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

[G]

how far the pendulum has swung in blaming physicians before even finding out what went on.

Yes.

(Let's just leave it at that....)

[FIREshrink]

Yes, this culture of shoot first and ask questions later makes me nuts. Filing a complaint before a face to face conversation is inappropriate and should be take as seriously as the complaint itself.

“Nurse so and so, you think the doctor did this wrong. He or she has vastly more experience than you, but we’re happy to hear your side of the story first. Did you ask him or her about it? If not, do you really think this is important enough to waste all of our time because you are afraid of asking him or her about it??”

Talk about lake Wobegone. There is a real power difference between physicians and other staff. This is why you can't require your nurses or aides to have unsupported face to face conversations with the docs - they are often intimidated or frightened about retaliation themselves and won't do it. Them things escalate and as a results we all know that outrageous doc who's practiced without consequence for years.

So nurse goes to charge who goes to house supe who goes to CNO who goes to CEO or CMO who goes to med staff president and that is how these meetings end up happening. Not ideal but there are few options if a person not in a position of authority has a grievance. These environments of power imbalance also foster sexual harassment which is why allegations are taken so seriously.

Putting aside poor OSman, who has been a good sport, I'm surprised by how many of you despise, hate, detest, or distrust your hospitals, your admin, your nurses. That seems like a recipe for poor care/defensive medicine through CYA and poor communication. Why don't you leave?

[VentAlarm]

Talk about lake Wobegone. There is a real power difference between physicians and other staff. This is why you can't require your nurses or aides to have unsupported face to face conversations with the docs - they are often intimidated or frightened about retaliation themselves and won't do it. Them things escalate and as a results we all know that outrageous doc who's practiced without consequence for years.

So nurse goes to charge who goes to house supe who goes to CNO who goes to CEO or CMO who goes to med staff president and that is how these meetings end up happening. Not ideal but there are few options if a person not in a position of authority has a grievance. These environments of power imbalance also foster sexual harassment which is why allegations are taken so seriously.

Putting aside poor OSman, who has been a good sport, I'm surprised by how many of you despise, hate, detest, or distrust your hospitals, your admin, your nurses. That seems like a recipe for poor care/defensive medicine through CYA and poor communication. Why don't you leave?

I mean this with all due respect, but the practice of psychiatry is so different from my clinical practice that I don’t think you have room to intelligently comment. If I am attending on 15 patients in the icu, they may be scattered across 4 geographic icus with 4 different sets of day and night charge nurses, nurses, rts, etc. We’re literally talking with potential interactions with 100+ people in a week with an ever changing cast of characters. A few will be incompetent. A few vindictive. A few will have egos. Suggesting you leave that environment is essentially saying just leave your field.

[StarTrekDoc]

The hard part of admin is this - they need to make/change something to show big splash to get to the next rung on the ladder -- new paradigm [insert fav Dilbert comic] presentation. couple that with medicine and its propensity to be slow in change management - makes a lot of poor interactions with docs and admin --- especially the young admin vs older docs who've seen 5+ cycles of 'new paradigms' that tend to recycle.

[White.Beard.Doc]

One thing drives me crazy in these situations... when an administrator hears of a problem and then fails to investigate all sides of what happened prior to taking their next step.

Good leaders don't shoot from the hip. They pause and gather relevant information before making important decisions. It isn't like clinical emergency medicine where you are sometimes forced, in the face of life threatening circumstances, to make your next best move with limited information.

[VentAlarm]

One thing drives me crazy in these situations... when an administrator hears of a problem and then fails to investigate all sides of what happened prior to taking their next step.

Good leaders don't shoot from the hip. They pause and gather relevant information before making important decisions. It isn't like clinical emergency medicine where you are sometimes forced, in the face of life threatening circumstances, to make your next best move with limited information.

Agreed. I would even go so far as to explicitly tell the boss that he or she is shooting from the hip. I wouldn’t admit any wrong and would say that by bringing in administration instead of just asking me out for a cup of coffee he or she is shooting from the hip. He or she has already assigned blame and that is poor leadership.

[FIREshrink]

One thing drives me crazy in these situations... when an administrator hears of a problem and then fails to investigate all sides of what happened prior to taking their next step.

Good leaders don't shoot from the hip. They pause and gather relevant information before making important decisions. It isn't like clinical emergency medicine where you are sometimes forced, in the face of life threatening circumstances, to make your next best move with limited information.

Isn’t that potentially what the admin is doing with this meeting? Gathering more information?

