I was asked to be “friendlier” when giving feedback about serious safety issues

by Alison Green on May 10, 2023

A reader writes:

I’m (she/her) a physician working in an academic teaching clinic (outside of the U.S. in case that’s relevant). One of the medical residents I work with, let’s call him Dwight, has some major performance issues and really struggles with responding to feedback. He’s on informal remediation with a learning plan and a coach, and I’m not currently in a position where I’m making decisions about the outcome of that, but I do regularly need to give him feedback and document it.

I’m struggling with how to respond in the moment when he reacts negatively to feedback. I don’t think the issue is my delivery. I’ve had people observe me to give feedback on how I give feedback, and for the past several months I have tried not to be alone when giving him serious feedback. I’m calm and kind, but I don’t soften things unnecessarily. I’ll say things like, “I know you thought llama pox wasn’t a possibility for that patient because llama pox is very rare, but they did have tiny llamas growing out of their face, which is classic llama pox. It’s unlikely that anxiety, which was your diagnosis, would cause that. And this is important for us to discuss because llama pox is fatal without treatment.”

A couple of days ago, when I was giving him that kind of feedback, he told me wants me to be “friendlier” when I talk to him. I said I wasn’t trying to be unfriendly but that it is my job to give him feedback and these issues are serious and could kill someone. He said he wishes I would frame it as “friendly advice that he can consider” rather than “telling him what to do.” I had no idea how to respond to that other than to reiterate that this was a serious concern and it wasn’t optional to address it.

Do you have any suggestions for how to respond in the moment when I’m having to give him feedback on serious safety issues and he takes issue with my tone or me not being friendly enough?

Right, he’s jeopardizing people’s health and lives but let’s center his feelings about hearing that uncomfortable fact.

Assuming you are in fact simply being direct — and not, for instance, calling him names — it’s wildly inappropriate for him to respond to serious feedback by asking you to be friendlier. And I’d be really, really interested to know if he’s made this request of any men, or if it’s only women who he thinks he can ask to stop speaking so directly about his mistakes. (Spoiler: it’s almost certainly only women.)

The response you gave him — that the mistake was serious and addressing it isn’t optional — was perfect. If he brings it up again, you might try saying, “I’m concerned that that’s where you’re focusing, rather than on the very serious mistakes I’ve been bringing to your attention. This is not ‘advice that you can consider’; my feedback in situations like this are directives that you must follow if you’re going to be successful in this program.”

More importantly, though, loop in whoever manages him right away. It’s important that they hear about this conversation, because it bodes really badly for Dwight’s ability to meet the program’s goals. Frankly, I’d argue that whoever’s in charge should already be concluding that; “major performance issues and really struggles with responding to feedback” tells you all you need to know in a job where the stakes are this high. I know that’s not your call — but make sure the person making that call has all the same info you do.

Dwight should not be a doctor.

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  1. Luanne Platter*

    OP, you sound like an awesome doctor. I wish more US based physicians in positions of leadership/ training others would call this out. So common to receive a diagnosis of “anxiety” when the real issue is something physically wrong.

    Thanks for standing up for the patients and giving Dwight honest feedback.

    1. The Somewhat Average Gilly Hopkins*

      100% Agree. Thank you, OP for all your work and for advocating for patients!

    2. Ann Onymous*

      It’s particularly common for female patients to be dismissed in this way. Since it sounds like Dwight’s issues may be rooted in sexism, him becoming a doctor without this getting addressed is going to perpetuate gender-based disparities in the health care system.

      1. Cat Tree*

        Yeah, I had an appointment with my doctor today, to tell her about chest pains. I even told her that it might be anxiety (which I have a history of). She referred me to a cardiologist anyway. She said it’s too easy to brush off those concerns. I *hope* it’s just anxiety (which I’m also treating), but if it’s not I’ll get the care I need. This is why I drive 45 minutes to stick with this doctor even though I moved out of that town.

        1. Science KK*

          Sending props to your doctor. A family friend was sent home from the ER because she was “an anxious old lady”. She died at home maybe an hour later, and her husband lasted less than a year from the anger/guilt.

          1. Peon*

            My mother was dismissed with “women your age don’t have heart attacks”. So she out and out lied and told her doctor she was having the classic men’s symptoms and he sighed and said well, now I HAVE to send you for testing but you did not have a heart attack. Spoiler: she did indeed have several. And blocked arteries. And she still goes to that doctor because she says she’s “broken him in”.

            So OP, keep fighting the fight!

            1. Slow Gin Lizz*

              Smart of your mom to tell him she had the classic men’s symptoms but ugh, too bad that wasn’t the wake-up call she needed to find a new doc.

              1. AbruptPenguin*

                And disturbing that it wasn’t a wake-up call to the doctor that his sexist bias is going to kill patients!

            2. botanist*

              Oh. My. Freakin’. Gosh. How hard will some men’s minds work to stick to the narrative?

        2. Ridiculous Penguin*

          Same with mine recently (though he’s much closer). I also see a DO rather than an MD because they actually spend time listening to me.

          1. MigraineMonth*

            I chose a Nurse Practitioner as my PCP because I feel like she takes the time to address all of my concerns.

          2. SimonTheGreyWarden*

            Saw a DO for years and only stopped when I got pregnant and he recommended I find a doctor closer to me as he was over an hour away by then. Now I see an ANRP and I find she listens to me much better than any other doctor I tried out.

        3. metadata minion*

          I spent a long time trying to figure out one of those symptoms that could be basically anything (yay it’s fixed now!) , and also asked whether it could be anxiety because I definitely have that. The doctor’s response was that it was pretty unlikely, but not impossible, so to pay attention to whether it seems to correlate to periods of higher anxiety, and whether relaxation techniques made it any better. And yes, *that* is how you address possible somaticized anxiety.

          1. MigraineMonth*

            I was told that a developing health condition was probably due to stress, so I quit my stressful job. It turns out that no amount of stress reduction and meditation can remove a large tumor.

        4. Frenemy_of_the_People*

          I’ve been there! Recently I took a bad fall. I was in a lot of pain and went to the clinic (we’re military, so you don’t always see the same Doc) where I was told “you’re just bruised; take up to 4000mg of Tylenol and you’ll be fine.” After another week of increasingly intolerable pain, I went back. THIS doctor said, “first let’s get you comfortable with pain meds and muscle relaxants and then let’s get some images.” Came back the “bruising” was a fracture. I ended up with REAL pain meds and a follow up because this doctor sat in the room and LISTENED to me. The first one was so dismissive it was insulting and I felt like I had wasted his time.

          1. Ch*

            It’s awful how often that happens. I had an oral surgeon scold me for wasting his time and send me home. A few days later I had a terrible infection that was one of the most painful things I’ve dealt with, and needed a root canal. Had to quickly find a new surgeon because I sure as heck wasn’t going to let him be the one to do it.

          2. Mayern*

            ah, it’s because you didn’t drink enough water with your Tylenol and change your socks often enough. were you wearing your reflective belt when you fell?? /s

            but seriously, it’s really frustrating trying to get Today’s Random Doc to take you seriously (even when your issue is extensively documented in your records), especially when you’re in pain. hope you’re feeling better!

          3. Reed Weird*

            God, when I was 19 and in college I found lumps in my breast that hadn’t been there the month before and went to the campus clinic where you also don’t get to pick who sees you. The doctor asked me to describe the lumps, any other symptoms (none), and then told me it was probably mastitis and gave me a course of antibiotics. Not only did the lumps not go away, the antibiotics wrecked my gut and basically ruined the last of that year because I was too nauseous to do anything but drag my sorry butt to class and eat rice and crackers. Went home, went through actual decent doctors, and eventually got the lumps biopsied and labeled benign fibroadenomas. I’m still on (very expensive) daily meds to prevent ulcers because of that misdiagnosis, and trying to get into a gastro in my area to make a more sustainable plan.

      2. Beka Rosselin-Metadi*

        I was just thinking that here is the reason why so many of women’s health issues are ignored or belittled-it starts with this guy.

      3. Nesprin*

        Agreed. Dismissive to a female superior giving negative feedback is not definitive, but highly suggestive that you have a sexist jerk.

        1. DJ Abbott*

          To me it also suggests denial. It sounds like he’s not willing to acknowledge what he’s doing, let alone address it.

      4. zuzu*

        Just an FYI: not only do female patients get brushed off as having anxiety; their symptoms often don’t present the same way as male patients, so they’re not recognized by doctors.

        Why? Oh, because medical trials were historically done only on male patients unless they were for specifically female medical issues. Men had “standard” bodies and women were deemed to be just non-standard but more or less the same as men.

        Except not. While men will usually present with shooting pains in the left arm as a sign of a heart attack, women will often feel tightness or heaviness, which they (or doctors) often dismiss as anxiety or other illness.

        It’s what killed my mom — she thought she was getting the flu, and it wasn’t until two days later that she sought medical care because she was only getting worse. By then, her heart had shredded itself and was irreparable.

        Seek care. Insist on being taken seriously. Insist on tests. Don’t let them just send you home without ruling out the worst.

        1. mother_of_hedgehogs*

          This is also true for racial disparities. The “white male” model often doesn’t apply, although in most cases it’s still the standard, because as you said, that’s where the research (money) went.

          1. goddessoftransitory*

            The latest recommendations for mammograms starting at 40 was in part because of historic racial disparities.

        2. Grumpy Elder Millennial*

          The medical trials thing makes me incandescent with rage. Like, either women’s bodies are more or less the same as men – so including us doesn’t hurt anything – or are “non-standard” – so should be included to see if there are differences. Like how drugs aren’t tested on women because hormone cycles are complex. I’d like to know if that’s going to matter before I take the drug, bro! Either way, there’s no justification for excluding women from research.

          1. whingedrinking*

            I seem to remember hearing once about a medical trial for a drug that was intended to treat ovarian cancer – and the trial *didn’t include anyone with ovaries*, because that would have “skewed the results”. (I may be getting some of the details wrong but it was definitely targeted at anatomy that no one in the trial group had.)
            The fact that apparently no one stopped to say “Hey, maybe this is a bananapants idea” is part of the reason people find it hard to trust doctors.

        3. CatMintCat*

          Symptoms often aren’t treated the same. Two years ago I (female) had a knee replacement – which is acknowledged as the most painful orthopaedic surgery around. In the leadup to surgery I was told to take Panadol (Tylenol) for pain relief. After the surgery I had some good drugs but after five days I was sent home with … Panadol.

          Last year my husband (male) had the same surgery. Same surgeon, same hospital. Good drugs in the lead up for pain relief, time off work, good drugs home from the hospital for several weeks afterwards.

          Also, he was certified for three months off work for recovery. I got six weeks.

          We’re both fine now, but the differences were confronting, to say the least.

          2. Reluctant Mezzo*

            Tell me about it. I had a doctor (who was an angel with my husband) who listened to my heart, ignored my complaints about arrhythmia, and finally his nurse misread the speed of my pulse. I was out of there. Once I had a female doctor, she put a Holter on me and a week later had the a-fib diagnosis.

          3. amethyst*

            I had to have two biopsies recently, a lymph node biopsy and a colposcopy (cervix).

            For one, I went to an outpatient exam room, was clipped with no anesthetic, and sent home with no pain relief.

            For the other, I was reassured and prepared by a fleet of nurses in a surgical wing and given generous anesthetic – I barely felt the procedure. They still had a recovery room where I could rest and I was given pain relief on my way out.

            Guess which one was which!

            1. Dog momma*

              amethyst,
              I had 2 colonoscopies /2cervical biopsies in the office… by a female GYN, was told you will have heavy cramping..and sent home with instructions for Tylenol. it was pretty painful

            2. JHS*

              For my hysteroscopy and biopsy I was told to take paracetamol and antiinflammatories two hours beforehand and given nothing by the hospital. This was at a maternity hospital. I was nearly screaming during it, I’ll be very hesitant if they want to do one again…

          4. rebelwithmouseyhair*

            A female relative took over a month to get used to her replacement hip. A guy who went to the same place for physiotherapy at the same time only took a week to get used to it. She expressed some frustration, and one doctor said yeah women are more fragile. Then another doctor off-handedly admitted that the replacements were too big for most women because they were made to fit men.

        4. fhqwhgads*

          HEPPP
          Hot
          Exhausted
          Pain
          Pale
          Puke
          Heart attack symptoms for women. Not trying to derail, but that’s my PSA for the day.

          2. Seashell*

            Rosie O’Donnell had a little song to go along with that acronym in a comedy special after she had a heart attack. It was catchy, so worth a watch.

          3. rebelwithmouseyhair*

            Thank you, I knew the symptoms were different but couldn’t remember them. I just skimmed through and thought “OK that’s not me” but then the women I was talking to about it also wanted to know the symptoms and I felt really sheepish having to admit I couldn’t remember! Now, I can remember! HEPPP!!!

        5. Been There*

          I often get emails seeking people to join clinical trials. 2 out of 3 are still only men, and even more often they put a BMI limit on who is allowed to join.

          1. ItsAlwaysTheWeight*

            well don’t you know that people who are overweight don’t ever have other medical problems? Every single thing that they feel/experience is just their weight. And to add to the fun, you can’t get the right amount of medications prescribed because the allowed maximum doses are for “normal” people – i.e. people who weigh less. Letting them in clinical trials would just mess it up for everyone else, dontcha know? *rolls eyes*

        6. action kate*

          The advice I’ve been seeing recently is to insist that the doctor write in your chart “I am refusing to order/administer TEST to patient even after patient requested it.” Anecdotally, that seems to get the doctor to order the test.

          Dwight is being a sexist, self-important idiot and is going to kill people. Do not let him become a doctor. Do No Harm.

    3. Yoyoyo*

      Seconding this and the recommendation to go to whoever is managing Dwight. He is going to kill someone.

      1. Where’s the Orchestra?*

        Or he’ll become just like the doctor who “fired me” as a patient for being difficult (I was being difficult because I was insisting the doctor write a prescription for an antibiotic I can take to treat a case of Strep – and not one that I’m allergic to with the allergy flagged everywhere possible on my chart).
        Dwight needs to not be a Dr and not have patients lives in his hands.

        1. New ED*

          My daughter’s dentist “fired” us because I wanted a second opinion on wether she needed extensive treatment on baby teeth. I find medical professionals shockingly willing to dismiss concerns from patients. We need more doctors like OP and fewer like Dwight!

          1. Where’s the Orchestra?*

            At least my Dwight got his comeuppance – he wasn’t my normal Dr – the Lead Physician in the practice (who also happened to have been my dad’s college roommate for five years) was. My dad “happened to catch up over coffee” with his old roommate the day after we got the letter. That Dwight got fired for patient endangerment so fast……

            (I was 15, Dwight had kicked my mom out of the room because I was “old enough to do doctors on my own.” Boy did he pick the wrong teen to mess with – and yeah, I had no problem letting my dad help out at that point in my life.)

            1. rebelwithmouseyhair*

              Dammit no at 15 you’re not old enough. I remember arriving to pick my daughter up from an X-ray and she was standing there trying to cover her breasts by crossing her arms. I immediately said “have you finished? OK, darling, you can get dressed now.” grabbed the results and walked out, telling my daughter she doesn’t have to stand there half naked.

          2. OP*

            That’s so wild to me that someone would “fire” a patient for something like that. I’ve only ever “fired” a handful of patients and it’s always been for violence/threats/sexual harassment of my staff (without some underlying cause like dementia or illness). I figure if patients don’t think I’m a good fit, they’ll go somewhere else, it’s not my call. And I would hope people get a second opinion if they’re not sure about major surgery. I’m primary care so less applicable, but still.

        2. Fishsticks*

          I had a lot of infections as a kid, primarily ear infections. It is well known in my medical history that Amoxicillin, the first line of antibiotic treatment, doesn’t work on me. It does literally nothing. I have known this all my life.

          I am 37 years old and have to argue with doctors who INSIST on prescribing amoxicillin, even doctors who have tried it before and KNOW it doesn’t work. It’s in my chart. It’s in my medical history. It’s EVERYWHERE. But because I tend to say, “Hey, amoxicillin doesn’t work but the next one on the list usually does,” suddenly they absolutely refuse to try anything but the medicine I already know won’t work, as far as I can tell just because I had the temerity to know something about my own body.

          1. Full Banana Ensemble*

            Ugh, sounds like my experience with metronidazole, another antibiotic. The first time a doctor prescribed it, it made me vomit. A lot. So I’ve tried to avoid it, and yet, in the 14 years since, doctors seem positively determined to put me on it, and never accept a no on the first try. I’ve gotten, “Well, what if we try it along with Zofran for the nausea?” and “Okay, so not by mouth, but maybe you can tolerate it by IV?” instead of just… prescribing literally any other antibiotic in the world.

            FINALLY, one kind physician said, “I’m going to list this as an allergy in your chart, so you won’t keep getting asked about it.”

            See if you can guess what happened next.

            Yes, the next doctor I saw actually asked me, “Okay, but HOW allergic are you? Like, do you need an epipen?” And when I foolishly said, “No, it just makes me vomit,” they said, “Well, let’s try it and see.” (!!!)

            I was in the hospital at the time, so I said, basically, “Fine. I’m not gonna be the one cleaning up puke.” Alas, neither was the doctor – it was a poor nurse who didn’t have any control over the situation wielding the barf bucket.

      2. Observer*

        Yes, he’s going to kill someone. And (in case your management is as sexist as he is), it might not be a woman, either. Because he also sounds like an AWFUL diagnostician.

        1. ThatGirl*

          I 100% believe that women have a harder time with this, but I also witnessed my dad, from afar, be treated terribly in a small-town ER in a rural area. He, age 63, family history of heart disease, thin and white, went to the ER with diffuse chest pain and they told him it was probably muscle pain. Sent him home with muscle relaxants and not an EKG in site.

          Reader, he had a massive heart attack that he barely survived. I’m still mad at that doctor.

          1. Ridiculous Penguin*

            The left side of my body was going numb/stopped working and my doctor said it was because I driving a car with a manual transmission.

            I had a brain tumor.

            1. Enai*

              *Stares in German*
              Like, every car by default is stick shift here. Why has nobody I know ever complained about losing the use of their left half of their body as a common consequence? You’d expect it to be at least as frequent as tennis elbow or carpal tunnel syndrome, wouldn’t you?
              Man, what arrant nonsense. I hope a competent doctor found the brain tumor in time for successful treatment.

              1. Warrior Princess Xena*

                My mom DID start developing negative side effects from driving a stick shift – in her right hand, in her forties, when she started a new job requiring a very long commute, and with a family history of early arthritis. And that was considered an outlier case.

                At no point did ‘numbness in entire half of body’ seem like a reasonable symptom.

                1. DJ Abbott*

                  If it happened It would be on the right side, not left, because that’s the hand you shift with.
                  Duh!

                2. Ridiculous Penguin*

                  He said it was because I had a long commute and was using the clutch a lot.

                  And that doesn’t even include the neurosurgeon who gave me a note for only two weeks off and refused to give me a referral for OT after my surgery.

                  I have motor deficits and cognitive issues that almost certainly would not have existed had I been given more time to recover and resources to heal.

                3. DJ Abbott*

                  @Ridiculous Penguin and others here with bad experiences, I hope you looked into suing these doctors for malpractice.

                4. Splendid Colors*

                  I got arthritis in my left (clutch) foot after driving stick shift for a decade, and it gradually worsened. Eventually I got an automatic, and my foot recovered in just a few months of resting while driving instead of having that much pressure on one joint.

              2. Nina*

                Like, every car by default is stick shift here.

                Ohhhhhhh that has suddenly made so many things that have happened to me make so much more sense.

                1. Enai*

                  Please, can you elaborate? In the open thread at least? I’m always interested in small, unexpected cultural differences of the “But everybody knows X!” vs. “No, X is obviously wrong, Y is correct!” sort. We think the way our immediate surroundings are organised is sensible (it mostly is, usually) and therefore a slightly different arrangement makes no sense and then are plum surprised when other, equally sensible but clearly different arrangements exist that, again, “everybody knows”. And that’s fascinating and awesome.

            2. baby twack*

              My dad was experiencing stroke-like paralysis on his left side and the ER doc told him it was anxiety and sent him home with an anxiety Rx. Turns out it was brain cancer. And yet, he remained on the anxiety med until he died. Make it make sense.

          2. I AM a Lawyer*

            My doctor gave me an EKG in her office because my heartrate was high. It took like 10 minutes, most of which was placing the sticky pads on me, and was done by a medical assistant. It’s baffling to me why they wouldn’t be willing to be extra careful and use a pretty easy diagnostic tool. Bias is a powerful drug. I’m glad your dad survived.

            1. Bunny Lake Is Found*

              I was in the doctor for digestive issues and my BP was really high and the doctor literally told me if she didn’t see a normal EKG she was sending me to the ER.

              I told her my BP is always scary high (I’m working on it with my GP) but yeah, she was like “I need to see this is normal or it would be malpractice to allow you to leave” and “I know you are telling me this is normal for you, but this is a time I cannot really take your word for it because the margin of error is death”.

              EKGs take a few minutes and are almost always covered whenever the doctor thinks there is a risk of a heart issue (so much cheaper than an echo or anything that will happen in an ER).

              2. Chas*

                I had a similar experience when a blood test at a new doctors showed that I had very low calcium levels, due to having had 3/4 of my parathyroid glands removed as part of thyroid cancer removal a few months before. (I’d been eating a bunch of calcium tablets each day, but the other doctors should really have been given vitamin D to help with the uptake instead- but they’d been more worried about getting my thyroid hormone levels right and had all-but-ignored the calcium stuff).

                Even though I’d been living with it for months and hadn’t had any serious issues, they called me as soon as they got the result and told me to go straight to A&E, where they gave me the right medication and insisted on doing an EKG to make sure my heart hadn’t been affected by the lack of calcium.

                I can’t imagine having a test that easy to do and not bothering to do it even when someone comes in with symptoms and a family history for it.

            2. Ann*

              My doctor gave me an EKG that came back clean, except for a really fast heart rate. So of course, I was having panic attacks. This despite the fact that five minutes before the EKG, the doctor and nurse both noted that I look awful and not like myself at all. Well, that’s it – I was a nervous case, nothing to see here. I’d come in with a bag packed in case the doctor sends me right over to the ER, and instead went home with a recommendation to rest more and drink calming tea.

              I was back in her office three times over the next few months before she sent me to a cardiologist. At that point, cardiologist had nothing to go on except residual symptoms and my description of how I felt a few months ago. Apparently I had pericarditis, which went totally untreated when it was still acute. I ended up with a couple of years of chest pain and tachycardia, and I’m lucky my heart held up at all – my heart rate really spiked a few times. Maybe it would have been less bad if I wasn’t “stress-tracked” the first time I came in.

      3. goddessoftransitory*

        Yes! If he really thinks “Say Dwight, some friendly advice to think over; YOUR PATIENT IS HAVING A HEART ATTACK” is how he should get feedback he is in the wrong damn profession.

    4. Cee Cee*

      I’m wondering how much of the soft skills is evaluated *before* the students are admitted to the program. OP described how Dwight was resistant to feedback. It sucks to invest in so much time and money then they find out the nature of the job is not for them.

      1. NotAManager*

        It does suck, but to be fair, part of residency is figuring out how well one works in a real-world environment. This is really the time for Dwight to be evaluated for his skills as a doctor and between misdiagnosing a patient AND responding extremely poorly to feedback about it, unless he shows IMMEDIATE improvement and willingness to change (like coming back TOMORROW and apologizing for the way he recieved that feedback), I don’t think being a physician is the right job for him.

