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

[VentAlarm]

I agree with FLP insofar as I believe you should treat all staff with respect, but I also treat all staff like they could file a complaint. That’s not to say I don’t directly confront people who screw up. If I have a nurse who makes a mistake, I tell them directly and explain how it is directly linked with an actual or potential poor outcome. I will ask what the issue was and seek to understand. I also explain what the right move would have been in that situation. In the case of MaxPower, I would have asked why the PRN pain meds wasn’t give or I wasn’t called as those steps should have been taken. I would have asked if there was anything I wasn’t aware of (maybe she tried to page you and it didn’t go through or had the wrong doctor in the call list). But that doesn’t mean everything is cool.

I don’t yell or call names, but I also don’t let people hurt my patients. Allowing incompetent staff to harm my patients for the sake of “showing respect” isn’t showing respect, it’s cowardice. I’ve had RTs screw up the vent and damned near kill people - I will tell them to not touch my vent again without talking to me. If they want to file a complaint about that, I’m happy discuss their attempted murder and ask their boss what a better solution would be (?hire only competent staff).

I have had one complaint filed against me where I admittedly lost my cool - that being said, the reason I lost my cool was that the person who filed the complaint made an egregious mistake and raised her voice at me.

I think it’s good we don’t still live in the age where doctors are 100% unquestioned and can yell and throw scalpels. It’s better for patients. But I think we’ve gone too far the other directions. Orders aren’t suggestions, and treating them as such is bad for patients. At the end of the day, that’s what we all care out - the patients.

[tailwind225]

Also, usually second offense, unless egregious does not lead to loss of privileges or termination for cause in most organizations. There would be too many docs on the medical staff who have 2 offenses. Usually first offense is warning, second offense is to tell you “hey this is serious and your final warning” they third or more could be termination. Too risky for them otherwise. They need to be able to prove consistent pattern to back up severe action for a “for cause” termination. If they only have two offenses documented, they would have to be perfectly documented with no question of you being at fault. Not worth the risk for them. If they have 3 well documented infractions, it shows a pattern and even if one can be argued successfully, if well documented, it is unlikely all could be challenged successfully.

[fatlittlepig]

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.

Read my post again. These things are rarely clear cut and can be explained without invoking malice or intentional disregard for patient welfare. I guess you could chastise the nurse, report her to the chief nursing officer and nursing board, but here’s what I would do: “Hey next time there’s an issue with the hip abductor pillow, just give me a call or call the on call hospitalist, call at any hour” Either way, feedback is given. Ultimately how we treat people is a reflection of our values, and a reflection of our profession.

[Anne]

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.

I agree. Why not practice it here when addressing fellow physicians who may have slipped up in being their absolute best in a moment of frustration despite being an excellent caring physician?

[OSman]

Also, usually second offense, unless egregious does not lead to loss of privileges or termination for cause in most organizations. There would be too many docs on the medical staff who have 2 offenses. Usually first offense is warning, second offense is to tell you “hey this is serious and your final warning” they third or more could be termination. Too risky for them otherwise. They need to be able to prove consistent pattern to back up severe action for a “for cause” termination. If they only have two offenses documented, they would have to be perfectly documented with no question of you being at fault. Not worth the risk for them. If they have 3 well documented infractions, it shows a pattern and even if one can be argued successfully, if well documented, it is unlikely all could be challenged successfully.

My gripe with round one is they clearly did not speak to all parties who were witness to the event (including my NP who expressed willingness to give testimony). So as far as I'm concerned, it feels like a witch-hunt. If a nurse said it happened then it must have happened, period, the end. It's hard to have respect for the system and feel like I should change as a result of that. I really don't know what this is about but I'll be surprised if they've interviewed anyone that was around to corroberate the story. Ultimately @zyphod is right. The move is to get out. He's been coaching me on the matter for years. Fortunately I'm in a private practice friendly field and even have an employment offer in hand. My days in the hospital (and my one doctor department) are numbered in one way or another. Thank God for non enforceable non compete states!

[VentAlarm]

My gripe with round one is they clearly did not speak to all parties who were witness to the event (including my NP who expressed willingness to give testimony). So as far as I'm concerned, it feels like a witch-hunt. If a nurse said it happened then it must have happened, period, the end. It's hard to have respect for the system and feel like I should change as a result of that. I really don't know what this is about but I'll be surprised if they've interviewed anyone that was around to corroberate the story. Ultimately @zyphod is right. The move is to get out. He's been coaching me on the matter for years. Fortunately I'm in a private practice friendly field and even have an employment offer in hand. My days in the hospital (and my one doctor department) are numbered in one way or another. Thank God for non enforceable non compete states!

