Some may think I am a traitor.

I testified against one of our colleagues. And his employment was terminated.

It feels terrible. The type of gut-wrenching terrible that baits my tear and steals my sleep. I find myself rehashing the testimony, always startled afresh at the unambiguous answers.

“What were your concerns?” Counsel asks.

“Patient safety.”

“Do you think he should be employed at this company?”

“No.”

Seemingly simple words that seal a 60-month saga.

My first meeting with my fellow physician, Alex, is memorable. He is middle-aged, pudgy, with rimmed spectacles and an affable smile.   His high-pitched, Urkel-esque, voice captivates my attention. His staccato-style laughter punctuates, and punches, the air, like the rat-tat-tat of rapid gunfire. The circular nature of our discussion–repeated words and ideas–piques me. I marvel as social cues pass unrecognized.   When I am finally able to end the conversation, I experience an intense curiosity about the nature of my new colleague’s patient interactions.

Over the next year, Alex and I rarely encounter each other.   However, I heard whispered exasperation about him from our co-workers.

“He talks a lot,” they say. “He always runs behind.”

Initially, I dismiss these statements as anecdotal. He is friendly. He lets the care guide the encounter’s duration.

Then, I am tapped for a leadership position. It is in this capacity that I become aware and worried. Two hundred incomplete medical notes spanning a quarter of a year. Missing specialty referrals. A seemingly omnipresent inattentiveness and penchant for excessive chattiness at inopportune moments. Mounting staff-generated safety reports.

Alex and I talk. His skeletons tumble out. Academic remediation during residency. Family member deaths. A loved one’s health issue. Exhaustion after a deluge of clinical and administrative responsibilities masterminded by metric-driven administrators.   The irony of my own chief medical officer (CMO) role is not lost on me.

We discuss the struggle of moral injury and the need for self-care.   I purposely omit the word du jour “resiliency” because it feels reactive, as if the onus of recovery is wrongly relegated to the injured. Alex nods his head in agreement but balks when I tell him that he will be placed in abeyance. Just a month to close notes, I reassure; but, privately, I wonder if it will be enough.

It is not. Alex returns to practice and limps along. He starts at half the expected daily patient load with plans to be incrementally advanced back to a full schedule. But he never gets there.

We also minimize Alex’s distractions by physically isolating his office. His colleagues place a sign outside their door that discourages interruptions. We tug-o-war over the use of administrative assists like dictation support. Alex is reluctant to tangle with technology. Truth be told, he is not alone; many of our colleagues share his struggles.

This approach appears to correct some of the problems, but the cycle repeats itself. With exactly the same professional performance deficiencies that were present before the interventions. At least, I console myself, there are no open medical encounters. “Because they are being prematurely closed to meet note completion deadlines,” one colleague reports.

Conversations generate a spectrum of opinions regarding these observed behaviors. Some worry that he has undiagnosed comorbid behavioral health struggles while others suggest scheming Alex benefits from reduced work expectations.   I wonder whether he is “neurodiverse.” No matter the label, he lacks the insight to understand “its” impact, including the possibility of losing his job.

I frequently feel as though I am willing Alex’s success more than he. I take on the role of coach and cheerleader. I worry and lose sleep. I privately cry—bawl like a baby–when I realize he will not succeed.

As issues mount, the clinic’s CEO mandates Alex’s enrollment into a Physician Health Program (PHP). I disagree; mandatory anything is not the same as motivated actualization.   Besides, Alex has informally been treated as such with a reduced workload and schedule-protected medical care, albeit it is delivered by partisan providers. The boss insists.

Sure enough, a new circus begins. Alex believes everything is fine. He reports “fine” to his own psychiatrist who, in turn, relays the same to the PHP lead. The PHP lead then informs me. It is an oddly successful game of “telephone.” The repeated verbiage is technically correct from first to last. However, it is inaccurate. Nothing is fine.

Whenever I raise concerns about Alex’s continued practice, I meet resistance.

“What about his career?” the CEO, still furious over the generated National Practitioner Databank report, queries.

“What about patient safety?” I counter.

“Not enough documentation.”

“Five years’ worth.” I correct.

Our risk manager sighs and shrugs his shoulders when I confide my frustration. “He’s not emotionally ready to ‘call it.’ We need to be patient until he is.”

Alex would go on to practice an additional six months after my departure. I leave the clinic feeling defeated and disillusioned, wondering how impaired provider support and patient safety became divided loyalties. Why is the default instinct to preserve a colleague’s career despite his clinical conduct?

Shortly after settling into a new work position, I am contacted about Alex. The CEO is ready to “call it.” When I do testify, there is no sense of vindication or triumph. No recognizable heroes or villains. Just visceral relief that patients may finally be safe.

Traitor? Despite the label some might apply to my testifying about Alex’s deficiencies, I reaffirm my patient safety prioritization. I do so lamenting this predicament might have altogether been avoided had Alex’s deficits—the first hints of which surfaced during training–been addressed earlier by other colleagues who, in turn, may have been drawn towards the alluring code of silence.

Our professional duty to self-regulate seems aspirational at this point. Few among us want to be the squeaky wheel that calls out another colleague. I certainly did not.  Perhaps, in the near future, the U.S. health care system will mature to proactively surveil and support physician performance while safeguarding our charges’ well-being.

Kasi Chu is a preventive medicine physician.

Image credit: Shutterstock.com