        1. Cee Cee*

          Some pre-med are good in “gaming” the admission process to make themselves look good. I feel bad about genuinely compassionate but less academically strong individuals are overlooked.

          If the med student is in residency, the program fails to address interpersonal issues during the program. Such a space is wasted on individuals who should not be doctors.

        2. KitandKat*

          This. The attitude may have come out in med school but he has the option to pick recommendation letter writers who liked him. The level of responsibility is way higher in residency so it’s possible it didn’t get to a point that it impacted what was expected in terms of academic (diagnostic) skills, at the time.

      2. I WORKED on a Hellmouth*

        It’s not the nature of the job, though–it’s wanting to tone police a woman and not have mistakes or the potential consequences of those mistakes be called out directly.

        That’s some internalized crap that is going to cause problems in just about any job.

        1. Properlike*

          Right? I’ve gotten this treatment from men in ever professional space, ever. To the point where we should recognize it for what it is and stomp it out once and for all. Doesn’t have to be coming from a doctor to kill people.

          1. I WORKED on a Hellmouth*

            That doesn’t mean that he won’t be a poor employee, or that he won’t still have a terrible impact on other people. The bar isn’t “Killing people is unlikely” for attitudes and behavior like this.

            1. Bunny Lake Is Found*

              It isn’t, but also if he is behaving like this in a non life or death situation it is much easier for everyone to just let him fail and do bad at his job until he gets fired. If the effect of Dwight’s errors is potentially death, everyone around Dwight will do whatever possible to minimize the impact of Dwight’s shitty attitude. If the effect is instead that Dwight looks embarrassed in front of a client or supervisor, everyone is going to be more inclined to just let him go forth and show his ass.

                1. Bunny Lake Is Found*

                  But he is going to have to work SOMEWHERE. We don’t have an option to just pay Dwight a stipend to stay out of the work force. So I don’t think it is wrong to suggest that he should be confined to workplaces where his behavior will get him fired more quickly and where the impact isn’t death.

                2. Boof*

                  Op can’t force dwight to change behavior, just tell him the behavior is not compatible with residency and make sure those in charge of his position are aware of the severity of the problem. As a doc i agree Dwight sounds dangerous and most of that is due to what sounds like arrogance and dismissiveness

        3. umami*

          I ended up in the ER on a recent vacation due to severe abdominal pain and neck pain, which really freaked my spouse out because I pretty much refuse to get medical care most of the time, so he knew it must be bad. They said they would give me morphine via IV and that I should feel almost immediate relief. I’ve never had it and didn’t know what to expect. Well, I didn’t feel any better after about 20 minutes (while waiting for them to decide if they were going to do Xrays or an ultrasound), so I told my spouse to let the nurse know I was still in excruciating pain. So they gave me another dose of morphine, and I did actually start feeling better. He thinks they didn’t actually give me anything the first time because I complained about pain in two discrete locations so obviously it was in my head. We were at the start of a 10-day vacation, and I was basically in pain the entire time

      3. MigraineMonth*

        Huh, I’ve always thought “soft skills” meant the ability to collaborate well, communicate clearly, and be generally easy to work with. For a doctor, that would be bedside manner and coordination with the care team.

        The ability to make an accurate diagnosis and to respond appropriately to corrections (including those from women) seem like “hard skills” to me. Even someone with zero patient contact and little contact with a care team (e.g. someone who interprets imaging) need those skills.

        1. Elizabeth the Ginger*

          In this case, the lack of soft skills (receiving feedback well) is leading to a lack of hard skills (diagnosing accurately). Before starting training in medicine, a student could reasonably lack the skill of diagnosing, so you wouldn’t want to screen for that – but if someone had caught earlier than Dwight wasn’t going to let women teach him the hard skills, then they could have given his spot to someone who was willing to learn.

          1. MigraineMonth*

            Does this mean I can start listing “not a misogynist” as one of my soft skills on resumes, or is that something that belongs in the cover letter?

            1. goddessoftransitory*

              I’m starting to think interviewees should just wear a tee shirt with that on it.

            2. rebelwithmouseyhair*

              No just wear a T-shirt saying “I’m positively woke”, that should amaze everyone.

      4. rebelwithmouseyhair*

        There are plenty of things you can do with a degree in medicine that don’t involve patients. But of course, we don’t want sexist people running research programmes either so…

    5. 2 Cents*

      Or obesity when my problem is I broke my finger and I need a splint. Or something else physical—just believe me that I have pain and I’m not just imagining it!

        1. Becky*

          And even if weight is a contributing factor “lose weight” is not a solution to an acute problem!

          2. Nea*

            I’ve now had to fire two doctors for being more interested in making me lose weight than addressing my issue. The first one left me with permanent nerve damage; I didn’t give the second one the chance.

          3. AnonyNurse*

            Ugh, yes. Similarly, yes I know that stress contributes to my migraines. That doesn’t mean I don’t have a migraine. I have a freaking migraine! Talking to me about my stress levels is not helping my migraine or my stress. (And I’m a nurse…)

          4. goddessoftransitory*

            Like, are you supposed to just drop your excess weight like a backpack right there in the office? “Nobody told me until now! God bless you, doctor!”

          5. Katie Impact*

            Yep. I’m currently being treated for sleep apnoea. There’s a good chance it will improve as I lose weight – but that’s going to take about a year, because there’s a limit to how fast you can safely lose weight. And in the meantime, I still need to sleep.

            1. STAT!*

              Also, as I understand it, bad sleep can be causative of weight gain. Presumably then, better sleep may help you lose weight, or at least prevent you from gaining any extra. So yes, you definitely need to be able to sleep properly first.

          6. Chirpy*

            This, I had chronic knee pain for almost 10 years because every time I tried asking a doctor about it, I was told to lose weight. I gained that weight *because I was in too much pain to exercise* and became a stress eater instead of a stress hiker *after* the original knee injury.

            Once I figured out that I’d clearly pushed the original injury too much too soon (also by following a doctor’s timeline instead of going with how it felt) and trial/error/google learned how to strengthen and stop re-injuring it, I also started losing weight….

          7. Quill*

            Or a chronic one! Often excess weight is a symptom of a chronic problem not the cause of it!

      2. KatEnigma*

        I went in with a severe double ear infection, and the doctor glanced in my ears and then proceeding to lecture me about my weight (don’t know why just practically, when I COULDN’T HEAR HIM) until my husband intervened and asked if he was going to do anything about my ear infection.

        My husband has MS and he has to fight to get doctors to not just brush any and all symptoms off as “just MS, to be expected” without investigating.

        1. MigraineMonth*

          This is awful, and I’m sorry you went through it, but I love the image of a doctor going on a long lecture about losing weight that you can’t hear because the problem *is in your ears*.

        2. Cyndi*

          Oh God we have such similar anecdotes and I hate that for both of us. I’m so sorry that happened to you and keeps repeatedly happening to your husband.

        3. 2 Cents*

          In addition to being overweight, I have MS, so what isn’t attributed to one is attributed to another. Thankfully, I’ve finally found a curious neurologist who’ll say “sounds like MS, but we can run X tests or try X and see if it helps.” Hugs and commiseration to your husband.

        4. Dahlia*

          That’s super common with trans people, too, who are often dismissed as all their issues being “trans issues”. Some people I know have had doctors refuse to treat them because they “don’t do trans healthcare” and it’s “too complicated”. You know, because trans ear infections and broken wrists are a thing.

          1. Katie Impact*

            The colloquial term I’ve heard for this is “trans broken arm syndrome”, based on the image of a patient coming in with a broken arm and the doctor trying to connect that to them being trans somehow.

      3. Well...*

        So I had a wild moment recently at the Dr. I told my Dr about some vitamins I’m taking that I was recommended to help reduce recurring UTI’s (they either work or they are fantastic placebos in my experience), and my Dr said, “We prefer evidence-based solutions to problems.” I was like, yes! Great! Give me that! How can I make this stop?!

        And his answer? Eat a balanced diet.

        I’ve never been able to directly relate to the treatment of “just lose weight” that obese people go through, and I still can’t. But I imagine it’s somewhat similar to being told “just eat healthy” is a solution to an annoying health problem. Completely infuriating.

          1. 2 Cents*

            Just imagine, then, asking for what a balanced diet is and either getting 1,000 answers or “you know what you should be doing.” As if I’m just willfully fat!

            1. JHS*

              Oh, I was like this for years. Asked for help (weird food intolerances made things tough for me) and got handed a food pyramid. If that were enough, no one would be overweight! And then I saw a public health dietician who told me I’d never be able to lose weight and that she didn’t believe in food intolerances. My digestive system doesn’t take her opinion into account when it has a hissy fit over vinegar… Ironically, getting diagnosed with Type 2 diabetes helped hugely because using the exchanges diet has been great for my blood sugars, my intolerances and my weight! I got diagnosed thanks to a great GP who looked at my swollen feet and said ‘Let’s do bloods for multiple things and get you on antibiotics’. That woman has saved, if not my life, certainly my quality of life. I wish more doctors were like her…

        2. Grumpy Elder Millennial*

          And I’m guessing that he didn’t ask any questions about your eating habits in advance.

        3. AnonyNurse*

          For you, a balanced diet appears to include the vitamins you are taking! Glad they are working, whether in the typical-use way or the placebo way. The placebo effect is real.

          1. AnonyNurse*

            By which I mean, the placebo effect can be really beneficial. If you feel better, aren’t having flare ups, recurring infections, etc. it is a win. Not to be dismissive in anyway.

        4. Artemesia*

          So curious — is it one of those cranberry/vitamin C things? I have wondered if they work.

          1. Well...*

            I have tried those, and they’re okay but not great. The thing that seems to work for me is Precision D-Mannose (I think it’s some pro-biotic). I don’t know why it works, and I can’t say there’s any real evidence that it does, I just heard this word-of-mouth from other people who say it helps. It seems to help me.

            1. Eric Christenson*

              Mannose sounds like a sugar…which could show up in the urine and cause competing beneficial bacteria to inhibit growth of the bad bugs, or maybe a metabolite inhibits growth. But seriously, who knows, maybe it just makes you thirsty enough to keep things rinsed out?

              Or if you want to get wilder, I forget which drug it was that the “inactive” ingredient was the critical one to its effectiveness.

        5. JustAnotherKate*

          Yeah, I got a lecture from my doctor’s MA about how I should stop “eating so much fatty meat” (I’m a pescatarian) and “at least try to get a little exercise, like get up and move around a litte” (I work out 6-7 hours a week) because my cholesterol was slightly elevated. I’m not fat, so I was kind of taken aback by the body shaming, but I’m sure it’s worse to just be used to it.

          1. TinyViking*

            Omg same, I got the advice to “eat less meat” from my doctor to help with my high cholesterol – I’m literally a vegan and had already told him so.

            I do have sympathy in that I know medical professionals are busy with more patients than they can handle, so they fall back on the simple “truisms” they were taught in medical school (or culture at large?). But like, this is America and I’m paying a lot of money for the privilege of this experience. I can be not-helped for free at home.

        6. goddessoftransitory*

          God, I know. Like, okay, I get I’m not supposed to be eating nothing but Cool Whip and Cheezits, but exactly how much balance can I achieve, here? The equivalent of the Flying Wallendas on my plate every single day will cure XYZ?

          It’s like when you have an exercise program and everybody can’t wait to tell you you really should be doing X instead of whatever it is you are doing. I finally realized I’d have to quit my job and spend fifteen hours day working out to “get in” every kind of “necessary” exercise out there.

          1. Kay*

            OMG I died reading this! I actually had to ask my doctor once which exercises I could remove from the lineup because 2 hours a day of just rehab style exercises wasn’t sustainable (especially since progress wasn’t being made). As to where the cups and cups of calorie free nutrient packed superfood goodies are hidden – still haven’t figured that out.

            1. goddessoftransitory*

              I really would like to know where that magical field of lo-cal Magic Blueberry Salmon trees is located, for sure.

      4. Keymaster of Gozer*

        Dwight sounds like the doctor I had the misfortune of having in the NHS for several years.

        Severe depression? Must be because I’m a woman and blamed it on hormones.
        Arthritis flare up? Lose weight
        Sudden unexplained drop in weight combined with blurred vision and massive anxiety? ‘Keep it up!’

        It’s all signs of a lazy doctor. Doesn’t actually want to do their job but still wants the pay.

        1. Bagpuss*

          YEs. I have *mostly* been fairly lucky with my regular doctor but did have a consultant, when I was around 12 and broke my leg, who a complete Dwight. I’d been given a lightweight cast which was made of some form of plastic/fibreglass – which as it turns out, I am allergic to. Consultant was massively rude and patronizing to me and to my mother, who had insisted on me being seen. He said (in as many words) that I was making a fuss about nothing because children don’t like the itching you get under a cast, but that since my mother was being so irrational and insistent, he would give instructions for the cast to be removed so we could see there was nothing wrong, but that we needn’t expect them to replace it afterwards!.

          It took hours to remove because the reaction meant that my skin was completely raw where it had blistered and the blisters had broken, and in some cases started to get infected. I was in massive pain because any touch or pressure hurt like crazy (I didn’t realise, but apparently they switched over and at least three different nurses were taking it in turns because they were finding it so distressing to be causing so much pain.
          I couldn’t have a cast back on because my skin was in such bad shape and I still have a couple of scars from the worst affected places , and I shudder to think what might have happened if my mother had been less willing to keep on insisting that there was something seriously wrong, despite the doctor’s attitude. (And she is an articulate person, bolstered by having been advised by my godmother, a nurse, to trust what I was saying about it hurting rather than being itchy, and to push for it to be properly checked out)

          I did also have an experience a few years later when I asked my GP about the fact that I was getting periodically swollen glands. I’d had glandular fever early in the previous year and had been told that they might carry on swelling up on and off a I recovered and specifically told him that
          (i) I wasn’t particualrly worried
          (ii) they were’nt very swollen,
          (iii) I just wanted to know if it was normal for them to keep swelling up periodically nearly 2 years after having had glandular fever., or whether it was anything I should be tracking .

          He felt them and told me they weren’t very swollen (which I had told him) and that sometimes you get swelling after having had glandular fever (which I’d told him I knew)
          He never did answer the actual question I had asked him, even after I repeated it. I was only about 17 and didn’t push it again.

          And from time to time, it happens to men as well. My younger brother got something (possibly glandular fever again) when he was in his early 20s. He was concerned that he was turning yellow and had read and found that it does sometimes affect the liver and cause jaundice, and can be a problem at that point if not treated. The first doctor he saw w dismissed his concerns and it wasn’t until he claimed to have pain and tenderness in that area that they took it seriously .(turned out that his liver was badly inflamed and he did need proper treatment, but the first doctor hadn’t been welling to listen to what he was describing and just fobbed it off as ‘everyone gets glandular fever, rest and it will be fine’

          He didn’t apologise and we didn’t see him again for any of the rest of my follow up treatment. I still regret slightly that no formal complaint was made

      5. Avery*

        Especially when some of these problems can be why the patient is overweight instead of vice versa–it’s awfully hard to exercise when doing so causes you significant pain, for instance!

      6. BeautifulVoid*

        When I was in college, it was a running joke that it didn’t matter what you went to the campus health clinic for if you were female, the first question was always “could you be pregnant?” It’s winter, it’s been snowing for three weeks straight, you slipped off the curb and twisted your ankle, and two of your girlfriends are helping you hobble in? Are you sure it’s not because you’re pregnant? Better run a pregnancy test on all three of you just in case.

        1. Galadriel's Garden*

          Ours was like that, too! I went in for viral bronchitis, and they insisted on giving me (then a virgin, no less) a pregnancy test. I get that it probably has something to do with liability – they assume girls will lie about their activities, and don’t want to risk prescribing something that could do harm to a fetus, but like…that is not a great feeling.

        2. umami*

          I went to the ER as a 52-year-old woman and that was the first thing they asked me lol. Like, what? No. But they still were required to give me a pregnancy test before any treatment :/ I get it, but also, ugh.

          1. Emma*

            I’ve only ever heard of this happening in the US, surely it’s a charge-you-extra thing?

          2. Quill*

            Can’t get normal maintenance meds prescribed unless I take a pregnancy test… the meds treat something that likely makes me infertile! (I say likely because it costs money to test that, and I do not have that kind of money, or any interest in having kids…)

          3. JHS*

            The joys of the 8th Amendment in Ireland, which granted equal rights to a foetus, meant that women could be denied treatment if they were pregnant (and denied scans if they couldn’t prove they weren’t). It led to some women dying from preventable causes and still took years to repeal. It was completely horrible…

        3. SHEILA, the co-host*

          Ours was like this too. One time, a friend had a doctor insist she must be pregnant after she said she was a virgin. She pretended to faint in excitement and announced to the doctor that she must be carrying the second coming of Christ. [This was at a Catholic institution]. The doctor begrudgingly admitted that perhaps she wasn’t pregnant, and acquiesced to her demand that another provider be sent in. I forget what the actual diagnosis was, but it was something like a sinus infection.

        4. Bunny Lake Is Found*

          I don’t mind if the default is to always run a pregnancy test, especially with our laws regarding having to carry non-viable pregnancies to term and the serious risks some treatments may cause to fetal development. The issue is then acting like getting a positive test would explain EVERYTHING. Like, even if you WERE pregnant, you can still roll your damn ankle!

        5. CatMintCat*

          I had treatment for breast cancer in 2019. At every single medical place I went, I was asked for the date of my last period and if I could be pregnant. I was 60, my last period was sometime in 2007 and I was pretty sure I wasn’t pregnant. It became a running family joke.

        6. Nightengale*

          We may have attended the same college.

          I wrote a paper senior year for my medical anthropology class on student experiences with the health center, titled, “Are you stressed, dear, or are you just pregnant?”

        7. goddessoftransitory*

          I mean, I get asking before giving drugs or radiation or something, but yeah; dude, if my leg is broken I don’t think the fetus swung a club at it, okay?

        8. Snowy*

          Ugh, I went in once for a sprained back, and they wouldn’t give me anything until I took a pregnancy test. Rather painfully, because of, you know, the sprained back. Didn’t matter that I was an asexual virgin. Then they gave me anxiety medication for it instead of painkillers (which did help somewhat as it was a muscle relaxer, but still.)

          1. Snowy*

            And I wasn’t told it was anxiety medication until I went to the pharmacy the next day, either.

        9. Queer Earthling*

          I always feel obligated to mention the time my spouse went in for surgery to fix some accidental damage done during their hysterectomy a few months prior, and they still insisted on a pregnancy test.

        10. JustAnotherKate*

          LOL, I literally dropped a frozen turkey on my foot and broke it (the foot, not the turkey) while making Thanksgiving baskets at my college volunteer job, and the first thing I was asked at the health center was when was my last period and could I be pregnant? I thought maybe it was because I needed x-rays, but it was still weird.

      7. goddessoftransitory*

        God, yes. I work out five days a week, we cook our own meals, and that’s all I have the time and inclination for, Doc. I don’t need to hear this when I’m actually in the ER with a sprained wrist.

    6. Constance Lloyd*

      This is especially infuriating because it is EXTREMELY NORMAL AND HEALTHY to feel anxious about a serious medical condition!

      1. Bee*

        God, yes – when I was experiencing long covid-like symptoms before we knew that was a thing, I had a couple people ask me if I had anxiety, and like, no, not before this, but I DO have a lot of fear about how awful I feel with no apparent explanation, yes!

      2. Cyndi*

        Last year I had a double ear infection that was maybe the most pain I’ve ever been in in my life–it felt like I had been smashed in the face with a bat. It got bad VERY suddenly and I had to snag the only same day CVS Minute Clinic slot I could get, leave work early, book it across town, locate the CVS inside a Target with an entrance hidden inside a parking garage?????? arrive two minutes late and mash randomly through the automated check-in process…so I could sit for about a year and be lectured by the RN because my blood pressure was a bit high. The only way I finally got her to look in my ears was by responding to everything she said with “Sorry, I couldn’t hear you, I’m in too much pain.”

        1. Observer*

          so I could sit for about a year and be lectured by the RN because my blood pressure was a bit high.

          What in incompetent idiot! Of COURSE your BP was high – you were in pain! Add to that your stressful experience getting there, and a slightly elevated BP number indicates that your nor normal numbers are probably OK.

          1. Cyndi*

            In hindsight I should probably have complained about her, but it was almost a year ago now. She also said my right ear wasn’t infected–which even I knew was wrong, because the pain had started on that side, and a different nurse confirmed it when I went back next week because the first round of antibiotics hadn’t cleared it. (NB: they were oral antibiotics, so the mistake didn’t actually impact my prescribed treatment.)

            And she gave me my flu shot somewhere in the middle of that lecture, which I would have gotten anyway, but I feel weird that I was asked to make decisions in a state where I would have done basically anything if it would get someone to give me antibiotics and painkillers.

            1. MigraineMonth*

              On the one hand, it’s great she was providing non-urgent preventative care. On the other, her priorities are… questionable.

              1. Cyndi*

                I remember being super disoriented when she offered it, because it felt like a weird time of year to be thinking about my flu shot, but it took me a minute to work past HELP HELP THERE’S AN ICE PICK IN MY SKULL to remember what month it was (August).

        2. ronnie*

          my spouse has chronic pain and had a hard time getting his pain meds on a regular basis at the last place we lived. we recently moved and got him an appointment with a new doc ASAP. at the initial appointment the doctor said his blood pressure was pretty high (had never been a problem before) and was quite concerned, saying she wanted to send him to a specialist and a dietician and have him start meds and on and on. he managed to get her to agree to hold off until his follow-up a week later. at the follow-up, she said his blood pressure was now textbook perfect and was just baffled. it finally took her nurse pointing out the only difference between the previous week and that day was that my spouse’d had a solid week of effective pain management for her to understand what happened.

      3. Freenowandforever*

        I went to a gastroenterologist because I was having gallbladder pain (My Mom had suffered with gallbladder pains for five years before they would take hers out, so I knew what I was talking about.) After giving me a rectal exam, the doctor told me he thought I had an ulcer, because I seemed anxious. I told him that he’d seem anxious, too if someone had his finger up his ass. Tests confirmed my diagnosis. He then told me that I could have laparoscopic surgery if the surgeon didn’t think I was too overweight. (I was 5’ 91/2” inches tall, had a large frame and wore a size 16.) The surgeon, my cousin, said, “I don’t know what he’s talking about.” I had the laparoscopic surgery and no one in my family ever utilized that doctor again.

        1. AbruptPenguin*

          Haha! That reminds me of a James Herriot story where a farmer calls the vet out to a sick horse he’s been unsuccessfully treating with home remedies. The farmer says the horse seemed uneasy on his legs, so the farmer pushed raw onions into its rectum. The vet says that the farmer might also be uneasy on his legs given similar treatment, and the farmer is gravely offended and never forgives the vet.

        2. Grumpy Elder Millennial*

          It’s extra awesome (/sarcasm) because a lot of ulcers are caused by h. pilori bacteria and have nothing to do with anxiety.

          1. AnonyNurse*

            And the way a researcher finally proved that — in 1984 — was by drinking a vial of H. pylori filled ‘broth’ as no one would believe him and his colleagues that a bacteria was causing ulcers. Their papers had been rejected, their research dismissed. Within literal days, he’d developed a full-on ulcer, despite having a clear endoscopy just before drinking the broth. For his (literal) pain and troubles, Dr. Barry Marshall was awarded a Nobel Prize, with a colleague, Dr. Robin Warren (who as far as I know, did not also drink the ulcer-juice).

