Kangaroo Courts in Surgery Part 1: Firing A Resident

"We’re getting rid of her one way or another. You’re the only chief who isn’t on board with this decision." Dr. Williams leans back in his chair and adjusts his navy blue tie, holding firm eye contact with me. His gray hair is neatly combed and white coat freshly pressed.

We are sitting at the far end of a long mahogany table that stretches down the center of the conference room like a runway. I look around at the familiar framed photographs of former department chairs: an uninterrupted parade of white men in white coats. I've sat in this room for morning conferences countless times during my nearly five years as an ENT resident.

I peer down at the stack of papers in front of me and let out an audible sigh. One of the second-year resident's names is typed neatly at the top of the first page.

Professionalism Issues.

Below the heading is a bulleted list of offenses. I turn the page.

Patient Care Issues.

More bullet points, complete with dates and times. I scan the list and try to reconcile the resident I know with the one being described on the page. 

How did she get branded with a scarlet letter?

I cross my arms and legs, thinking back to the time I told one of the fellows, in so many words, to "fuck off." I think about my intern year, standing stunned in the operating room after one of the chief residents stormed out in a rage and slammed the door hard enough to shatter the glass of a nearby cabinet. I recall my coresident insulting an emergency medicine physician in the electronic medical record for putting in what he documented as a “stupid consult.” 

None of those incidents resulted in a meeting like this one or generated a multi-page file. And yet here we are. Talking about professionalism.

Dr. Williams uses his right hand to slide the papers toward the center of the table, then clears his throat. His mind was already made up. I sat at the table uncomfortably for a few minutes before I timidly nod my assent. They were going to fire her. I wouldn't stand in their way.

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The thing about professionalism in medicine is that it’s never clearly defined. Amongst the hundreds of hours spent learning how to dissect the IVC, preserve the facial nerve, and tie knots in spaces no larger than a thumbnail, nobody sits us down to explain what behavior will end a career.

The core pillars of professionalism in medicine should be clear: patient welfare, respect for patient autonomy, and social justice. But somehow being a doctor has been bastardized into a popularity contest. A conclusion is drawn, and deductive reasoning is used to mine for evidence of “unprofessionalism” to support that conclusion. 

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The resident who was fired from our program was ultimately accepted to another program, where she went on to thrive. That was more than a decade ago. Today she is an associate professor of surgery who has made it her work to change the system that tried to end her career before it began. The file that was supposed to prove she didn't belong in surgery became, instead, a footnote in a career that will ultimately leave a legacy of surgical excellence and resident advocacy.