Dilemma, could use advice

[StressedMD20]

Longtime user under new name for anonymity. We're about to go into a new year and its the last year for my class. One of my classmates and a good friend has been terminated. I on the other hand am starting as chief resident. My friend has asked for help in the appeals process, not on vouching for him, but help with getting things together and doing a run through to help plan his case. He will present his case in July. I don't fully agree with his termination (it was not patient related or anything dangerous and it also wasn't substance abuse or anything like that) but I know I'm not objective because this is someone who has been a good friend to me. My research mentor warned me not to get involved even behind the scenes and don't offer advice because of my role as chief resident. I don't see the conflict, but my mentor does. I don't want to cause problems for myself but at the same time if it comes down to being chief or a friend I have to be a friend first and continue doing what I'm doing which is helping my friend. Am I making the right choice?

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[mostwanted]

I would help the friend.

 

[brabbit2222]

Longtime user under new name for anonymity. We're about to go into a new year and its the last year for my class. One of my classmates and a good friend has been terminated. I on the other hand am starting as chief resident. My friend has asked for help in the appeals process, not on vouching for him, but help with getting things together and doing a run through to help plan his case. He will present his case in July. I don't fully agree with his termination (it was not patient related or anything dangerous and it also wasn't substance abuse or anything like that) but I know I'm not objective because this is someone who has been a good friend to me. My research mentor warned me not to get involved even behind the scenes and don't offer advice because of my role as chief resident. I don't see the conflict, but my mentor does. I don't want to cause problems for myself but at the same time if it comes down to being chief or a friend I have to be a friend first and continue doing what I'm doing which is helping my friend. Am I making the right choice?

Personally, I would stay out. I think it depends on how good of a friend he really is, as he could potentially do something or say something that would help his case but screw you over. Tread lightly.

 

[justaregularmed]

Maybe the best thing you can do is help them find a more experienced mentor to help.

 

[smq123]

Longtime user under new name for anonymity. We're about to go into a new year and its the last year for my class. One of my classmates and a good friend has been terminated. I on the other hand am starting as chief resident. My friend has asked for help in the appeals process, not on vouching for him, but help with getting things together and doing a run through to help plan his case. He will present his case in July. I don't fully agree with his termination (it was not patient related or anything dangerous and it also wasn't substance abuse or anything like that) but I know I'm not objective because this is someone who has been a good friend to me. My research mentor warned me not to get involved even behind the scenes and don't offer advice because of my role as chief resident. I don't see the conflict, but my mentor does. I don't want to cause problems for myself but at the same time if it comes down to being chief or a friend I have to be a friend first and continue doing what I'm doing which is helping my friend. Am I making the right choice?

I agree with your mentor. Do not get involved, and do not offer advice behind the scenes or anything.

For example, you offer your friend advice, and the advice backfires (or doesn't help) and the friend blames you.

Or if you offer your friend advice, and he/she twists your words and somehow gets you in trouble as well.

Just stay out. Get your friend another mentor who can help them (if that is possible), but don't go any further than that.

 

[ddjamb]

A friend in need is a friend indeed.

 

[Light at end of tunnel]

Karma is a mofo, OP.

 

[AdmiralChz]

This is really hard, and I'm sorry you are in this position. At my program, chief residents are essentially an extension of the administration that helps to enforce rules and make schedules. As a chief you'll also likely have more access and information on confidential matters - you may come to find out there was more to this termination than you realize. And if you are involved with enforcement (likely), then your friend may quickly blame you partially for the situation. Or worse, expect you to use new contacts to influence a decision - remember, this is someone's livelihood we are discussing and it can bring the worst out in people.

I would discuss with your PD about this, honestly because it can absolutely be a conflict since you are very close to both parties (your friend and the program). If you did help your friend you would need to be open and honest about this with your program/GME office and recuse yourself from any of the meetings.

