“Unprofessional”—how one word is used to censor, harass, and intimidate doctors

Unprofessional Doctors

Pamela Wible: I just got this letter I want to discuss with my friend and colleague, Sydney Ashland, who’s helping me answer all the letters I receive from medical students and doctors needing help.

So Jamie, an anesthesiologist, writes:

“Today I came across a blog post you wrote entitled, ‘Words that Blame Doctors.’ I saw this comment (see screenshot) about the use of the word, ‘Unprofessional.’ I too have been shamed for actions considered to be unprofessional and threatened with probation, which never happened, but you get the idea. Could you send me the advice you sent out in the email reply to this commenter?”



Unprofessional Doc

Pamela Wible: Sydney, what’s your gut reaction to this letter?

Sydney Ashland: We often pathologize each other in medicine, because we are focused on diagnosing patients, finding the label for what’s wrong with someone. In this highly stressed, unbelievably pressure-filled environment, when we are confronted with the truth or something that makes us pause, something that is unexpected, we have this knee-jerk reaction of pathologizing each other, trying to put a label on the other person, to quickly dismiss it, move on with our stress-filled lives.

Pamela Wible: Here’s the actual definition of professionalism—exhibiting a courteous, conscientious or generally businesslike manner in the workplace. And for doctors and med students sometimes that extends to outside the workplace because they want to see what you’re doing online and what you’re posting on Facebook and all of that. So it is very invasive the way that professionalism is used with health professionals.

Unprofessional would therefore be not exhibiting a courteous, conscientious or general businesslike manner in the workplace. For example unprofessional attire. I think we can all agree you don’t want to show up in smelly unlaundered clothes; unprofessional comments or behavior like cursing and screaming. We can agree on that.

Then there’s the ‘showing disrespect’ to anyone, including attendings, patients, and staff. So the problem with disrespect is it’s a little bit subjective. Hurting somebody’s feelings. That whole ‘disrespectful’ category of unprofessionalism—that’s the gray area where we get into trouble where medical students and doctors get thrown under the bus. Is it not pretty subjective?

Sydney Ashland: It is subjective. Any time we use labels in medicine to hurt each other, dismiss each other, we’re at risk of losing our humanity and no longer being healers but perpetuating a toxic system. We need to be careful. One of the responses that people should have when they’re accused, in this case, of being delusional is, “Can you give me an example of what you would consider delusional behavior? And what is your definition of delusional?” When you ask the question, the other person then has the responsibility to clarify for you exactly what they’re talking about.

Pamela Wible: Yeah. I think a lot of the problem is our lack of precision with terminology and throwing people into these trashcan diagnoses like ‘unprofessionalism.’ I want to give some obvious examples because there are times when people do have lapses of professionalism such as dishonesty, lying, cheating, plagiarism. I think we can all agree on that. But with disrespectful behavior that has a negative effect on others—there’s a gray area.

Sydney Ashland: Would you consider truth-telling disrespectful?

Pamela Wible: Absolutely not though there are more effective ways to truth-tell that will lead ultimately to much more success. People risk feeling blown off when talking to the wrong person at the wrong time.

Sydney Ashland: Sometimes what trips people up is when they feel like, “I am just trying to get to the truth, I’m just trying to ask a question,” and they’re confused because instead of having that question answered, this label—this projection or pathologizing happens. If you’re looking for fairness, if you’re looking to be respected then ask yourself the question, “How can I better communicate what I’m trying to in this moment, so that I can have a sense of fairness?”

Pamela Wible: Here are some examples of unprofessionalism’ that medical institutions claim negatively impact others. The one that always disturbs me is the phone call that I had one day from a resident at a hospital who was written up for unprofessionalism because she actually cried in response to a difficult case. She was calling me to ask if I had any scientific literature to support her right to cry, or that it was okay to cry. Is that not strange?


Sydney Ashland: I think we’re very uncomfortable with strong emotions in the sterile environment like hospital or clinical settings. We want to feel like we can just intellectually process whatever is at hand and we really don’t need to access those deep feelings because those deep feelings scare us.

Pamela Wible: Another example is from Physician Suicide Letters—Answered. A med student with migraines wrote me, “I was dismissed from medical school in the beginning of my fourth year because I had a medical condition that didn’t help the school’s technical standards. I suffered abuse my entire third year from residents and physicians telling me that I wasn’t fit to be in medicine, that if I knew what was good for me I would just drop out. My school told me that being sick was akin to being unprofessional, and that I should give up my dreams of wanting to become a physician.”

