The resident who "fired" me did me a favor

The author was unaware that her stressful private life was affecting her job performance—until a young resident came by to talk.

By Kerri Peterson, MD
Family Practitioner/Salinas, CA

Most physicians have large egos. Until I was "fired" by one of my residents, I thought I was the exception. I was an attending physician in a family practice residency program. There were 21 residents in the program, 10 faculty. I was the adviser to three of those residents, one in each postgraduate year. I held regular quarterly meetings with each resident to update them on their progress, review evaluations from supervising physicians in other departments, and just to "advise." We'd discuss the resident's professional conflicts and progress, problems with colleagues or other attendings, troubles at home, financial difficulties, psychological problems, and anything else he or she felt important.

Then one day Sophie, a third-year resident I'd been advising for two years, walked into my office and closed the door behind her. She sat down, took an audible breath, and said she was unhappy with the way I'd been performing as her adviser. She wanted a different adviser for the remainder of the year.

I was stunned. Although I kept my emotions under wraps—and praised her courage in taking such an action—inside I was devastated.

But perhaps I should have seen this coming. Had I thought about it then, I might have realized that I'd given her the idea. One of my faculty responsibilities had been to lead the "year group" meetings, in which third-year residents met weekly to discuss issues pertinent to their departure from training and entrance into the real world of medicine. During one recent meeting, I had mentioned that since they are responsible for their own education, they needed to ensure that their needs were being met while they were still here. Among those needs: a suitable degree of comfort with their adviser.

Advisers are randomly assigned at the onset of internship, and although residents know they may switch if they're dissatisfied, no one ever had done so. Certainly it did not occur to me when I reminded my students of this policy that I would be the first target of its implementation.

But what had I done wrong that Sophie felt thus compelled? My instinct was to assume that her decision arose from some character defect or personality flaw on my part. Choking back tears, I asked Sophie why she was dissatisfied, and what she would suggest I do differently in the future to prevent such an event with another resident.

Sophie was forthright. Frustrated over having to deal with a chronic physical illness in addition to the stresses of residency training, she wanted an attending adviser who was more available for her, both physically and emotionally. She wanted someone who would take the initiative in setting up requisite quarterly meetings, so she wouldn't always have to do this herself. She wanted someone with whom she could feel comfortable discussing personal issues—her struggles with a long-distance boyfriend who was in residency in another part of the state. She needed advice in dealing with her overly demanding parents (who still wished she had chosen a more "prestigious" specialty). She wanted an adviser who would ask her out to lunch occasionally, who was more outgoing and friendly, and who was less self-absorbed.

Again, I shouldn't have been surprised. Although Sophie expected more of an adviser than many residents do, her demands weren't unreasonable. The faculty, in creating the adviser role, intended to help residents maintain both educational and personal well-being while sustaining a lifestyle fraught with time constraints, exhaustion, and psychic conflict. I was not satisfying this need for Sophie. When she left my office, I released the tears I had held back during our interview. Her confrontation had succeeded in surfacing a barrage of feelings I had been struggling to deny or suppress for several years. I felt like a failure.

The truth, I had to admit to myself, was that Sophie was right. I was not there for her. I may not have been truly present for any of my residents. Sometimes, in fact, I wasn't even available for my patients.

I had been diagnosed with breast cancer three years previously, and had recently suffered a recurrence. But determined to "carry on as usual," I maintained my hectic schedule—working full time, single-parenting my 4-year-old triplets, renovating my new home, pursuing a fledgling alternative career as a writer—all while undergoing chemotherapy and multiple surgeries. Like the typical resident, I was exhausted most of the time. Indeed, when I was at work, I was not giving 100 percent, or even 75. My children had become a greater priority for me, especially since my diagnosis. And my dream of being a writer had become more urgent as well. The shift in my priorities, together with the decrease in energy, had taken a toll on my commitment to my faculty duties.

Sophie's confrontation was a wake-up call for me. A lot had changed in my life. I needed to acknowledge those changes and make the necessary adjustments.

The next day, I met with the residency director, an extremely compassionate, understanding man who was eager to help. Together, we worked out a part-time schedule. In fact, he'd long suspected I was carrying too much load, and had nearly confronted me about it himself. But he knew I didn't want special treatment because of the cancer, and against his better judgment he had let me go on. He knew that, like most physicians, I can be very stubborn and determined. I was used to being the "supporter," not the needy one. I'm proud of my ability to handle so much stress. I even feel a secret pride when people mention how energetic I am, how quickly I move, how much I accomplish in a day. Yet I had deluded myself into thinking I did not have the "typical" physician ego problem.

Today, I am proud to say that I am learning to slow down. I'm able to admit that I cannot do it all. I can't give 100 percent to doctoring, mothering, writing, teaching, and keeping up a home. I'm learning to prioritize; to decide what's truly important, and to let some things go. Cancer teaches us that life may be shorter than we expect. I can't say that I've truly learned to live each day as if it were my last, but at least that adage has taken on some meaning.

After my talk with Sophie, I changed my approach to residents. I'd still discuss how I could best meet their needs, but not without also letting them know of my own limits. Neither of Sophie's colleagues—my other two residents—switched out of my advisory. But had they done so, I'd have been okay with it.

Meanwhile, I am grateful to Sophie for having had the gumption to speak up to me. She taught me that in order to best serve others, we must first serve ourselves. I did that by cutting back on my work hours, hiring a new nanny and housekeeper, getting a roommate, and asking for more active parenting from my ex-husband. I also began taking more time for myself—to read, write, take naps—so that by rewarding myself with activities that renew me spiritually and physically, I can be more dedicated when I must be available for others.

Thank you, Sophie, for firing me!

 

Kerri Peterson-Tapson. The resident who "fired" me did me a favor. Medical Economics 2002;17:94.