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Per Diem Politics

I recently got pulled off all of my shifts by my ex-employer for an unknown reason. I played tag with the chief, the assistant chief, the head of HR, and finally back to the assistant chief. In the end I got a phone meeting with the head of HR and one of the lawyers.

I’ve been left in the dark for the past 2 weeks. It wasn’t a good feeling. In the end it ended up being a blessing in disguise as I’ll discuss below. Per diem politics aren’t pleasant but come with the territory.


The Phone Meeting

HR and legal were incredibly respectful and obviously doing their job to investigate the details of the situation. The conversation started without revealing the reason for this inquiry. Instead, the lawyer asked multiple questions as to:

  • my job title
  • my responsibilities
  • whether I was aware of compliance and professionalism

I learned years ago that whenever you are in a phone meeting and there are lawyers present, know what you will say ahead of time. Then take notes of exactly what you said and what you didn’t say. Ask if the conversation is being recorded. And ask if I am at the center of the investigation or if it’s pertaining to something indirectly.

The Big Reveal

This whole situation was regarding an RN who got fired and who accused me for being the main reason she got fired.

So it wasn’t the d-pics I had sent to the patients, it wasn’t the about licking the morphine vials, and it wasn’t about stealing the staple removers.

The Accusation By The Nurse

Everything was implicit during the conversation. So there were questions like: “Did you yell at the nurse and force her to do the EKG even though she didn’t want to and tell her that if she didn’t do it then you’d do it yourself?” 

Uhm, no, I have no fucking idea how to use an EKG machine and I’m pretty sure our machines require codes for access since patient info is stored on them. And I had no reason to yell at the nurse, it wasn’t even a tense situation and she had no qualms about doing an EKG.

“Did the nurse tell you that she wasn’t allowed to do an EKG on a patient that wasn’t checked in and that she wouldn’t be able to document on them?” No, nor would I have objected if she did.

The Accusation By The Ex-employer

“Did you think it was appropriate to bring this patient into the back of the urgent care instead of having her check in? Is this standard protocol?” No, not standard protocol but it was the best way I could think of getting this patient to do her EKG which she had been putting off.

“Did you leave with the patient or did you go your separate ways after leaving the urgent care?” Wtf?! Yea, we went into the bathroom, had sex and then we parted ways. Why? Is it a problem to trade a quicky for an EKG?

There have been plenty of times when I’ve been stopped by random people in the lobby who complained of an acute symptom and I decided that it would be best to evaluate them sooner rather than later. I’d bring them back and start the workup.


The Actual Situation

I was moonlighting at a different clinic not affiliated with my ex-employer. The patient in question was an employee there who started a conversation with me and we got to talking about some symptoms she’s been having for which her doctor recommended an EKG which the patient had been putting off for months. I told her that she should go to the urgent care to get the EKG done.

She gets there, there is a line, she doesn’t want to check in and wants to leave. I advised her to get the EKG to make sure it’s not anything serious. She agreed. We walk back, I ask the nurse to do the EKG (without a gun to her head), she agrees and it looked fine.

After the EKG she didn’t want to check in and just wanted to take that EKG back to her PCP.

The nurse got in trouble because she didn’t chart on the patient. To save her ass she tried to make it seem as though I pressured her and that she was under so much duress that she forgot to chart. Of course she wasn’t let go for something so small, she has been a problem employee for some time.


The Per Diem Politics

An issue of compliance and professionalism was brought up by legal probably because they assumed this female patient was my little booty call. Maybe because she was attractive? Was it because it was a woman?

The lawyer, though courteous, made it seem as though it was unprofessional behavior to bring a patient with such complaints to the back for EKG testing and that she should have waited for an appointment.

I brought up 2 recent death cases which I won’t share the details of here. But both patients slumped over in the waiting room and neither was revived. Both would have benefited from being evaluated in the back and not left waiting in the waiting room – hence the name “urgent” care.

I’m not sure if it’s more my ego that got crushed or my faith in my ex-employer.


Lessons Learned

1) I was 100% at fault for not following procedure. I was also an idiot for not recognizing the situation better with this woman being attractive and me being a per diem.

2) I discussed the situation with my chief and per diem politics had a lot to do with it. It’s unlikely that it would have been an issue if I remained a staff physician.

3) 2 weeks of not knowing why HR and legal needed to speak with me was enough to keep me from ever wanting to be in such a situation again. It’s not pleasant to feel dispensable.

4) I am still warming up to the idea of not needing to work any longer for an income – it is still sinking in. Having lost them as one of my sources of income has made a positive impact in my lifestyle because it has freed up even more time. And the income that isn’t there, isn’t missed.

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