            Medicine just loves its long-held assumptions.

            1. Grumpy Elder Millennial*

              HOLY SHIT.
              And very annoying that we’ve known this for almost 40 years and it’s such a common misconception.

        3. Happy meal with extra happy*

          I suffered with gallstone attacks for nine months, including two or three ER visits and a GI doctor, to get told it was just stress and constipation before finally getting diagnosed by a wonderful nurse practitioner on the eve of a five-day hospital stay due to acute pancreatitis.

        4. Sopranohannah*

          Part of my job is reviewing medical charts on a surgical floor. I probably review 2 or 3 gallbladder removals a day. Every gets laparoscopic surgery. I’ve seen 1 open removal in my career, and that was due to excessive bleeding, not weight. I don’t know what that doc was smoking.

      4. Lucky Meas*

        If I had a dollar for every medical condition I’ve had that could possibly be exacerbated or caused by stress, and therefore stress must be what triggered it… I would have enough money to treat those conditions.

    7. different seudonym*

      Oh F yeah to this comment. I delayed seeing my then-PCP about something that turned out to be SERIOUS because she usually treated me like I was stupid or irrational. I was eventually fine, but it was bad.

    8. The Shenanigans*

      Yup especially for women. It took me ~15 years to get a serious health problem properly diagnosed and treated because I kept being told it was all in my head. I am so grateful for doctors that actually truly physically examine a patient.

    9. I'm A Little Teapot*

      Yes. Frankly, I know there’s a shortage, but if a “doctor” can’t treat women as human beings rather than silly little girls then they shouldn’t be doctors.

    10. DJ Abbott*

      All my life my debilitating symptoms were dismissed by doctors as stress. Or worse, “impossible”. I’m female and this is how I was treated by male doctors.
      I ended up diagnosing my own food and airborne allergies and learning to manage them, and eventually found excellent (female) doctors to help me.
      The worst doctors are those who dismiss anything they don’t understand as stress or anxiety. If he really missed obvious symptoms of a fatal disease, he’s also incompetent. It sounds like he’s in denial about both these things, which means he won’t work on it. Please don’t let him become a doctor. Ideally he’ll get a job where he does only minimal damage.

    11. Katefish*

      I’m female and literally got an anxiety misdiagnosis one year in the ER as the cause of my vertigo. It was actually bad ragweed allergy, thank God urgent care knew that.

    12. UKgreen*

      As someone who was fobbed off for several by various doctors in the UK’s apparently world-leading NHS that my symptoms were ‘anxiety’ before I collapsed with a massive pulmonary embolism and had to be resuscitated, thank you for advocating for your patients.

      1. Molly*

        This happened to my mom. She was in the hospital, recovering from having a stent replaced, and began feeling dread and knew something was very wrong in her body. She’s not an anxious person. She alerted the doctor who brushed her off. She insisted and she was right; she had a pulmonary embolism. To his credit, he did apologize, but she might not have survived if it had been ignored – which is what he was prepared to do, chalking it up to anxiety.

      2. Dina*

        A family member of mine had liver failure misdiagnosed as anxiety.

        She did not survive.

    13. goddessoftransitory*

      YES. Speaking of “probably not pulling this with dudes,” how many patients of Dwight’s have been told “you’re just stressing/have hormones/are hysterical” and also happened to be women?

      Because if he’s trying this crap on with his BOSSES you know he’s ten times as bad with the patients.

    14. rosebramblewolf*

      I’ve had doctors repeatedly screen me for depression due to how little energy I’ve had over the past several years. Turns out it was cancer, and it had to crush one of my vertebrae and do possibly permanent nerve damage from the waist down to get diagnosed correctly. But, you know, have I tried seeing a therapist?

  2. Madame X*

    I am very concerned for Dwight’s patients. A doctor should not be prioritizing his feelings of his patient’s’ health.

    1. Bigger-the-hair…*

      Sounds like Dwight needs to find a new area of medicine. Research maybe? If he can’t handle feedback, how can he handle life/death decisions. This is non-sense. “Friendlier” is BS!

      1. NotAManager*

        I thought that too, but if Dwight insists that all feedback be given to him as “suggestions/advice” rather than “telling him what to do” a research lab might not be the best environment. It is possible that Dwight’s resistance is based in sexism and that he might actually listen to the same feedback given the same way by a man, in which case…he still shouldn’t be in a lab. Sexism in STEM fields is an ongoing problem that isn’t going to be solved by making sure sexists can be sexist while still getting their work done.

        2. Cedrus Libani*

          Also, they don’t get work done. Dwight is the guy who’s read four whole papers on something, which makes him a world-class expert who has nothing at all to learn from the long-suffering female lab manager who has been doing this work since he was in diapers. He will be completely useless for months, maybe years. She’ll try to help him, but no, Dwight is a big boy who can figure it out all by himself.

          Not that I want this guy as my doctor, but I don’t want him in my research group either.

        3. goddessoftransitory*

          Anybody who needs their job responsibilities couched as “friendly advice” isn’t going to last long no matter what job they have. I can’t think of any manager who actually wants to get things done putting up with that nonsense.

      2. anne of mean gables*

        this is exactly what pathology is for, no?

        (I know and love many pathologists!)

          1. MigraineMonth*

            While I admit it would be extremely difficult to kill a patient there, I still want medical examiners to be able to learn from feedback (particularly around safety issues) and interact respectfully with women. I honestly can’t think of a job where I would want someone like Dwight.

          2. AnonMEofc*

            Forensic pathologists interact with the families of the deceased; they’re frequently asked to explain the findings of the autopsy to family members, for example. You’d be surprised by how outgoing and friendly many of them are. Source: I work for/with one and communicate with their colleagues as well.

        2. RMNPgirl*

          Depends on the pathologist. If it’s clinical pathology when you work with the laboratory – absolutely not! Laboratories are staffed by medical lab scientists who are overwhelmingly female. And probably know more about medicine and diagnostics than Dwight (70-80% of medical decisions are based off the lab work so lab scientists get real good at figuring out what’s going on just by the results we get)

        3. goddessoftransitory*

          Depends on whether or not he misses something like “this person just died of [incredibly contagious disease] that needs immediate containment.”

        4. Pathologica*

          I am a pathologist and work with residents on a daily basis. These are incredibly concerning behavior traits for a trainee. Although (most) pathologists do not work directly with patients, communication skills are incredibly important, as you will be interfacing with other lab staff, surgeons, oncologists, primary care doctors, and many other members of the medical team. Plus, as mentioned by other commenters, medical examiners are ofter interacting with family members. I would find it extremely problematic if I was trying to tell someone “this is cancer, but you diagnosed it as benign” and they told me that I needed to be friendlier and not to tell them what to do.

      3. KatEnigma*

        If he can’t take feedback from women, he doesn’t belong anywhere in medicine. There are a lot of women in all the life sciences, but particularly in medical research.

        My SIL would fire him on the spot if he asked her to not tell him what to do.

      4. ecnaseener*

        Definitely not research lol! I sure wouldn’t trust anything he published, if he can’t A) make good judgments B) follow procedures or C) take feedback/peer review.

      6. Quill*

        I mean, having been in medically adjacent research, I wouldn’t *like* him as a colleague but also he’s unlikely to kill anyone by repeatedly introducing drug samples to tissue cultures.

        (He’d be a terrible researcher. But. Those get fired before somebody dies.)

    3. Ultra Anon*

      I’m very concerned that Dwight made it all the way through Med School without receiving any un-friendly feedback. I hope he’s not planning to be a surgical resident because those dudes can be brutal.

  3. Resident Catholicville, U.S.A.*

    I don’t have any advice, I’m just here to compliment you on, “I know you thought llama pox wasn’t a possibility for that patient because llama pox is very rare, but they did have tiny llamas growing out of their face, which is classic llama pox,” because that is the best. Just- absolutely perfect.

    2. MsM*

      Yeah, OP, I do not think you need any help with your communication skills. In fact, can you teach me? Please?

      1. Observer*

        Yes!

        OP, you are FINE. You are MORE than fine!

        And it’s a good thing that someone is in the room with you when you deal with this guy, because I have no doubt he’s spin the interaction like a top otherwise.

        1. MigraineMonth*

          Yes, very smart. I wonder, would it be possible to meet with both him and the person who’s deciding if he can stay in the program the next time you have to deliver serious (non-urgent) corrections to him?

    3. Drago Cucina*

      “…tiny llamas growing of their face…” needs to be in the Hall of Fame for examples.

      3. whingedrinking*

        Especially followed by, “It’s unlikely that anxiety, which was your diagnosis, would cause that.”

      4. Grizabella the Glamour Cat*

        I started giggling so hard at the mental image of tiny llamas growing out of someone’s face that I could hardly get through the rest of the letter! That made my night. 8-D

        P.S. Imo, Dwight has an attitude problem. I’d hate to be one of his patients. He sounds like a know it all who would blow off any concerns I might raise to him. I hate doctors like that!

    4. Hills to Die on*

      Is it wrong that I want this to be a thing? And while I do not want llama pox, a small part of me would be delighted to have a tiny llama growing out of my skin.

        1. Resident Catholicville, U.S.A.*

          “No, I didn’t eat that box of Girl Scout cookies last night- it was all the llamas growing out of my face. They also force me to watch Law & Order: SVU until 3 AM. You gotta obey your face llamas.”

        2. The Eye of Argon*

          It’s the most adorable deadly disease ever!

          Plus, I’m a knitter, and having a steady supply of tiny llama fiber would make me very happy.

        3. Stinky Socks*

          Welp, the latest strain of avian flu is crossing over into mammals. Maybe we’ll get lucky and the llama version will involve little sores…

    8. Goldenrod*

      This is what I came here to say! I love that image. It’s too bad that llama pox is fatal, because I love the idea of tiny llamas growing out of my face.

    9. 2023, You are NOT Nice.*

      All that we have had to worry about recently, and now I learn there is a danger of tiny facial llamas…. will the madness ever end????

    11. Nesprin*

      Lol, I had to go check the Poxviridae family to make sure there wasn’t a Llama pox- there’s a swine pox, a salmon pox, dolphin pox, sea otter pox, 2 flavors of crocodile pox, kangaroo pox, mothpox, rabbit pox, moose pox, seal pox, camel pox, penguin pox and turkey pox.

      And yes! There is a parapox virus that affects llamas!

    12. Nostalgic Wellness Coach*

      A Dr. Dwight that I used to work with would correct you and say that tiny llamas are ACTUALLY called alpacas.

        1. MigraineMonth*

          I read a book about the super “hero” named Inspector Well Actually. He was the smartest person on the planet, but only while correcting women. He lost his powers when his girlfriend got fed up and left him.

        1. Quill*

          Yes, it’s a louder and less fatal disease… that you only get from working repeatedly with camelids that have acne.

      3. STAT!*

        And I would correct your Dr Dwight to point out it depends on the part of your body affected. The ones on your feet are vicuna verucas.

    13. SometimesCharlotte*

      I read this and thought: someone thinks that’s harsh?!?! I’d say it’s almost TOO kind!”

    14. Karen*

      I have followed this comment thread just to make sure someone complimented OP on the llama pox diagnosis, because I 100% agree that it was just perfect.

    15. I Wish My Job Was Tables*

      I’m gonna use llamas for my example problems from now on.

      e.g.
      “I coded this wrong and filled the screen with llamas.”
      Or,
      “I whipped the eggs, but instead of meringue I made a llama.”

      1. PotatoEngineer*

        “I thought I was building a deck, but ended up with a llama. It bleated at me.”

    16. Too many birds*

      This is exactly what I wanted to say. Brilliant humorist, excellent physician, clear communicator. I want you as my doctor, OP.

  4. KatieKat*

    Yikes.

    For what it’s worth, I admire the presence of mind you had to respond that way in the moment. As Alison says, it is really a perfect response.

    Let’s hope this guy gets a major, immediate wake-up call or finds another profession.

    1. paxfelis*

      I vote for both. I have a feeling that if he did get a Clue to the face, he’d find a way to minimize or displace it, and go right on with the same behaviors except in that one instance.

      “Doctor, I think I have pangolin pox.”
      “No, you just need to shower more frequently. It’s not pangolin pox, it’s eczema.”
      “I have a pangolin growing out of my eyelid!”
      “It’s not pangolin pox. It’s NEVER pangolin pox.”

  5. Veryanon*

    Good lord. This guy makes life and death decisions and he’s all in his feelings because he thinks you are not friendly enough? *bangs head on desk*
    Please make sure that whoever oversees this guy’s training is aware that this is how he responds to feedback (in addition to the fact that he just sounds generally incompetent).

    1. EPLawyer*

      I’m not even stuck on his feelings. I’m stuck on he is being told people COULD DIE because of misdiagnosis and he just thinks that is something to THINK ABOUT. Like, I will decide whether that is something I should do or not. Not — oh yeah misdiagnosising is a big deal and should NOT happen.

      1. Myrin*

        RIGHT?? “Friendly advice that he can consider”, so, advice he can take some time to think about and then decide whether he wants to follow or not? I THINK NOT!

        1. Sparky*

          I feel like he just wants the feedback PRESENTED that way, even if he understands he has to follow the new rules. He basically wants it to look to other people like he’s taking the woman’s advice under consideration and choosing to adhere to it on his own volition.

          1. Observer*

            What difference would it make?

            And why would anyone try to consider that he didn’t REALLY mean the terrible thing he actually said? Because even if your possible interpretation wasn’t terrible too, it would still be a total dis-qualifier for him to be a person who thinks that this statement is acceptable to have come out of his mouth.

            Like if you are a cashier, it’s bad to steal the money in the register. But it’s almost as bad to boast about having stolen the money, even if you didn’t actually steal it. You would still get fired in most work places.

              1. Observer*

                I get that. But I still don’t get the point of the comment. It doesn’t change anything. Not just that it’s not actionable, but it doesn’t really add anything from what I can see.

            2. Butterfly Counter*

              The difference is showing OP that there is no way that this guy is going to follow her instructions because he doesn’t want to follow instructions from a woman. It’s not something the OP can fix in this guy and she shouldn’t waste her energy in trying.

          2. Sparkles McFadden*

            That’s a distinction without a difference. The LW wouldn’t be doing her job if she wasn’t being completely clear that the guy was putting a patient in danger.

          3. AbruptPenguin*

            I think it’s for himself, not other people. He doesn’t want to have to take feedback from a woman, or be corrected by a woman, but he knows he has to accept this in order to keep his job. Rather than shift his perspective, he expects LW to take on the work of turning her feedback into “friendly advice” to cater to his sexism.

            1. AbruptPenguin*

              And no, it doesn’t change anything, just a wrinkle to this absurd and infuriating situation!

            2. Ampersand*

              My read on it, too. He wants to save face—but if he’s more interested in saving face than saving lives, dude needs to be shown the door.

            3. Dog momma*

              As a retired nurse, there were a lot of doctors like that in my day. Some were foreign, some not. it’s like women didn’t have a brain. But this guy is a resident and not listening to his supervisor or staff ( nurses). He’s gonna hurt somebody. I remember one evening shift where I had problems with our R3 with one of our chronic vent patients in the CT ICU. Thank goodness the Chief Resident rounded before he went to bed. He went up one side of that guy and down the other, and wasn’t quiet about it. Last time we had a problem with that particular resident.
              OP it may come to that if this guy is so bull headed that he is right all the time.

        2. La La*

          And they’re not colleagues! OP Is his INSTRUCTOR and superior.
          Dwight sounds like a fragile little misogynist.

      2. Observer*

        I’m stuck on he is being told people COULD DIE because of misdiagnosis and he just thinks that is something to THINK ABOUT.

        Yeah. That’s just BREATHTAKING.

        I mean, how does someone hear “this is fatal if left untreated” and come back with “I get to decide if I should consider it or not”?????

        1. Radioactive Cyborg Llama*

          Because he is a god in his own mind and it should be presented as an option because he and only he has the knowledge and wisdom to decide if it’s correct or not.

          1. Dog momma*

            Yep,saw it all the time. Luckily things did improve as we got to the end of the last century.. gosh I’m old

      3. kiki*

        Yes! I think Alison has said before that the biggest thing she and good managers are looking for after an employee makes a mistake is that the employee understands the severity and implications of the mistake and is doing what they can to rectify it. Dwight was told that he misdiagnosed a fatal condition and instead of taking it seriously, he’s focusing on the tone of the person telling him about the error. That shows that he deeply misunderstands the priorities of his role. That’s a much deeper issue to fix than just not taking feedback well and is likely something he should be let go over. Is someone managing his PIP aware he said this to you? If not, I would make sure to reach out and let them know.

      4. Blue*

        And the way he heard (paraphrased) ‘this disease is fatal so it’s important you don’t misdiagnose it’ and went straight to ‘don’t tell me what to do.’

    2. Lulu*

      My response would to him in that moment would be: “I am not your friend, and this is not friendly feedback. It’s professional and clinical feedback, and it is essential for you to take it seriously and not as a comment that you can consider if you agree with it or like it. As your attending/preceptor/supervisor/whatever, it is essential that you understand our respective roles in this setting.”

    3. Butterfly Counter*

      Oh gosh, I’m suddenly reminded of commenting in a long-ago feminist website. The overall topic was a news story about a man assaulting a woman for turning him down for a date. The men flooded the comments about how, if women could just do it “the right way,” they wouldn’t get assaulted.

      They should just be straightforward and not string the guy along by softening the message and making him have hope.
      But not too straightforward or else that’ll make men angry and want to assault women.
      But don’t smile too much while doing it, or else the guy will think you’re flirting again.
      But no, not like that.
      Like this, but not this.

      In fact, it would just be best if women went along with everything a guy said, that way they don’t get assaulted! That’s the ticket!

    1. LimeRoos*

      Lol yes! I’m picturing tiny Kuzco faces from The Emperor’s New Groove popping out all over. It’s disturbingly endearing.

      1. Yay! I’m a llama again!*

        “Uh huh, uh huh uh huh uh huh”

        Sorry, felt I should comment!

        Absolutely astounded that Dwight thinks he can respond this way!

    3. Ferret*

      It makes me think about the cartoons that were made about the first vaccinations showing people with cows popping out of their faces…

    4. Enai*

      I imagine them running around like the face is a tiny planet and the skin their meadow. Gravity, schmavity, llamas don’t know about the laws of physics and thus don’t need to obey them.

    6. goddessoftransitory*

      I’m picturing the llama lady Wammawink from Centaur World, forcing me to make fanzines about cute boys and singing.

  7. Jane Bingley*

    As a disabled person: thank you for protecting the public by correcting Dwight and taking this so seriously. “Llama pox is rare, so you must have anxiety” is exactly the kind of thing people with unusual medical conditions hear regularly. Sincerely, a zebra.

    1. Yoyoyo*

      Yup. I’m an embedded mental health provider in a primary care clinic, and while my providers are generally very good and listen to their patients, I do occasionally get a wonky referral that really should be referred for additional medical evaluation. I recently had one for “anxiety” where the patient had all the classic signs of an endocrine problem and their thyroid labs had been all over the place for the past year. My “intervention” was to advocate for a referral to endocrinology.

      1. AMT*

        I get this all the time (private practice psychotherapist). “Waking up in the middle of the night with your heart racing when that’s never happened before and nothing has changed in your life? That’s not anxiety—go run some tests!”

    3. Pam Beasley*

      Yesss! My daughter has a visual impairment that’s very hard to diagnose. We’ve been extremely lucky to have medical providers who err on the side of caution instead of turning us away, but the more I get involved with the community the more I hear about others spending years getting the correct diagnosis :(

    4. MigraineMonth*

      I was in treatment for digestive issues for more than 2 years before anyone did abdominal imaging. Taking laxatives and reducing stress don’t fix the problem when the problem is an 8lb benign ovarian tumor.

      1. Dog momma*

        Thank God it was benign. Mine was 6# and malignant. No symptoms, just back pain from an old work injury. Found on MRI.

    5. Keymaster of Gozer*

      Agreed. I got fobbed off for over 20 years about a uterine problem – told to stop complaining and go have a few babies – and finally got one exceptional gynaecologist who LISTENS and said ‘no, that’s not normal and it’s worrying’.

      Exploratory surgery and he approved and did my hysterectomy last year.

      A doctor who actually does their job is worth their weight in gold.

      1. invisible dragonfly*

        It’s amazing how many people get the “have babies” advice from doctors. Because when do babies take away problems or solve anything?

        1. Dragonflight*

          My doctor didn’t believe I had random tired spells (still do, they’ve never figured out a cause) and decided that having babies would change my hormones enough that it would fix it. Well, I’ve had a few kids (on my own terms) and the tired spells continue.

          1. BubbleTea*

            Pregnancy actually did massively improve my chronic illness (and I had a hunch it would, but only a hunch because it’s one of those weird illnesses mainly experienced by women so we don’t really know anything about how it works…) by suppressing my immune system just enough. If I hadn’t been completely determined to have a child whether or not it was going to help, it would have been a heck of a gamble.

            1. Quill*

              Other people’s kids make me tired and I’m just seeing them playing with automatic doors and running free across the parking lot!

    6. Fluffy Fish*

      It’s also notoriously done to women and that’s matters in this space.

      Dollars to donuts he treats his female patients differently than his male ones.

      If OP is looking for permission to call out any gender bias in his interactions both with patients and professional staff – she’s got it.

      1. littlehope*

        One of the conditions I have has an average time from first seeking medical attention to accurate diagnosis of 15 years. For women. For men it’s 4 years.

    7. Kyrielle*

      YES. My son lost a THIRD of his body weight before his zebra condition (actually two of them, one caused by the other being left to go on) was properly diagnosed.

      Counseling doesn’t work well when you need antibiotics and other medications. You just can’t talk-therapy the germs or immune system into behaving.

    8. just some guy*

      We know llama pox is rare, because we have so few diagnoses of it.
      We teach our doctors not to diagnose it, because we know it’s so rare…

  8. Sara*

    First of all, even though its fatal, llama pox sounds adorable.

    Secondly, this is a Dwight problem and not a you problem. He can’t accept your feedback and wants to consider it ‘advice’ and not sustainable information, that’s a problem he will deal with to his detriment. Keep having a second person in the room for big conversations so he can’t twist your words. But it sounds like your tone and feedback is clear and concise.

    1. Velomont*

      And an individual newbie in the early stages of his career should not be single-handedly trying to change the accepted culture and conventions of that career. He could possibly run into far harsher supervisors and critics – will he try to tell them to change their approaches, possibly after 20 or 30 years of experience?

    2. Properlike*

      Yes, OP, it was perfect feedback. I’m concerned that you had a moment’s doubt that it wasn’t. I’m even more concerned a different colleague had to be in there as a witness.

      This also sounds like a problem with your Med dept leadership.

      1. Observer*

        This also sounds like a problem with your Med dept leadership.

        I think it’s too soon to come to that conclusion. But what they do about this situation is going to say a LOT about them.

    3. Anon for this*

      Agreed on having another person in the room. Unfortunately I’ve seen assertive female colleagues be reprimanded for how they give feedback to employees when said employees twist what they say and there hadn’t been clear documentation and witnesses it would have gone very poorly for the female colleagues.

      1. Zelda*

        Possibly a double-edged sword, though, if a) the observer is also one of those people who labels the exact same behavior bossy/shrill if it’s coming from a woman vs. showing leadership/assertive if it’s coming from a man, or if b) being called out in front of a third party is some of what’s driving Dwight’s defensiveness.