[afan]

As soon as one is talking of what to "demand" of others, or "getting after" those who do something you don't like, you are far from handling a situation professionally. People make mistakes sometimes. People are careless sometimes. If patient care fails unless everyone is perfect all the time, your systems are failing badly.

All members of the health care team, from the world famous Chief of Surgery to the janitor the first day on the job, must be treated professionally and with respect. ALL THE TIME.

If someone is incapable of doing this, or unwilling, then they need a job where they need not interact with anyone else.

Hostile or abusive behavior leads to deterioration in patient care. It does not improve it. Life is frustrating. Practicing medicine is frustrating. No one can take that out on others. You can be correct that someone made a significant error. But be absolutely wrong about how to respond.

Healthcare has moved from blame-assessing approaches to lapses in care to system adjustments. If the nurse did not know what to do when a patient is not tolerating the post op orders, make sure that they know the next time. Make sure that all the nurses know what to do. If one did not know, then there is a good chance that others don't knw either. Yelling at one individual does not solve the problem and it does not hasten the patient's recovery. It does lead to a tense work environment that makes it difficult to attract and retain good people. A little poisoning of the relationships can go a long way to creating unhappy employees. A one minute blow up, or a pattern of sniping, can damage relationships that take months to repair.

At my place, we don't point fingers at people when things go wrong. We review the incident, try to understand the breakdown and avoid it next time. Clinical errors are handled with system changes and, if needed, remediation. No hostility. No accusations. No recriminations. Just professional attempts to do better next time.

People who don't get this are shown the door. Like our former Chief of Surgery.
Like a string of prima donna former docs who could not or would not control themselves.
Some went elsewhere. Some found that their behavior had rendered them unemployable. So they "retired".

Having learned some hard lessons, we are quicker to blow the whistle now than in the past. After appropriate opportunities to reform of course.

To the OP: trust me, your boss is even less happy about this meeting than you are. They have plenty of other things to do, almost all of them more gratifying than running down complaints. They would not have called it if they thought they had a choice.

Whether you leave or stay, go into the meeting with a positive attitude and a resolve to make it cordial and professional.

I would not whip out a resignation letter during or at the end of the meeting. Wrong mental approach. Do not burn any bridges.

If OP can do so without breaking laws or bylaws, I see no reason not to record the meeting. If they were to present the recording in a legal case then the entire thing would be reviewed. Knowing this may help the OP maintain a demeanor that they would want recorded. The service chief, not knowing it is recorded, may or may not behave appropriately.

[FIREshrink]

I mean this with all due respect, but the practice of psychiatry is so different from my clinical practice that I don’t think you have room to intelligently comment. If I am attending on 15 patients in the icu, they may be scattered across 4 geographic icus with 4 different sets of day and night charge nurses, nurses, rts, etc. We’re literally talking with potential interactions with 100+ people in a week with an ever changing cast of characters. A few will be incompetent. A few vindictive. A few will have egos. Suggesting you leave that environment is essentially saying just leave your field.

Of course I am not an intensivist. That is one reason (among many) I have declined to serve as Med Staff President or CMO; despite other strengths there are large parts of hospital operations where I do not claim expertise.

The attitude in the thread is not about a few bad apples. What I’m reading is wholesale rejection of cultures and institutions, and I don’t understand why folks continue to work in those environments when are there are better options..

I don’t think one needs to be an intensivist to appreciate the challenge of cooperating with large numbers of human beings weekly. Work by Robin Dunbar and others have shown that the ability to cooperate with large numbers of individuals is correlated with frontal lobe functioning, both between species and within species. In other words, successfully communicating with hundreds of others in our species is something basically only human beings have to do, and most humans don’t have to do it regularly. And many human beings are not capable of doing it at all. So consider it a privilege that your social status demands you perform this task, but also understand it comes with a responsibility to do it well - or else.

[fatlittlepig]

This thread (and the other one I started) has for the first time since I started posting on WCI forums, made me sad. There seems to be a undercurrent of bitterness and lack of self awareness and appreciation of how fortunate we are as physicians. The whole us versus them attitude, it’s really too bad. I suspect this is not the prevailing sentiment or attitude amongst physicians in practice but who knows. The recent post by user afan was really well written and wise in so many ways, thank you sir for writing that. Moderators: is there a way you can deactivate this account.

[ENT Doc]

This thread (and the other one I started) has for the first time since I started posting on WCI forums, made me sad. There seems to be a undercurrent of bitterness and lack of self awareness and appreciation of how fortunate we are as physicians. The whole us versus them attitude, it’s really too bad. I suspect this is not the prevailing sentiment or attitude amongst physicians in practice but who knows. The recent post by user afan was really well written and wise in so many ways, thank you sir for writing that. Moderators: is there a way you can deactivate this account.

