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To my face

Posted by Signout on August 19, 2008
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Last week, I got invited into my program director’s office for a little chat. My previous week’s attending had emailed him about a complaint made by a family with regard to the way I’d handled an event on the general pediatrics wards.

The exact events don’t really matter: all you need to know is that I made the mistake of relying on second-hand information while something fairly concerning was evolving. Although nothing untoward came of this, the perception of a delayed reaction on the part of a patient’s family was enough to provoke a complaint.

And another thing, said the email. For part of the week, I’d seemed sad, and not myself. She’d just wanted to let them know.

The whole thing, I felt, was a stunning display of ballslessness. If someone plans to give me career-damaging criticism, they should give it to my face first. This gives me the opportunity to discuss events with someone who knows the other people involved–in this case, the family and the nurse–and who is able to give some context to my actions. In addition, the circuitous route taken in this case results in a substantial delay in receiving important feedback. That delay makes it nearly impossible to achieve one of the most important outcomes after hearing negative feedback about a family interaction, namely, making things right with the family.

There’s something else that bothers me, though. If this attending thought I’d seemed sad, why didn’t she say something to me? Why did she instead choose to mention this in a tone not unlike criticism, in a letter otherwise dedicated to questioning my clinical performance? How can this even vaguely be confused with being supportive of residents? Or even, with being human?

It’s incredibly important to communicate directly with trainees, whether it’s to give constructive criticism or to offer support. To do otherwise creates a climate of fear, where lending a hand comes secondary to rapping knuckles.

After talking with my program director, I understood where the family was coming from, and the things I can do to avoid situations like this in the future. I expressed as much in a conversation with the family the day following the chat, and I think we’re OK.

This attending who sent that email, however? I wouldn’t piss on her if she were on fire.

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  1. #1 PlausibleAccuracy
    August 19, 2008

    This reminds me of an incident I had a couple of years back in graduate school. A few of my labmates had done some things that made me upset, justifiably so in my opinion. Instead of yelling at them I stormed out of the lab to take a few minutes to clear my head. Later on (maybe the next week), I was called into my advisor’s office. He said that some people had come to him and told him that they thought I had an anger management problem.

    This posed a rather interesting Catch-22. I was angry now, because rather than come to me to discuss this they had gone over me to my boss. However if I acted angry here it would lend credence to the accusation. I think I managed to say in a calm voice that if I had an anger management problem I wouldn’t have walked out when I got mad, but it was a tough few minutes to make it through.

  2. #2 Dave
    August 19, 2008

    Don’t know about the rest of your history with this person. So as an isolated snap shot and off the cuff, but the description read by an … ex shy/non confrontational person the “seems sad” could have been a way to help. Ya, I know strange but I’ll try and explain.

    There was the confusion/misunderstanding that caused stress. And the attending know you are usually more on your game than that. So what would cause you to screw up? Alot of people have a hard time accepting that things just happen sometimes, for no particular reason. And the possible solution they came up with was the “seems sad”. If they aren’t self confident in personal interactions (which as an attending is strange) then talking to you wasn’t an option. OR they thought it might not be “proper” for whatever reason. Ergo being included in the email.

    Shitty thing to do? Ya. If you think you’d see this person after your residency, then mention it. Don’t re-enforce the lack of personal skills.

  3. #3 Orac
    August 19, 2008

    Welcome to the world of medicine. This sort of stuff happens all the time in residency and fellowship programs. Get used to it, because it ain’t going to change before you graduate.

    First, the families. Families often view doctors as authority figures (yes, even residents), and they are often very uncomfortable complaining about their behavior to their faces. (Whether the complaint is justified or not is an entirely separate issue.) It’s also not uncommon for them to fear that any criticism directly to you might result in your not being as attentive to their family member’s needs as abefore. Consequently, they will almost always complain to the superior, rather than bring up their concerns directly to you. Consequently, when you’re an intern, they’ll complain to your senior resident; when you’re a senior resident they’ll complain to your fellow or attending.