Sydney Ashland: And it’s so ironic that this is happening in an environment where the whole industry is focused on health.

Pamela Wible: Another one. Extremely disturbing. A third-year peds resident died by suicide, actually shot himself after being fired by a residency problem, just a few months before graduation. This guy was an excellent doctor, didn’t do anything to harm a patient. yet when his co-resident questioned what happened she was sent to the program director and written up as unprofessional and threatened to be sent to a psychiatrist for asking about her colleague’s death.

Sydney Ashland: Wow. That’s unbelievable.

Pamela Wible: Punishing doctors in training for having normal emotions, for having physical ailments, for not controlling their physiologic response to sadness. How is an illness a lack of professionalism? The last case is just direct censorship when asking about a colleague’s termination leading to suicide.

Sydney Ashland: I think that sometimes those in authority have a hard time filtering what is appropriate and inappropriate. Some of what impedes this relationship between the superior and the resident or medical student is that the person in authority isn’t sure how far they should take things. They weren’t treated with dignity and respect and they feel like they’re treating their medical students and residents so much better than they were treated. There’s an inability to really trust that people can filter their emotions, that they can express their emotion and ask for a time out or a little space, that they can have a chronic health condition and still be professional and show up for work and carry their own weight. So I think that’s part of the problem.

Unprofessional FB

Pamela Wible: I posted on Facebook last night, “Have you ever been reprimanded for being unprofessional in medicine and why?” Lots of responses which I categorized into three areas. One is forced hierarchy and professional distance, another is human rights abuse and censorship and the third is natural physiologic responses. One woman writes, “I got written up for sitting on the edge of a patient’s bed holding his hand and laughing at his jokes. I was told I was being inappropriate.”

Sydney Ashland: That’s breaking professional distance. When the person was really just being compassionate.

Pamela Wible: “I prayed with a patient.” When the patient initiates and is going to be feeling more hope and help by attaching to a doctor and praying with them, what is the problem?

Sydney Ashland: There’s no problem. That’s a patient being vulnerable. It doesn’t even have to coincide with your own religious or spiritual beliefs. You’re there for the patient and you’re supporting that patient and what they need.

Pamela Wible: Again, it’s breaking through professional distance which I call professional closeness. Let’s get with modern times and connect with each other without fear. Another one. “I was told that I was too friendly and that it was unprofessional because I tried to make small talk with my surgery attending as a medical student, was humiliated in the hospital hallway and told I was not going to be successful because of this.”

Sydney Ashland: Wow. Reminded to stay in your place, and that’s the forced hierarchy.

Pamela Wible: “Yes, in medical school, for suggesting I should keep my promise to help at a flu shot clinic for the homeless instead of attending a floof lecture by a big name they had visiting, which was made mandatory with only a few days notice because they wanted impressive turnout. When I told them I wouldn’t go because of the prior patient care commitment, I was told I was unprofessional and would be written up in my file for it if I didn’t go to this lecture.”

Sydney Ashland: Ugh. You know. And the problem with that is then you force someone to come to a lecture like that, and you really fuel resentment and a lack of engagement in whatever’s going on at the lecture.

Pamela Wible: And, “For being too nice to staff who they considered below me, basically admin didn’t want docs to have good working relationships with those they considered easily replaceable.”

Sydney Ashland: It’s really sad to keep people in their bubbles, in their boxes, so that there isn’t a sharing of information, a sharing of support for each other, and then people feel isolated and in that isolation, trouble begins.

Pamela Wible: The last one on forced hierarchy is, “Being my first year of practice in Colorado for allowing my staff to call me Karen.”

Sydney Ashland: Some areas of the United States we’re definitely breaking down those barriers where we are more comfortable identifying by our first name, but there are still areas where they’re really resistant.

Pamela Wible: We’re going through a culture change. We are breaking down barriers. People are having more direct relationships. It’s actually okay to break down hierarchy and have more of a partnership with your patients, not be a dictator, have more of a partnership with your professors, and I think that is the modern way that we should be relating to each other. The danger in continuing to be in our own little cubicles is that divide and conquer is at play. We remain alienated. It’s easier for power structures to take advantage of us and control us.