What account?

[AR]

Since I know I am leaving... any reason NOT to submit my 60 day notice right before the meeting? A few details still to be worked out with the place I am going to but they are all minor issues and things I can stop negotiating and just accept as is if need be.

You should absolutely do this. And do it ASAP. What you want is for them to just cancel the meeting and just forget the whole thing. The longer before the meeting you give notice, the more apt they are to cancel it (because the meeting will be closer to your last day).

I know people are suggesting that you might actually learn something from this meeting. But let's be real. You are who you are (for better or worse). The potential benefit you get from this meeting is massively outweighed by the potential downside. If at all possible, you want this meeting not to happen.

Another benefit of quitting well before the meeting is that no one can say that you decided to quit because of the meeting. You gave notice before it even happened. This kind of thing can come up when applying licensure,etc. in the future.

[MaxPower]

What account?

Instead of just leaving or not posting anymore he’s making a show out of it by asking the mods to deactivate his account. Maybe if we beg he’ll stick around...

[AR]

As soon as one is talking of what to "demand" of others, or "getting after" those who do something you don't like, you are far from handling a situation professionally. People make mistakes sometimes. People are careless sometimes. If patient care fails unless everyone is perfect all the time, your systems are failing badly.

All members of the health care team, from the world famous Chief of Surgery to the janitor the first day on the job, must be treated professionally and with respect. ALL THE TIME.

If someone is incapable of doing this, or unwilling, then they need a job where they need not interact with anyone else.

Hostile or abusive behavior leads to deterioration in patient care. It does not improve it. Life is frustrating. Practicing medicine is frustrating. No one can take that out on others. You can be correct that someone made a significant error. But be absolutely wrong about how to respond.

Healthcare has moved from blame-assessing approaches to lapses in care to system adjustments. If the nurse did not know what to do when a patient is not tolerating the post op orders, make sure that they know the next time. Make sure that all the nurses know what to do. If one did not know, then there is a good chance that others don't knw either. Yelling at one individual does not solve the problem and it does not hasten the patient's recovery. It does lead to a tense work environment that makes it difficult to attract and retain good people. A little poisoning of the relationships can go a long way to creating unhappy employees. A one minute blow up, or a pattern of sniping, can damage relationships that take months to repair.

At my place, we don't point fingers at people when things go wrong. We review the incident, try to understand the breakdown and avoid it next time. Clinical errors are handled with system changes and, if needed, remediation. No hostility. No accusations. No recriminations. Just professional attempts to do better next time.

People who don't get this are shown the door. Like our former Chief of Surgery.
Like a string of prima donna former docs who could not or would not control themselves.
Some went elsewhere. Some found that their behavior had rendered them unemployable. So they "retired".

Having learned some hard lessons, we are quicker to blow the whistle now than in the past. After appropriate opportunities to reform of course.

To the OP: trust me, your boss is even less happy about this meeting than you are. They have plenty of other things to do, almost all of them more gratifying than running down complaints. They would not have called it if they thought they had a choice.

Whether you leave or stay, go into the meeting with a positive attitude and a resolve to make it cordial and professional.

I would not whip out a resignation letter during or at the end of the meeting. Wrong mental approach. Do not burn any bridges.

If OP can do so without breaking laws or bylaws, I see no reason not to record the meeting. If they were to present the recording in a legal case then the entire thing would be reviewed. Knowing this may help the OP maintain a demeanor that they would want recorded. The service chief, not knowing it is recorded, may or may not behave appropriately.

I work at a place that operates like this too...at least in theory. In fact, it's only in theory. If you look at the way things actually go down, it's quite different. But it sounds great. And it sounds great because it actually would be if it could be implemented as imagined. But that's not how it goes. At least that has been my experience. Maybe you are luckier than I.

I'm sure everyone agrees that you should always treat everyone else with respect. Where the problem arises is when the mere pointing out of a mistake qualifies as disrespect. That is a problem in and of itself. It's actually kind of a joke where I work. All one needs to do is claim that someone is being disrespectful to them, and the perceived perpetrator will get a talking to at the least. Now don't get me wrong. The vast majority of people are decent and don't make these claims unreasonably. And sometimes, unfortunately, people are treated poorly and don't complain when they ought to. But there are plenty of times where people use it as a weapon. I've seen it happen, and it's not pretty. Fortunately, I've never been in such a situation myself, but I've seen a couple of good docs who have.

[CordMcNally]

Moderators: is there a way you can deactivate this account.

Didn't you do this before after the Rolex debacle?