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Monday, September 27, 2010

calling on readers again: lazy coworker in a medical setting, with tenure

Our earlier experiment with throwing a reader's question out to other readers to answer was a huge success (who knew so many of you are librarians?), so let's try another one:

I am a pediatrician in a training program at a medical school to become a specialist. One of the faculty members of our division refuses to answer his pager or phone when he is on-call for our specialty service. He is on-call about one week out of five. He does not answer pages from the emergency department, the residents working on the wards, the clinic, nor does he answer his cell phone or home phone. As a result, I am frequently called whenever (which is usually) he doesn’t answer the pager or phone. Bear in mind that these calls are almost always regarding the care of one of our patients. Numerous written complaints have been sent from the emergency department and others to the chairman of our department regarding this issue. Additionally, several people have complained to the chief of our division (who reports to the chairman).

The response has always been that this person would be “talked to,” which has resulted in no change in his behavior. He also does not complete all of the chart documentation for many of his patients (such as writing the drug prescribed and the dosage). Our clinic starts at 8:00 pm and he does not arrive until 10:00 am, which he always blames on traffic. I have spoken numerous times to our division chief, who tells me he can’t do anything because this person is tenured.

I feel that many patients are having their care compromised by this person’s actions (or inaction). I have tried to speak with him personally about the issue and told him how difficult it makes it for other people to do their jobs and to assure that people are receiving appropriate care. I think I was very calm and kind during the discussion, but he got mad at me, threw a fork on the ground, and started cursing. He is 63 years old and keeps saying he wants to retire, but he needs to get his 401K built up, so he may be here another 10 years. Other people who have worked here for a long time tell me this behavior is not new; he has “always been this way” and he’s worked here for 25 years.

I am leaving soon because my training will be complete, but I feel guilty leaving without seeing that something is done to prevent people from getting sloppy care, or in some instances no care. Do you have any suggestions?

I am a big believer in the principle that if your manager won't manage -- and if no one above him/her is willing to force the issue -- there's very little you can do, and you need to either resign yourself to the problems continuing or leave for a new spot where managers are willing to do their job. This question brings a new spin though, because it involves patient care and tenure. I'd love to hear from readers with experience working in medical settings -- or from anyone else who wants to weigh in. What's your advice? 


Anonymous said...

Call his wife when he doesn't answer his calls/pager.

Jamie said...

Wow - all of my major triggers rolled up into one employee...whose charge is the medical care of children. I am speechless and super glad to work in an industry where there's no such thing as tenure.

They can get rid of tenured people for cause, but if he's been like this for 25 years that's not going to happen. He's riding out until retirement and they are going to let him.

If you had knowledge that the care he provided was substandard then of course you have an obligation to report that no matter how high you have to go over his head - isn't that the whole "do no harm" thing.

But the issues you've laid out aren't something hidden. Everyone knows he isn't picking up so they call you. When you are gone they'll call someone else. Writing the wrong med/doses on charts is one thing - leaving them blank is also something everyone will see and someone else will have to correct.

AAM has said posted many times that much of what she learned about being a good manager came from having some really lousy ones first. If anything he's been a shining example of what not to do.

I understand the logic behind tenure - in theory. But in practice I can't help but feel in every instance at every level employment should be a cut sport.

Charles said...

This sounds like a no-win situation for everyone involved.

Managment might be too afraid to do anything because of his age (and perhaps, his own medical issues? throwing temper tantrums at 63 could be something else) and they are "waiting for the problem to retire." This would not be the first time management has taken what they think is the easy way out of a problem.

It sounds like the OP and everyone else has done all that they can do - especially covering themselves if/when patient care suffers - so that they cannot be blamed.

At this point the only thing that might cause mangement to do something is complaints from patients (unless that has already happened?) or worse a patient really suffers from this person's actions/inactions. (Even then, who knows? How many hospitals did Charles Curran, AKA "the Angel of Death", work at before he was caught? - they just kept passing him from one hospital to another)

Aside from that I see nothing that employees can do - even in a medical setting. Complain too loud and too often can/will result in the messenger being shot instead of the message being listened to - this even happens in hospitals.

The only advice I can think of (other then get out yourself) is that the OP and others continue to document what they have done to bring this matter to management's attention. Make sure that you have done everything possible to "CYA" and provide for patients.

Prairie Dog said...

The first poster has the best advice. I recall reading a story some years back about a person who worked as an assistant to a plant manager. The manager would regularly leave his office to wander around the plant (not necessarily shirking his duties) but never bothered letting anyone know where he was going. Whenever the manager got calls or was needed for some other reason, even if he was paged, the assistant never had any luck finding him.

Having worked for the guy for several years she knew that he had once had an issue with fidelity in his marriage. That was in the past, but he wanted to make sure his wife never had reason not to trust him again. So whenever someone called looking for the manager, no matter who it was, the assistant would page him and say his wife was on the line.