Sydney Ashland: And more mistakes are made in that model because people aren’t talking to each other. People are afraid of each other. People resent each other. So, you know, it’s so much more effective to have a wonderful working relationship with the unit secretary, to be able to talk to the lab tech in a way that is respectful and human, and then you will have people who will leave no stone unturned in helping you find that elusive diagnosis or get that stat test done in the midst of a really busy crunch.

Pamela Wible: So two examples under the next category—human rights and censorship. The first one. “Six months ago, I sent an email labeled ‘feedback’ to my manager at my part-time job. I work at a medical school part time as a community mentor. I explained that the contract didn’t account for the hours spent working. This apparently was unprofessional.” And I think a lot of times when students and residents are forced to work excessive hours and correctly identify the hours worked they are thrown under the bus with the term ‘unprofessional’ and punished for work-hour violations. Another one:

“During my internal medicine residency continuity clinic I had a patient turn around, block me in by putting his arms around my waist, and kiss me on the lips in the exam room. Understandably alarmed, I immediately went to my attending and told him. I made it clear that I did not feel comfortable reentering the room alone. He told me that I needed to work on my professionalism and boundaries. After that, I always grabbed a male medical student to shadow me when I saw a patient.”

Sydney Ashland: It’s so discouraging to hear these stories. I can’t believe that the liability of lying on your time card is more important than actually having your physical space and your body be intruded upon and invaded by someone. That’s where the disconnect between what is truly unprofessional behavior, which was the behavior of the attending or the supervisor who didn’t help the student who had been treated like that with the kiss and the unwanted physical contact, I mean, that’s the unprofessional behavior.

Pamela Wible: And why should you be written up as unprofessional for involuntary natural physiologic responses? Three examples:

“I nearly vomited while holding a cup for a patient to expectorate into when I was a med student. I was told this was unprofessional.”

“When one of my pediatric oncology patients died, I openly cried on the ward. Written up, unprofessional.”

“I cried when a baby died. Again, they didn’t use the word unprofessional, but it was heavily insinuated. I wasn’t sobbing, but just a couple of tears sneaked out.”

Sydney Ashland: I hear these types of stories all the time, and natural physiological response can include fainting in the ED when witnessing terrible pain and you’re putting in a chest tube and it gets really trauma-filled experience, and somebody faints, or somebody throws up. And instead of us just dealing with each other with compassion, like they do in the war zone when a soldier throws up or a soldier faints, his buddies or her buddies help restore her to her feet and life goes on, and that’s what we need to do in these really stress-filled environments.

Pamela Wible: My purpose for discussing this unprofessionalism topic is not to demonize anyone. I don’t want to create more obstacles. I want people to feel comfortable to really develop sincere relationships with their attendings and the staff and patients. Let’s be in an honest, caring environment. Stop with counterproductive labels.

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There are, however, legitimate lapses in professionalism, and this was something that was shared on Facebook by an attending.

“I’ve seen students Snapchat sensitive pictures that are on the screen in lectures and then also ask to go home around 2 PM on a seven-to-seven internal medicine inpatient shift to feed their parents’ cats, and the list really goes on. Being compassionate is not unprofessional, but the term is still appropriate to use in certain circumstances in medicine. In my experience students are coddled too much these days and get away with almost everything. I think the pendulum has swung from malignant to apathetic. Just my two cents.”

What would you say to this attending?

Sydney Ashland: This seems like very isolated incidents because that is not my experience when working with people. I think certainly there are the times where there’s some black humor if you’re working in a hospice or you’re working in a morgue and there’s a certain level of survival, coping strategies that can kick in. It’s a fine line between that and truly unprofessional behavior.

Most of the people that I talk to are afraid to go to the bathroom. They’re afraid to call in sick when they have fevers and horrible viruses. They don’t want to pass it onto their patients, but they know that if they don’t come in they will be told that they’re not a team player. So I really do not experience these people as being coddled or apathetic. Actually just the opposite.

Pamela Wible: Two more comments from Facebook. From a doctor in training, “Professionalism is the weapon of a malignant regime in a residency.” And from a medical student, “Our school uses ‘unprofessional’ practically anytime anyone speaks up against something the school is doing. Honestly the word has lost any significance for me at this point.”

In summary, the truth really is in the details. We need to be very specific about why something is unprofessional. You need to ask, “What specifically did I do that was unprofessional?”