I think it’s great that you have another offer, but don’t make any rash decisions if you otherwise like your job. You probably come off harsher than you mean (this comes from someone who’s wife tells me I frequently do this), but if you didn’t have problems through med school and residency, and the very fact that you brought this to the forum, suggests this isn’t a long-standing personality disorder. You’re probably just a little gruff and in a place that is a little too snow-flakey for you and you have an admin that is too quick to place blame. The fact that you can walk out tomorrow and start somewhere else is huge. Go into the meeting comfortable. Barring a sexual harassment claim or something of similar concern, the odds they are firing you approach zero. They are probably going to present a complaint, offer a remediation plan and put you on notice; at which point, I think you have free range to voice your concerns. “Look Dr. X, I feel like I’m being targeted. I’ve only ever had one other complaint. When that complaint was brought, you didn’t do your job - you didn’t ask person X who was present about it, you just blamed me. You’re now bringing another complaint to me, but you didn’t ask persons Y & Z about this one. I have to ask, are you trying to force me out? How am I supposed to keep doing a good job taking care of patients when I feel like I have a target on my back and the only time you ever call me is when there is a problem?”

I would also read or reread Never Split The Difference between now and the meeting. It’s incredibly useful in tense situations and can teach you how to phrase questions to get the answer you want.

[billy]

My gripe with round one is they clearly did not speak to all parties who were witness to the event (including my NP who expressed willingness to give testimony). So as far as I'm concerned, it feels like a witch-hunt. If a nurse said it happened then it must have happened, period, the end. It's hard to have respect for the system and feel like I should change as a result of that. I really don't know what this is about but I'll be surprised if they've interviewed anyone that was around to corroberate the story. Ultimately @zyphod is right. The move is to get out. He's been coaching me on the matter for years. Fortunately I'm in a private practice friendly field and even have an employment offer in hand. My days in the hospital (and my one doctor department) are numbered in one way or another. Thank God for non enforceable non compete states!

How good is the offer in hand? I only ask this, because lets say this is a witch hunt and they are trying to establish a pattern so they can later terminate you. If this is true and you realize this, does the timing of your resignation then matter? You'd have to get the resignation in before any official investigation or word of termination, right? Would it affect your answer to the future credentialing questions of "did you ever resign from a position while/as a result of losing credentials or undergoing a termination process" or whatever the exact question is they always ask.

[Bellescamp]

If you truly did nothing wrong I wouldn’t sweat things. As above, we can all be better physicians and humans, but from a job standpoint I would not worry.

they may make you uncomfortable and you may loose some sleep. But I will say in my experience as department chair it would take repeated acts of egregious behavior to result in any meaningful penalty. Actually, this was a frustration as I felt some people needed to see some consequences for their behavior and due to bylaws this never happened. This doesn’t sound like you are anywhere near that.

Thick skin. Rub some dirt in it

[VentAlarm]

How good is the offer in hand? I only ask this, because lets say this is a witch hunt and they are trying to establish a pattern so they can later terminate you. If this is true and you realize this, does the timing of your resignation then matter? You'd have to get the resignation in before any official investigation or word of termination, right? Would it affect your answer to the future credentialing questions of "did you ever resign from a position while/as a result of losing credentials or undergoing a termination process" or whatever the exact question is they always ask.

No way they’re firing him for a second complaint. Some of our surgeons practically put notches on their belts with complaints like this. If this isn’t one of the new virtue-signaling issues (racism, sexism, etc), then it’s a nonissue. It will be a discussion of a remediation plan.

[OSman]

The offer is my current salary. I've just been negotiating buy in terms to the practice which is now down to 6 months. So really my intent was to make this move regardless. At this point all I care about is maintaining a positive relationship at the hospital so I can still operate there and making sure I don't end up having to report things for board and licensure renewal. Do remediation plans require this?

[uteomfs]

The question I have is why are you even dealing with a hospital as an OMFS. Our hospitals beg us to work. I have no clue if what you did was wrong or not, I unfortunately don't hold the omniscient abilities of FLP, but after the first incident it would have been deuces. My definition of ************************ is working with Hospital Admins and add practioners like FLP, its a hard no. Trust me, you don't need to be in this predicament, just get out an move on.