        LW said “I have tried not to be alone when giving him serious feedback,” but it may be necessary to actively prime the third party about the situation beforehand. Dwight’s embarrassment can’t really be catered to here, but I do wonder whether either having the other person out of line-of-sight, or explicitly including them as already aware of the issue and aligned with the LW (not just hearing about it now), would make any diiference.

    4. Goldenrod*

      “Secondly, this is a Dwight problem and not a you problem.”

      Agreed!! If anyone needs coaching on their communication skills, it’s DWIGHT. He needs some training in how to LISTEN TO WOMEN respectfully, otherwise he’s going to be one of those terrible doctors who thinks his women patients are crazy and that they are imagining their symptoms.

  9. Ginger Cat Lady*

    I wonder if Dwight would tell a male physician giving him the same feedback that he needs to be “more friendly”
    Probably not.

    1. Not Tom, Just Petty*

      I also wonder how many male patients with llamas growing out of their faces are told it’s anxiety.
      Let’s be real.
      To borrow from the doctor, if you hear hoof beats, it’s probably not a zebra, it is most likely a male chauvinist pig.

      1. EPLawyer*

        YEP. This is also something LW should look at — are these serious safety concerns only with women patients?

      2. Watry*

        Definitely. Assuming LW hasn’t changed the specific details, Dwight smacks of ingrained sexism, and honestly we do not need another sexist doctor. And sexism doesn’t tend to come on its own.

        LW–if you haven’t changed the details and it’s within your purview, please address this, especially if the patient was AFAB. A sexist doctor’s assumptions have had long-term consequences for me.

        1. quicksilver*

          “Especially if the patient was AFAB”

          Please don’t reduce this to birth assignment. It seriously minimises the intense misogyny that trans women specifically often face in accessing medical care (as well as erasing the experiences of trans men / transmasculine people who are in fact perceived and treated as men).

          1. Watry*

            Point taken. I think I meant to write something closer to ‘feminine presenting’ but I got interrupted.

            1. Watry*

              And also that doesn’t quite hit it either. Genuine question, what is good language to use here?

              1. Hlao-roo*

                “Women” is simplest and covers both cis women and trans women.

                “Women and people assumed to be women”–I don’t love this wording, but it covers women and pre-transition trans men and feminine-presenting non-binary people.

                1. Ann Onymous*

                  fwiw, gender-based biases and discrimination tend to negatively impact pretty much everyone except cis-men.

              2. Bruneschelli*

                I’m not sure there is a catch-all simple term that’s intersectionally inclusive beyond ‘folks who aren’t cis white dudes’. The medical establishment isn’t good at recognizing medical issues in bipoc populations of any gender identity.

      3. L. Bennett*

        I was wondering this as well. Betcha a lot of those “anxiety” patients are women.

      4. Proud Feminist*

        First of all, although I too am worried Dwight will kill someone if allowed to be a doctor, I’m actually MORE worried about the dozens or even hundreds of patients he’ll belittle, talk over and dismiss because they tried to advocate for themselves. He’ll take any question or negative response as an attack on his precious little ego and treat that patient badly because he thinks he can/should. Even without an actual misdiagnosis, he can damage many many people.

        Second, ” if you hear hoof beats, it’s probably not a zebra, it is most likely a male chauvinist pig” ALSO deserves to be in the comments hall of fame. I am going to try to work it into conversation whenever I can.

      5. Gray Lady*

        Depends how old they are. Older people also face “it’s just anxiety” or “it’s just normal aging.”

        1. OrigCassandra*

          “That’s just how menopause is” is one that has me ready to unleash my inner rageasaurus.

        2. I have RBF*

          My dad probably died 10 years before he had to because his cancer was misdiagnosed as “that stuff just happens as you get older” – the “stuff” being excessive tiredness, random aches and pains, random broken bones, and unexplained weight loss.

      6. Statler von Waldorf*

        I was a male patient who was told that my health issues were all the result of mental health issues. Sure, that was part of it, but the issues that sent me to the doctor were almost all caused by undiagnosed severe sleep apnea. When I started CPAP, almost all of the symptoms that the doctor claimed were “in my head” resolved themselves.

        I’m certainly not going to claim that women don’t get it worse than men on average. However, I am going to push back on the idea that it’s only women who get this kind of poor treatment from doctors.

        1. Goldenrod*

          “However, I am going to push back on the idea that it’s only women who get this kind of poor treatment from doctors.”

          Yep, I agree with this too. Bad doctors can be bad doctors with male patients too!

        2. Not Tom, Just Petty*

          I made the zebra/pig comment.
          I stand by it, but I do not want to belittle or sweep aside your experience. I think Dwight’s “my feelings before your facts” policy affects most of his interactions.
          I feel that the gender issue in this case is a blazing red flag, but OP should definitely see how he interacts with members of all walks of life.

      7. Hiring Mgr*

        Not that it changes anything overall, but I don’t think the llama patient’s gender was mentioned in the letter.

      8. Chirpy*

        If you hear hoofbeats, check that you aren’t next to a zebra farm before assuming it’s a horse. :p

    3. Chauncy Gardener*

      I agree. It is highly likely that if OP were male, Dwight wouldn’t be all in his feelings about the accurate feedback he’s been receiving

    4. Dovasary Balitang*

      This was entirely my thought. “Well, you know he’d never expect that softening from a man…!”

    5. Jay (no, the other one)*

      Nope. I’m a doc. I spent twenty years working in clinical education where I was routinely criticized for being too aggressive and not being nice enough. Meanwhile I had male colleagues who literally threw objects at nurses and residents without consequences. It’s absolutely about gender. Whoever is managing Dwight needs to a) deal with the clinical incompetence and b) give him feedback about his sexist behavior. I am not 100% confident that A will happen; I’m pretty sure B will not.

        1. Enai*

          Channel your inner Wednesday Addams and smile like she did for the camp counselors in “Weird is Relative”. Burning shit down afterwards is optional, but strongly encouraged.

          1. Kyrielle*

            Honestly I feel like covid has done one small favor in this regard: we have a lot more really creepy smiling masks (cheshire cats, zombies) that can be kept handy to put on when one of these … jerks … demands we smile.

  10. Saberise*

    As someone that deal with residents at a major university medical center I would be very concerned if he was having that reaction to attending giving feedback that he would also react poorly or disregard it if a patient questions him about something.

    1. Sopranohannah*

      I remember very early in my nursing career watching an attending dress down a couple of residents for not addressing a patient’s condition quickly enough. Their response was “yes, ma’am.” I can’t imagine a resident with any sense addressing feedback in Dwight’s way.

    2. Victoria Everglot*

      He’s probably one of those doctors who bristles at questions with “hey, *I’m* the doctor here” even if your question is something like “but I can’t be pregnant, I’m biologically male” or “no, that third leg I’ve got growing in hasn’t always been there, I would have noticed”

    3. Ultra Anon*

      Yeah, I’ve seen docs ream out other docs for missing a diagnosis (one of those patients was me and I was seen in the speciality that I worked in at the time) and it’s just a fact of life that you’re going to get the business at some point. Not that it’s good to verbally abuse coworkers, but when mistakes can result in serious disability or death of a patient, not to mention financial liability to the organization, tempers can run hot.

  11. Falling Diphthong*

    Frame it as “friendly advice that he can consider” rather than “telling him what to do.”

    This is not how remediation plans work. Even if you just made decorative llama widgets and no one’s life was at risk, if his iconoclastic bold decisions would have led to bad decorative llama widgets having to be tossed out, the problem would be “You are doing it wrong” and not “Here is a little interesting trivia you might enjoy.”

    I’m with Alison on alerting the person who’s supposed to oversee his remediation plan that he objects to being told he did something wrong, and instead wants all such feedback to be optional things he can consider or ignore in future. Because this is strong evidence this plan is not working.

    1. MaggieC*

      Words – “Don’t tell me what to do.” Thoughts – “You’re just a woman.”

      1. laser99*

        In this case it might be “Well I’m not letting a CHICK boss me around.” He sounds like a real Neanderthal.

    2. TootsNYC*

      I have a 24yo son with a growing interest in cooking. We cooked together the other day, in order to speed things up (since I’d eaten up a chunk of time with fixing the clogged freezer drain).

      I -did- frame several comments as “friendly advice you might want to listen to.” Stuff like, “I like to scrape the bell pepper trimmings out of the way before I start cutting up the rest, because it gives me more room and I don’t have to worry about separating them.”

      Llama pox is not one of those kinds of things.

    3. Troutwaxer*

      Maybe he needs to be on a “formal” rather than “informal” remediation plan.

    4. Anne Elliot*

      To me, the focusing on his own feelings/preferences instead of the merit of the feedback, is derailing and therefore is itself another issue that needs to be addressed. It is also classic misdirection/”the best defense is a good offense”/let’s talk about you instead of me. All of that needs to be nipped in the bud. So there’s two conversations.

      First: “I am concerned that rather than accept the feedback I am giving you, you are focusing on the manner it’s being communicated. I need you to assure me that you understand the seriousness of the problem I’m flagging here, and I need you to be able to articulate to me what steps you will be able to take going forward to make sure this doesn’t happen again. That’s the subject of this conversation. If you want to have a separate conversation about my communication style, we can have that too, but right now we’re talking about a missed diagnosis.”

      Second: “It concerns me that when I have performance issues to discuss with you, you attempt to redirect the conversation to make it about me and my communication style rather than focus on the problem. But having addressed the llama pox issue, let’s talk about your feedback to me on communication. The reality is that I don’t have the ability to discuss these types of issues with you in a way that you find more friendly or accessible. There’s a couple reasons I can’t do that: The first is that I would run the risk of miscommunicating the gravity of these issues if I were to discuss them with you in a way that seemed “friendly” or that were couched as “suggestions.” These are very serious issues and one way I underscore that is by discussing them with you in a serious manner. The second reason I can’t do that is because, to be very honest, these types of serious errors are not things I feel positive about and I can’t start presenting myself in a way that is insincere or dishonest just because that would be your preference. I hope I am always professional and, to the extent possible, collegial, but I don’t feel super friendly in these sort of difficult discussions and I can’t pretend that I do.”

      IOW: “We’re not talking about that right now” and “Your feelings are not more important than mine.”

        1. Anne Elliot*

          You’re welcome, and thank you! I have to admit my extensive experience on this particular topic comes not from managing employees but from ‘managing’ a lively teenager who would always prefer to make a conversation about how she needs to meet her responsibilities into one about what a mean parent I am. :)

      2. Darsynia*

        These are superb and important (and as an aside, picturing Anne Elliot giving them is delightful).

      4. Grumpy Elder Millennial*

        Totally agree with you on the derailing/misdirection. Dwight is trying to have the conversation he wants to have, rather than the one the OP needs to have with him. You’re right on the money suggesting that it’s important to prevent him from doing that.

        Also, it needs to be made exceptionally clear to Dwight that the OP is, in fact, emphatically *not* providing suggestions for him to consider. And she *is* telling him what to do. Which is not only allowed, but an expected part of residency (as I understand it). More senior doctors are going to tell you what to do.

    5. Double A*

      If he literally said, “Frame it as friendly advice,” the clearest response would be “This is not friendly advice. This is feedback you must take action on if you want to become a doctor. That you think it could be otherwise indicates an additional serious performance issue.”

    6. FromasmalltowninCanada*

      He wants OP to preform female for him because she’s not. Don’t do it OP. This is not a you problem this is 100% a Dwight problem.

  12. Lobsterman*

    OP I am begging you to make it your life’s work to keep Dwight away from being a doctor.

    1. Just*

      He is a “medical resident.” A resident is already a doctor.

      We already have enough doctors like Dwight. If Dwight reacts this way to a female with power (and experience and knowledge), just imagine how he treats women patients (females without power). OP, thank you for doing the hard work to try to improve Dwight (and therefore improve the quality of care for all of his future patients).

      1. Ultra Anon*

        He’s a doctor on paper, but he’ll still have to take clinical boards to become a licensed practicing doctor. Residents cannot be enrolled/credentialed to provide care on their own and their notes/diagnoses have to be reviewed and signed off on by the attending physician. They’re docs with training wheels. If they cannot pass their boards, they cannot practice medicine even though they have the fancy MD behind their name.

        1. Just*

          They can go on to provide direct patient care, but not as an independent, licensed medical doctor. These care providers are scary, and their bitterness as not being the doctor-that -they-deserve-to-be poisons the quality of care the patients receive. So many places in the US are so desperate for health care providers that the Dwights of the world keep getting hired. Or, just passed along (and even graduated from residency) to become someone else’s death sentence/problem.

    2. laser99*

      I feel the same. It’s unfair the OP has to deal with this, but she should escalate. If he’s this snotty to a fellow physician, what is he like with the patients?

  13. theothermadeline*

    I’m screaming. In horror, with laughter, in existential crisis – just all screaming.

  14. LCH*

    “He said he wishes I would frame it as “friendly advice that he can consider” rather than “telling him what to do.” ” UMMMMMMM.

    I would speak with his coach about this. You are not giving him friendly advice, you are trying to train him to be a competent doctor. How does he not understand this?

    1. Not Tom, Just Petty*

      Exactly, throw it back on him.
      He said he wishes I would frame it as “friendly advice that he can consider” rather than “telling him what to do.”
      “You seem to misunderstand, I am not giving you friendly advice. I am telling you either to do something or not do something. Why do you have a problem with that?”

      1. LCH*

        YUP

        “Why would I do that? This isn’t friendly advice I’m dispensing. I’m actually telling you what to do because you are here to learn.” Or however one says it in an instructional physician/resident way.

      2. ursula*

        “This isn’t friendly advice, it’s a correction from one of your supervising physicians. I’m concerned that you don’t see it that way! You are a resident here, which means you’re still learning. It’s my job to tell you when you make mistakes, and your job to take that feedback seriously. Otherwise, you’re going to miss out on information that is going to have huge health impacts for your clients. So I’m going to continue giving you feedback like this, and I need you to work on how you respond.”

        1. LCH*

          Yeah, it’s probably better if OP become less, not more friendly since Dwight just doesn’t seem to understand the gravity of the profession.

    2. Chutney Jitney*

      I read that and instantly was like, “Oh, hell the f— no.” Advice to consider?!! I’m risking patients’ lives, but don’t you dare tell me what to do. What a horrible man-child.

      1. Grumpy Elder Millennial*

        LOL. “Hey Dwight, just a little thought, could you maybe consider paying attention and not misdiagnosing people because you ignored an inconvenient symptom, y’know, as long as it’s not too much trouble.”

    3. AngryOctopus*

      “But I’m NOT giving you friendly advice to consider. I’m telling you that you made a terrible diagnosis that could have resulted in the death of this patient, and you need to be more careful and thorough in the future. However, if I’m ever giving you friendly advice, I’ll keep this ask in mind.”

      Seriously. This dude needs to get his head out of the sand (or wherever) and OP, you need to tell whoever is supervising him all this immediately. He should not be seeing patients if he can’t handle this kind of feedback.

    4. DeeBeeDubz*

      Right?! I’d be tempted to respond with something like “This is not optional feedback for you to consider. This is a mistake that requires corrective action and cannot be repeated. Had we not caught this error, this patient could have died. Do you think it was friendly of you to write off her symptoms as anxiety?”

    5. my $.02*

      As a nurse that has worked with many residents, I am just floored. I can’t imagine this person being able to successfully complete a residency program with this attitude. I hope he encounters a veteran ICU or ER nurse and they will set them straight!!

      1. Grumpy Elder Millennial*

        I feel bad for nurses or care aides who have to interact with this douchecanoe. If he’s treating a supervising physician like this, I can only imagine how he treats people he thinks he has power over.

      2. Ultra Anon*

        He’s lucky he hasn’t run afoul of an attending ICU doc on their 20th hour on the floor. He’d probably have no flesh on his face left after all the yelling.

      3. EZM*

        This is unrelated, but I have to say that residents and medical students frequently encounter terrible treatment, even bullying, from nurses. I get there is a legacy of poor treatment by physicians historically, but the lack of respect for colleagues by some nurses is honestly galling. It sounds like that’s what you’re referencing here, and I’ll hope you would consider what a toll that takes on us after 10+ years of training. It does no one any favors.

        1. Dog momma*

          I’ve never seen a nurse bully a resident, but I have seen them refuse orders & call the Chief if the ordered treatment was detrimental to the patient. Many times the Chief backed the RN and the troublesome resident paid attention to detail after that. We ran a very fast paced, high patient turnover CT ICU – 1200 open heart cases average per year. You had to be able to work together and take direction if you rotated in. None of this “I’m special, I’m the doctor”.

        2. Bunny Lake Is Found*

          In my field (law), after your 7 years and multiple internships, you might be “the lawyer” but you rank seriously below the secretaries and the paralegals. Yet I’ve seen young lawyers whine about being bullied by paralegals and that bullying almost always amounts to “but I went to law school and she’s telling me what to do!” or “I ignored her instructions because I am the lawyer and now she’s yelling at me at how the filings are all wrong. She should have made it clear to me that these were real instructions!” And a whole host of “respect” not being given which amounts to “they didn’t drop what they were doing to do the thing I needed” or “They didn’t do it the way I told them. Sure, they did it the correct way, but they should differ to me because I have the doctorate!”.

          1. EZM*

            Of course nurses who have been in a dept for 20+ years often have a much better idea about things than a new resident in that department. But there is a widespread culture of nurses that bully and intimidate residents, even mocking them at times. This is often worse with female trainees. Your comment “I’m the doctor, I’m special” seems to highlight exactly this. In my experience, most residents just want to be treated decently by the nursing staff. And of course, this isn’t the case with every or even most nurses. Many are welcoming, kind, and supportive. At the end of the day, nursing staff and residents do have different levels of training. Why this is controversial confuses me. That’s not to say that an experienced nurse doesn’t have very important contributions to make to patient care (and should of course be respected no matter their level of experience!), but ultimately it is the doctor who bears medicolegal responsibility for patient care decisions for a reason.

          2. EZM*

            This is really uncharitable and pretty dismissive. Likely things are different in your field, but whining that “I have the doctorate” is not at all what I’m talking about.

  15. Claire*

    The therapy group I was in had a lot of people who were, at least initially, very resistant to important feedback. One of them was a medical student (maybe resident?) who was there specifically because of issues that included this sort of response to supervisors telling him that he was screwing up. His response to the psychiatrist running the group sounded almost exactly like what you’re describing. (“if you’d present your concerns in a more friendly way, then I’d be able to hear them” – i.e. it’s not my fault, it’s yours)

    Point here: a good medical program will take this VERY seriously, and require him to deal with the underlying issues that prevent him from (frankly) being a competent physician. The individual I met had to grow/learn a LOT before he was able to continue in his program. (but, thanks to that intervention, he did) (it was not a fast process, and required the sort of professional intervention that we had in that therapy group)

    PLEASE bring this up before he a) continues to gaslight vulnerable patients or b) kills someone.

    1. Dwight's Boss*

      Actually Dwight, telling me you’d hear what I say if I said it in a friendlier manner tells me that you *did* hear and just don’t like it. Your reaction is quite unfriendly and, when addressing your boss, is insubordinate. It is you who needs to adjust, if only for your own preservation/advancement.

  16. Cyndi*

    You know, there are some letters where I genuinely wonder how Alison is able to write a calm and reasoned reply. Which is maybe the biggest reason I value this website! But oh my God if I had to give advice on things like this it would begin and end with “chuck Dwight bodily out through a window and never let him back into the building, not even to get his wallet.”

        1. Grumpy Elder Millennial*

          Are any of you familiar with the song Malcolm Solves His Problems with a Chainsaw? The end of the chorus is the line “and he never has the same problems twice!”

        1. Isben Takes Tea*

          The fact that there is an official historical event known as “The Second Defenestration of Prague” which includes the (correct) assumption that there was the First Defenestration of Prague is one of my favorite historical facts.

          2. Phony Genius*

            Which, in turn, is how this word came about. Historians decided that they needed a term to describe this event, and so “defenestration” was born.

            Prior to knowing this, I was wondering why somebody thought to come up with a word for this specific action and not for others.

            1. Phony Genius*

              Also, there was a “Third Defenestration of Prague.” The three occurred in 1419, 1483, and 1618.

      3. Queen Ruby*

        In grad school, most of my classes were on the 21st and 22nd (top) floors of a building. It was super common to hear someone(s) say they were going to defenestrate on particularly rough days. I *may* have started it….

      4. Not Tom, Just Petty*

        I studied German in jr and high school. During that time, I heard the word “defenestration” and thought, weird, because in German, das Fenster is window. Wonder what other word has a root fenster and what it means.
        Dude. It means throw out the window. OMG. I cracked up. There is a word for that.
        Of course there is.

    2. Amber Rose*

      “Tattoo a red flag to his forehead so everyone knows to be careful.”

      But I suppose the legal and professional advice should be taken first.

      1. Student*

        In the book Snow Crash, which is set post-apocalypse, there’s a character with “Poor impulse control” tattooed on his forehead. In the book setting, it’s a way to communicate about who’s committed a serious crime clearly between disparate factions.

        I like the twist of going with a literal red flag instead.

        I know we can’t do it in real life for myriad good reasons, but I wish in my dark heart that more people came with such clear warning labels.

    3. goddessoftransitory*

      Yes; because my first reaction would have been “Dwight needs to go on a car trip to the pine barrens–do not tell him about the shovel in the trunk.” Which probably wouldn’t be legally the best thing to say. BUT I WOULD WANT TO.

  17. SarahKay*

    When Dwight’s wearing a bright orange shirt that makes people’s eyes ache by all means frame it as friendly advice.
    When he’s making a bad diagnosis that could kill someone then keep (politely) telling him what needs to be changed and if his response isn’t ‘thank you’, or at least ‘I understand’ then Dwight is a huge problem, your feedback to him was fine, and the only change should be that you should go on and, as Alison says, feedback his response to his supervisor.
    Wow. Just….wow.

      1. New Jack Karyn*

        It’s just an example of a minor, almost superficial issue that a newbie to the workforce might make. “Hey, Dwight, bit of advice–try wearing more muted colors on Rounds days. Folks will see you as more of a professional.”

  18. M_Lynn*

    “he wishes I would frame it as “friendly advice that he can consider” rather than “telling him what to do.”

    I would go further and clarify to him that in fact, it IS your job to tell him what to do. That is the professional relationship you have, so offering advice he can consider (or not) is directly antithetical to the purpose of your feedback.

    1. LCH*

      OP needs to push back that it isn’t actually friendly advice she is giving. He is mistaken about what is going on. She actually is there to tell him what to do if he is doing the wrong thing.

    2. Turquoisecow*

      Yeah exactly. I’m not in medicine but if I had that response to feedback from my boss, they’d be within their rights to say “no, actually, as the boss I CAN tell you what to do and I AM telling you what to do and if you don’t you may well be fired.” The fact that this is a MEDICAL thing and actually LIVES are at stake makes it even more important that he gets this right and learns from his boss, even bosses who are women.

      1. Observer*

        Exactly this. In my head I was saying “Yes. And I *am* telling you what to do! That is my job. Why is that a problem.”

        In fact, I suspect that I would have reacted like the OP. At least I HOPE I would, rather than just looking at him with an open mouth.

    3. Snarky McSnarkerson*

      “Wish in one hand and poop in the other. See which one gets filled up first.”

      My Grandma Emma

      1. Not Tom, Just Petty*

        I’d always heard “pee in the other.” And the reason I bring up the difference is that OP has just been invited to a pissing contest.