Sydney Ashland: There are cases, just as you said, where there are unprofessional behaviors, with someone who may just lack the filter that they need to understand the difference, or who are so overworked and under rested that they aren’t able to really discern what’s appropriate or inappropriate. But the more specific you can get, the more questions you can ask about what is perceived as the inappropriate behavior, and what you could have done differently, that’s key, because if you know what you could do differently. And if there’s no response that probably means it was a manipulation or a bullying technique. But if there is a specific response, then rather than be defensive, take it to heart, go talk to a friend, to a mentor, and get some feedback.

Pamela Wible: There’s just immense pressure to conform and accept the current culture of medicine and medical training, but my message to anyone out there who is in medicine (especially if you’re new to the field) is that medical culture needs to change. We actually need more disruptive medical students and physicians who are not afraid to ask, “Why?” Think independently. Ask questions.

This is supposed to be a learning environment where we all work together for the good of the patient and we all become healers, and more well-adjusted, not tormented by our training.

So I’m very curious what you think. Contact me or Sydney. I’ll give Sydney a chance to share how you can reach her.

Sydney Ashland: My website is SydneyAshland.com. I have very flexible hours and segmented periods of time that I’m available, with 15 minutes, 30 minutes, an hour, whatever people need. And I’m very reasonably priced so even a medical student can afford $30 for 15 minutes to get sage advice and a mini action plan.

Pamela Wible: Sydney, I’m just curious if you could share with everyone what sort of categories of things that you handle on these calls?

Sydney Ashland: I deal a lot with people who are wanting to exit their current job situation and begin to create an independent practice for themselves. I work with students who are struggling with passing various step tests or who are having a hard time with an attending or within their school system. I work with residents in helping them to be a team player and also set healthy boundaries for themselves, and communicate in a way that isn’t offensive or doesn’t create defensiveness. I help people with PTSD, anxiety, because even if you’ve gone to a really great medical school, some of what you see in a hospital setting, some of what you are asked to do can be quite traumatic. So I help people to move beyond that, quickly integrate the experience, so that they don’t spend years with a sleep disorder or with some dissociative issue.

Pamela Wible: I do want to be there for all the people reaching out to me. I answer every single email. I really do appreciate the time that you’ve taken to help those with emotional issues so that I can focus on the higher-level business strategy which is my true gift for the world.

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16 comments on ““Unprofessional”—how one word is used to censor, harass, and intimidate doctors
  1. Bodhi Goforth says:

    Dear Pamela,

    Brava! This article is excellent in so many ways.

    Thank you for being in my life! I love you!!!

    Bodhi ❤️????

  2. Pamela Wible MD says:

    Just a few excerpts from a very active Facebook discussion on this blog:

    “I told administration I would not commit Insurance fraud. I advocated for a change in procedure because current policy was unsafe. I documented the facts on an ER visit where the specialist would not come in. All three times I was called unprofessional and the last two disruptive and not a team player.” ~ Amanda Jean

    “I was very sick with a stomach bug and vomiting between every patient I saw in clinic. I got so dehydrated I passed out in the hallway during clinic and my nurse called EMS. I had been told that not coming to work that day would result in getting fired. I ended up admitted to the hospital with acute renal failure. My boss reprimanded me for “inconveniencing patients.” ~ Amanda Jean

    “For raising my hand in a class to help a classmate with a question. The professor couldn’t answer the question and his back was to me so I had to say the professor’s name and ask permission if I could answer my classmate. For that I was later emailed by the professor and told I was unprofessional and rude.I was in no way either unprofessional or rude. I truly believe that the male professor was upset because he didn’t know the answer. His email lashing for me trying to help another student was unbelievable.” ~ Metivia Berke Whitmore

    “For ‘fraternizing with the help’— went out for dinner and drinks with my medical assistants after a record breaking patient visit day.” ~ Michelle Wanner

    “For being ‘jovial.'” ~Earl Smith

    “I am now recalling the many times I got in trouble for being ‘too happy’ at work. I made the miserable people feel more miserable so disrupted the culture of despair.” ~ Pamela Wible