    Now, your attending. I agree what your attending did was the height of gutlessness. She should have discussed the complaint with you first. Sadly, even in an academic center where everyone should be dedicated to training residents, all too many physicians are gutless. They don’t view dealing with complaints about residents as “their job,” and so they throw it in the program director’s lap to deal with. There’s little point in complaining about it, even though it’s crappy. I learned that the hard way during my residency. It’s better just to realize that this attending is a weasel and in future dealings with her make very sure your ass is always covered. It’s a matter of self-preservation.

  4. #4 PalMD
    August 19, 2008

    Piss-poor attending-ness. Proper feedback is face-to-face, and if possible, is given in time to allow for remediation.

    On behalf of all teaching attendings, well…

  5. #5 PhysioProf
    August 19, 2008

    I am really having a lot of trouble picturing you sad. Maybe it was just the coffee shortage?

  6. #6 Ken Shabby
    August 19, 2008

    The back-stabbing low-life prick of today is likely to be the administrator of tomorrow.

  7. #7 Zuska
    August 19, 2008

    So being sad is a punishable offense now? Geez. I really can’t think of any good reason for her to have said that in the email. It’s ostensibly an expression of concern but functions as a reprimand and possibly as a criticism of your quality – “she wasn’t really doing that good of a job, because she was showing emotion, and negative emotion at that.” Gah.

    Also, I am with PP – having trouble visualizing you sad in any case!

  8. #8 Signout
    August 19, 2008

    As usual, you’re all far too kind and supportive. Vicodin for everyone!

    Orac, I have already decided to just swallow it for now, then regurgitate it on my bitter written evaluation.

    Zuska and PP, I guess you guys would be surprised. Although it doesn’t happen that often, I get pretty cloudy when things go really badly. Also, I’m totally a crier, which makes it harder than I would like to be inconspicuous about a low mood. (This last episode happened during the crisis around a friend’s life-threatening injury. I publicly decompensated, like, three times that first day.)

    Coffee does help.

  9. #9 Ctenotrish
    August 20, 2008

    I second Orac’s comment r.e. families, and extend it to co-workers. Confronting a person *in person* is hard, so most people will happily pass it up the line. Sounds like you have a not-helpful attending… Info like a family (or co-worker) complaint is most useful when you have the chance to correct the issue.

    Hope things are better/getting better! Cheers, Ctenotrish.

    Personal anecdote – I extended Orac’s comment to co-workers after a recent experience where I was asking a series of tough questions of a vendor. Vendor couldn’t answer anything, so vendor lunch was (apparently) unpleasant for several of my co-workers. None came to me, but several did complain to someome else, saying that I basically was mean and scary to the vendor. It sure surprised the heck out of me, since my asking questions was why I was there. It took me a while to realize that no one approached me because they thought I would be mean and scary to them too (which doesn’t apply to your situtation, fyi). Nope, not unless you are selling thousands of dollars of mis-advertized services about which you know nothing!

  10. #10 Holly
    August 20, 2008

    Learning to stand by, up to, with another person is a learned behavior. I know this. I had to learn it. Then I had to practice it. It is almost never easy for .anyone. to do it. That said, as difficult as many decisions are in the field you have chosen, ANY supervisor should already know how to do this and if they do not, they need to learn.

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    August 16, 2010

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    August 17, 2010

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    August 17, 2010

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  14. #14 dr mustafa eraslan
    May 4, 2012

    They don’t view dealing with complaints about residents as “their job,” and so they throw it in the program director’s lap to deal with. There’s little point in complaining about it, even though it’s crappy.

  15. #15 panax
    www.kibarli.net
    May 23, 2012

    They don’t view dealing with complaints about residents as “their job,” and so they throw it in the program director’s lap to deal with. There’s little point in complaining about it, even though it’s crappy. I learned that the hard way during my residency.