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

[DrSam]

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

That option can be a bit more or less firm depending upon one's circumstances, particularly in an employed position. I mean, sure you obviously always have options, but realistically, sometimes the potential consequences are somewhat prohibitive.

Beyond that, declining (or more realistically postponing) such a meeting really only has the effect of kicking the can down the road and prolonging the period of time during which you experience stress and anxiety wondering what this meeting is all about.

[MPMD]

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.

these situations change pretty drastically when there has been a clearly documented negative event. it doesn't mean that you can scream and throw office supplies but it does change the calculus. i would still be very hesitant to "get after" a bedside nurse without a third party present from higher up the food chain -- nurse manager, unit supervisor etc.

to the OP: no lawyer. i agree with what others have said about figuring out why this has happened a couple of times. unless you can truly convince yourself these are isolated personality conflicts (which do happen) then i would commit right now to paying for one of the coaching services jim advertises (no financial relationship with either entity). every time a doc is in trouble they always bring it back to patient care. it's not that it's wrong it's just that it's the catch all excuse even when it's obviously incorrect.

fwiw i got taken to the principals office once my first year as an attending and i definitely deserved it. i spent an insane amount of time making sure that would never happen again. i didn't have professional help but if i would have needed it it would have been money well spent.

a good rule of thumb for docs is that you just can't direct negative emotions at staff at work under almost any circumstances. sounds extreme but it's good leadership. follow the Omar Little rule from the Wire, "if you come at the king, you best not miss." there will be times when you need to raise concerns about staff members, potentially even to their faces, but this must always be done in a way that leaves you protected and in the right. 99.9% of the time this involves all fact and no emotion. this is basic HR stuff here that any really successful leader in medicine will agree with.

[Hatton]

It is very hard to make an intelligent comment here since no except the OP knows what we are really talking about. I was a department chief at my hospital for a few years. A less formal watch out meeting would involve just me and the doc. A behavioural issue could be discussed or a clinical concern could be expressed. If the meeting involved me and an administrator in the "principal's office" then something was egregious or repetitive. My advice is to not bring a lawyer to this initial meeting. I would not record it either. I would try to remain calm. Do not become hostile. Find out what the problem is. Fact find. If false claims are being made then defend yourself with facts. Depending on what you find out you may need a lawyer. It is possible this is not as bad as you think. There are physicians and administrators who seem to enjoy using their powers over employed physicians. Please report back about the meeting.

[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.

Want to know what may have happened? Perhaps the patient actually could not tolerate a wedge lodged between her legs after having surgery. Would you have sedated an severe copd patient with Ativan possibly suppressing respiratory drive to keep the pillow between her legs, should the nurse have restrained her? I don’t know. But I do know that the reason had nothing to do with incompetence or uncaring. People for the most part are doing the best they can and deserve to be treated as such.

[ENT Doc]

Well, good luck. And let us know how it turns out.

[GastroMastro]

I learned a lot from all of these posts. I’ve been burned by a few staff who weren’t doing their job acceptably, but who somehow turned the tables on me for being snarky about it. Either way, you lose!

[MaxPower]

Want to know what may have happened? Perhaps the patient actually could not tolerate a wedge lodged between her legs after having surgery. Would you have sedated an severe copd patient with Ativan possibly suppressing respiratory drive to keep the pillow between her legs, should the nurse have restrained her? I don’t know. But I do know that the reason had nothing to do with incompetence or uncaring. People for the most part are doing the best they can and deserve to be treated as such.

Or maybe the nurse could have called me to come look at it and see if something could be modified, or even asked me if it was ok, instead of just going “against doctor’s orders” and doing what she wanted to make her night easier.

I love how you replied twice to the same message from me.

[fatlittlepig]

Or maybe the nurse could have called me to come look at it and see if something could be modified, or even asked me if it was ok, instead of just going “against doctor’s orders” and doing what she wanted to make her night easier.

I love how you replied twice to the same message from me.

The middle of the night phone call may have prompted an interesting response from you thereby explaining why said phone call was not placed.

[MaxPower]

The middle of the night phone call may have prompted an interesting response from you thereby explaining why said phone call was not placed.

Lots of assumptions about someone you’ve never met before.

[OSman]

Lots of assumptions about someone you’ve never met before.

Yeah I've been impressed with everyone's input here except fat pig. Has otherwise been a very productive discussion and I really appreciate everyone's input. I'm just laying low for the moment... the guy won't respond to my query as to the nature of the meeting so for now I'm not going to plan for a meeting. When it happens I will certainly keep everyone posted.

[fatlittlepig]

That sometimes happens when we hear something we don’t want to hear or are not ready to hear. It’s ok. Good luck.

[jacoavlu]

consider perusing your med staff bylaws. Sometimes there are official processes that are supposed to be followed for particular situations. I’ve seen official processes play out and I’ve also seen situations where people try to avoid a codified process for one reason or another. It can only help to have some awareness.

[Larry Ragman]

That option can be a bit more or less firm depending upon one's circumstances, particularly in an employed position. I mean, sure you obviously always have options, but realistically, sometimes the potential consequences are somewhat prohibitive.

Beyond that, declining (or more realistically postponing) such a meeting really only has the effect of kicking the can down the road and prolonging the period of time during which you experience stress and anxiety wondering what this meeting is all about.

OK, I hear you. But why give a jerk of a boss that sort of power over you state of mind? I’ve been in the Navy; I’ve had bosses. It is very difficult for anyone to hurt you in a work situation if you don’t let them. Take the meeting when it is convenient (within reason here of course - but a Friday summons to a Monday meeting if you are going out of town is not), listen attentively, and respond appropriately.

[tailwind225]

For better or worse, the outcome of the meeting has likely already been decided though, it can be made worse if you are not cooperative. If this is your second offense/event, there is already probably a plan of how this will be remedied. They won’t just be making it up at the meeting as their actions could be under scrutiny if you decide to get counsel later. They will be following hospital policy to a tee and checking the bylaws is a good idea as someone suggested. Best thing you can do at this point is be extremely cooperative, listen and let them know you will make sure you arent in this situation again, and whatever issue is causing this, fix it immediately.

[GastroMastro]

The middle of the night phone call may have prompted an interesting response from you thereby explaining why said phone call was not placed.

FLP, you are basically trolling MaxPower at this point. This nurse clearly made an egregious error and clear disregard for a physician's orders resulting in a major, major complication, to the point that she potentially could (should?) face nursing board disciplinary action if this were to ever be reported.

For how much nurse's fret about following the rules, documenting every little thing, etc, that sure didn't happen in this hip case.