He picked up every time.

Back to the OPs problem, I hate to sound negative, but this will never, EVER be fixed. If he's been doing it for this long, management is well aware of it and he doesn't seem to give a rat's fart, why should anyone bother lifting a finger to change it?

Actually, there is the possibility that he could be fired, but I suspect that will only be after his negligence results in someone else dying, and that's far from an ideal solution.

Class factotum said...

I understand the logic behind tenure - in theory.

I sure don't. Please explain. Why should anyone be unfireable?

Ask a Manager said...

In academia, tenure is supposed to protect academic freedom, ensuring that faculty can pursue controversial or unpopular academic research and lines of thought, instead of feeling pressure to stick to "safe" areas. But even tenured faculty are supposed to be able to be fired for serious misconduct (although my understanding is that that ends up being very, very narrowly defined).

I'm not defending or advocating tenure; I don't know enough about both sides to be able to do so. But that's the basic argument.

Heather said...

If you think this is actually negatively affecting the care of patients, could you possibly report him to the state licensing board?

Kimberlee Stiens said...

I side with those who think this shouldn't be allowed to continue. If he's reducing the level of care patients are getting (and I think you said he is), then he should be fired. Surely all the complaints would serve as adequate documentation.

I would say, if you're not on call, don't answer, and tell others not to as well, but that could well result in someone's death, so I agree that its not the ideal solution.

Maybe if you and all the other people who might be called when he's on call all sat down with him and the chief of your section (or whatever you called him) and said "When you are on call, we won't answer. It's your job. If someone dies, then it happened on YOUR watch." Maybe with the impetus on him, such a tragedy would be avoided, while also freeing others from his behavior? Having the supervisor there is helpful because then they know about it and action is being taken that they really SHOULD have taken themselves, but they're being spared the responsibility.

I don't work in a medical setting, so maybe that wouldn't work. But that's my best advice.

Anonymous said...

I would look into the state licensing or professional ethics board.

Brian Tate Asmussen said...

I’ve worked in academic and community healthcare over the past 10-years. I’ve seen strong chairs and division chiefs knock the lazy out of several faculty. So much so that they are afraid they could lose their jobs. Here are my thoughts as to the best way to document/report this issue:
1. File an incident report on the hospital side each time the physician fails to respond to his pager. The hospital must document all incident reports and show efforts to correct the issue. You should also have all nursing staff, midlevel providers, and yourself file the incident report each time this happens.
2. Talk to your residency director about the appropriate chain of command to follow in order to file a formal complaint. My assumption is that the chain of command is as follows: Division Chief -> Chair -> Dean. There may be some vice chairmen and vice deans in there, but either way this is the normal path to follow.
3. Patient Relations – does your medical facility or school of medicine have a patient relations department? If so, you should also file a complaint with patient relations “on behalf of patients” being put a risk by this physicians actions. I would be ready with documentation of dates, times, and patients affected by this providers failure to respond. If this directly affected patient safety then it could be reported all the way up the chain of command (hospital CEO, Dean of the school of medicine, chancellor, etc.)
4. Lastly, you could report his actions to the state board of medical examiners, but I would exhaust all your other options before you threaten his license.
All the best in the completion of your residency. At least you’ve learned actions you never want to emulate when you are practicing medicine.

Rose said...

I would write a formal complaint to basically anyone you can think of who would be named in a malpractice suit. If anyone should sue them, they could use your letter show that his employers knowingly put patients in danger.

Make sure you document, though. I think you can take pictures of incomplete charts as long as there is no patient info visible and therefore comply with HIPAA, but there has to be a union office or healthworkers advice line to call.

I think the biggest issues here are that the LW is a good person and feels called to stand up against this and also, that the organization probably has other potentially dangerous issues related to patient care if they're being so uninterested in this guy.

Eric said...

Go public. Anonymously send this note to a local TV or newspaper and see if they will do some digging.

Class factotum said...

tenure is supposed to protect academic freedom, ensuring that faculty can pursue controversial or unpopular academic research

Which might be OK if that's how it actually worked, but where I live, the community college teachers automatically get tenure after three years. I'm not sure that we need to protect the academic freedom of teachers doing research in cosmetology, dental hygiene and baking.

Oh wait. They don't do research.

Our public school teachers get it, too.

Anonymous said...

I don't know where you live, but where I live, Community College teachers are called "professors," they have advanced degrees, they do research, and they publish. They also teach things like math, biology, and literature.

Anonymous said...

I'm not involved in the medical field, though I am in academia, so I'm not sure of the relationships.

If the hospital is a separate entity from the medical school, would it be possible for him to have his privileges revoked from that side? It seems like that would force some action from the academic side.

MedSurg said...

To Brian Tate Asmussen: Have you ever seen this work without retaliation against the whistleblower? In my experience with similar issues, doing something like what you're proposing tends to get the "troublemaker" run out of their job, if not the whole region's health care industry. I guess a nearly-finished resident doesn't have to worry about the former, but still.

