The Kiss of Death

Episode 88: It’s a kiss because it’s something nice that you can frame and hang on your wall. It’s death because you’ll never be able to work as a doctor.

Download Transcript: Kiss of Death

Today’s episode is all about the kiss of death when it comes to a residency training.  You never heard of this before.  I can guarantee it.  Let’s get started.  I just got out of a meeting called the Residency Training Committee Meeting, and I learned about a particular action that a residency program can take toward a resident that they feel Is not doing well that is essentially the kiss of death for their medical career.

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But let me set the stage first.  Residency training hearkens back to the days of like 1904 when Nathan Hale brought his ideas from Germany about the way medicine should be taught in America, and they were tough.  They never left the hospital. Burn out, and difficulty, depression and stress is a part of our medical training heritage here.  It was done that way by design.  It’s not an accident.  We go about 80 years in history until 1980, it was either ’84 or ’86 when Libby Zion died and her intern hadn’t slept very much.  Her resident was fatigued back in the good old days up in New York where they just ground residents into the ground.

Her husband was, I believe, a New York Times writer or something big, big writer and editor, and had a lot of connection and made a big media and legal case out of it and the upshot of all that is what you now recognize as the ACGME Duty Hour Restrictions on residents.  ACGME is the Accreditation Council for Graduate Medical Education. You’ve heard of OSHA probably, the Occupational Safety Health Administration?  That group is generally responsible for safety in the workplace, but when it comes to physician training they have stayed out of the argument so all of the typical OSHA requirements like having to get a lunch break and different stuff like that don’t apply to doctors at all.

The limited scope that the ACGME has is simply what they’ve made for themselves, in other words, duty hour restrictions, time off between call shifts, etc.. That’s it.  Residency programs can do anything they want to to residents besides violate those things on any kind of consistent basis or they face losing accreditation.

That’s kind of the backdrop is that it’s a difficult place.  In the old days, residency meant residency.  You actually lived there.  At the DeBakey Center in Houston, Texas, at Baylor, those residents never left the hospital.  They literally when they did a rotation with Dr. DeBakey did not leave the hospital for 30 days.  That’s what we have come from and you already know, I’m sure, about the duty hour restrictions.  That’s kind of where we are, but understand that at its root it’s a place where they’re supposed to train you and teach you.

That brings us to today’s topic because some of us don’t take the lessons very well.  We get too comfortable.  We get cocky.  I’ve mentioned that recently on a podcast.  It goes to our head.  We get some criticism.  It can sting, but what about when you are felt by a particular faculty member to not be cutting the mustard, not be measuring up to your restrictions, or to your requirements and they want to fire you?  Or they want to remediate you?

Let me give you a few definitions of some words.  What you have to correct folks is monthly evaluations.  That’s the simple stuff.  I generally say keep it clean unless your trying to stack up documentation to keep somebody fired.  Yes, you will be filling out evaluation forms on your peers, and they will be filling them out on you.  If there is a consistent pattern, which means two or more times you mess up doing ...