I have hesitated about posting this because it's very personal in nature. This is a personal story, but it's a story many will find familiar. I am a doctor, which means I completed a residency. Residency is a strange little world that cannot be fully understood by those who have never experienced it. Hours nowadays are limited to 80 per week. That wasn't the case for me.
Imagine spending years and thousands of dollars while in college just getting into medical school. Once admitted you move to another state, or another country, spend tens of thousands of dollars more, lock yourself in the library studying ridiculous hours, to finally graduate. You now have an MD. Damn!
But you're not done; you still have a residency lasting several years. Most of the attendings (doctors who have completed their residency) are nice and supportive people. Some aren't. You will work with a different attending every month or so. You will run into one miscreant, possibly more than one. Maybe even several in the same month. That's my story.
This is actually a letter I sent to the program so you'll notice that I address them directly at points. I conclude it with some suggestions for protecting the residents and for residents to protect themselves.
I recognize that there are a lot of important things happening in the world, and that in the end I wasn't raped or killed, and that I have a successful career in spite of everything, but if you want a little window into how abuse sometimes then read on. In any event, people sometimes just want to be heard and maybe that's why I'm posting this.
I experienced a significant amount of abuse while a resident in psychiatry at the University of Virginia Roanoke / Salem program during the period of 2001 – 2004. While at this program I experienced verbal abuse, sexual harassment, libel, discrimination for having Tourette’s, threats, and the general creation of a hostile work environment. I felt powerless to respond and felt my career could be threatened if I did.
While in the program I was afraid of reprisals if I reported the abuse, and after I left I just wanted to put it behind me. Eventually I realized that resident abuse exists because people like me don’t report it. Unfortunately when tried to report this to the ACGME and EEOC I learned that the statute of limitations had expired. The next time a resident in your program is abused they may be more proactive. So now I’m telling you. If you haven’t fixed these problems then you need to clean your house.
Verbal abuse and Sexual harassment:
I spent a month on internal medicine at Carilion Memorial Hospital around May of 2002. During this month we admitted a patient who had driven in from the University of Virginia in Charlottesville where she had seen a gastroenterologist named Dr. Cynthia Yoshida. Dr. Yoshida contacted me as asked me to keep her updated on her patient. My attending, Dr. Ashutash Kaushal, approved of this. I spoke with Dr. Yoshida several times regarding the condition of this patient, and every time we spoke she was verbally abusive. She spoke in a loud voice, used a hostile tone, she would cut me off, and she was condescending. Additionally, she routinely called me “darling” in a derogatory manner. This was clearly meant to belittle me and it created a hostile work environment. Although she was not employed by the Carilion hospitals, she was a part of the University of Virginia system with which my residency was affiliated.
She later wrote a letter complaining that the care provided was inappropriate, that I was inadequately supervised, and that I had been pestering her with updates. If the care was inappropriate or if I was inadequately supervised then the fault would have belonged to Dr. Kaushal. That I was pestering her by providing updates which she requested is mind boggling. When Dr. Kaushal presented me with the letter I explained to him that she had been verbally abusive and sexually harassed me. He made no comment. I don’t know if he even heard me.
During the last week on that rotation Dr. Kaushal was replaced by Dr. Begovich. She was verbally abusive to me every single day I worked with her. To be specific she spoke loudly, used a hostile tone, and stood too closely. I remained calm during the abuse and consoled myself that the month was almost over. My refusal to become upset seemed to anger her further. To provide some specific examples she yelled at me for not correcting a normal potassium level, she yelled at me for following her instructions, and she became angry when, after she explained a medical protocol, I said “that makes sense.”
During that month we had a patient who was dying. Everybody on the team knew that he had a month to live at best. I prefer not to list his ailments here because I feel it could compromise confidentiality. But that he was dying, and soon, was not disputed by anybody. His family asked me if he could refuse treatment, if he would pass more quickly if he did, and if it would be painful. I answered these questions openly and honestly as I had been taught to do in medical school. Dr. Kaushal would later accuse me of attempting to engage in physician assisted suicide.
