Day 295 Resident with Usmle Scores 98 & 99 Gets kicked out !!

I suspect that the situation I'm gonna talk about is one that doesn't happen often. You might here about someone with 99's on their boards not getting residency (which is most of the time due to visa issues) but you never heard of one of them get kicked out of a residency program. Well lets talk about one of that is no longer part of my program. I will give him a false name to preserve anonymity. We'll call him Dr.Jack. So it so happens that jack was a replacement second year for a spot in the second year that was open due to the fact that one of the 2nd years got sick. He had been a recent first year from a program in Manhattan. (It was one of the mount Sinai hospitals) I spent a great deal with him, so I knew him well compared to the other residents, but as it turns out, not too well. It must have been 3-4 weeks of him starting the program that trouble started to arise. I still remember clearly the day all "Hell" broke lose. It must have been around 6 pm at night and I was taking a break in the resident lounge when we heard in the over head microphone of the hospital: "Paging Dr. Jack. Dr. Jack Please pick up line 8765". Being the intern and newbie, I didn't think anything of it, but in the next 30 minutes there was about to be an explosion. I was sitting at the computer and writing some orders when the door of the lounge opened and it was jack. Jack seem to be his cheerful self. I got along with him well. I said "hi "and kept doing my work. 5 minutes passed and I heard screaming from another second year resident. She was pretty upset. I didn't understand everything she was saying because she was speaking arabic to him. But she was really upset! They were in a room and there was one more 3rd year resident in the room with them. When the door opened all three of them were in the middle of the lounge and they were going at it!

"I told you ... why didn't you pick up? why didn't you go to the unit when they were calling u?" she said to him. He responded "I told you I was in the E.R. I didn't hear the page and I was taking care of someone that was having an MI. How can I be blamed for this?" . She responded back "You are not suppose to do this! If the unit is calling you , then you must go. You cannot behave like this!" I learned later on that their was a critical patient in the unit that needed a resident to evaluate (knowing the unit, it must have been someone desaturating or someone in an acute rhythm that needed help.) In other words, a pretty critical situation. I also learned that you shouldn't have your name called out loud in the speaker. It basically means that you are not being reached by your pager, or that you are not returning calls to you. So most of the residents cringe if they hear their name pronounced over head. And it seems that our friend jack never heard the page. It also turns out that the admission he was doing was of a patient who had been having chest pain, but was stable. Troponin might have been mildly elevated, but a person who was not in any critical state. (We have tons a patients each day that come in for chest pain. They are closely monitored for 24-48hrs and most get stress testing and cardiac cath.) Anyways, that was what they were talking about, but they were really screaming and arguing. He didn't feel like he did anything wrong. I still remember raising her hand and pointing to his face and screaming in arabic something pretty bad. I remember him just looking at her and kind of surprised. She left the lounge and he stayed their kind of perplexed. He stayed talking with the other senior. Wow, was she pissed! I've never seen her so upset. I remember him speaking to me after this had happened. He had told me that he wasn't going to leave the patient.

The next few days it seemed like most of the second years really didn't like working with him and were complaining to the program director all the time. And it only got worse. It turns out that nurses were complaining about him -that he didn't call back and that he didn't handle their problems, and didn't order the medications they asked him to. An attending also complained that he had been a bit flirtatious and un-profesional. Looking back I still remember the moment. It was in the E.r and we were doing an admission, and he was discussing the case with the attending. At the start of the conversation it went something like this "HI how r u?.... You remember me? Its Dr.Jack. We had good time last time Remember? (he's talking about the last time he had discussed a case with her)" It sounded a bit strange when he said it, but I didn't think anything of it. But turns out that attending had complained to the medical office about that conversation. Depending how you look at it, it can be seen as some type of harassment? I had also heard that he had given his phone number to one of the nurses. (I was their when he gave it to her. I found it awkward, but then again he was a very friendly guy, Always laughing and telling jokes.)

Over all, I think the seniors expected him to get use to how the hospital runs in a short period of time. This is a small community hospital, but the patient load is heavy and their is a lot of work to do. I don' think he ever adjusted to it. And it kind of hurt him. People had to pick up the pace for him, and were having to work extra and were not happy with it. SO even if he might have made small mistakes, they were exaggerated a bit. I still remember being in the E.r and hearing on of the cardiologist on the phone complaining about him to the administration because he was to slow. They were doing cardiology rounds, and he had spent about 2 hour on one patient! And these cardiologist had 30 patients to see!! I also remember him talking a lot about religion and arguing about it with the residents. He was deeply religious. He spoke very softly to me. I considered him a good friend. I still remember doing a 3-hour cellulitis admission with him one time, and him talking the attending to sleep over the phone while he gave a 30 minute admission call over the phone at 3 am in the morning. I can still remember him speaking into the phone "Hello?...Hello?.... are you there?...hello?" But perhaps the most amazing story I heard about him was when he fought with the program director. He was in her office, and she had been trying to work with him and explain the situation, when he grabbed her by the side of her arm and said "don't worry about me, my god will provide for me."
It turns out that Dr. Jack was a very spiritual person. I had endless private conversations with him about religion. He use to walk to attendings and start kind of preaching to them. I thought it was a bit strange, but then again he was a strange guy. I heard he also had problems with the chief resident who was trying to help him with the situation he was in. They had paged him for an admission and never went to the admission and blamed the chief for never getting paged for the admission.

I'll never forget the last time I saw him. It was 730am in the morning and their was sign out. And like usual, whoever was overnight, signs out to the morning team and we distributed the work. I sat down and started handing out patients and then I cam to a name on the bottom of my sheet. It said DR. Jack Pgy-1. They had demoted him to first year again as a trial basis to catch up with the system. I still remember the look on his face when I called his name out loud in front of the group. I said "Dr. Jack? Ok these are your patients for today." He seemed embarrassed and upset. That was the last time I saw him. Later that day around 6pm I heard that he had been escorted out of the hospital with security . I felt bad when I heard that it had occurred. I was told later on that he had been arguing with a nurse in the telemetry and he had grabbed her the wrong way, and their was a complaint of harassment placed on him. After he had left the program I spoke to one of the first years who told me that he had seen that he had scored a 98 and 99 on his boards and 97 step 3. I was kind of shocked. He said that he had been working with him on applying to other programs and had seen his cv. To this day we were all in shock when we had heard that he had scored so high. Some believe that he probably stole someones grade, but I believe that he just wasn't use to the system we had here. It was a change for him and the work that he had been doing in his previous hospital was not as intense as it was here. I later found out that he had gone to a VA Program his first year, where there were a lot of patients, and where you don't do a lot of admissions the first year. (We have been doing admissions from day 1 here.) Over all, it was a very sad situation. He was a warm fellow that was poorly understood. I wish him the best. I have tried to call him a few times, but he never picked up his phone. I hope he was able to find another program. IT might be difficult if the previous program calls here for references.

I believe that it is important to have good grades. Knowledge comes by reading, but it also comes by doing. Most of the residents here have learned there medicine at the bed side. Next to a patient. This is how you perfect your medicine. I will try to call him today . I'll let you guys know what happens.

God bless

DR. Mike

"I hear and I forget. I see and I remember. I do and I understand." - Confucius