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Some may think I am a traitor.
I testified against one of my colleagues. And his employment was terminated.
It feels terrible. The type of gut-wrenching terrible that baits my tears and steals my sleep. I find myself rehashing the testimony, always startled afresh at the unambiguous answers.
"What were your concerns?" counsel asked.
"Patient safety."
"Do you think he should be employed at this company?"
"No."
Seemingly simple words that sealed a 60-month saga.
My first meeting with my fellow physician, A, was memorable. The circular nature of our discussion -- repeated words and ideas -- piqued me. I marveled as social cues passed unrecognized. When I was finally able to end the conversation, I experienced an intense curiosity about the nature of my new colleague's patient interactions.
Over the next year, A and I rarely encountered each other. However, I heard whispered exasperation about him from our co-workers.
"He talks a lot," they said. "He always runs behind."
Initially, I dismissed these statements as anecdotal. He was friendly. He let the care guide the encounter's duration.
Then, I was tapped for a leadership position. It was in this capacity that I became aware and worried. Two hundred incomplete medical notes spanning a quarter of a year. Missing specialty referrals. A seemingly omnipresent inattentiveness and penchant for excessive chattiness at inopportune moments. Mounting staff-generated safety reports.
A and I talked. His skeletons tumbled out. Academic remediation during residency. Family member deaths. A loved one's health issue. Exhaustion after a deluge of clinical and administrative responsibilities masterminded by metric-driven administrators. The irony of my own chief medical officer role was not lost on me.
We discussed the struggle of and the need for self-care. I purposely omitted the word du jour "resiliency" because it felt reactive, as if the onus of recovery was wrongly relegated to the injured. A nodded his head in agreement but balked when I told him that he would be placed in abeyance. Just a month to close notes, I reassured him; but, privately, I wondered if it would be enough.
It was not. A returned to practice and limped along. He started at half the expected daily patient load with plans to be incrementally advanced back to a full schedule. But he never got there.
We also minimized A's distractions by physically isolating his office. His colleagues placed signs outside their doors that discouraged interruptions. We tug-o-warred over the use of administrative assists like dictation support. A was reluctant to tangle with technology. Truth be told, he was not alone; many of our colleagues shared .
This approach appeared to correct some of the problems, but the cycle repeated itself, with exactly the same professional performance deficiencies that were present before the interventions. At least, I consoled myself, there are no open medical encounters. "Because they are being prematurely closed to meet note completion deadlines," one colleague reported.
Conversations generated a spectrum of opinions regarding these observed behaviors. Some worried that he had undiagnosed comorbid behavioral health struggles, while others suggested A benefitted from reduced work expectations. I wondered whether he was "neurodiverse." No matter the label, he lacked the insight to understand its impact, including the possibility of losing his job.
I frequently felt as though I was willing A's success more than he was. I took on the role of coach and cheerleader. I worried and lost sleep. I privately cried -- bawled like a baby -- when I realized he would not succeed.
As issues mounted, the clinic's CEO mandated A's enrollment into a Physician Health Program (PHP). I disagreed; mandatory anything is not the same as motivated actualization. Besides, A had informally been treated as such with a reduced workload and schedule-protected medical care. The boss insisted.
Sure enough, a new circus began. A believed everything was fine. He reported "fine" to his own psychiatrist who, in turn, relayed the same to the PHP lead. The PHP lead then informed me. It was an oddly successful game of "telephone." The repeated verbiage was technically correct from first to last. However, it was inaccurate. Nothing was fine.
Whenever I raised concerns about A's continued practice, I met resistance.
"What about his career?" asked the CEO, still furious over the generated National Practitioner Data Bank report.
"What about patient safety?" I countered.
"Not enough documentation."
"Five years' worth," I corrected.
Our risk manager sighed and shrugged his shoulders when I confided my frustration. "He's not emotionally ready to 'call it.' We need to be patient until he is."
A went on to practice an additional 6 months after my departure. I left the clinic feeling defeated and disillusioned, wondering how impaired provider support and patient safety became divided loyalties. Why was the default instinct to preserve a colleague's career, ?
Shortly after settling into a new work position, I was contacted about A. The CEO was ready to "call it." When I testified, there was no sense of vindication or triumph. No recognizable heroes or villains. Just visceral relief that patients were finally safe.
Traitor? Despite the label some might apply to my testifying about A's deficiencies, I reaffirmed my patient safety prioritization. I did so lamenting this predicament might have altogether been avoided had A's deficits -- the first hints of which surfaced during training -- been addressed earlier by other colleagues who may have been drawn towards the alluring code of silence.
Our professional duty to self-regulate seems aspirational at this point. Few among us want to be the squeaky wheel that calls out another colleague. I certainly did not. Perhaps, in the near future, the U.S. healthcare system will mature to proactively surveil and support physician performance while safeguarding our .
Kasi Chu, MD, is a preventive medicine physician.
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