  3. Donald says:

    curious enough. the system, particularly internship, is a brutal initiation by fire and was forced into major alterations following a break-down of its own doing. the changes I opposed despite their apparent sanity and practicality but from an educational continuity perspective. I reference Libby Zion, 1987, a misfortunate case where the break-down began with her PMD and went right through hospital residency IM system. horrible and stupid where all stages led to the death of the 18y old. I, too, have experienced break-downs of the system with no untoward effects other than repercussions without thought or reason. but when each performs their position well, there is no issue. there is a hierarchy, a pecking system, and the shit flows downhill with gusto, and it is incumbent on each person in the hospital to stop the flow at themselves and help and teach the newbies behind. residents should be mentors to the intern proteges, and each should be looking for the other, yet who knows who is willing? there is the rub.

    attendings generally have thick poles up their arses as they guard their relative positions, so do not rock the boat the system; do your time and rock on baby. they dump on you? tough shit; learn it and make it better from you, especially when you get out and move on. when in interviews with candidates for medical school, the most important question I had-what is your escape mechanism? how do you cope, de-stress? most are physical-run bike walk, while few read bake. something. I used to run 10 miles in 70 mins then enjoy a (1) cold beer while reading the NYTimes. unprofessional? yes, be serious attentive aware focused and proper with deference to attendings.

    do not cry. get tough and save the tears for friends mates home. you cannot function efficiently while being emotional. you must think clearly and act defiintively and lead the team. especially a cold blue where you follow rule number 1, take your own pulse first, stop think breathe act. the trick is to remember to re-surface your emotions when you leave the hospital and head home. most docs forget all about their emotions. cold bastards. get your work done, do rounds, and get the hell out of there. until tomorrow. for those who cannot handle the blood and guts, shot sliced burned bodies, find something else to do.long ago I was at a large county coroners office closing heads one day with a couple other fellows when one flipped back the face and said “I know you” to an old high school chum who had OD’ed. humour can be perverse.

    well, cheers, and back to the present.

  4. Nurse says:

    When I was in nursing school I had the flu and pneumonia and my instructor said I would fail if I didn’t show up for my psych lock down. I was sopping wet from chills and fever. I had never missed a day of school.i was coughing until faint feeling. Yet in lock down in a psych ward. The instructor said one of the girls didn’t have a babysitter so she could make it up. So unfair yet so ridiculous! I was contagious and a nursing instructor didn’t care about the patient or me.

  5. Tom says:

    It is SO impotant to look at the marked differences between EAP’s for physicians and those for lawyers. In most cases, lawyers’ EAP’s continued to be EAP’s while physicians’ EAP’s took a darker turn and became modern PHP’s.

    The contrast is as fascinating as it is stark.

  6. Shalena says:

    I have a story that is similar to the doctor who got sick in the office….. I was poisoned (I guess I ate something) with Campylobacter jejuni toxin. It was really bad. There are two forms, the toxic one is extremely painful. I thought I had meningitis, because it was so bad. All my muscles were in severe pain, my head felt like it was going to explode when I laid down, but I had to lay down because I was going to pass out due to dehydration, I had bloody diarrhea and the intermittent abdominal cramping was worse than childbirth. It felt like someone had their grips on my intestines and was twisting them like wringing out a towel. I barely made it to the ER and I brought a lovely poop sample with me in a tupperware container. I was doubled over of course and looked like hell. Since I had been to the ER earlier and was sent home, the nurses had attitude problems. They scolded me for coming back in. They were mean to me. When the ER doctor came in, I explained to him the severe pain, etc and the bloody diarrhea sample. I also explained that I was a medicine resident and I actually just took the first day of my USMLE step 3 exam and I was scheduled to take the second half of the exam the following day. The ER doctor was nice to me thank goodness. After that, I heard the nurses saying “Sheee is a doctor, she doesn’t act like a doctor” Good thing I brought that sample in because I got the call a week later from the state health department.
    I had a similar experience another time, which I care not to discuss, where I heard the nurses saying “she doesn’t act like a doctor”

