients the care they need with a smile and treating everyone nicely how I'd like to be.

To do things your way, start your own practice, stop torturing yourself.

[Dusn]

I hate to say this but many times if you’re not actually in a position of authority, you can’t actually demand that other hospital staff provide better care for patients and it’s even very tricky to suggest ways that they can improve their care without them getting upset.

Ideally, authority would be based upon clinical knowledge and the ability and compassion to provide great care to patients. But it’s nothing like that in the real world. Even if they wanted to, most administrators and most hospital staff don’t know enough to judge good clinical knowledge in your field anyway.

In most hospitals, you provide good patient care on your own time. The administrators and many other staff only care that you’re not making their lives any more difficult.

[MaxPower]

this is what i have done my entire career: treat everyone you come across from custodians, physical therapists, discharge planners, nurses, random people moving supplies in the hallway as an equal, and with respect and kindness. bad behavior can't be justified by (i was demanding excellent care for my patients: we all are but we have to behave respectfully and professionally).

I don’t think it’s mutually exclusive to treat people with respect but also call them out when they screw up. Real harm can be done to people by well intentioned but incompetent or uncaring staff.

An example from me just this week—did a hip hemi on an extremely sick mid 60s lady with bad COPD, on 4L at baseline for a hip fracture. 2nd night post op, the night nurse took her out of her hip abduction pillow because “she couldn’t tolerate it” and the patient dislocated overnight. So I had to take her back to the OR, another general anesthetic, and open reduce this dislocation all because the nurse disregarded my order, all at not inconsequential risk to the patient.

I didn’t yell at the nurse but I asked her why she did it and got after her a little bit for disregarding the order. If she’s a snowflake she could report me for an “inappropriate interaction” and I would be in trouble for that? I agree there are respectful ways to handle things, but not everyone is going to take criticism, constructive or not, in the manner in which it might have been intended.

[fatlittlepig]

I don’t think it’s mutually exclusive to treat people with respect but also call them out when they screw up. Real harm can be done to people by well intentioned but incompetent or uncaring staff.

An example from me just this week—did a hip hemi on an extremely sick mid 60s lady with bad COPD, on 4L at baseline for a hip fracture. 2nd night post op, the night nurse took her out of her hip abduction pillow because “she couldn’t tolerate it” and the patient dislocated overnight. So I had to take her back to the OR, another general anesthetic, and open reduce this dislocation all because the nurse disregarded my order, all at not inconsequential risk to the patient.

I didn’t yell at the nurse but I asked her why she did it and got after her a little bit for disregarding the order. If she’s a snowflake she could report me for an “inappropriate interaction” and I would be in trouble for that? I agree there are respectful ways to handle things, but not everyone is going to take criticism, constructive or not, in the manner in which it might have been intended.

There's a way to give feedback where the feedback receiver does not feel threatened and feels respected and valued, it's a good skill to have when speaking to what you call incompetent and uncaring staff. yes you did the surgery but guess who took care of that patient for the other 23 hrs and 59 minutes of the day when you are rounding.

[Zaphod]

I hate to say this but many times if you’re not actually in a position of authority, you can’t actually demand that other hospital staff provide better care for patients and it’s even very tricky to suggest ways that they can improve their care without them getting upset.

Ideally, authority would be based upon clinical knowledge and the ability and compassion to provide great care to patients. But it’s nothing like that in the real world. Even if they wanted to, most administrators and most hospital staff don’t know enough to judge good clinical knowledge in your field anyway.

In most hospitals, you provide good patient care on your own time. The administrators and many other staff only care that you’re not making their lives any more difficult.

exactly

[SerrateAndDominate]

Agree with what others have said. We don't know the full details nor need to, but be open minded, listen, and show the right non-verbal reactions. I'm admittedly bad about an unintended RBF.

I've never been in one of these situations, but if I lived in a one-party consent state regarding recording, I'd consider making a record of things. Of course, your work contract or other hospital rules may already forfeit that right. Lawyers on here can chime in on that part.

[childay]

What sort of administrator are we talking about?
Agree with above, no lawyer at this point.
I generally avoid such issues similar to Zaphod, but do not underestimate the lengths personality disordered mid-level managers may go to
On the other side have seen very egregious physician behavior with minimal consequence ultimately

[G]

agree with others that it is unfortunate that the only time you see these folks is when something has gone wrong.

no attorney, unless they change the guest list and show up with counsel.

I've been in these situations before--sometimes it really is informational or fact-gathering. if it isn't, keep your mouth shut, don't volunteer info, and stick to the documents...just like a deposition.

to the younger physicians out there: this is a good advertisement for the value of being involved in med staff leadership. how do you think the dynamic changes when you just finished a QI project with the chief and the last charity fundraiser had you eating dinner next to that hospital bureaucrat and having drinks with her husband?

and for OSman...I am agnostic about your situation, but if you are that passionate about things, you should seek a leadership role. rocking the boat at that level is (can be) considered visionary or transformational...rocking the boat as a pit doc is considered a PITA.