[AR]

OSman,

1. I definitely feel your pain. As others have said, when you work in an environment like you are in, you almost always have to be willing to lower your standards. There is no way around it. So staying and accepting it or leaving are the only options and it looks like you've chosen the latter. I think that a great choice for many. It's not easy, but I think in the long run you will be happier.

2. If you truly are going to leave no matter what, what I would do in your spot is put off the meeting as long as possible and at some point before the meeting, give notice that you are leaving. It's very likely they may just choose to drop the whole thing if they know you are on your way out the door. And if the meeting doesn't happen, that is advantageous to you in a lot of ways.

[jfoxcpacfp]

Read my post again. These things are rarely clear cut and can be explained without invoking malice or intentional disregard for patient welfare. I guess you could chastise the nurse, report her to the chief nursing officer and nursing board, but here’s what I would do: “Hey next time there’s an issue with the hip abductor pillow, just give me a call or call the on call hospitalist, call at any hour” Either way, feedback is given. Ultimately how we treat people is a reflection of our values, and a reflection of our profession.

I’m not on the “inside” obviously, but my precious hubs just got out of 3 wks in hospital (yes, it was h3ll, esp in tax season). If I found out a nurse had ignored a doctor’s orders and caused him to need an unnecessary surgery, both his daughter and I would be most upset in such a way that finding out the doctor had treated it so casually would definitely be, shall we say, inspiring. There is judgment and there is putting the patient’s health and needs first over trying to avoid a meeting with administration and being “nice”.

I’ve never sued anyone nor wanted to (that I can recall), but this would cause me to think after I calmed down. A lot. Maybe put yourself in that situation with your kid or spouse needing general anesthetic and another surgery. Geez.

[White.Beard.Doc]

Of course, hospital care is often complex. Things happen. Handling difficult situations requires finesse. Otherwise you can get yourself into conflicts, into a lot of trouble.

One surgeon I know is a rather large man. He has a split personality. On any given day, he can be his teddy bear self, or his grizzly bear self. He does so much damage to his reputation and to his relationships with staff when he starts yelling, berating. Yes, issues come up that need to be addressed. How you address them is critically important to the outcome. Some of us are better at this than others.

A hospitalist I know quite well kept trying to say that he was simply advocating good care for his patients. Maybe in his mind that was what he was doing, but he was constantly getting into fights with consultants and nurses. There was a clear pattern. While in his view he was advocating for good care in complex and stressful situations, everyone else simply thought he was being a jerk. His chief met with him on several occasions. There was a deep lack of insight on the part of the physician. His chief made efforts to advise him to change his behavior, to seek a coach for behavioral modification, to look inside, all to no avail. He was terminated.

I have no idea where fault lies in the situation under discussion in this thread. Often there are issues on both sides of a negative interaction, And after the fact, there are leaders who handle the follow up well, or not. It is a good sign that you are being introspective, to assess what part, no matter how large or small, that you might own.

[StarTrekDoc]

OP - sorry to hear this is happening. Stressful when you simply don't know the agenda item which is a poor reflection on admin in itself; but as folk have pointed out it's not a little thing if an official administrator is on hand - usually means a staff issue.

No lawyer. Sit. Listen. Offer basic rebuttal point of view. Admit and sign nothing.

These days, the old adage - honey catches more flies than vinegar - rings a lot more true - even when the involved party is clearly in the wrong/made a mistake/ignored an order. It's hard to bite down and hold your tongue and get appropriate management involved STAT when the wrong can be SO WRONG.

The art of giving 'constructive feedback' to staff delicate balancing point. These days, unless it's politics, openly berating anyone will bring a swift reprimand and that dreaded 'hostile workplace' label.

I do wonder how 'malignant' residency programs of the past would fair in this modern era of niceties. I remember our M+Ms would bring chief residents to tears from the dressing down critiques certain attendings were famous for delivering. Those days are long gone for better or worse -- mostly better.

Overall, many of these cases do stem from an ongoing level of sustained interactions that are perceived as adversarial. OP, would advise you to reflect on how some words/actions may be delivered or received poorly. Be ready for that feedback at this meeting too and a way to respond in a measured thoughtful way.