Class factotum said...

Anon, the teachers at Milwaukee Area Technical College for the most part do not have PhDs. They do not do research, yet they are paid more than UW-Milwaukee professors.

Anonymous said...

Class factotum:

Community college teachers are professors! They are addressed as such. They need to have at least a Masters degree in the subject they teach.

Furthmore, community colleges are a lot more than just the three subjects you mentioned. Actually, those you listed are more of a trade school than a community college.

And they do research. They have to. Teaching on the college level requires researching, and depending on your level, you might have to either publish or perish.

So either you live near a community college that doesn't have high standards or you misunderstand community colleges.

Anonymous said...

I would file a complaint with your state medical board. Hopefully you would be able to do it anonymously. The State Medical Board has the most power to do anything because they can investigate the physican and pull his license. You may want to write an anonymous letter that specifically points out the lack of chart documentation and anything that affects patient care.

nuqotw said...

The other argument for tenure (and this applies to K - 12 teachers as well) is that since educational institutions typically pay less than a Ph.D. could earn by working somewhere else, they instead offer job security as a form of compensation.

There have been a few tries at offering faculty higher salaries in exchange for foregoing tenure, but the long-term outlook on such a system is unclear.

Finally, while nominally all faculty at post-high school institutions are required to do research, the reality is that community colleges, there is substantially less emphasis on faculty research when a tenure decision is made. Community colleges primarily want faculty who are excellent instructors, which is not necessarily the same as excellent research; many if not most will tenure someone who is an excellent instructor, even if the person does little or no research. Research universities, by contrast, will give tenure to someone who does excellent research, even if his or her teaching is merely good (if it's truly terrible, that person will get tenure nowhere). There are good arguments for and against such a system which I don't mean (or want) to get into, but that is the nature of the post-secondary educational beast.

It is worth noting that a master's degree - the degree requirement to teach at a community college - by definition does not require original, publishable research, whereas does the Ph.D. - the degree requirement for teaching at a research university - does require original publishable research. Community college professors of course, may well hold a Ph.D. and may well do research... it is just not a requirement for tenure to the same extent as at a Ph.D. granting institution.

I don't know much about hospitals, but in less critical to life fields, tenure may be revoked for illegal behavior. Is it illegal to ignore call? (It should be!)

Anonymous said...

Class factotum,

Not all public schools teachers have "tenure". In fact, I don't know of any, but I'm willing to stipulate that you have facts that I do not.

Most K-12 teachers, if they are Union contract employees, have years of service which provides seniority, which can provide some protection from the yearly round of layoff notices. Yes, yearly! Not at all the same thing as tenure. Small compensation for being under constant attack from kids, parents, administration, and now of course the public, IMO.

Anonymous said...

Anon @ 5:52:

In my state, all public school teachers (and some private school teachers) gain tenure by teaching 3 years and 1 day. However, I don't know if that can be transferred from school to school if a teacher decides to switch jobs. It does not work if you happen to teach a full school year as a full-time sub for a teacher on maternity leave. But if you worked in your high school, for example, for 3 years and the first day of the 4th, you'll gain tenure automatically. Yes, my state does have a teachers' union.

In case if anyone is interested, take a look at NYC news, and you will hear about the question of tenure for public school teachers. Mayor Bloomberg is thinking about making tenure available to the teachers who have proven themselves through the progress of their students instead of just handing it to them after x amount of time.

Class factotum said...

Anon, you are correct. I confused tech school with community college. The Milwaukee Area Tech College awards tenure after three years to teachers who may or may not have an advanced degree and who (probably) do no research, although someone has to make those advances in cosmetology, I suppose.

And yes, Wisconsin does provide tenure to grade-school teachers, which means a first grade teacher who cuts off a student's braids is not automatically thrown out of the school and is indeed protected by the union (I don't know what has happened since):

Anonymous said...

"It is worth noting that a master's degree - the degree requirement to teach at a community college - by definition does not require original, publishable research..."

Uh, so that whole master's thesis I wrote was "not required?" Not sure where _you_ got your MA....

Anonymous said...

I'm not sure why this conversation turned into an argument about community college and tenure, but I'll comment on that and then on the original topic.

First, for the most part, public school teachers are required to sign contracts for school districts saying that they, the teacher will work for the school district for 3 years, but the school district does not have to employ the teacher for 3 years. We can be fired at any time, and we are. Several of my coworkers were fired last year for poor performance.

As far as the doctor who is negligent, I do agree that documenting is always the best policy, but one person can only document so much. Especially when the rest of the staff appears to not care about the incompetence of their coworkers, and will most likely not help you if you ask them.

I think you should leave with your dignity intact, but cover your a** in writing in case his malpractice ever comes back to bite you in it. Once you move on to a new place you'll just appreciate it that much more because you'll know how bad it could have been.