--best wishes, (presently) a PITA pit doc

[StateOfMyHead]

I hate to say this but many times if you’re not actually in a position of authority, you can’t actually demand that other hospital staff provide better care for patients and it’s even very tricky to suggest ways that they can improve their care without them getting upset.

Ideally, authority would be based upon clinical knowledge and the ability and compassion to provide great care to patients. But it’s nothing like that in the real world. Even if they wanted to, most administrators and most hospital staff don’t know enough to judge good clinical knowledge in your field anyway.

In most hospitals, you provide good patient care on your own time. The administrators and many other staff only care that you’re not making their lives any more difficult.

Totally agree but find it depressing to accept.

[DrSam]

Agree with others who say don't bring a lawyer....don't admit to any fault or sign anything etc.
Agree with others that frequently the doctor needs to self-reflect and find ways to improve his/her own behaviors
Don't agree with others who are quick to assume that the fault here lies with OSman. Not saying it doesn't, but my own experiences inform me that this is an improper assumption to make. I've personally worked in a lot of different environments and not had even the slightest hints of any issues. I've worked in a few however where one or two people who have the ears of the higher-ups, seem to delight in stirring up sh*t. Bullying is not limited to grade school.

One thing I will comment on is the way this is being handled by OSman's higher ups. This "We need to have a meeting...but I won't tell you what it's about ahead of time" is absolute and utter B.S in my opinion. I've experienced that sort of thing myself a few times and witnessed it pulled on others. In my case, it has typically been done along the lines of a message conveyed to me via a nurse or receptionist telling me on a Friday afternoon "So and so's secretary just called and you have been scheduled for a meeting with him at 8am on Monday." When I immediately call "So and so" to see what's up, I get..."Oh, I'm sorry. You just missed him. He's gone for the weekend, but will see you at 8am sharp on Monday." I've seen the same or very similar done to others. What an absolute passive-aggressive a$$hole move. As much as you attempt to compartmentalize your thoughts, and leave work at work, that sort of thing is absolutely guaranteed (and calculated to be in my opinion) to ruin your weekend, cause you to lose sleep wondering what is going on, cause you to post messages on the internet asking if you need a lawyer, etc.

Several years ago, I had this type of thing pulled on me on a Friday afternoon just before my wife I were scheduled to fly out of the country for a short vacation that she had been planning for months. Meeting dumped on me was scheduled for 8am the day I returned from vacation. Vacation was basically ruined for both of us.

If you are in a position of leadership, DON'T DO THAT CRAP! If you do, you suck. Fine, you don't want to get into all the nitty gritty details with me ahead of time, but if you want a meeting with me, show me the same level or courtesy and respect you would want if you were in my shoes.

[Larry Ragman]

Agree with others who say don't bring a lawyer....don't admit to any fault or sign anything etc.
Agree with others that frequently the doctor needs to self-reflect and find ways to improve his/her own behaviors
Don't agree with others who are quick to assume that the fault here lies with OSman. Not saying it doesn't, but my own experiences inform me that this is an improper assumption to make. I've personally worked in a lot of different environments and not had even the slightest hints of any issues. I've worked in a few however where one or two people who have the ears of the higher-ups, seem to delight in stirring up sh*t. Bullying is not limited to grade school.

One thing I will comment on is the way this is being handled by OSman's higher ups. This "We need to have a meeting...but I won't tell you what it's about ahead of time" is absolute and utter B.S in my opinion. I've experienced that sort of thing myself a few times and witnessed it pulled on others. In my case, it has typically been done along the lines of a message conveyed to me via a nurse or receptionist telling me on a Friday afternoon "So and so's secretary just called and you have been scheduled for a meeting with him at 8am on Monday." When I immediately call "So and so" to see what's up, I get..."Oh, I'm sorry. You just missed him. He's gone for the weekend, but will see you at 8am sharp on Monday." I've seen the same or very similar done to others. What an absolute passive-aggressive a$$hole move. As much as you attempt to compartmentalize your thoughts, and leave work at work, that sort of thing is absolutely guaranteed (and calculated to be in my opinion) to ruin your weekend, cause you to lose sleep wondering what is going on, cause you to post messages on the internet asking if you need a lawyer, etc.

Several years ago, I had this type of thing pulled on me on a Friday afternoon just before my wife I were scheduled to fly out of the country for a short vacation that she had been planning for months. Meeting dumped on me was scheduled for 8am the day I returned from vacation. Vacation was basically ruined for both of us.

If you are in a position of leadership, DON'T DO THAT CRAP! If you do, you suck. Fine, you don't want to get into all the nitty gritty details with me ahead of time, but if you want a meeting with me, show me the same level or courtesy and respect you would want if you were in my shoes.

Leadership at fault in this scenario for sure, but you always have the option to decline the meeting.