He further stated in my evaluation that I had often not rounded on my patients. I can’t say for certain why he said this, but it may be related to the following. After grand rounds he would routinely give us thirty minutes to have breakfast and then we rounded as a team. I felt that breakfast wasn’t as important as sleep so I typically pre-rounded on some of my patients before grand rounds and then the rest following grand rounds while the rest of team had breakfast. One day he announced that we would round as a team immediately after grand rounds. There was no advance warning and I was therefore caught unprepared. When we rounded as a team it was clear that I hadn’t seen all of my patients. I felt it was clear that the problem was an unannounced change in the routine and that his accusation was another libel.
Violation of the Americans with Disabilities Act:
At one point during that month Dr. Kaushal took me aside to inform me that somebody in the ICU had complained that I had been overheard swearing. I informed him that although I did not remember this event I had been having trouble with my Tourette’s disorder. My Tourette’s is exacerbated by stress, fatigue, and caffeine. This was a brutal month with many sleepless nights and 36 hour shifts, so I was very tired. To keep going I needed to drink coffee despite the fact that this made my tics worse. The work, abuse and harassment had me very stressed. I do not normally exhibit coprolalia unless I am having a severe exacerbation, like I was that month. I do not notice every tic that I have, so it follows that I would not recall the incident he was describing, especially since having a tic is not an “incident”. This explanation made no impression upon Dr. Kaushal. He went on to fail me for the month, citing the allegation of swearing, the letter of complaint from Dr. Yoshida, and the allegation that I had attempted to engage in physician assisted suicide.
When I was put on probation I didn’t press my rights under the ADA because Dr. Sattler had advised me that if I accused the committee of violating the law they would make things worse for me. In retrospect that was bad advice.
To be fair I did make one serious error that month: I spent too much time in the bathroom. I didn’t know it at the time but I have irritable bowel disease, and, when stressed, I need to use the bathroom frequently. The abuse and stress I was under contributed significantly to the trouble I had with my IBD. This caused me to miss some pages. For some reason it never occurred to me to use Immodium AD which I have since found to be effective. That was my fault.
After I had been failed for that month and put on academic probation I complained to my program director, Dr. Yazel, about the verbal abuse, sexual harassment, libel, and discrimination. I specifically stated that this was illegal. He responded by declaring it was all my fault, and “if you’re not happy here you’re free to leave the program,” and “if you think you have a lawsuit on your hands you have another thing coming.”
I would like to digress for a moment. Earlier in the year I had learned that UC Davis had a second year position open. I contacted them and they invited me out for an interview. Dr. Yazel informed me that he had another resident who was interested in my position, and that if I went on the interview he would give my position away and wouldn’t be able to return for my second year. I wasn’t that confident in my ability to get the spot at UC Davis because I hadn’t passed step two of the boards yet. UC Davis had also told me they had others interviewing for it as well. Since I didn’t want to be left out in the cold with no position to go to I declined the interview. It wasn’t until later that I realized my class had an opening already, so if Dr. Yazel had somebody who wanted to transfer in it wouldn’t matter if I had left or not. He had simply made that up to prevent me from leaving.
He knew that I had already given up an opportunity to transfer into another program, and he also knew I didn’t have some other program up my sleeve to transfer into, so when he said “if you’re not happy here you’re free to leave the program” it sounded a lot like “let them eat cake.”
After being dismissed and threatened by my program director I did not feel safe voicing complaints. I knew that I could be abused again and then blamed for it. I further knew that Dr. Yazel was not somebody I could speak to about problems I was having. Remarkably, after being threatened I tersely thanked him for his time and got up to leave; he replied “you’re always welcome to my time.” Was he being funny? Because it went so well the first time?
Hostile work environment and Unethical behavior:
I repeated a month of internal medicine in August 2002. That following spring, around May of 2003, I was scheduled for a month of substance abuse. The chief resident, Rob Lite, informed me that I was switched to consult liaison at Carilion. I had already done four months of C&L and complained that I hadn’t gotten my month of substance abuse yet. Rob Lite spoke with Yazel and reported back that substance abuse wasn’t required but C&L was and I was needed on C&L. There was a fourth year resident on C&L who did virtually no work, so I’m not certain why I was needed.
