One day, in the first few months of my second year of residency, I was called into the office of one of my superiors in the Graduate Medical Education Department. I didn’t know why I was summoned or whether it was a good thing or bad, but I was not prepared for what I was about to hear.
Paraphrasing (because it was some time ago):
Superior: “Did Dr. So-and-so talk to you?”
Superior: “Dr. So-and-so didn’t talk to you about a patient interaction recently?”
Superior: “I got a call from Dr. So-and-so and he told me you were rude to a patient. That you said something that upset the patient.”
At this point, my heart was racing and my mind was spinning. I was grasping in the realm of my short-term memory…. Probably turning as pale as a person like me can get, I said,
“I don’t know what you are talking about.”
Superior: “Dr. So-and-so said that you went to a patient’s room and said that the patient got you in trouble.”
Me: “That never happened. I don’t understand what he is talking about.”
Superior: “So, you’re saying this didn’t happen?”
At some point in the conversation he revealed when it happened, and it was on a day that I was not even working. I pointed this out to him and was utterly confused about why I was being accused of something completely out of my character.
Superior: “Well, I don’t need to get in the middle of this then.” (This part is verbatim, unforgettable).
“That’s it? ” I thought. “You tell me about something fictional that damages my reputation and character and then leave it for me to lose sleep over? You are already in the middle of it.”
I was shaking inside as I left that room. I felt completely helpless. All the hard work of proving myself over the past year as a trustworthy, reliable, diligent, consistent and attentive physician who took good care of patients was thrown out the window with an unfounded accusation. Lest you think I was overreacting, let me point out that Dr. So-and-so was very highly regarded in the institution and the head of his particular department, which happened to be a field I was strongly considering for fellowship. That dream was over with this event.
Several days went by and with time there grew a constant, queasy feeling in the pit of my stomach. I started to realize that if Dr. So-and-so believed this about me, word would travel to all the attendings on staff in the hospital. Perhaps some residents could brush something like this off. (I wished I could be just as nonchalant.) Perhaps others could just let it brew. (I was already taking that route). However, my integrity was in question, and neither approach seemed right.
I got more and more uncomfortable with the knowledge that I had to work in this institution for another year-and-a-half and would be interacting with everyone in Dr. So-and-so’s department. I mentioned my situation to a few trusted residents, who were just as aghast. Sympathetic, but solution-less, they were. Even my Superior, whom I felt should have had my best interest in mind, offered me no advice whatsoever.
Once resolved to end this issue once-and-for all, I looked up which section meetings that Dr. So-and-so was expected to attend at the end of the day. I picked one and waited outside the door until it was over. When I approached him and asked if he had a minute to talk privately, I could see he was hesitant. But he agreed.
I am going to be completely honest about my feelings here, as it is crucial to the story. You, the reader, may have been able to accomplish the following with ease. But for me (in my twenties) to approach this well-regarded physician (probably in his 50s) who held significant clout and a stand-offish temperament was a psychological and emotional challenge. Telling patients that they had cancer was an easier task for me. And that is very difficult.
Dr. So-and-so and I went to a private room and I told him my side of the story. (Did I even have a side? I wasn’t there!). I am sure my voice was feeble. I am sure I looked meek. Together, this probably made me look guilty. The expression on his face showed that he was disengaged. My heart sank and I started to believe this approach was useless.
Dr. So-and-so didn’t interrupt, however, as I laid out the facts of the matter and that I really had no idea what the issue was about. He then told me his side of the story. His patient had told a nurse that a female resident with dark hair reprimanded him for something and it upset him. The nurse identified me as one of the residents working with the patient, so she told Dr. So-and-so that I had caused the patient’s distress. I had not been the only one with dark hair working with this patient, I pointed out to Dr. So-and-so. Furthermore, other details of the story just didn’t add up to prove any culpability on my part.
Dr. So-and-so’s expression softened (as much as it could for him) and he acknowledged my point. Maybe he said he was sorry. Maybe he didn’t. I don’t remember. But I was able to complete the rest of my training with some dignity and without defamation of my character.
There are a few lessons here, the personal ones so obvious I won’t write more about them. Firstly,
The decline of face-to-face resolution of conflicts as we develop advanced technological ways to communicate is lamentable. For example, I know an employer who received lengthy e-mails about grievances from an employee even when he was working side-by-side with that person daily, as if the issue didn’t exist except in cyberspace. One might say intimidation is a factor. I can relate to that (see above story).
In fact, I was reminded of this story when I read a recent New York Times article about an unpleasant interaction between a nurse and a doctor. The nurse, who wrote the piece, details this incident and goes on to describe the types of bullying physicians perpetrate towards nurses and potential solutions to stop it. It would have been interesting to learn whether she reported her specific incident, what channels there were for reporting such behavior, and whether her hospital’s administration (which tends to affect the tone of the working environment) did anything to help resolve the issue. In addition, any attempt to address the issue directly with the physician is not mentioned in the article, except for the fact that she says, “As we walked out of the patient’s room I asked the doctor if I could quote him in an article.” An article that was published months later. To correct a wrong, timeliness and directness is most effective.
Secondly, if you are involved in medical education as an attending, program director, assistant program director, or chief resident, do not forget that, in addition to teaching the scientific knowledge of medicine and the nuances of doctor-patient relationship and the importance of work-hour restrictions, etc, you are helping to mold these new physicians. You are important examples and should be mentors for the betterment of their professional and personal development. In some ways, you are family for these residents, who live, eat, sleep, and breathe with you more than they do their own families. In my opinion, the duties of a physician in a teaching institution go beyond getting them to pass the boards. It is to also guide them in being able to handle difficult ethical and moral situations and to advocate for what is right. This will serve them and their patients well in the future.
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