    So how is a sick doctor suppose to act? Really? This obvious problem with the unrealistic expectations that society has about how doctors should behave, is only the tip of the iceberg. Where it is only obvious that a doctor who gets sick is just as vulnerable to the effects of illness as any other person, the other more subtle or covert expectations are still pervasive and they extend throughout MEDICAL BOARDS who are comprised mostly of lay persons and worse, lawyers. The few doctors at the boards seem to have less power, at least here in California. The lawyers seem to have taken over the medical board here in California. When the agency who is charged with licensing and disciplining physicians, holds the same old fashioned and unrealistic expectations of physician behavior, that society does, and is completely OBLIVIOUS to the politics of bullying in medical training, we have a HUGE problem.
    Doctors need to take over the medical boards- we need a revolution. This is bu…sh..t! REVOLUTION!!!! IMPEACH THE MEDICAL BOARDS! All of them! We don’t need them! We can create a national standardized medical license. We can create a different process for consumer complaints which focuses on helping the patient or family and doing whatever it takes to right a wrong. The doctor who makes a mistake can go to a special university where he/she has to present the case like an M&M conference and then an educational presentation about the subject after. In addition, if we were not in fear of medical boards, we can point out our colleges that need help or need correction or education without fear of punitive results. We should have a non-punitive avenue for addressing doctors who practice below standard. Unless the doctor is criminal, punishment does no good. Expressing apology toward the patient and or learning from mistakes is what is needed. If patients knew that their case was made into a learning didactic for other doctors to learn from, I know at least some of them would feel some sense of justice or empowerment and although it wouldn’t reverse what had occurred, it would help tremendously psychologically and it would support healing, while at the same time improving our education and our health care system in general. We don’t need these medical boards filled with justice department attorneys and judges without medical experience, investigators without medical experience— to run a medical board! They are doing a terrible job and its a waste of money and resources….. IMPEACH THE MEDICAL BOARDS!

    • Pamela Wible MD says:

      The answer we truly seek is a culture change. Creating a new board or system or institution while we still have the same people at the helm will lead to the same misery. Society must honor the fact that doctors are human and that our physiologic needs are the same as anyone else.

  7. JG says:

    That’s so interesting. I had a co-resident find out much later than he should’ve that he was being held under scrutiny because his demeanor was “too happy.” Having worked with this resident, it wasn’t as if he was prancing down the hallways of the OR singing. He just had a calm disposition. It’s such an inane and stupid bit of criterion to hold against someone, and “unprofessional” is the poorly-defined term in play.

    It should be used to ensure physicians don’t engage in misconduct and unethical or callous behavior. It /should not/ be to drag down our colleagues when we have disagreement over subjective matter.

    And it’s true that people expect you to just accept that “it is what it is” when it comes to the culture of medicine, especially in residency. As I began my exodus from my previous program, most people expressed concern over my experience. But a small handful said “well, residency’s hard.” Residency IS supposed to be hard, but not because it’s abusive. We shouldn’t accept that at face value, and doing so doesn’t make you stronger for it. It makes you complicit in a system-wide problem.

    We need to recognize, especially the younger physicians-in-training that are poised to take positions in residency program leadership in the future, that power corrupts and we should check ourselves regularly.

    This is what will make us stronger as a profession. There’s no heroism, no pride earned in being complacent.

    • Pamela Wible MD says:

      We should be held to the highest standards of telling the truth in medicine. Using precise terminology is part of telling the truth. Labels that are misused cause significant harm not only emotionally to the individual, but may have repercussions on their ability to get a residency or future employment. This goes on one’s permanent file!

  8. Dr. S says:

    Thanks Pamela, an interesting read.

    I was reprimanded and even sent before my hospitals “promotion and conduct committee” for playing xbox with a patient. He was hospitalized over Christmas and I was on call, it was like 9:00 pm and literally nothing else was going on or needed to be done. Apparently bonding with patients outside of morning rounds is forbidden.

  9. Jeff Friesen says:

    HI all,

    I am not a medical staff, but rather admin in a clinic. 12 years ago the medical director and I made the business choice to stop billing insurance and focus on our patients instead. We had done an analysis of how much time was spent billing as opposed to patient care and found that almost as much time was spent on billing on one way or another once we added up all staff and contractors. It was insane. And as someone who used to work at BC/BS I saw the writing on the wall. Sadly, the situation we fled in order for focus exclusively on patient care has only gotten worse. Much worse.

    Why do I mention this? Not to poo poo insurance (I would strongly support a single payer or other universal care system to replace our insane and dysfunctional system), but rather to point out the problems with a system that focusses on private insurance, button sorting, and not focusing on patient care.

    IMO the best way to do the best job for patients as an administrator is to make sure the medical staff from doctors to medical assistants and maintenance is to make sure that they are taken care of. If they are, then they will take care of the patients. It’s really that simple.