  19. saskia*

    The guy who can’t do his job correctly doesn’t want to be criticized? Shocker. As long as no one in a position of power above you has given you this feedback, I wouldn’t even think twice about it. You seem to have handled this well and know what to do.

    1. Lexi Lynn*

      The only caution I would have is that she mentioned being outside the US. It would probably be worth having a conversation with someone you trust to make sure American-direct is appropriate in that culture. It might be something as easy as adding a “sorry” at the beginning, then continuing on as you’ve been to make the message more in line with the culture.

      1. MGW*

        I guess I am also speaking from an American perspective, buuut. I am a woman who in my personal life and often at work is prone to over apologizing if anything (trying to work on it). But I’m also a veterinarian and if at work I see someone doing something that is endangering themselves or a patient and I need to correct it I do not soften it at all.
        So I might soften criticism of how someone put charges in the computer, for example. But if I see someone stick their hand directly under the X-ray beam, or improperly restrain an animal, I am EXTREMELY direct. And I think regardless of culture, if someone (patient/coworker/whoever)’s health and/or life is being affected, softening the message with a “sorry” undermines the importance of what you are saying.

      2. saskia*

        For sure. Certain cultures have vastly different practices around feedback, criticism, directness, etc., that need to be accounted for. It may be worth checking in with superiors about the resistance you’re encountering too.

        That said, anyone in medicine will quickly have to learn to work with different nationalities, especially if this is a setting bringing in foreigners regularly. Plus, this is a teaching setting and, as a physician, this OP is considered to be more knowledgeable by default. All that coupled with the fact that she’s had observers approve of her methods, it seems like the issue is probably not the delivery.

      3. Erin*

        I was wondering about this as well. The LW mentions that she is working outside of the US. I just moved from the Pacific Northwest to the Deep South, and the cultural norms are completely different, and that’s within the same country!

        While Dwight definitely needs to respect his manager’s advice and authority, regardless of their sex/gender/cultural background, I wonder cultural differences are a factor in how he perceives & reacts to this feedback?

        I would absolutely escalate Dwight’s comments to senior managers. He might not be getting the warm fuzzies he is looking for with feedback, but the impact of him not respecting his manager’s professional advice could have serious impacts on patients, as well as malpractice lawsuits, if they exist in the country where this takes place.

        1. Observer*

          I wonder cultural differences are a factor in how he perceives & reacts to this feedback?

          Not THIS much! To the extent of asking her to frame it as “friendly advice”? No.

        2. OP*

          He and I are from different cultural backgrounds, but he has responded similarly to other women who are from the same cultural background as him.

      4. Susan Calvin*

        You’re not wrong, but LW seems to have already been soliciting feedback from peers, so she might well already be as well calibrated as possible!

      6. Not Tom, Just Petty*

        In OP’s place of work (if she is an outsider to that culture) is it appropriate for a student to challenge a teacher? I’m betting it is not.
        I bet that Dwight does not tell other people in OP’s role that they must consider his feelings when they instruct him.
        So while I agree with your overall statement that culture plays a role, Dwight can’t have it both ways.

      7. OP*

        I’m in Canada, so people are often less direct here than in the US, but it’s certainly not considered wildly inappropriate or way outside of cultural norms to be American-style direct.

        1. Grumpy Elder Millennial*

          Canadian commenter here. I think Alison’s scripts are entirely appropriate. Particularly since this is life and death stuff. If ever there was a time to be extremely clear and direct, it’s when someone needs to fix something so that they don’t kill anyone.

        2. Irish Teacher*

          I’m in Ireland, where feedback is often very indirect and where bosses often give instructions far more indirectly than seems to be the norm elsewhere (for example, at an interview, I was once told by a pretty-direct-by-Irish-standards principal that “we start at 9, but I’m sure you’d want to be in before that, wouldn’t you?”) but I still think your feedback to Dwight was polite and understanding even by our standards.

          1. Quill*

            See, I would have taken that one as “please be ready and in your seat by nine” instead of “clock in at nine, proceed to put your lunch in the fridge and boot your computer.”

            And I would probably still be later than what your boss wanted.

      8. Lucky Meas*

        Even in cultures that are extremely indirect, it is almost always acceptable for a boss/superior/elder to be direct and critical with their team member/inferior/younger person. Yes female bosses get sexist criticism because women are expected to be more polite than men, (same if the boss is younger than the team member). But the boss is still allowed to be more direct.

  20. Ex-prof*

    Bets that the llama-pox patient whom he dismissed as suffering from “anxiety” is also a woman?

    Yeah, there is definitely some gendered stuff going on here. Dwight sounds like he’s this close to suggesting he and LW discuss the issue over dinner.

    1. Not Tom, Just Petty*

      Funny, my first thought was, “dude is going to tell her to smile. I just know it!”

      1. A Simple Narwhal*

        Same!

        “You’re telling me my negligence might kill someone or whatever, but if you could be more attractive when you say it I miiight consider listening to you.”

      2. goddessoftransitory*

        “And have a baby already! Lettin’ that womb go to waste makes wrinkles, little lady!”

    2. MsM*

      Wouldn’t surprise me, but I get the feeling Dwight disregards most input from people he considers inferior to him. Which is probably most patients.

  21. Peccy*

    As soon as I saw the title on being friendlier I knew it would be a woman giving feedback to a man

    Just so gross

    2. VivaVaruna*

      Same. I’m AFAB nonbinary, and I ran into this constantly when I was in a supervisor position. It was retail, so the stakes were significantly lower, but it was infinitely frustrating nonetheless. My manager (who was a woman!) would actually ask me why I wouldn’t frame stuff like this as a suggestion instead of a directive. I had to tell her on more than one occasion that every time I *did* that, it was taken as something they could ignore rather than something they had to follow.

  22. Jezebella*

    There are days I should not read AAM at the office. I guess today is one of them, because I’m in an absolute rage over Dwight’s behavior and I’m having to suppress it. Anyway. I will bet one million llamapox vaccinations that Dwight’s patient was female. Anxiety, MY ASS. I hate him so much. I will bet another million that he does this to women constantly.

  23. CheesePlease*

    I would try a phrase like “I understand that I provide feedback, you would like to receive suggestions rather than directives, but the fact of the matter is that when it comes to patient safety and livelihood, there is no room for suggestions. These are directives focused on patient care. So I need you to exclusively focus on a patient’s well being and medical best practice, which you are here to learn. Is that clear?”

    You can acknowledge his request and then directly tell him it’s not reasonable. You’re not asking him to dress more professionally or send more polite emails. You are literally asking him to treat patients properly so they don’t die!!

      1. CheesePlease*

        Thank you! A priest of all people taught me this phrasing method and I love it. “I understand X (feelings, frustrations etc), but the fact of the matter is Y (need / requirement/ rule), so I need you to Z (action they need to take)”

        I even use it with my toddler “I see you want to keep playing, but we need to leave the house and toys don’t go in the car, so the legos need to stay here please”. I mean she still cries but at least I feel like I did a good job parenting haha.

    3. Ellie*

      You are much more tactful than I am. I think I would have said, ‘How badly do you think you will feel if you kill someone?’

  24. Miss Muffet*

    I think it’s really noble of you to have had other people sit in/observe how you provide feedback; your self awareness that there could potentially be an issue with your own style stands in striking contrast to Dwight’s! It never hurts to have done a little self-evaluation but it’s good that you are seeing that it is most certainly not your style that is at issue here. Hopefully he can be managed out/into something he can be more successful in.

    1. Silver Robin*

      +1 It is wonderful that OP took the opportunity to double check that they were being reasonable. I call it “integrity due diligence” for myself. As a plus, once I confirm I have absolutely been acting reasonably, then it means I get to pull rank/be petty back/[insert power move here] and feel zero shame about it.

      All this to say, OP you do not sound like you feel bad about any of this, but in case anything is niggling in your head, know that you have acted perfectly. And you should absolutely be reporting this to Dwight’s supervisor/coach/etc. They need to know and Dwight needs some serious help in self-awareness category.

      And men call *us* overly emotional. Bah.

    2. Grumpy Elder Millennial*

      It’s also a wise move in case Dwight decides to complain about OP. Now, there are witnesses around who can confirm that OP was entirely appropriate.

  25. Dust Bunny*

    Pretty sure that telling him what to do is, in fact, your job. He’s a resident. He doesn’t really know what he’s doing yet.

    Do residents have advisors/get evaluation at the end of their residencies? Because that could look interesting if he doesn’t learn to deal with the fact that he’s a rank novice and, yes, needs feedback.

    1. KarenK*

      Residents in medicine get evaluated constantly throughout their residencies, have comprehensive evaluations every year, and have final evaluations at the end of their residencies. These are both written and verbal (face to face, like in the OP). Absolutely the worst thing you can say about a trainee is “does not take feedback well.”

      Source: Program Manager in graduate medical education for over 30 years.

      1. Dust Bunny*

        Okay, thank you–that’s what I thought but I wasn’t sure if it was something I’d seen on TV or if it was real. I knew that had some oversight but I wasn’t sure if it was more like student-grade intensive oversight or employee-grade “you should know what you’re doing” less-intensive oversight.

        I’m very glad, especially in this instance, that it’s the former.

        1. OP*

          Yes there are daily written evaluations, and regular formal progress reports all along the way with very clearly defined object and standards.

  26. Not Tom, Just Petty*

    Wow, wonder how many women survived group projects and study groups with Dwight in school?

      1. Quill*

        If he wasn’t in medicine instead of religious studies I would think Dwight was in my undergrad thesis group – we didn’t have a bingo sheet but we did have a running tally of greatest hits.

        Greatest hits being “there’s a reason they don’t let women become pastors, you just can’t understand!” and later in the conversation “what would YOU know about figurative language?” responded to with “More than your dick knows about god.”

        In my course evaluation I said maybe we shouldn’t put classics, religious studies, and social work in the same group for thesis…

    2. Slow Gin Lizz*

      I wonder more how Dwight managed to survive any of those group projects. I would have yeeted him into the sun. (I would have tried, anyhow. In reality, I would complain to the teacher about the awful group member and the teacher would just tell me to, essentially, suck it up. No wonder I went to a women’s college.) (And no, I’m not a snowflake who needs coddling.)

  27. Doctor is In*

    How did this guy make it to residency? Should have been weeded out in medical school!

    1. Your Computer Guy*

      Dwight reminds me of a joke my father (who was a doctor) liked to tell:
      -What do you call the person who graduated bottom of their class in medical school?
      -“Doctor”

      1. Sedna*

        Heard a similar story about a guy who graduated bottom of his class and was thereafter referred to (and self-identified as!) “Doctor Stupid”.

    2. Flying Fish*

      Yeah, academic aptitude doesn’t always lead to good clinical sense. I’ve been in healthcare 20+ years and have met some very smart people who are kinda stupid.

  28. Wine not Whine*

    +1,000 on the “I bet he wouldn’t say that to a male-presenting physician.”

    But the description of llama-pox makes my day.

  29. Pool Noodle Barnacle Pen0s*

    “Here’s some friendly advice, Dwight: If you can’t handle professional feedback, then this career isn’t for you. Reframe your expectations immediately or find another field. I will not have this conversation with you again. The next step will be to terminate your residency. That’s how serious this is. Do you understand?”

    5. learnedthehardway*

      Yeah – my feedback in response to Dwight’s derailing would be SIGNIFICANTLY less “friendly” than my original feedback.

      I think this wording is perfect.

    8. goddessoftransitory*

      To quote a favorite meme of mine, you don’t know me but we’re going to be married.

    9. Polly Hedron*

      Reframe your expectations immediately or find another field.

      But what field would put up with Dwight?

  30. Lavender*

    If OP actually did start delivering necessary feedback as “friendly advice,” I wonder how Dwight would react if he then got removed from the program as a result. Something along the lines of “You should have made it more clear that those were serious issues,” I’m guessing.

    1. Properlike*

      “Friendly advice, Dwight. Your feedback will get positive when you’re not about to kill people.”

  31. I WORKED on a Hellmouth*

    OP, you are awesome and I am so sorry that you are dealing with a Dwight, because reading that just made me go all “FLAMES! FLAMES ON THE SIDES OF MY FACE!” and I can not imagine how difficult it would be to remain professional and calm and tell him that you aren’t giving “optional advice” and that the situation is serious. Because WHAT. THE HELL.
    How on earth did the guy make it to resident??? I can’t imagine you get much coddling in med school.

  32. MaggieC*

    I am deeply concerned about Dwight as a caregiver. As OP describes him, he is a male that refuses to take criticism from a female supervisor, tells her to be “friendlier” towards him, and, most troubling of all, diagnoses serious physical ailments as “anxiety.” This attitude raises a whole field of red flags.

    1. Myrin*

      It also sounds like the physical ailment, although rare, was actually fairly obvious, which raises my concern on a purely medical level as well.

  33. OP*

    Thank you to Alison and the commenters so far for the validation that my tone isn’t the problem! I didn’t want to make the question excessively long but in addition to being a doctor I also have a rare chronic illness that’s somewhat visible so I’ve been accused of being overly sensitive because of that.

    It’s very unlikely that Dwight will finish residency unless he dramatically changes, but the process of getting kicked out takes at least 6 months of various levels of remediation and probation and doing everything by the book because some people who shouldn’t be doctors will hire lawyers to challenge being dismissed from residency because some technicality of the process wasn’t followed. And I am documenting every incident of this in writing in our online assessment system.

    1. Sedna*

      Thank you for your care and persistence in dealing with this guy! I have a kidney transplant in large part because of delayed diagnosis of a rare disease; you are absolutely doing the right thing in insisting that a doctor /do his damn job/. Anxiety, my foot.

    2. Not A Raccoon Keeper*

      Hi OP! I agree that your tone is not the problem here! And as a patient with complex chronic illnesses, I think your lens as a patient can only help train better doctors.

      I’m staff in a medical school (not on the Ed side) – I wonder if a chat with one of the residency managers would be helpful for you, if you haven’t done that yet? It sounds like you’re doing all of the right things to manage him, but I’m sure they’d like to know, and would probably be a very affirming conversation. Good luck with him!

      1. OP*

        They are already involved because of the informal remediation (which is still documented and concrete with expectations and deadlines, so it is somewhat formal), and thankfully they are very helpful.

    3. Dell*

      Thank you so much for what you are doing! I know it can be exhausting but it really matters. Thank you, thank you.

    4. MsM*

      …Accused by Dwight? If so, I’d add that to your documentation. Or whoever selected Dwight? Because if so, I think your employer needs to take a bigger look at that process and whether more training is needed across the institution to avoid letting bias interfere with good care and judgment.

    5. Silver Robin*

      You go, OP! Frustrating as it is, I am glad you are keeping up with the documentation. Lots of folks find it overly burdensome and give up.

      Best of luck dealing with him in the meantime! Your tone is fine, Dwight is a dolt.

    6. Fives*

      OP, I hope you’ll send in an update once he’s (hopefully) gone. This one was one of the worst I’ve read lately (him not you).

    7. Dr. Anonymous*

      You’re doing it right. I’d also relay this conversation on his response to your feedback directly to his advisor. The advisor may want to directly counsel him on this issue and document that conversation as well.

      As a resident, I got plenty of feedback, some of it too vague for me to understand how I should correct my flaws as a resident, some of it VERY CLEAR, and I may have cried once or twice, but it never would have occurred to me to correct my attending on their TONE. I’m awed by Dwight’s sheer gumption.

      I also wonder if the residency program can look into its recruitment process–having candidates spend some significant informal time with the residents before ranking applicants can often unearth this kind of jackassery.

      1. No name yet*

        Yes, this! Or even making sure to have people interview with staff/attendings of different genders. We had a residency candidate here a few years ago, on interview day had great connections with the male staff clinicians, they thought he was great. The female staff clinicians? All of them felt talked down to. If he acted that way while interviewing and presumably on his best behavior, I hate to think what supervising him every week would be like.

        1. miss_chevious*

          This happened to me when I was hiring a direct report (I’m a lawyer). The guy interviewed with our whole team (2 men, 5 women). The guys loved him and every single woman (including me, the person who would be his boss) was like “ABSOLUTELY NOT.” His manner was so different (and objectionable) between the two genders that it seemed like we were talking about two different people when we reconvened.

    8. Chutney Jitney*

      Ah, yes. I used to work at a company that designed the medical boards for US med students. The complainers were always soooooo sure they couldn’t possibly have failed the test, it must have been a mistake on our end. And we had to investigate every one.

    9. Zarniwoop*

      “He’s on informal remediation”
      I think it needs to become formal ASAP. If it takes 6 months to bounce someone all the more reason to start now.

    10. Lady_Lessa*

      Thank you for dropping by.

      I suspect that your chronic illness is making you more sensitive to the patients, which is never bad.

      Off topic, I am reading/enjoying/recommending the book “Maybe you should talk to someone” by Lori Gottlieb. She is a therapist who is also getting help for her own issues. She writes about both in a light interesting way.

        1. littlehope*

          We need more people with chronic illnesses and disabilities working in healthcare, and I know the system doesn’t make it easy. You’re very valuable and I’m glad you’re there, it sounds like you’re doing great work to protect patients!

    11. Irish Teacher*

      Honestly, I think you were extremely kind and gentle with Dwight. “I understand that llamapox is rare so you didn’t think it was a likely diagnosis” is a very understanding reaction.

      And quite frankly, the fact that you have a rare chronic illness should make people more willing to listen to you, not less. I’m a teacher and one of my colleagues had some struggles in her own school years and you’d better believe that when she gives some insight into why a student might be acting out or what their struggles might be, I listen, even more than I would to other colleagues, because she does have a level of insight that many of us don’t. I imagine the same is true of a doctor with a rare chronic illness.

      And really, even if there had been something wrong with your tone (which by the sound of it, there really wasn’t; you sound like you were really understanding), it wouldn’t be Dwight’s place to tell you off. For one thing, he is the one you are correcting, so he is invested in a way that makes it hard for him to judge your tone accurately (hearing you misdiagnosed somebody and could have done them real harm is likely to feel harsh no matter how it’s said, though I think most people would be more horrified that they could have done that than annoyed at the “messenger”) and for another, it’s not his role.

      You sound not just like a fantastic doctor but also like a fantastic boss.

    12. Calamity Janine*

      this immediate update, knowing that it’s highly unlikely he’ll finish out residency unless dramatic change for the positive occurs, is a balm unto my soul.

      thank you for being a good teacher – and for being a good doctor.

    13. Grumpy Elder Millennial*

      Thank you for doing all this work to protect patients from Dwight.

  34. fine tipped pen aficionado*

    This reminds me of a common thread in the books they cover in the If Books Could Kill podcast of men claiming that when they don’t do something they should have, it’s because they weren’t asked to do it in the right way.

    Of course it isn’t only men that do this and it’s not all men, but it seems to be part of the way gender is socially constructed in the west and the pattern shows up in huge books like Men Are from Mars, Rich Dad Poor Dad, and Nudge.

    Anyway, Alison is spot on, LW, and I am so sure there is no way you could deliver this feedback that Dwight would be willing to receive it.

    1. A Simple Narwhal*

      This made me think of that too!

      “Oh I totally would have done this task that I shouldn’t have to be asked to do, but she asked ‘could I’ do it instead of ‘would I’ do it so I said I could, but then I purposely didn’t do it. It wasn’t a lie because technically I could, I just didn’t. And that’s on her for not asking right.”

      And then the point of those anecdotes wasn’t “hey man maybe don’t be a semantic a-hole” it was “hey women if your husband sucks it’s your fault”.

      I’d believe that Dwight was a could vs would argument guy.

      1. learnedthehardway*

        This is precisely the reason I implemented a flow chart for group projects when doing my MBA. We had someone who took everything as “suggestions”. It was easier to make it very visual and very obvious that he was the bottleneck in the process, as the situation was that nobody was the boss of anyone else.

        Possible option for others dealing with similar situations, whether due to sexism or just plain lack of commitment.

    2. triss merigold*

      “Oh sorry Dwight, I should have said WOULD you please accurately diagnose llama pox instead of writing someone off as having anxiety?”

      Yeah this is exactly it. It’s a point isn’t the specific wording or the tone or whatever, he doesn’t like being wrong and he doesn’t want to admit that he’s wrong so he’s finding ways to make it OP’s problem and not his. Everyone has done this to some extent but part of growing up is not doing it anymore. Especially when you’re becoming a doctor!!

      1. Grumpy Elder Millennial*

        And he definitely doesn’t want to admit he was wrong to a woman / a woman knows more than he does.

    3. Grumpy Elder Millennial*

      Yup! And it serves the same purpose of shifting to another conversation (how to ask / give feedback) from the conversation about the feedback or incomplete task and making it the other person’s fault. Mike and Peter are pretty clear that they absolutely do not believe that these men would actually do anything differently if the other person changed their phrasing or tone.

    4. TrixM*

      Oh, THANK YOU. I’ve been looking for a new podcast to add to my feed, I love Michael Hobbes, and the deconstruction of zeitgeisty books that somehow permeate the culture while being full of garbage is right up my alley!

  35. Michelle Smith*

    “Dwight should not be a doctor.”

    Correct. And you’ll be doing the community a great service by ensuring to the best of your ability that this is addressed BEFORE he harms or kills someone out of his negligence or ignorance.

  36. SereneScientist*

    You know, I’m very much in the camp that feedback can be given in a direct but kind way and that modulating feedback for the person’s style is generally good. But I work in professions where people’s lives don’t potentially end if we mess up. And Dwight works in medicine, so no, this situation is ridiculous and he should not be practicing at all if his feelings matter more than his patients’ lives.

    1. MsM*

      Even if LW’s example weren’t already considerate but firm, I don’t think there’s any profession where you don’t occasionally run across scenarios where “please consider a different approach” is insufficient when the message that needs to be conveyed is “this can’t happen again.” Nobody’s going to die or violate any federal regulations or even have grounds for a lawsuit if I let confidential information related to my job slip, but I still can’t do that if I want to work in this field and not cause my employer headaches. Dwight just doesn’t like being told that he’s wrong, and that’s not a “feedback style” that can be worked with.

      1. Bunny Lake Is Found*

        I think the difference is that “this can’t happen” in non life or death fields means “and if it does, you will be fired.” So anyone offering corrections of “You cannot do that again or we will have to let you go” is still going to probably opt for a softer touch– it isn’t a moral failing to have constant spelling errors in your presentations or to miss important deadlines, but these are still things that are incompatible with continued employment. By contrast, if a person’s mistake could literally result in untimely death, then it does become an issue of “if you make this error again you will kill someone”, rather than “if you make this error again, the balance sheet will be wrong again, and we will fire you”.

    2. Ace in the Hole*

      Even in professions where lives are on the line, this is still true. Feedback can be direct while still being kind, and it’s generally good to adapt communication to fit the needs of the person you’re talking to when feasible.

      But… LW was direct and kind. As corrective feedback goes, that was downright gentle! You can only soften a message so much before it gets completely lost in a pile of mush.

      1. Splendid Colors*

        When I saw the headline for this letter, I assumed it was going to be about someone hollering a warning at someone about to be mangled in heavy equipment and getting in trouble even though they saved someone’s life or limbs.

        This was about as gentle as a correction can get without losing the point that Dwight’s misdiagnosis was potentially fatal.

        The appropriate reaction to hearing that should be horror that your mistake could’ve killed a patient.

  37. what the nope*

    I spend 10 minutes with my doctor, maybe once every 3 years, and even then find it traumatizing due to past medical emergencies. I can’t imagine Dwight making that experience worthwhile.

