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The Case of Dr. Z

The Case of Dr. Z. Meet Dr. Z. 35-year-old PGY-1 USMG, performed well Transcripts, recommendations solid Performed in 2nd quartile Professional dancer before entering medicine Married, no children. She Said-She Said. Dr. Z has words with ward clerk over a requisition

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The Case of Dr. Z

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  1. The Case of Dr. Z

  2. Meet Dr. Z • 35-year-old PGY-1 • USMG, performed well • Transcripts, recommendations solid • Performed in 2nd quartile • Professional dancer before entering medicine • Married, no children

  3. She Said-She Said • Dr. Z has words with ward clerk over a requisition • Clerk complains that Dr. Z is rude • Dr. Z reports clerk as “completely out of line,” denies rudeness • Students and senior residents enjoy working with Dr. Z

  4. Second Rotation - Main Hospital • No problems • Dr. Z handles busy clinical service very well • Attending is pleased with Dr. Z, “particularly pleasant and hardworking”

  5. Third Rotation - Hospital Setting • Two nurses report Dr. Z is “routinely abrupt, very sarcastic, and mean” • No patient complaints • Senior resident has not seen inappropriate behavior from Dr. Z who is always polite in her presence • Quality of work excellent

  6. Fourth Rotation • Senior resident reports Dr. Z “screaming” at a nurse • Dr. Z “created quite a scene” • Dr. Z’s resident has had no problems • Nurse refuses to file incident report • Dr. Z files incident report

  7. Same Stuff - Different Day • On 5th rotation, student complains that Dr. Z “screamed” and used foul language over an incomplete x-ray requisition, threatening to fail student for “routinely forgetting responsibilities and being lazy” • Dr. Z denies inappropriate behavior • Attending: Dr. Z does excellent job, student is very weak

  8. Same Stuff, Two Days Later • A nurse asks that somebody “do something about Dr. Z” • Dr. Z is abrasive and difficult to work with

  9. What should be done regarding Dr. Z?

  10. Faculty Information - Issues • Dr. Z has trouble with ancillary staff and occasionally with students • Clinical performance and relationships with seniors trouble-free

  11. Group Discussion • Differential diagnosis to include • personality disorder • depression • maladaptive techniques • Documentation of “he said/she said” episodes • Management techniques for supervising someone older

  12. Other Issues • Difficulties obtaining corroboration • Nurse with medication error refuses to comment, fearing negative repercussions

  13. Pick your ending • Resident is in midst of divorce proceedings, acting out as a result; counseling resolves issue while divorce is completed • Persistence of explosive behavior toward “inferiors” requires ultimatum for behavioral modification • Dr. Z is depressed, therapy resolves issue

  14. Common Queries • What is the problem? • Is there a problem? • How does one document the problem? • What is the differential for such behavior? • How can this be managed in the workplace? • How do you deal with someone older than you?

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