    The problem is that the large medical care systems (hospitals) have been taken over by bean counters who are in place to respond to the insurance bean counters. And medical care staff have been placed in the middle of that insane squeeze put in place by private corporations who only are interested in the short term bottom line.

    Frankly I would be much happier if we put the docs and nurses back in the drivers seat and dumped the useless admins in a ditch somewhere. But that’s just me.

  10. Vera says:

    I’m the epitome of unprofessionalism. It followed my entire GME.

    –When I was suspended for a week without pay and then on 3-month probation a week into my very first week as an intern. Why? Because I dared to respectfully ask my attending about how to review ALL treatment options with a patient for a patient he had just made a treatment decision as though it was the only one. The final straw was when I dared to tell him that if I was the patient, I’d honestly pick the one he didn’t offer based upon outcome risks. That afternoon I ended up cornered in a dictation room with this attending and he called the supervising resident who stood on the other side. They both kept belittling me, demanding questions of me, and then cutting me off if I dared to say anything for 15-20 minutes. I finally loudly exclaimed that the conversation was unproductive and I needed to leave the room. So I did. The program admin targeted me the rest of the year but at least I was able to still get off probation despite this. After written and verbal apologies to my attending, of course.

    –When I was again put on probation repeatedly, failed rotations, told I was incompetent and more at my next program. Why? I admitted that I knew other insulins, but didn’t have experience with NPH and asked for someone to help me. My 2 attendings turned away, awkward silence, an intern zoomed through how and they moved on all in about the same breath. Another intern whispered she’d help me later. We celebrated a Christmas in July, and I took a few leftover homemade treats to a special paraplegic patient of mine who didn’t have much quality of life even when not inpatient, where he’d already been for 2 weeks. Of not answering my pager when it was my supervising resident to do a late admit just before end of shift while I was unable to move from the loo so she was also harassing me on my cell phone with texts and yelling at me to come out. When I admitted that I have performance anxiety and wanted limited audience for my fourth delivery ever so I could focus and wanted to perform well, which prompted my attending to tell me he’s never heard of such a thing before, that this just means I’m not confident in my abilities and that I was selfish and not a team-player as I was asking to deprive medical students from an educational experience so he’d let in as many people as he wanted and it’d be at least 5. After the delivery by the nurse station, he scolded me again before grabbing me painfully on my arm and telling me to get out. I had to tell him to let me go, but per him and all the nurses who like him that saw it never happened and I was too upset and tired to think to take pictures of the marks before they disappeared after my next 16-hour shift I left there to go start. I dared to use my knowledge of adult medicine to remember the differences when treating children instead of just knowing how to treat children. I dared to go to the program director when given a shift schedule for traumasurg giving me only 1 day off the entire month that had special permission for no hour limits and 2 more call shifts than the other non-surg residents rotating with me. This caused me to get failing evals, not invited into surgeries and blocked from all procedures. And let’s not forget when I told an attending that I needed to answer the pager that had gone off 5 minutes earlier but I would take care of everything he wanted and was there anything else before I went to find a phone. That was enough to set that dude off like no one else. He passive-aggressively controlled the other, new attendings and my fellow to giving me bad marks despite consistently getting good verbal feedback from them before evals were due.

    I guess my unprofessionalism of expecting to be treated as a human is too unconscientious of me.

    These are only the brief highlights.

  11. RuralDoc says:

    Good article. In the hospital, other services consult me for any behavior that is a barrier to care and expect me to resolve it and improve compliance so they can focus on fixing the patient. They don’t understand that I can’t fix all patients with a pill and a personality disorder takes years of therapy to change behavior. Plus, as a psychiatrist, I am frequently defensively double checking medical workups from other physician’s getting frustrated and saying patient problems are all psychiatric in nature. Just because you are frustrated with the patient, doesn’t mean it’s a psych problem. Also, patients behavior won’t change if they are unwilling to change it or unwilling to see that there is a problem. Psychiatry is the highest regulated field of medicine. If a patient is not voluntary or engaged in my care, I can’t force it on them. All patients have a right to refuse, even dementia patients. I have gotten into so many fights about why we can’t inject someone with haldol unless they are violent. Patients have a right to be psychotic, manic, and disorganized as long as they are not violent or suicidal. This is the law.

    The more rural you go, the less people know about the law… Even the hi hospital lawyers…

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