  38. bunniferous*

    Honestly, my response to him when he wanted me to be friendlier would have been “I beg your pardon”???? (And I would have been THINKING “well, people in hell want ice water.”:)

    As long as you are being professional-and I’m sure you are-feel free to ignore his tone policing. Stern and firm are quite appropriate in a profession where getting it wrong could kill somebody.

    1. Silver Robin*

      “People in hell want ice water” had me giggling at my desk. I will be adding that to my sarcasm responses, thank you XD

      Absurd that Dwight expects to be coddled in such a high stakes profession.

    2. goddessoftransitory*

      “I want a million dollars and a pony, Dwight, but I guess we BOTH have to be disappointed today.”

    3. Random Bystander*

      Or “That was my friendly mode. You don’t want me to tell you how you failed to accurately diagnose the patient in my unfriendly mode. Now, let’s get back to the point [the whole bit about the inaccurate diagnosis and potential outcome].”

  39. 4eyedlibrarian*

    I’m a medical librarian who teaches med, dental and public health students. I definitely face more resistance from male students and residents than the female ones. Luckily it’s still pretty rare.

  40. TootsNYC*

    I have said that to people:
    “The way you are reacting makes me worry because you are focusing on the wrong thing here.”

      1. Just*

        Please be documenting that Dwight does not listen to feedback but instead deflects. And wants to downgrade that feedback to mere suggestion. Obviously with quotes of Dwight’s statements. I am sorry you have to deal with this.

    4. Grumpy Elder Millennial*

      Simple, direct, elegant. This is perfect, Toots! I love how this makes it clear that they have just made things worse; not only was the mistake a problem, we now have a second issue that your approach right now is bad.

  41. Somebody Call a Lawyer*

    Joking but not really joking that I’ll need a content warning for tiny anythings growing out of someone’s face.

    Great advice, and very much agree with the suggestion above to tell Dwight it’s OP’s job to tell him what to do to avoid him misdiagnosing a potentially fatal illness.

  42. Hiring Mgr*

    If that was a representative example of Dwight’s blunders, he has much more serious problems than taking feedback. I agree with talking to his coach (or boss) – maybe they can get Dwight to have a come to Jesus moment.

    1. Observer*

      Yeah. But the feedback issue is a clear symptom of these other problems.

      I would say that he’s a misogynistic idiot and someone with absolutely no capacity to understand a situation correctly, which leads to him being unable to take the feedback and unable to make a reasonable diagnosis.

  43. Nicki Name*

    Dwight sounds like he’s growing up to be the villain in every article about how women’s serious health complaints are too often brushed off as “just hormones” or “you just need to lose some weight”. You are doing the world a service by not soft-pedaling your feedback.

  44. Diocletian Blobb*

    I will now think about this letter every time that I have a disappointing appointment with an incompetent urgent care doctor, which unfortunately will probably happen sooner rather than later.

    1. Cyndi*

      I swear most of my bad medical experiences have been with urgent care, including the time I couldn’t use my right arm for a month after a weird fall, one urgent care diagnosed it as “eh, not broken” and the other called it a strain. Neither of those were UNTRUE per se, but when I finally got referred to PT the therapist immediately went “Oh yeah, your shoulder dislocated temporarily when you fell, and this entire side of your body has muscle damage.”

      Dwight reminds me of this delightful period of my life, for some reason! Can’t imagine why.

    2. The Eye of Argon*

      Like the one who prescribed antibiotics that can interact with my anxiety medication and cause FATAL HEART ARRHYTHMIAs!!!!!!

      Thankfully I took the Rx to my regular pharmacy to be filled instead of having them fill it at urgent care because they caught the interaction.

      The patient care survey I received the next day was filled out very thoroughly and honestly.

      1. *kalypso*

        I can’t imagine not checking one’s own scripts for excipients and potential reactions and interactions. Do y’all just not get CMI leaflets?

        1. metadata minion*

          We do, but they can be hard to understand for laypeople once you get into the statistics on side effects and potential interactions. And once you’re on more than a couple medications at once, it’s much easier to just say “hey, person whose job it is to know these things, does this new medication play well with everything else I’m on?”.

        2. Jezebella*

          Sometimes in times of stress, pain, or illness, it’s a bit too much to research every single medicine I’m prescribed. Maybe don’t be so judgy about that?

        3. WS*

          I work in pharmacy and this is literally the pharmacist’s job. Expecting people who are sick and stressed to catch medical errors is just victim-blaming.

          1. *kalypso*

            It is, but I’m so used to also checking it myself because it’s not the doctor’s job, I have to remind the pharmacist that no really I am allergic to that, and just generally being involved in my health care enough to learn how to read the information in the packet and see ‘this should not be taken with that’ or ‘this causing headaches is normal, only see a doctor if you’re worried for other reasons or they last more than 48 hours’.

  46. Never The Twain*

    It may be that Dwight should not be a doctor, but if he somehow manages to do it, I know exactly the type of doctor he’ll be. One who spends his days yearning for the golden days of half a century or so back when any ‘advice’ would be prefaced with an acknowledgement that the hospital is truly blessed to have a doctor like Dwight, and that there’s a tentative suggestion which he might like to consider – but no pressure if it doesn’t suit, just throwing it out there, mad as it is – that might make him an even greater adornment to the profession he graces, if such a thing were ever possible.
    I’m pretty certain that if OP’s feedback had come from anyone he perceived as being junior to him then his own response wouldn’t have been ‘friendly’.

    1. Fishsticks*

      Reminds me of times on Scrubs when the nursing team would save lives by catching the mistakes that doctors made and that learning to trust the nurses and understand their importance was a big part of JD’s early residency, and how on That 70’s Show, Kitty and the other nurses were shown as competent in ways the doctors around them never acknowledged unless they had to.

      Which is not to downplay doctors whatsoever, but just that… there’s a reason “the doctor is always right” is, um, wrong. And it’s because of doctors like Dwight.

  47. Katie*

    Also practice medicine. He’s a huge liability and jeopardizing people’s lives. He doesn’t belong in medicine if this is his attitude. He’s there to learn, not to be coddled.

    1. OP*

      My first instinct is always to look at my own approach, because that’s what I can control, but I really don’t think I’m being mean to him. I’ve gotten feedback from observers that I am more patient than they would have been with him, and I’ve had multiple learners comment on anonymous evaluations that I give feedback in a way that’s direct but constructive and respectful. I wish the issue was me being mean, because I could fix that.

      1. Zarniwoop*

        If most people say you give good feedback then it’s most likely a “him” problem.

      2. Lauren*

        If he dismisses your for tone again – maybe don’t sugarcoat the formal part of his evaluation. Your path to becoming a doctor is in question when you keep trying to redirect serious conversation about patient lives to my tone. You need to get your diagnoses correct the first time and not default to ‘anxiety / weight / women’s issues’ when you don’t know the diagnosis. You keep searching. You keep treating the patient as if their lives are at stake, which they were in this instance if I let you misdiagnose that patient the way you wished to.

      3. goddessoftransitory*

        If you aren’t pushing him over, pulling his hair, or calling him Dumb Dwight during his evaluations you aren’t being mean to him. Just because Dwight has decided any and all interactions need to be presented like a damn birthday party invitation doesn’t mean the rest of the world goes okay, sure!

  49. Helewise*

    I believed for a really long time that if I just improved my communication skills, if I found the right words and the right tone and the right time and the right setting that I could guarantee a productive conversation – and that if the conversation wasn’t productive I must be doing something wrong.

    Nope. Sometimes Dwight is just going to Dwight.

  50. Kel*

    The people I know who went through med school as residents would likely drop dead before they ever asked someone to deliver ‘friendlier’ criticism.

    Yikes, Dwight.

  51. Jojo*

    Ah, so this is what the internet dude that dismisses arguments because you are “emotional” are like in the workplace. (Just kidding, I know what theseguys are like in the workplace. Sigh.)

  52. Healthcare Manager*

    I work with a lot of doctors – can confidentially say there is an ego problem, made worse by sexism.

    Continue being direct and factual OP.

    1. Dust Bunny*

      Seconding.

      I work with them sort of tangentially but there is definitely a subset of (older, white, male, in particular) doctors who expect to be waited on and kid-gloved. Sorry, dude–you’re in my area of expertise now. We do this my way.

  53. Gray Lady*

    I wonder if Dwight is one of those who thinks that since he has his degree and the title “doctor”, all other doctors are just “colleagues” he’s just “consulting” with, even while he’s still in residency.

    Graduating medical school is a fantastic accomplishment beyond the reach of most of us. It’s not the culmination of all knowledge, and you DO have a lot to learn from others, and some of it needs to be taken extremely seriously, not just “things for you to consider.”

  54. spaceelf*

    I don’t even know how to react to this. I am all for thoughtful and constructive communication but there is a point where feelings no longer matter – I go full Dr House when it has anything to do with health and safety

  55. knitcrazybooknut*

    I have a friend who is severely disabled in multiple ways, involving her spine, brain stem, bones, etc. She recently asked for legally-required accommodations during a doctor’s visit. The doctor refused, and then denied her coverage for medically necessary procedures out of spite. She now has to travel an extra hour away to get treatment, which, shockingly, exacerbates her conditions.

    Thank you for your work with Dwight. I wish you the best, and I hope he can find a suitable, less healthcare related profession.

  56. Observer*

    “I’m concerned that that’s where you’re focusing, rather than on the very serious mistakes I’ve been bringing to your attention. This is not ‘advice that you can consider’; my feedback in situations like this are directives that you must follow if you’re going to be successful in this program.”

    This was my exact first thought.

    Allison is right that being resistant to feedback is already something of a dis-qualifier for a doctor. When it’s at a point where the person is framing the information and feedback about something that can literally kill someone as “friendly advice” that he has the option to “consider “?! This guy is a menace and has no place in a safety critical position.

    Also, OP, I was wondering about the example you chose. Obviously, you weren’t talking about real lamas on anyone’s face. But if you sub in a real illness that has a similar profile, it sounds like he also has really bad diagnostic skills. And given what he landed on, I also have to wonder if these kind of errors tend to show up more often when he diagnoses women. Keep in mind that women are far more likely to be diagnosed with anxiety or some other mental health issue when they are actually suffering from a physical ailment than men are.

    1. metadata minion*

      Doctors can be weirdly terrible at diagnosing obvious things if they “don’t happen in X people”. I was in urgent care a while back and the doctor wanted to run the EKG again because it was so different from the one they had on file three years ago. Yes, I said, I got a pacemaker last year. “Oh, I thought that’s what it looked like, but you’re so young!”. Indeed I am, but *I* could probably identify pacemaker signals on an EKG; that’s how distinctive they are. It’s also why I wear a medic alert bracelet that says “pacemaker”. But no, young people don’t have pacemakers.

        1. metadata minion*

          This was a female doctor, and I didn’t have the opportunity to before she saw my ekg.

          1. metadata minion*

            I did, however, tell both intake nurses, and it’s listed on my medical record.

    2. OP*

      He does have a lot of difficulty with diagnosis and clinical reasoning, and definitely more often in women, minority genders, or cis men who are in any kind of more marginalized group. He considers many more possibilities in middle aged, able bodied, “normal” BMI (don’t even get me started on the feedback I’ve tried to give on the problems with BMI and medical fatphobia) cis hetero men.

      2. *kalypso*

        Well, yeah, are you controlling for how conditions present differently in populations that aren’t middle aged able bodied not-obviously-over/underweight men on which most of the medical field’s diagnostic standards and testing is based on? Are those things taught in your program? Because if they’re not, how is someone who doesn’t have their own real-world experience of that meant to get a clue by four?

  57. Exme*

    Just some friendly advice to consider maybe not killing people, just some interesting trivia that women are dismissed with ‘anxiety’ instead of receiving lifesaving interventions, just some friendly chit chat buddy pal friend I thought you might like it, if not my bad and sorry for boring you friend guy.

    1. teapot analyst*

      bro, it’s totally a drag but if you could like, listen to what the patient is telling you rather than assume they are a turnip, that would be awesomesauce.
      just puttin it out there, brah

  58. Nanny Ogg In Training*

    Good grief. Does Dwight also tell you to smile more?
    There are far too many Dwights in the medical profession, and not enough OPs.

  59. Eddie*

    I’m so confused how this person even got as far as residency. the feedback in med school rotations is not gentle…

  60. Meghan*

    Dwight is a jerk and should not be a doctor. The only instance where I’d accept that “you need to soften your criticism” is when an outside third party would tell you that. And even then, there are all sorts of gender nonsense that I don’t want to get into where I’d *still* question if that’s necessary.

    1. Goldenrod*

      Yeah. I mean, in some situations, people do need to soften their criticism.

      This is obviously not one of these times.

  61. MicroManagered*

    Ummmmmmmmmmmmm can I have Dwight’s real name and what country he’s in so I can be really REALLY sure I am never his patient? WTF.

    (in case it needs to be said: JK not really asking for identifying info /s)

    1. Enai*

      I’m more interested in _OP’s_ name and place of employment. She sounds competent, conscientious and probably has good bedside manner.

      (Don’t actually tell us this, OP.)

  62. Dark Macadamia*

    The idea of Dwight becoming a doctor makes me so anxious I have tiny llamas growing out of my face.

  63. Zap R.*

    I try not to jump to conclusions here but the combination of “You should be nicer to me when giving me feedback” and “You don’t have llama pox; its’s just anxiety” seems pretty indicative of Dwight’s attitude towards women.

  64. Beeb*

    I’m non-medical but in a position where I work a lot with nursing faculty. They Do Not Mess Around when giving feedback to students in the clinical setting. Feedback is given in an even, calm tone, but there’s zero fluff or softening or any need to be “friendly.” From what I know OP is 100%, entirely, completely, working within professional norms. If Dwight can’t take this kind of feedback, I hope he washes out because it doesn’t bode well for his future patients and OP ought not change a thing.

  66. Troutwaxer*

    The only advice I might give the OP, who seems to be doing everything right, is this: If there’s someone at your facility who is generally seen by everyone else as having truly amazing communication skills, ask them to sit in next time you speak with Dwight. It’s conceivable that such a person might spot something you haven’t spotted. But this is advice for going “above and beyond” not advice for fixing the problem, (which seems very much like it’s Dwight and not the OP.)

    1. RussianInTexas*

      I think in one of the episodes of Scrubs JD tried to diagnose someone with Kuru, to the Dr. Cox’s great hilarity.

    2. Collarbone High*

      I’m currently rewatching ER and I cannot IMAGINE the ensuing chaos if someone told Kerry Weaver to frame her orders as “friendly advice.”

      1. New Jack Karyn*

        Even Mark would have boggled, and he was a damn saint (in the early seasons, he got more human later on).

  68. Cat's Paw for Cats*

    I’m not proud of it but in OP’s position, I’m afraid I might find myself telling Dwight that he should concern himself less on the friendliness of my tone and more on the safety and wellbeing of his patients.

  69. KatEnigma*

    This might be a time for a hard “No” like with the LW yesterday.

    “No, I am not going to soften my words. These situations are literally life or death and what I’m telling you isn’t a suggestion to consider, but something I am absolutely “telling you to do.” That is my job at this clinic.

    Then let him go whining to the program head, as well as you reporting this to his supervisors. Hopefully that will end his participation there.

  70. Sally*

    I think you have to figuratively smack him down immediately: “this is NOT friendly advice, this is absolutely a firm directive, which you must follow to succeed in this program. Your patients lives and health depend on you, your competence at your job supersedes your feelings.”

  71. Lisa Simpson*

    Don’t worry, Dwight can always get a job at some university’s student health clinic, where he will diagnose all students with a) stress b) pregnancy c) hangover, even if they have appendicitis or whooping cough.

    1. I WORKED on a Hellmouth*

      Oh my god, back at my college’s clinic there was this one doctor who, no matter what you came in for, ALWAYS SAID YOU MUST BE PREGNANT. She never looked at your chart. She never listened if you gave her legitimate reasons for pregnancy being impossible (examples: “I have never had sex, I have a history of anemia and am experiencing the symptoms that typically mean I need an iron pill prescribed, I have a sinus infection”). The worst was when a really good friend of mine who happened to be overweight went in for strep throat. Very, very obvious strep throat. They croaked out their symptoms and that they were pretty sure they had strep throat, and she sighed deeply and said “It doesn’t sound like strep throat to me. It sounds like you are pregnant.”
      My friend just stared at her a moment before going “So, my name is DAVID.”

      1. Cyndi*

        Look, I believe you, but I don’t WANT to believe you. I want to believe this was actually a sitcom someone was filming on campus that your friend wandered into by mistake.

        1. I WORKED on a Hellmouth*

          I wish that was the case. But I went through her, too. When I explained that I couldn’t be pregnant because I hadn’t had sex in over a year and that I was not, in fact, an elephant so being pregnant wasn’t possible, she gave me an infuriatingly knowing look and said “Uh huh. I’ll be here in a few weeks when you’re ready to talk.”

          I’m not sure what I said to that. I only remember blinding white hot rage.

          1. Silver Robin*

            I can only imagine! My heart rate skyrocketing just *reading* that. I am sorry you, your friends, and your classmates were subjected to such awful “care”.

          3. Grace*

            If it had been me, I can pretty much only imagine going “then test me for it, so we can get your delusion out of the way so I can get some science-based medical help.”

        2. Observer*

          I want to believe this was actually a sitcom someone was filming on campus that your friend wandered into by mistake.

          Exactly. To this entire thread.

          If only….

      2. L. Bennett*

        Ours was allergies. Everything was allergies. “My arm’s off!” “Must be allergies.” Turns out, the doc was taking kickbacks from a pharmaceutical company every time he prescribed allergy meds. He had his license revoked shortly after that discovery, I believe, and all the students rejoiced.

        I also went into the clinic once for a urinary tract infection and they immediately slut shamed me about it…. I had never had sex before so I was super confused about how my condition was a STI…

        2. Lisa Simpson*

          One of my friends got screamed at during a pelvic exam for “drug seeking” because her previous doctor had prescribed pain pills for her condition. It turned out she had a very complex diagnosis of several different medical disorders and neither her home doctor nor student health was able to correctly identify it.

          Another got told his appendicitis was “just stress” but thankfully he was able to get to the ER before it burst.

        3. Fishsticks*

          My family’s pediatrician, on the other hand, REFUSED to believe ANYTHING was allergies. When my older sister started having weird symptoms that only showed up in specific situations, she was diagnosed with stress. Losing weight? Stress. Getting ill for weeks on end? STRESS. “You’re just stressed because you’re in high school.”

          Turned out it was allergies that were progressively worsening. We weren’t able to get the doctor to consider that until my sister collapsed when she had to be in a room that had live pine trees in it.

        4. Zap R.*

          God, what is it with doctors being dinks about UTIs? I always get an extremely condescending explanation of how to wipe my own butt.

      3. Goldenrod*

        Oh my god.

        A friend of a friend of mine in colleage had a similar situation – she was not named David (!!), but she eventually ended up having to explain to the insistent doctor that there was NO WAY she was pregnant because she had never had sex.

      4. Zap R.*

        Oh lord, when I was in university, the clinic repeatedly missed my oozing gastric ulcer and kept insisting on pregnancy. My protestations that I’d never had sex with anyone were met with disbelief. I literally had to say “It would be an actual biblical miracle if I were pregnant” before they referred me to a specialist.

    3. RMNPgirl*

      My college health clinic basically told everyone they were dying. They thought hoofbeats were zebras every time. They once told my roommate she had liver disease. She most definitely did not.

    4. Bunny Lake Is Found*

      Went in with a sore throat that made me feel like I was dying but, didn’t have a fever (my temp is always all over the place) and I could talk (I had chronic strep as a child and learned how to basically talk completely in my head voice). Doctor didn’t even want to look at my throat, I think assumed I had just been up late yelling? Finally had a look and said “Well, your tonsils do look a little red, but gargling with salt water will make it feel better” My response: “I had my tonsils out when I was 12”. My throat had just swollen up so much it looked like they were still there.

      Retrospectively, not sure if I am more concerned that she didn’t want to even look at my throat in the first place or if she seemed to not understand what was and wasn’t a tonsil.

    5. goddessoftransitory*

      “Bleeding from the eyes happens all the time in pregnancies! And you’re a woman so definitely pregnant. And have anxiety.”

  73. Fikly*

    Going to make a not at all wild guess that the patients he thinks cannot possibly have a medical condition because it’s rare and instead just have anxiety are women, too.

    Because rare means they can’t have it! Even though they have symptoms and the condition exists in the first place. But they’re women, they’re just anxious!

  74. DataGirl*

    I work in Graduate Medical Education in the US. Your regulations are probably different than ours, so pardon if I say something that won’t work for you.

    Make sure you are documenting all these interactions. Have the resident sign that the meeting took place- he does not have to agree with what was said but he had to acknowledge you spoke. Since he’s so problematic, have the witness sign as well

    Talk to his Program Director about probation, remediation, or dismissal if that hasn’t already been done. At a minimum he should not be advanced to the next year of training if he hasn’t demonstrated the skills necessary for this year

    I’d love to say more but I don’t know how GME works in your country.

  75. Lala*

    Don’t actually do this, but the evil part in me wants the OP to get so “friendly” in her feedback to Dwight that she goes full preschool teacher. Like,”Uh-oh! Did Dwight do an oopsie? That nice lady has llamapox, not anxiety! Next time, be really, reeeeeeally careful! We don’t want to kill our friends!”

      1. Emily*

        Oooh, I love this! Haha. Seriously though, LW, it sounds like you are doing a great job and Dwight has no business being a doctor. I’m glad you are documenting everything. Hopefully Dwight will be gone soon.

    1. Hobbette*

      And (no doubt) the unspoken subtext “No woman is going to tell ME what to do.” Arrrrgh!

  77. Administrative Head of Medical Education*

    OP, I am not a doctor, but I managed residency/fellowship programs for years and am now an administrative head of medical education at the state level. PLEASE loop in the residency coordinator on what is going on. If it is an ACGME accredited program, there are remediation steps outlined to take with residents. If not, they are still going to want to know what is going on and can offer support (or even to talk to Dwight about this pattern if you feel like you are getting nowhere). You do NOT owe it to him to “be friendlier,” that is not a requirement of your job as faculty for a residency program. Please document everything – professionalism is one of the competencies they are assessed on, and Dwight isn’t demonstrating that (in addition to what sounds like a whole lot of other competencies he is not meeting!). The trainees are there to learn from you, and if they can’t or won’t, they need to leave.

  78. HannahS*

    Hi, I’m a medical resident who has been given and witnessed feedback in a number of different ways (abusive and not) and I think we both know that our field has a history of terrible abuse of medical residents. You are not doing that. Your feedback appears to be calm, reasonable, specific, appropriate, and actionable. I strongly suspect that Dwight does not want to receive feedback from anyone and especially not a woman. I had a somewhat fragile, narcissistic colleague who LOST HIS SH*T on me in medical school because my feedback to him wasn’t “nice” enough and I’m getting similar vibes from Dwight.

    The only thing I would suggest (and you’re probably doing it) is make sure that you’re communicating with the program about Dwight. It’s really easy for people like him to be propelled forward through the program, and I would recommend documenting your interactions with him, reporting them on your formal evaluation of him, and possibly contacting the PD.

    1. Grumpy Elder Millennial*

      Always fun when the people who act so invested in you being nice turn around and act like raging jerks.

  79. Sasha*

    UK physician and training program director here. This is classic Trainee in Difficulty stuff – complaining about your tone when you point out errors, lack of insight into their own performance, allegations (or threats to make allegations) of bullying if you point out errors (however nicely you do it).