 

[NotAProgDirector]

I agree completely with the Admiral. It's honorable, and laudable, that you want to help and support your friend. And perhaps you can, by helping them with a dry run. But there are some potential potholes ahead that you could you, or him, or both, into a sticky situation.

1. As mentioned, you may only know 1/2, or less, of the story. There may be large swaths of data of which you are unaware. if so, your advice might, or might not, be helpful. Someone from the faculty who can talk to the PD, hear both sides of the story, and then support your friend may be much more helpful.

2. It's possible that your friend might blurt out at some point: "But I told all this to StressedMD20 and he/she agreed that I deserve another chance". Chances are, that's not what you will have said. But once they say that's what you've said, now you have to deal with that with administration.

3. Let's say your friend is successful in his/her appeal. Now as a chief you'll be neck deep in remediation and evaluation of this resident. You assessment of their performance might be critical in deciding whether they continue. (To be fair, because you're friends, I'd try to make sure that this didn't happen, as it's an unresolvable conflict of interest. But in a small enough program, and in some cases, it might be unavoidable).

4. Let's say your friend is unsuccessful in his/her appeal. They may partially blame you for "bad advice". Then again, they might blame you for "no advice". So this one could bite you either way.

 

[FutureInternist]

If you decide to do this, make sure you print out and and all evaluations you have received since you started, including any LoRs etc for Chief job.

 

[Donald Juan]

I think what you should do really depends on a lot of nuances of the situation. Generic advice would be to stay out of it, but I could envision situations where it would almost be morally wrong to not help out. It all really depends.

 

[bannie22]

It is very sad, and a very real extension of medicine, that this is even a question.
Please do not call yourself a friend when you wont help your "friend" in need.

He will walk on. And become a much better physician than you would even be.
Cant even begin to imagine how you would take care of patients.

I guess advocacy wasnt taught in this residency.

This has been very disappointing.
I would do anything (...legal) to help a friend in need, because that is why I wanted to go to medical school in the first place - to help people in need.

This is infuriating.
This guy, who considers you a friend, and you vice versa, is literally in the worst position of his life, terminated in his final year, has come to you for some help, and you are ??? considering it????

gosh. come on

 

[Apollyon]

It is very sad, and a very real extension of medicine, that this is even a question.
Please do not call yourself a friend when you wont help your "friend" in need.

He will walk on. And become a much better physician than you would even be.
Cant even begin to imagine how you would take care of patients.

I guess advocacy wasnt taught in this residency.

This has been very disappointing.
I would do anything (...legal) to help a friend in need, because that is why I wanted to go to medical school in the first place - to help people in need.

This is infuriating.
This guy, who considers you a friend, and you vice versa, is literally in the worst position of his life, terminated in his final year, has come to you for some help, and you are ??? considering it????

gosh. come on

Drama much? The person got fired. Where do you even get any idea that the person fired will be a "much better physician"? You know nearly nil about this case, and (as is common for you) are assuming facts not in evidence.

 

[rokshana]

It is very sad, and a very real extension of medicine, that this is even a question.
Please do not call yourself a friend when you wont help your "friend" in need.

He will walk on. And become a much better physician than you would even be.
Cant even begin to imagine how you would take care of patients.

I guess advocacy wasnt taught in this residency.

This has been very disappointing.
I would do anything (...legal) to help a friend in need, because that is why I wanted to go to medical school in the first place - to help people in need.

This is infuriating.
This guy, who considers you a friend, and you vice versa, is literally in the worst position of his life, terminated in his final year, has come to you for some help, and you are ??? considering it????

gosh. come on

Really? You're surprised that someone would weigh their medical career over someone else's? I dunno about you but the reason I went to medical school was to become a doctor so I could take care of people not so I could help someone else become a doctor to take care of people at the expense of my own.

This is not as black and white a decision as you make this sound to be...

 

[ThoracicGuy]

It is very sad, and a very real extension of medicine, that this is even a question.
Please do not call yourself a friend when you wont help your "friend" in need.

