We continue to attempt to identify the processes that are in place in the SLU hospital and medical school systems to report violations, complaints, disruptive behavior, etc. Those will be added as they are identified. Additionally, we anticipate being able to add information about organizations and individuals who can offer support. If you have a good link, copy of a policy, or pertinent information, please share with us so that we may add it here for others’ benefit. In the meantime, if you find yourself in significant distress or need immediate support, seek out your organization’s counseling office for help. SLU Med School Department of Diversity and Student Affairs would be a good place to start. Although part of the system in which we find many dysfunctions, our experience with that department has been supportive. Additionally, the medical school has recently added a link to confidentially report adverse events and violations.
You can also seek out your Ombudsperson from the Office of Graduate Medical Education. Talk to a faculty member that you trust, perhaps one from outside of your department. Speak confidentially to other residents that you believe could find themselves in a similar situation. Apparently, there is a Resident Association at SLU (SLURA – although this is a dead link as late as Dec 13, 2017), as outlined in the SLU GME policy regarding due process, that may be able to assist to some degree with resident grievances regarding the fair application of GME policies.
There are complaint outlets outside of the residency program and medical school, as well. Hospitals are responsible for monitoring disruptive physician behavior and should be very interested in the topic for reasons of litigation liability and patient care/satisfaction. Hospital medical staff services should have a reporting mechanism in place. Additionally, disruptive behavior should be reportable via hospital quality improvement/assurance mechanisms (if in doubt, ask a nurse manager which system the nurses are to use for adverse patient care events, like falls and medication errors).
Outside of the hospital setting, state medical licensing boards (like the Missouri Board of Healing Arts), should have reporting processes in place for disruptive physician behavior, and the ACGME has an ombudsperson and official complaint processes in place for residency concerns/violations. Ultimately, it may require legal action to force transparency and compliance in our sclerotic systems. This can be time consuming and expensive, which makes it especially difficult for residents who may be working more than 80 hours per week and have little disposable income from their residency stipends. Additionally, fear of retaliation and termination are particularly strong disincentives for heavily indebted residents who cannot readily match into another residency program. We believe this situation makes physician residents a vulnerable population and helps explain why systemic challenge and change are so rare. If you would like to speak to an attorney who has been vetted by us, who has worked as resident/fellow counsel in issues involving St. Louis medical schools, and who understands the nuances of ACGME requirements and the programs which violate them, please contact us.
Please know that from our own experience and conversations with dozens of residents, the number of students and residents affected by these issues is not small. Stepping forward (even if anonymously for now) and joining your voice with others will be instrumental in gaining attention and fomenting change in the systems upon which we depend for our well-being, education, and livelihood. Remaining silent can only purchase you persistence of the dysfunctions of the status quo – not only for yourself, but for your colleagues and for those that follow after you. We believe that the time has come to force compliance, transparency and change. We believe that we are forcing open a window for action and that the time to act is now. What does your conscience tell you to do?
Need a little food for thought? And maybe a helping hand?
“The question isn’t ‘who’s going to let me; it’s who is going to stop me?'” —Ayn Rand
“There is no such thing as a dysfunctional organization, because every organization is perfectly aligned to achieve the results it currently gets.” — Ron Heifetz and Marty Linsky, The Practice of Adaptive Leadership.
“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” —John Quincy Adams
“Real courage is when you know you’re licked before you begin, but you begin anyway and see it through no matter what.” —Harper Lee
“I am not a product of my circumstances. I am a product of my decisions.” —Stephen Covey
“Strength does not come from winning. Your struggles develop your strengths. When you go through hardships and decide not to surrender, that is strength.” — Mahatma Gandhi
“It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” — Charles Darwin
“Those who say it can not be done, should not interrupt those doing it.” — Chinese proverb
“People inspire you or they drain you – pick them wisely.”— Hans F. Hansen
“There are two primary choices in life: to accept conditions as they exist, or accept the responsibility for changing them.” — Denis Waitley
“The five stages of bureaucratic grieving are: denial, anger, committee meetings, scapegoating, and cover-up.” ― Charles Stross,
“Bureaucracy destroys initiative. There is little that bureaucrats hate more than innovation, especially innovation that produces better results than the old routines. Improvements always make those at the top of the heap look inept. Who enjoys appearing inept?” ― Frank Herbert,
“In any bureaucracy, the people devoted to the benefit of the bureaucracy itself always get in control, and those dedicated to the goals the bureaucracy is supposed to accomplish have less and less influence, and sometimes are eliminated entirely. [Pournelle’s Law of Bureaucracy]” ― Jerry Pournelle
Our school. Our future. Our responsibility.
SLUCP: Driving education, awareness, and positive change towards systemic improvement for St. Louis University med school residents, faculty, and staff.
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