    Does this trainee have an educational supervisor, or training program director, or local education lead you can escalate to? There should also be local training available on dealing with TIDs, as it can be tricky.

    Things we have put in place, with varying degrees of success:

    Weekly check ins and reviews of notes/letters for feedback. Should be with the same person each week.

    Direct supervision if necessary (we had to do this with one trainee who we really thought might not be medically qualified, they were so dangerous). Removal from the ward if they cannot follow instruction.

    360 and patient feedback – can be useful to have more than one person saying the same thing.

    Referring them to look up guidelines, and having them reflect in writing on how their management deviated from the guidelines, and what they could have done differently.

    You may have professional support units locally who can provide communication skills training for them (both dealing with colleague and dealing with patients).

    It is imperative that there is a united front with you and your senior educational team here – you all need to be very clear they this doctor needs to be able to take feedback, doesn’t necessarily get to dictate how that feedback is delivered (obviously not in a demeaning way, but not necessarily using their preferred phrasing), and they need to have insight into their performance issues. You need a united front, or the trainee will just claim you are a big bully and they are a poor little victim, and they will carry on as they are until they kill somebody.

    The UK Royal College of Physicians has some excellent free or cheap online resources on dealing with these trainees – I expect other training bodies have similar, but those are the ones I am most familiar with. Good luck! They are a nightmare and take up an almost unbelievable amount of time to deal with.

    For readers: they do all mostly leave medicine eventually, and many have other diagnoses or life problems which explain their difficulties (I currently have one TID with autism who was fine in medical school but cannot cope in work, one in a physically abusive domestic relationship, several with severe depression or anxiety, etc – these are not “bad doctors”, they are just not in a position where they can perform well in their current job).

  80. Primary Care MD*

    Female MD here, responsible for teaching medical students and residents. Please reach out to the Dwight’s Program Director with your concerns. This is a Dwight problem. At minimum, he should be on a Focused Professional Practice Evaluation plan.

    Based on my own experiences, his reaction is 100% rooted in misogyny. Your feedback was clear, concise, and accurate. It should not be framed as “friendly advice to consider”.

  81. Rainbow Bridge Troll*

    Dwight is the kind of doctor who told my mom her persistent sinus infections, throat swelling, scalp itching/burning, and migraines were due to dehydration and being overweight, and that she should “drink more water and get some exercise.” The actual problem was that she was having an allergic reaction to a medical device implanted in her skull 20 years ago that needed to be removed; another doctor listened and removed it – lo and behold, her symptoms disappeared.

    I hate Dwight and “doctors” like him. Mama, don’t let your babies grow up to be Dwights.

  82. JustMe*

    Yeah, you can honestly just laugh in his face and tell him that in life or death situations, there is no such thing as “friendly advice to consider” and report him to his supervisor.

  83. Lana Kane*

    Having been around physicians, residents and residency (in the US, for context), I think more info is needed before info giving any advice.

    Precepting physician feedback to residents historically is blunt and often harsh. However, newer residents are starting to challenge this approach. Because of diversity and inclusion improvements, at my teaching hospital this feedback from Dwight would have kicked off a larger review of how feedback is given. Having another physician to oversee another physician’s feedback is 1) not enough, because we don’t know what feedback style those physicians have, and 2) difficult to do because they all have heavy caseloads.

    The LW is outside of the US but we don’t know the cultural issues at play here. Is this an American provider who is working outside of their native culture? This may seem rare but there are plenty of American providers working in international med schools.

    Dwight is already in remediation – who is overseeing it? Has this been discussed with that group?

    Is Dwight having this issue with other providers? Or is this happening only to the LW?

    These dynamics are very specific to the profession and I would caution saying that Dwight shouldn’t be a doctor based on this. Kicking someone out of residency is very difficult and even with remediation isn’t likely – Dwight is very likely going to become a doctor. The residency program’s responsibility is to do whatever possible to make him a good one. I can’t stress this enough – it’s not that the resident has no responsibility, is that a resident is essentially still in school, and by accepting residents, a program has taken on a teaching/mentoring responsibility.

    My advice to the OP: check in with the residency leadership and/or the remediation group and talk this over with the as they may have suggestions on Dwight’s specific situation; they may also talk to him if they believe his approach to feedback is part of why he is in remediation in the first place. Also, there are ACGME resources out there that talk about how to handle these situations. Also, when this comes up again have a conversation with Dwight – it might help illustrate where he is coming from if this is indeed, say, a cultural issue, or if Dwight belongs to a historically-underrepresented demographic in medicine. Good luck to you both!

    1. Observer*

      Good grief! No wonder it’s so hard to make reasonable changes!

      There is NO WAY that a resident gets to tell an attending that they should frame their feedback on *life and death issues* as “friendly advice” much less something they “CAN consider”.

      Given what else the OP states in the letter (even ignoring her responses in the comments here) you are REALLY stretching here. And, I get it. DEI in medicine is important! It leads to better outcomes for not just for doctors, but for under-served communities. Same for just rooting out some of the toxic culture in many residency programs.

      But you do NOT get to real inclusion or healthy culture by trying to wave away bad behavior. Especially when there is also a fairly strong reason to believe that the behavior is strongly tied to well know patterns of bigotry and toxicity that have well known negative effects.

      1. L. Bennett*

        Thank you! This comment was really bugging me and I couldn’t put a finger on why it was. It feels like another way of saying “maybe the OP IS being mean and Dwight is actually a victim here” but doing it with more words that sound inclusive.

        1. Bunny Lake Is Found*

          I’m thinking Lana was more trying to present it less as “Maybe OP IS being mean” and more “Something else might be going on with Dwight that is causing him to react in this utterly uncalled for way when OP gives him perfectly professional feedback.”

          It seems more likely than not that the “something” is that Dwight is sexist and if that is the case then Dwight definitely should not be a doctor. But it is worth at least considering that the “something” might be something else that is correctable and that Dwight doesn’t need to per se be written off from medicine entirely. I don’t see it as particularly likely, but it’s not impossible. But even if that is the case, it in no way makes the OP’s feedback harsh or uncalled for and nor should the OP take steps to frame her corrections as requests.

          1. Sasha*

            It’s perfectly possible there is stuff going on that OP is not aware of – honestly my experience is that there usually is, the trainee just doesn’t tell anyone.

            My absolute worst trainee last year (incompetent, regularly just didn’t turn up to shifts, openly rude and aggressive to both patients and colleagues, bullying to juniors) turned out to be in a physically abusive relationship, something we weren’t aware of until she attempted suicide (we had tried to meet with her numerous times to discuss her issues, and she had actually refused to meet us).

            She was kicked off the program, but I felt tremendously sorry for her by the end – she wasn’t fit to work, but if her life had taken a different path she might have been absolutely fine. I hope she eventually gets herself sorted out.

            On a less dramatic note, I have another one who is going to get kicked out in August due to failure to progress in her exams – she has taken one exam 9 times over four years, and has no further chances. Excellent working doctor according to her supervisors. Refuses to be tested for dyslexia or processing disorders, despite us all thinking she probably has one. The testing is free and provided by the training scheme, and if she does have a SEN, she’d be eligible for exam support. But won’t go down that route, out of a sense of shame. I have others who won’t seek help for their barn-door depression.

            At the end of the day I am their TPD not their mum or GP, and I can’t force them to do anything, just signpost. But it is sad to see people refusing to access help, mostly out of shame, and failing out as a result.

    2. Dahlia*

      OP is American, I believe, and Dwight is Canadian.

      The cultural differences are not that different.

  84. Did you use the H word?*

    Oh my god if I had a dollar for every time a doctor dismissively diagnosed me with anxiety and ignored the fact that the anxiety was caused by the tiny llamas growing out of my face…

    LW, please check whether there’s a pattern in which patients Dwight in mistreating this way. Based on the misogyny in his behavior towards you, I bet you’ll see one. Alison is right, he should not be a doctor.

    1. Chirpy*

      “Hey, doc, you know what would really help with my anxiety? If you could just check out this llama on my face.”

  85. Nespresso Addict*

    Wow. Dwight’s reaction to your feedback reminds me of some of the ridiculous anecdotes and advice given in that book “Men are from Mars, Women are from Venus”. I was just listening to a podcast take-down of this book a few days ago so it’s top of mind I guess. A lot of their pushback on the podcast was to the sentiment expressed in the book that women would see much more willingness from their husbands to pitch in on housework and so forth if the wives would just be careful to frame what they need as optional requests, so that their husbands get the satisfaction of feeling like they are choosing to do their wife a favor rather than simply complying without agency. Softening language was suggested, ie instead of saying “Can you ….?”, say “Would you ….?”

    I think this mindset is a lot less common than it used to be, but it sounds like your resident is a holdover from the past and I’d bet has a pretty misogynistic worldview in general.

    1. selenejmr*

      It’s been ~28 years since I read that book. Our Amway group – that I left a year later – thought that the book was beneficial and wanted us all to read it. I couldn’t understand why they recommended it because I thought it was very patronizing and it pissed me off to no end.

      1. CommanderBanana*

        The If Books Could Kill podcase did a great episode on Men are from Mars, Women are from Venus.

    2. Irish Teacher*

      I’m guessing the book doesn’t make similar suggestions about how men can adapt their communication style to make women more likely to listen to them?

      2. Bunny Lake Is Found*

        I always assumed this was because women would see through surface changes in a communication style as a blatant manipulation and it would thus be ineffective.

    3. Crumbledore*

      Was coming here to say exactly this! It’s a perfect example scenario of the terrible advice in that book. It puts the ridiculousness of that advice into stark relief, with life-and-death stakes on the line. I loved that takedown (“If Books Could Kill”, right?).

      1. Nespresso Addict*

        Yes, that’s the podcast I was referring to – I just stumbled onto it recently and love it!

    4. Ellen N.*

      When Men are from Mars, Women are from Venus was popular my argument to anyone who touted it was, “If its premise were correct, same sex relationships would be free of communication problems. They aren’t.”

  86. Lyngend Canada.*

    As someone with anxiety, who would have liked to have said “hi, I know that I have issues with x y and z. But can we focus on x and y. Because the focus on how x and y will fix z is making things worse” (there was a feed back loop. If issues And X were solved, no one would care about Z, my low average handle time. But I was struggling with soft skill issues, where I was expected to do x and y, but also getting conflicting messages from customers (trying to hang up because their tech issue was fixed and I needed to say 30s more closing statements), other managers (why is your call so long. Reinforced the “get off the line asap”), and my managers “take the time to get it done right” without any help beyond “it’s easy to do, just take the time to do so”

    This is a complete absurd reaction from the dude. Like if he’d been going “hey, could you add a bridging statement instead of going straight to the corrections” that would be understandable. (by that I mean changing “hey [dude] you did x y Z wrong” to “hey [dude], I have some concerns about how you handled patient [name] issue. They presented with [symptoms] and you completely dismissed them….

  87. itsglaringlyobvious*

    OP this is not your delivery that is the problem here. The problem is Dwight. Your job is not to give him friendly advice, it’s to point out his mistakes so he can do better and by do better, we mean at minimum not kill any patient and hopefully actually diagnose and treat patients appropriately.

    Please take this to the next level. Dwight will kill someone if he continues ignoring critical feedback or cause other irrevocable harm.

    As a person with more than one condition that “is almost never seen in someone your age” I wish more doctors like you exist and less like Dwight. To be fair the conditions I have been diagnosed with have GLARING symptoms/indicators that are difficult to ignore or explain by any other means. The doctor just called out one to their scribe and the scribe walked over to the wall to get me a pamphlet on my new condition without it being named (waited for the doc to talk to me about it first then handed over the pamphlet).

  88. Peridot*

    I guess now we know where the doctors who misdiagnose any woman’s health concern as “anxiety” come from.

    1. not a hippo*

      I have asthma. It came about in my adult life but my mom’s had asthma all her life so I’m familiar with the symptoms.

      When I first started experiencing symptoms, I went to my doctor and told them what was happening. I used sitting in my car as an example of a time I had trouble breathing and they got so hyper focused on the fact that I had a traumatic event occur in a car that they couldn’t see past it and diagnosed me with anxiety.

      Went to a different doctor, did one of those lung test things and lo & behold. Wouldn’t you believe it, I have asthma.

      1. Bunny Lake Is Found*

        I swear, the more of these stories I read, the more I am glad I never went into medical malpractice. Let’s assume we call the “trauma in car” a “history of anxiety”. You also had a family history of asthma. There is no test to confirm for anxiety, there is a test to confirm for asthma and it is non-invasive. An asthma attack can be deadly.

        Legitimately, I would be prevented by my ethics requirement from providing any defense to the decision to treat for anxiety and not test for asthma other than “some other doctors would make the same choice and they have not been sanctioned.” Because I could not argue it was the safer course of action, the recommended course of action, or that it was the course of action the majority of practitioners would have taken.

      2. TrixM*

        I went to a doctor a few years ago with a feeling of pressure and suffocation in my chest – definitely not classic asthma, I’d had it as a kid and grown out of it – but I made the mistake of saying the feeling I couldn’t breathe made me anxious.

        Well, that was it – I was suffering from “anxiety” for the first time ever at the age of 48. I never got a satisfactory explanation, lol, but I feel like it was some residual effect from the smoke that had blanketed Australia’s east coast during the massive bushfires back then.

        Anyway, I’m back in my homeland now, zero breathing issues – nor did I have any by the time of the pandemic. You can bet I’ll never say the A-word again to a medic – at least I’m lucky enough to have that privilege.

    2. goddessoftransitory*

      You’re pregnant with anxiety. Soon you shall have an Anxiety Baby.

  89. Carmen*

    Potential doctors like this is absolutely terrifying. It’s doctors like this that dismiss patients and can ruin lives. Last year I had severe abdominal pain to the point where I had to go to the ER. The doctor did an ultrasound, saw I had an infected ovary and decided it was due to having an STD. I’ve been happily married for over a decade-imagine how devastated I felt at the thought of my husband cheating on me. Hubby went to a clinic the next day and tested negative for the STD. The pain continued for me and I finally went to an obgyn. It was NOT an STD- I may have to get surgery to fix the issue. If I had believed that stupid doctor my marriage and my life would’ve been ruined just because he wanted the easiest option to be right one.
    A few years ago I took my mom to the doctor since she was acting weird (weirder than normal). The doctor said it was a symptom of her Alzheimer’s despite us telling her something was off. Later that week she was admitted to the ER-she had TWO brain bleeds and because it was caught too late she died.
    It’s doctors like this why my husband refuses to go visit one.

    1. not a hippo*

      I’m so sorry for your loss. Doctors that don’t do thorough exams are a blight.

  90. FattyMPH*

    “He said he wishes I would frame it as “friendly advice that he can consider” rather than “telling him what to do.” ”

    I have a genuine question that may sound flippant: Does Dwight understand that LW is in a position of authority over him? Does he understand that her opinions of him *will* impact his future career opportunities? In the moment, I would be asking questions to help him realize he is making a bad impression. (“Are you sure that’s how you want to respond to this feedback?” “Is that a demand you would make of a male supervisor?”) Every time he asked me to be “nicer,” I would become less friendly. I would use the most serious language appropriate and invoke “big deal” concepts as much as I could — so for the llama pox example, I would go beyond “serious and not optional” to “negligence that could kill your patient, which would obviously create liability for you and the hospital.” I would also invoke these high level concepts when talking to Dwight’s immediate supervisor.

    I would also try to help him understand that his behavior is exceptional in a bad way… Does he understand that the remediation plan is in fact a *remediation* plan? He may not get it until you make it clear that his current behavior makes him a liability to patient care and the safe operation of the hospital, and therefore his spot in the residency could be on the line.

  91. Tobias Funke*

    I think I saw Dwight in 2015 – I had sepsis and they told me it was anxiety!

    Thank you, OP, for being so willing to go to bat for your patients.

  92. Littorally*

    Dwight does not get to consider whether or not to correctly diagnose a patient. This boy has some majorly screwed up priorities, and his delicate baby ego needs a few good solid verbal smacks at a bare minimum.

  93. KP*

    Ugh. Dwight should not be interacting with patients unsupervised. If he’s doing this to the OP, who has medical knowledge/experience and informal authority, how is he interacting with his female patients?

    I really think Dwight needs to be let go. But, in case his leadership goes with coaching, he needs to be paired with an older male physician who is wise to his misogynistic nonsense.

  94. Fluffy Fish*

    The old joke being called what to you call someone who graduated medical school with a C….Doctor.

    There’s plenty of crappy doctors from any school to go around.

    1. Fluffy Fish*

      spectacular nesting fail. this was in response to a suggestion that this sounded like someone attending a certain type of school.

  95. Teach*

    I use to teach nursing. There are two times I would hear unusual feedback 1: cultural differences (something to be aware of and consider) and b; students with a significant lack of insight. These are usually my “scary” students. I would work VERY closely with his school and give the frequent updates about ALL things concerning (misdiagnoses and unprofessional communication). You are doing the right thing by giving clear feedback. I have been in situations where students were not safe to practice and we’ve managed n various ways including much closer supervision or at times, removing the student from the clinical placement for safety reasons. I am not sure the the school uses reflecting practice but I find using the LEARN reflection tool is a helpful way for struggling students to develop insight into the impact of their practice issues.

    1. Teach*

      I find that some students in health care, because the programs are so competitive to get into, have a hard time getting used to the fact that they are no longer the smartest student in the room. They are used to excelling, but frankly, book learning and clinical practice are so different. Clinical practice requires book learning, but also critical thinking skills, people skills, flexibility etc. So some students are used to being the best, based on their previous marks, getting praise and minimal constructive feedback,but are unaware that they are lacking crucial skills for the profession

  97. NoMoreFirstTimeCommenter*

    It could be also from a place where people speak a different language, and she’s translating the terms to US English to be easier to understand. It’s easier to write “he’s a resident” than “he’s at a stage called xxxx which literally means yyyy in English but I think the closest thing in your system would be a resident”. I do this all the time when I speak or write in English. Thanks to movies and TV shows, US terms are often the best known versions around the world.

    1. NoMoreFirstTimeCommenter*

      This was supposed to be a comment to the comment about Caribbean schools and somehow ended up here. Sorry.

    2. Sasha*

      Yep, if I was seeking advice here I would say “resident” not “IMT3” or “ST7”, because I don’t really expect anyone outside of Uk medicine to know what those are… everyone the world over knows what a resident is, from watching ER and Scrubs.

  98. Anita*

    Many years ago I had a boss in another city who would infrequently ring me out of the blue and launch straight into a very directive conversation about an issue and what I needed to do about it. It wasn’t critical but I found it disconcerting.

    I asked him if he could take a minute or two at the start for pleasantries – how was my weekend, how was his, etc. He agreed and it made a huge difference. It didn’t change what he said about the work content but it changed the interaction.

    “Hello fellow human being, it is I another human being. Now we have remembered our shared humanity let us talk about work”

    I don’t know if this is relevant to your situation. My sense is you are doing the work content part just fine, but I do wonder something else in the broader interaction might be the friendliness he is looking for.

    1. Jennifer Strange*

      It’s very nice that your boss chose to do this, but there’s nothing wrong with jumping right into the issue at hand. In this case, it sounds like the LW’s job is to provide Dwight with feedback (and these are high stakes situations!) The fact that his request was that the LW give him “‘friendly advice that he can consider’ rather than ‘telling him what to do'” is pretty telling that the issue here isn’t lack of pleasantries.

    2. MsM*

      This isn’t happening “out of the blue,” though. It’s feedback being delivered as part of the standard training process, to someone who is (or at least theoretically should be) aware they have improvements they need to make. And in a medical setting, there isn’t always time for “hey, Dwight, how was your weekend? Rock climbing, huh? That sounds fun. So anyway, this patient was supposed to get 10 ccs of medication. If it’s not too much trouble, could you explain to me why you put ten times that on her chart?”

    3. Observer*

      I don’t know if this is relevant to your situation. My sense is you are doing the work content part just fine, but I do wonder something else in the broader interaction might be the friendliness he is looking for.

      No, this is not relevant. “looking for friendliness” does not – and CANNOT – translate into “You can’t tell me how to not kill patients. You have to give me suggestions on the matter and I get to decide if I’m going to consider it, even though I could kill someone if I don’t consider it.” Which is what this guy did.

  99. PGY-amIdoneyet*

    I’m a US-based fellow, so not sure how similar your program is to what I’m familiar with.

    While my first impulse is also to think there are gender issues at play here (which there very well may be), I wonder whether he is a person who overall does not grasp or respect the hierarchy in medical education. Does he act really buddy-buddy with all the attendings, calling people by their first names even in an environment where that’s not the culture? Because that would need to be addressed and reinforced to him in a different way. Also wondering what year this guy is, as that would also affect the way this is handled. Regardless, this response to feedback is not okay and all the core faculty (and chief residents) should be on board with reinforcing appropriate behavior and working with him on his responses to feedback. Specifically, I very much hope you (OP) have documented this and informed the PD & APD (or equivalent). I wonder whether providing him opportunities to give feedback to med students or juniors (in a supervised way, based on this vignette) would be helpful to him, or providing him with anonymized student feedback as that often contains responses to their own feedback that vary in level of professionalism.

    Do you think I’m too inclined to give this guy the benefit of the doubt? Would you be happier if I said that clearly he lacks any social graces that a doctor should have? Well, he’s already a doctor. You cannot make him not be a doctor. The best way for him to be an asset to his program, his community, and his patients is for him to be mentored and taught to internalize feedback–from any source–and adjust the way he practices based on that feedback as well as evidence and experience. And please remember that even though “things are so much better than they were!!!” residency is still a pressure cooker. He is probably working 60-70+-hour weeks for relatively little pay, potentially without any significant support system outside of work, and who knows what other stressors. And that is after medical school, which is an independent (not related to personal or family history) cause of depression (https://jamanetwork.com/journals/jama/fullarticle/2589340).
    One thing I kept repeating to myself for 2-3 years was “people approaching burnout are not always their best selves.” For an example, my program worked closely with a surgical residency. They routinely violated duty hours (that’s 80 hours per week) for the first three years or so. When they came in as 1’s, they were pleasant and easy to work with. From about the second half of that year through at least their third year, they grew progressively crankier, more short-tempered, and overall more difficult to deal with. After that? Almost to a one they were again pleasant, reasonable humans.

    Is this a messed-up system? Absolutely. Is it effective at producing kind, compassionate, self-aware physicians? Not really! Is there a quick fix for that? Not at all. A lot of people are working on changing the culture but that is a slow process. And unfortunately, depending on OP’s country, there is a good chance that their system is actually worse. There is so much more I could say on the subject but…
    tl;dr: they’re stuck with this guy and have to work together to make the best of it, but this behavior absolutely needs to be addressed by the faculty as a whole. For everyone’s sake.

    1. L. Bennett*

      Are… are you explaining to the OP (who is a doctor) what it’s like to be a doctor? Yeah, they’re under stress and pressures, but that’s… not at all what this letter is about and is irrelevant. Even under stress and pressure, they can’t be wildly misdiagnosing people and dismissing feedback related to that as damaging their fragile ego.

      “I wonder whether providing him opportunities to give feedback to med students or juniors (in a supervised way, based on this vignette) would be helpful to him” — why on earth would you ever have someone who is already being reprimanded for their poor performance give feedback to anyone else? This is wild.

      1. Troutwaxer*

        >>> “…why on earth would you ever have someone who is already being reprimanded for their poor performance give feedback to anyone else? This is wild.”