Foolishly I didn’t check the requirements. It simply never occurred to me that my program would lie so brazenly or act in such an unethical manner. Dr. Yazel later pretended surprise to learn that I hadn’t gotten my month of substance abuse and tried to use it as an excuse to prevent me from leaving for a child and adolescent fellowship following my third year of residency. When that failed he insisted that I would have to be delayed a month to complete substance abuse because there was no way I could do it as a third year.
When I completed my month of substance abuse James Nachbar rotated through. He was a fourth year resident who was also applying to child and adolescent psychiatry. He hadn’t gotten his month of substance abuse as a second year either. He informed me that was because there wasn’t enough room. He was the only resident from his year who was interested in child and adolescent and the only one who didn’t get his month of substance abuse as a second year resident. That was why he stayed for his fourth year and he wasn’t happy about it.
When Yazel wrote my letter of recommendation he stated that I would be delayed a month because I had missed a month of substance abuse while repeating a month of internal medicine. The reason I hadn’t gotten my month of substance abuse was because it was deliberately withheld from me. And Yazel knew it. He was simply trying to stop me from getting into a fellowship after my third year.
It turned out I could complete my substance abuse month in my third year by doing it one day per week in place of the weekly child clinic. For some reason Yazel couldn’t think of this, despite running a residency program for twenty five years - as he often liked to brag.
Furthermore, he wanted to delay writing the letter of recommendation until after our PRITE scores came back. Those scores weren’t made available until late December, and the interviews for fellowship ended in early January. This was clearly another attempt at sabotage.
There is a saying in espionage: once is an accident, twice is coincidence, three times is enemy action. I count more than three. If this wasn’t deliberate then Yazel must have been a grossly incompetent supervisor, even after twenty five years. Nobody is that incompetent.
Third year psychiatry residents are paired with an attending for supervision. I was horrified to learn that I was to have Dr. Yazel for supervision for the year. Why this would create a hostile work environment speaks for itself. I should have demanded somebody else but was afraid of reprisals.
Furthermore, I cannot believe that the other attendings were ignorant of Dr. Yazel’s grossly unethical behavior. Every attending has a responsibility to speak out when resident abuse or unethical behavior is observed.
It was hard to stay motivated after being treated like this. I was bitter, resentful, and depressed. I knew that I could be abused again at any time and that I could expect no support from the program. It also sends a message to the other residents that abuse is tolerated, and that residents are not supported.
Here are some suggestions:
• Every attending has a responsibility to investigate a claim of abuse made by a resident. I told everybody I had been abused and nobody did anything. This includes Dr. Wickham.
• Every attending has a responsibility to speak out when resident abuse or unethical behavior is observed.
• Listen to the residents.
• Residents should be informed of their rights during orientation, including how to file complaints with ACGME and EEOC if necessary.
• When assigning supervisors, resident input should be solicited.
• A resident who is threatened with probation should be advised to bring a lawyer. A man who represents himself in court has a fool for a client. I was that fool.
• The word of an attending should not count more than the word of a resident.
• The program supervisor should be of high moral character and integrity.
• Abusive attendings should not be allowed to work with residents.
• The program should not violate the Americans with Disabilities Act. It’s shocking that I should have to tell you that.
Some suggestions for the residents:
• Don’t assume ethical behavior. Double check everything.
• Make excuses. We are taught to take responsibility for our actions, but if there is some mitigating factor, or if the fault lies elsewhere, say so.
• Be aware of your body. If the stress and hours are causing physical distress talk to somebody.
• Speak up early about abuse. The person who complains first has the stronger hand.
• Report abuse and harassment to the ACGME and EEOC. You have a responsibility. There is a one year limit after you leave the program.
• If you are accused of improper behavior have a lawyer help you prepare your defense and attend the committee meeting.
• Leave a program if you’re unhappy there.
• If you have to – sue.