He will walk on. And become a much better physician than you would even be.
Cant even begin to imagine how you would take care of patients.

I guess advocacy wasnt taught in this residency.

This has been very disappointing.
I would do anything (...legal) to help a friend in need, because that is why I wanted to go to medical school in the first place - to help people in need.

This is infuriating.
This guy, who considers you a friend, and you vice versa, is literally in the worst position of his life, terminated in his final year, has come to you for some help, and you are ??? considering it????

gosh. come on

Maybe things are different for podiatrists.

 

[Light at end of tunnel]

Maybe things are different for podiatrists.

I wish I could like this post more than once.

 

[Light at end of tunnel]

Really? You're surprised that someone would weigh their medical career over someone else's? I dunno about you but the reason I went to medical school was to become a doctor so I could take care of people not so I could help someone else become a doctor to take care of people at the expense of my own.

This is not as black and white a decision as you make this sound to be...

Becoming a doctor does not mean you have to sell your soul to the devil, though.

Plus, isn't social justice a principle tenant of being a doctor?

 

[NotAProgDirector]

Re-reading the whole thread, I don't see the majority opinion = don't help. I think the concern was that the OP stated that they didn't see any potential COI, and several people pointed out what the potential issues might be. Helping a friend in this situation with a dry run is a reasonable option, as long as the OP is aware of the above caveats. As pointed out, getting an experienced faculty member to help would probably be the best help you could provide.

 

[Apollyon]

Re-reading the whole thread, I don't see the majority opinion = don't help. I think the concern was that the OP stated that they didn't see any potential COI, and several people pointed out what the potential issues might be. Helping a friend in this situation with a dry run is a reasonable option, as long as the OP is aware of the above caveats. As pointed out, getting an experienced faculty member to help would probably be the best help you could provide.

Why are you so reasonable all the time?

 

[Winged Scapula]

Why are you so reasonable all the time?

Its especially amazing given SDN "conventional wisdom" is that all PDs and academic faculty are evil.

 

[dannyboy1]

some programs always seem to fire people and some will bend over backwards not to. If your program is the former then they know how to dot the I's and cross the T's so the firing will stand despite the appeal. If your program is the latter then maybe there was a good reason.....
If you have a great relationship with your PD maybe you can approach them informally ...
good luck

 

[FutureInternist]

Its especially amazing given SDN "conventional wisdom" is that all PDs and academic faculty are evil.

Them's just the facts

 

[mercaptovizadeh]

Longtime user under new name for anonymity. We're about to go into a new year and its the last year for my class. One of my classmates and a good friend has been terminated. I on the other hand am starting as chief resident. My friend has asked for help in the appeals process, not on vouching for him, but help with getting things together and doing a run through to help plan his case. He will present his case in July. I don't fully agree with his termination (it was not patient related or anything dangerous and it also wasn't substance abuse or anything like that) but I know I'm not objective because this is someone who has been a good friend to me. My research mentor warned me not to get involved even behind the scenes and don't offer advice because of my role as chief resident. I don't see the conflict, but my mentor does. I don't want to cause problems for myself but at the same time if it comes down to being chief or a friend I have to be a friend first and continue doing what I'm doing which is helping my friend. Am I making the right choice?

I think doing what your friend is asking, i.e. a dry run, is not unreasonable. There would need to be a caveat of "this conversation never happened" but it seems like he's asking for logistical help and an "insider view" and has not specifically asked for you to internally advocate for him. There's nothing wrong with providing objective logistical information like when to file X and when committee Y decides on Z. That's just administration, not decision making or advocacy.

You should recuse yourself from future decisions. If the program is too small for you to recuse yourself, then you have to act according to conscience, and you have a duty not only to the program but as chief resident you are a liason between trainees and the program and need to advocate for trainees as well.

Also, why does your research mentor know about this and why the forewarning?