        It’s not entirely wild. Sometimes putting an offensive person into the other slot is a good way to help them see how awful their behavior actually is. They get to mentally model both sides of the interaction and see what the norms should be through being on the other side. I’m not a fan of this tactic myself, and I think Dwight, at least as described in the top post, might badly misunderstand what he was being asked to do, but it would be a legitimate strategy in certain circumstances. (I’d certainly want to know a lot more about someone than I know about Dwight before I recommended this path!)

      2. APD*

        It’s so interesting to see my own field represented! Alison’s advice is still spot-on but this comment here really provides useful context. Graduate medical education (where they’re doctors, but also training in an educational program) is a fascinating combination of an educational environment and a work environment. At its best, it’s like, imagine in your first job your manager was almost entirely focused on your development for a few years, and accountable for giving you all the supervision and resources you need to ensure good work product while you learned how to do it yourself.

        From this poster’s user name and description – this is someone who is also a doctor, who is still in a training program but very advanced in one (and at a level where many people don’t seek additional training – so many of this person’s medical school classmates are already independently practicing). So I see them not as telling an attending (their immediate superior) what it’s like to be a doctor, but reminding a superior of the stresses of training. And it’s absolutely true that there are parts in training where people just hit their personal rock bottom – most of us have stories of mid-residency behavior that we’re not particularly proud of.

        Now of course that doesn’t mean that Dwight’s behavior (medical knowledge or response to feedback) is acceptable – and certainly not common, this is a very low rock bottom. But in my program, an “informal” remediation would turn into formal based on this behavior, which is the first step to extending training or even dismissing a resident from a training program, which does happen though rarely (typical residency in a specialty is X years long, but it’s the program leadership’s job, through a clearly defined process, to make sure that people are ready for each next step and for graduation). An earlier poster mentioned something that I think is critical: Dwight is in a training program. And sure, not all are the same and some are more likely to let someone slip through the cracks than others – but at least in the US training programs have a clear and explicit mandate to ensure resident competency, remediating whenever necessary, not just in medical knowledge and patient care skills (which is sounds like is also a deficit of this resident) but in interpersonal and communication skills, professionalism, and other things. Over the past few years what it means to be “ready for independent practice” in these things has been clearly defined and is being tracked closely on a national level. I know less about Canada but in some ways they are ahead of the US on this type of thing. So I see how “should never be a doctor” seems like the obvious conclusion, but in addition to him already being a doctor – my professional take on this is “needs serious remediation and if this deficit is not remediatable, needs to be dismissed from his training program” which is not quite the same thing. We have a responsibility to Dwight to fix what’s fixable – and more realistically (at least in the US), wrongful dismissal of a resident has a huge financial impact on them (accrued medical school debt but now can’t practice), so is a winning lawsuit. It’s important to do this right, even if dismissal is the ultimate outcome.

        Research has shown, and this always-amazing comment section makes it clear, that the medical education system has not been a guarantee of ensuring doctors have all the skills they need to practice safely. Those of us who work in medical education consider this the main problem we are collectively fixing, using a definition of “competent physician” that’s becoming more comprehensive (e.g. incorporating interpersonal skills), modern (e.g. recognizing the need to practice equitably and that this has to be specifically taught in our current system), and accurately measurable (an ever-clearer consensus of how to ensure individual trainees meet these requirements) as time goes on. Not baby steps, but national sweeping initiatives being conceived, implemented, and studied by smart people. I’m not trying to say we’re done, but I am saying that we take it seriously to fix this longstanding systemic problem.

        So I want to add my two cents that Dwight’s behaviors are absolutely not OK and are a burning red flag for intervention – but also that there IS a system for intervention, remediation, assessment of success of that remediation … basically, medical education programs are expected* to have a process in place that meets all the criteria Alison describes as part of a good PIP. And it’s worth saying in defense of Dwight’s potential (though again, his behavior is unacceptable, and there’s a good chance many of the commenter’s conjectures about his view of gender, the role of his resistance to feedback in his medical knowlege deficits, etc are spot-on) that prognostication of a deficit (will Dwight ever be able to practice safely?) isn’t always clear.

        But yeah, if something doesn’t change with Dwight he shouldn’t graduate from training, and he probably won’t if the program is paying attention. But the “manager” in this situation is really the program director, and though this individual faculty member has supervisory responsibilities and it’s totally appropriate and expected for her to give feedback in her role, these interactions are more a data point in his “manager” (PD)’s assessment of him and his need for remediation (and, if unsuccessful, dismissal). So yes, she needs to give this data to the program director / APDs / chief residents / clinical competency committee – whoever is overseeing his informal remediation.

        *expected: this expectation has teeth. Do it right, justify that on a visit by a national accrediting body, or lose your accreditation which means your current residents are various degrees of screwed and you’ll never attract any more. And now your hospital has to shell out for much more expensive staff to make up for the residents you lost, in roughly a 1:3 ratio. https://thesheriffofsodium.com/2022/02/04/how-much-are-resident-physicians-worth/

        1. Sasha*

          This is a really great comment.

          I would add though, that lack of insight and inability to accept feedback are generally seen as poor prognostic signs! It’s hard to improve if you don’t really believe you need to.

          Sometimes this is a protective mechanism – the trainee has so spent so many years being invested in being a doctor that their whole self-image is tied up in that. They can’t accept they are failing, so blame everyone else around them. Unfortunately it is also totally counterproductive.

    2. Observer*

      Would you be happier if I said that clearly he lacks any social graces that a doctor should have?

      It would help if you started with actually naming the problem accurately. This is NOT about “social graces” or social anything. This is about someone who *refuses* to accept feedback regarding *life threatening* errors that he is making.

      Well, he’s already a doctor. You cannot make him not be a doctor.

      Nope. He may have the degree, but he doesn’t have the license to practice. And the OP (or rather the OP’s institution CAN keep him from getting licensed.)

      He is probably working 60-70+-hour weeks for relatively little pay, potentially without any significant support system outside of work, and who knows what other stressors. And that is after medical school, which is an independent (not related to personal or family history) cause of depression

      And? Since when is working insane hours and being under pressure make it OK to refuse to take on the feedback on (again) *life threatening errors*? Why does he get a pass when others in the program somehow manage to actually pay attention?

    3. I WORKED on a Hellmouth*

      I feel like 1) we just found the source of a lot of the problems with the US medical system here, and 2) your response to both OP and the other people commenting legitimately alarms me.

    4. Bunny Lake Is Found*

      The problem with all of this is that the OP is clearly seeing MANY doctors going through this program. She knows they are stressed and they are under difficult conditions. I am sure OP has seen behavior that, in a different work environment or even at a different stage in a doctor’s career, would be firing worthy level of unprofessional, but OP recognizes it as just a by-product of this stage of the process. However, Dwight’s behavior, even amongst his stressed out colleagues, stands out as a big problem.

      Dwight isn’t getting the medicine right but getting snappy because he hasn’t gotten more than 3 hours of a sleep a night for a month. He is screwing up the medicine AND disregarding corrections from his superior AND defending this disregard because his superior wasn’t “friendly” enough for him.

    5. BattleCat*

      Uh guys, just pointing out PGY-amIdoneyet seems to be a doctor too, they’re a “US-based fellow” i.e. of a medical college. PGY is the acronym for Post Graduate Year, referring to how long they’ve been training after graduating med school

      1. Leenie*

        I think the response from “I WORKED on a Hellmouth” shows clear understanding of that. I’d argue the OP being a doctor is the source of Hellmouth’s alarm.

  100. Puzzle2219*

    Not that I condone pimping/poor treatment of trainees in medicine, but I think he’s lucky she isn’t calling him names for stuff like this—that does happen. Seems like he is arguing with her tone because he knows he can’t argue about the substance.

  101. ILoveCoffee*

    I shared this with my fellow science professors at the community college where I work as lot of my colleagues teach the classes taken by students going into medical fields (nursing, radiography, etc) and we are seeing this attitude at every level. Students have told us that “feedback” (aka correcting their mistakes) makes them “feel bad” and we should be nicer about it – and shouldn’t “give” bad grades or assign “hard” homework or tests. Also, there is no need to memorize things anymore because they can just “google it” or “ask someone”. Um, I don’t want you taking care of me if you have to google what is and what is not a normal blood pressure (I realize medical people do need to look things up but the basics should simply be known) It’s particularly bad for the female professor’s so I’m really glad Alison addressed that.

    1. goddessoftransitory*

      Reminds me of a Slate column where someone wrote in that she didn’t see why her homeschooled daughter needed to learn any math beyond basic 1+1 because “there’s calculators for that.”

    2. OrigCassandra*

      I’m at an R1 and I’m seeing similar.

      I’m working toward getting out of higher ed. I can’t teach students who don’t want to be taught.

  102. Calamity Janine*

    this is a perfect response, tbh. you are completely right, OP, and Alison is also right that Dwight shouldn’t be a doctor with this attitude.

    if anything i would be a little more stern with him. this is not just a lack of professionalism, it’s him failing on the job. his direct supervisor who is overseeing these residencies is who to likely target this to. but if he’s botching easy diagnoses, it’s not just “well he needs to work on his bedside manner” – it’s not even just “this student has a major problem about ethically approaching work in this field and needs, bare minimum, to be reminded of the ethics he said he was going to follow” – it’s “this student is already a danger to others and it’s going to get way worse as soon as he stops being a resident, much less stops being a resident under doctors that can afford the time to be so diligent in double-checking”. (not that the other doctors with residents are slacking on the job, either – growing independence is supposed to be part of the work of residency. right now, Dwight is not on the path to that. Dwight is on the path to being a danger to others.)

    sadly, with his attitude, it may be time to call in reinforcements… because i doubt that Dwight will really understand unless it’s another dude telling him to cut out the misogyny. ‘cos, y’know, misogyny’s gonna misogyny.

    if you wanted to have a serious sit-down with him to (politely) take this from the top, OP, i think that this is an appropriate time to pull out the logic of “i am not here to be abusive, but it’s far more cruel to let you do bad work – and hurt others by doing bad work – than it is to correct you appropriately”. i would also be very clear that if you’re an overseeing physician and he is a resident, you are there to pull rank on occasion. that’s kinda your function. you’re the trainer, he is the trainee. the things you mention are not going to be friendly little tips that he can decide are totally optional.

    you’re not there to be microsoft office’s Clippy, easily ignored when you pop up to ask if he’d like some help writing a letter. you’re training him.

    it’s something where i don’t think you pointing this out to him will make him get it. sadly, it’s going to likely take the nearest dude of your rank or higher twisting his ear about it to get him to listen… or, honestly, odds may be bad he’ll listen at all. but having someone else point this out to him gives him the best possible chance to course-correct, and makes it less of a he-said she-said. it makes it a big enough problem to be on people’s radars – very suitably so, given it is A Big Problem.

    and honestly, i am cynical, but…

    …be on the lookout to make sure Dwight isn’t infecting his cohort of residents with this nonsense. if he’s going to be such a poisonous influence, well, the poison’s going to get in the groundwater.

    sometimes the true value of someone in an educational setting is to be a clear demonstration for everyone else of what not to do, lol.

    this will sound harsh, i know, but there are occasions where harshness is called for. should residents be abused? no. should residents be allowed to abuse others in order to preserve their own egos? absolutely not! you’re not discussing the first question here, you’re in the realm of the second.

    and honestly, if his cohort of residents gives him some pushback, the more people telling him this is unacceptable may be better. after all, i thought the usual stereotype is that residents went the entire other way in diagnoses, constantly chasing zebras when they hear hoofbeats instead of common horses, lol..! (i would also not be surprised that if you bring up his behavior a bit more visibly, perhaps as a “reminder to everyone, here’s not how to treat patients, just getting everyone on the same page” to the entire cohort, you may find that some of the other residents have tales of Dwight acting badly towards them… and that will make the problem way more clear, and possibly easier to act on.)

  103. Not Tom, Just Petty*

    Is there a corrollary/sequel book to The Gift of Fear called The Gift of Glow? It should be about solely about gaslighting, not in a way that can harm you, but just tip your off your feet a little bit.
    When the customer says “you always had X product.” When the coworker says, “you agreed to do X for this project.” When the client says, “we never agreed to pay for X.”
    Oh wait, I just realized as I write that it’s this blog.

  104. Dawn*

    I would bet good money that “Dwight is behaving towards you in a condescending and almost certainly sexist manner” is also veeeeeeeerrry indicative of why he diagnosed a patient with anxiety instead of the Llama Pox they actually had.

  105. not me*

    My cousin was kicked out of residency because he did something similar to Dwight. Of course my (male) cousin did it to both male and female doctors, so that may be why.

    “Dwight, your feelings are not the most important concern in the room. The patient’s health is”. That’s why I can’t give feedback.

    1. Peanut Hamper*

      Can we pin this to the top? Because this is the real issue here. Dwight places his feelings and opinions way above his patients’ needs.

      We’ve had generations of doctors like this. We don’t need any more.

  107. Enai*

    ““Dwight, your feelings are not the most important concern in the room. The patient’s health is”. That’s why I can’t give feedback.”

    Sounds reasonable if understandably exasperated to me?

  108. Just me*

    This situation reminded me of the time when a friend went to the student health center and they couldn’t decide whether he had maleria or syphilus. Went to his regular doctor back home and he had mono.
    A different friend questioned whether the doctor at the health center got his medical license out of a cracker jacks (brand of carmel popcorn with trinkets) box.
    Dwight sounds headed in this direction full speed ahead.

    1. Ugh Dwight*

      Omg my friend had mono and her doctor thought it was something else (can’t remember, long time ago) and whatever treatment they did you are NOT supposed to do with mono, she was not getting better. Our NP friend who actually *is* competent, and listens to her patients, diagnosed her over text by asking a few simple questions and she was able to get better. Unbelievable.

      1. Boof*

        Mono is a virus, the treatment is usually just supportive (and avoiding abdominal blows and unnecessary antibiotics)

    2. cardigarden*

      I had mono that originally got misdiagnosed as strep because I got a false positive on the test. 3 days of antibiotics and worse symptoms had them re-test for mono, which came back positive almost instantly. But they at least listened to me when I was like “hey so I think this is something else because penicillin is doing absolutely nothing.”

  109. Lauren*

    There are plenty of Dwights that do become doctors even if they are unqualified and put patients in danger. OP needs to escalates this before it is too late. No more feedback here. Formal complaint based on X patient who could have died, because he hasn’t realized or refuses to understand this. If OP is a woman and resident is a man, that is likely clouding the part where this is a real concern. Life and death. Like how AAM tells people to label complaints to HR as – Advise on Formal Complaint of Harassment, this needs a label too. AKA Formal Compliant for Medical Resident – Patient X misdiagnosed for fatal condition and could have died due to cavalier diagnosis. CC everyone up the chain including the resident.

  110. Ugh Dwight*

    Dwight is dangerous! I think it’s amazing you’ve had people listen in on your feedback, it’s clearly his problem.
    It reminds me of a situation (academia) where a friend of mine who is exceedingly kind and usually smiles/laughs almost all through talking (it’s sweet not annoying lol) had to say some feedback or comment to a grown man and he had a similar reaction SOLELY bc she wasn’t smiling. Like she was probably not even being extremely direct and definitely not rude. He might have even left for the day?
    Yikes. Thank you for taking this seriously it’s really scary

  111. Retired Vulcan Raises 1 Grey Eyebrow*

    Dwight’s hurt feelings are of zero importance compared to hurt patients.

    He’s just trying to deflect /divert the OP’s feedback.
    The OP should report that Dwight is doing this and is a danger to patients.

  112. not a hippo*

    I worked with a Dwight. He was like if Colin Robinson had a baby with one of the dudes from Dumb & Dumber. He’d give out wildly incorrect information to clients so we had to scramble to correct him.

    If we tried to correct him (“hey so you told Mrs. Pumphrey to give Ticki Woo 50mg of Llama dewormer, but the doctor’s notes say 15mg. You need to be very careful when advising clients), he’d get defensive and claim he said the right thing when it was obvious he said the wrong thing.

    He was finally fired but last I heard he was working for a corporate chain that I guess doesn’t care as much.

  113. Looper*

    If you were in a teaching hospital in the US he would already have been kicked from the program (at least at the hospital I worked at) so I’d push back very hard on this and frankly use capital to get him out. The world doesn’t need any more sexist, incompetent doctors.

  114. Indolent Libertine*

    “Dwight, when I’m actually giving you friendly advice I’m happy to frame it that way. When I’m correcting your performance, being ‘friendly’ is irrelevant, and direct instructions from a supervisor are not something you have the ‘option’ of ‘considering,’ they are orders that need to be followed. If you can’t adjust your attitude toward this reality of medical training, then this is not the right program or profession for you.”

  115. Mothman*

    At a remote job, I was literally told I needed to “use more emojis and exclamation points to convey tone” because apparently, I was coming off as “too harsh.”

    1. They never would have said that if I was a guy.

    2. It was in response to my finding a solution to a problem that had caused hours of extra work for literally everyone.

    3. I made the mistake of saying “Hey, I think I figured out how to fix it! I can institute the fix if you’d like–happy to help however I can. Here’s a link to the solution.” Clearly very aggressive.

    My poor boss was SO uncomfortable talking to me about it, but she had to because it was on my official “anonymous” peer review.

    I’m glad we have decided feelings are valid, as I was super messed up by being told none of my feelings were valid–as were many Millennials. But, I think in correcting the problem, we (yes, we, it’s not the kids’ faults), we forgot the second half of the concept. “You can’t control how you feel…but you CAN control how you act.” It’s one thing to be overwhelmed and burst into tears, as you can’t necessarily control that (and would have been a logical response from an overwhelmed student doctor like him!).

    It’s another to tell your boss they’re being super mean by giving you constructive feedback. That’s how you lose employment, no matter how old your boss is. I’ll tell ya, Gen Z–my favorite people–don’t put up with crap. They’ll help you out of any tough spot, but the moment your behavior becomes harmful, you’re done participating. Even if it’s at work.

    1. Wintermute*

      so their directive is to make yourself sound like PixieGurl87 on yahoo instant messanger? yikes.

      I mean, I have had that happen, and because I grew up in that generation I didn’t necessarily think less of a director who sounded like a classmate in highschool chatting on AIM, but it certainly didn’t make an outstanding positive impression either, and I imagine I am an outlier in not finding it impacted my impression of her professionalism.

  116. I just work here*

    OP, as someone in a tangential field (I’m a nursing professor) – I’d recommend following up all criticism with specific documentation that is copied to whoever is responsible for his PIP-equivalent. Students often think we’re being mean when really, we’re just trying to keep them from killing people. I had a cis-male student tell my department chair that I was “really bringing down his mood” last semester. Alas, because everything was documented thoroughly, she was able to explain that (alas, poor yorick)) it wasn’t his professor bringing down his mood, but his poor performance in a clinical environment.

    Also – as someone prone to the llama-poxes of the world, I appreciate your attention to detail. It really sucks to have an undiagnosed camelid disease. ;-)

  117. Nightengale*

    I am also a physician who does some clinical teaching
    Before that I was an educator
    I also have multiple chronic conditions

    So I do a lot of thinking about medical education and the practice of medicine
    And one problem is the implication of too many absolutes. Attending A tells the resident to do A while Attending B tells the resident to do B. Specialist C gives me this advice while specialist D tells me the opposite.

    Overall, there is probably a lot more room to be collaborative, both in teaching situations and in shared decision making with patients.

    I call it Multiple Right Answers theory.

    There are multiple right answers in medicine. Depending on the evidence base, clinician prior experience, patient values and perspectives, cultural considerations, etc, there may be options from watching vs medication, for therapy vs medication, for medication or therapy vs surgery.

    And there are also definitive wrong answers in medicine. Diagnoses that should always be ruled out. Treatments that all evidence and expert consensus recommends.

    Dwight needs to understand the difference between a situation where there may be right and less right answers (where a recommendation to consider may be appropriate) and a wrong answer, like missing llamapox.

  118. Ellen N.*

    You should not be “friendlier” when correcting Dwight and you certainly shouldn’t frame your corrections as suggestions. You should be documenting his errors and submitting your documentation to the organization that oversees medical licensing where you are.

    Dwight’s sexism is putting peoples’ lives at risk.

    I had a doctor do this to me. I had several symptoms of what I later learned were liver failure, including turning yellow. He prescribed anti-anxiety medication for another symptom, intense itching, without telling me it was anti-anxiety medication. He also didn’t warn me of the side effect of grogginess.

  119. PlainJane*

    I’m willing to bet that the llama pox patient was also female and her concerns about little llamas crawling out of her face were dismissed as anxiety because, really, she’s probably been reading those silly internet articles again and worked her fluffy little head into a tizzy about it. The behavior toward OP makes this seem EXTREMELY likely. The only thing it would be missing is a comment on how the patient’s body weight is undoubtedly inviting the llama infestation. Which isn’t real anyway.

    1. Zap R.*

      Are we sure the llama pox weren’t caused by hormones? Those level out once you have a baby, you know. Why don’t you try having a baby? /s

  120. Bill and Heather's Excellent Adventure*

    Kill Bill sirens go off

    WEE-OO, WEE-OO! Sexist, sexist, sexist. Please speak to Dwight’s supervisor as soon as possible, because if he’s already behaving like this with someone who’s senior to him, I’m worried about how he’ll treat female patients.

  121. RVA Cat*

    Dwight must be stopped before he becomes the next Dr. Death – the arrogant spinal surgeon whose mistakes killed patients and left others paralyzed.

  123. Texas Teacher*

    I have atopic dermatitis and a peanut allergy. This leads to arguing with newish ER doctors/medical students/residents about if I can have a touch allergy to peanuts. I am grateful for nurses who got other doctors to intervene and those doctors.

  124. London, but with drugs*

    “If I ever have friendly advice for you, I promise to be friendly about it. This, however, is advice about how to keep your career from ending before it starts.”

  125. One who has been down OP's road*

    I am a male academic physician, and I agree with others who have noted that gender issues may play a role, but not necessarily. I have encountered this problem myself, in giving feedback both to male residents and to female residents. There is a segment of students/trainees nowadays who just can not take constructive feedback unless it is couched to them in exactly the way they want it to be couched. There is this weird mentality that their oversized and inappropriate hostile and defensive reaction to feedback is the responsibility of the feedback giver to solve; it’s not their responsibility to examine why they react to feedback in this way when their colleagues don’t.

    I think the OP should remember that the ultimate supervisor of the resident is not the OP but the residency director, and the OP should formally discuss Dwight with the residency director before moving forward, because if the residency director doesn’t back up OP’s approach, it could be bad news for OP. Part of my personal frustration is that the residency director for the residents I interact with the most is very, very concerned about whether he is liked by the residents, and there is no question in my mind that he would respond to Dwight’s statement by doing exactly what Dwight wants. (I’m not saying that he would avoid giving the feedback or holding back certification if Dwight had performance issues, but if Dwight told him he wanted to get feedback only if the giver was wearing a purple shirt, this residency director would wear the purple shirt.) OP, if Dwight’s residency director won’t back you up 100% on your approach, you are in for a mountain of aggravation. Do not ask me how I know this.

  126. Vio*

    “Hi, having a good day? Good, good. Just wanted to let you know that you’re doing a great job, we’re really proud to have you here! You have the longest record ever for having no negative feedback from patients although we’re maybe just a tad concerned that perhaps it might be because they all died horribly of easily curable illnesses? Just a thought, I don’t want to tell you how to do your job, but it might be better if they get correctly diagnosed and treated. I’m sure you’re doing your best and we hope all their deaths aren’t getting you down.”

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