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School of Medicine

Standards and Policies

Offer Help; Seek Help

Faculty, housestaff and students should:

  • Provide help or seek assistance for any member of the health care team who is recognized as impaired in his/her ability to perform his/her professional obligations.
  • Be mindful of the limits of one’s knowledge and abilities and seek help from others whenever appropriate.

Cases for teaching and discussion


Case 1: Inappropriate gesture

You are on your Internal Medicine rotation and your service has been especially busy this month. On all of your other rotations you have done a great job and you are seen by others as a very good student. However, this month you are having trouble keeping up with your patients and feel as though you are “winging it” on rounds and other times when you have to answer questions or make decisions. There is a resident who is friendly and organized and you are tempted to talk to him/her about how to get better organized and manage your patient and study workload, but you’re afraid that this might hurt your grade on this month of Medicine, especially since you have a reputation for being such a good student. What should you do?

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Discussion:
  • It is not uncommon for medical students to have an “off” rotation at some point. Fatigue and burnout throughout each year can cause a medical student to develop these behaviors. It is important that the medical student seek help when this situation continues. The Division of Health Careers/Education and Special Services for Students and the Special Services for Students Disability Service Provider can work with the student on a one-on-one basis to get back on track. The service is free and confidential. Any enrolled student can call or stop by the office to make an appointment to see the Director.

    (Information/comments from: Cheryl Chesney-Walker, M.Ed., Director and Coordinator, Student Academic Support Services and Services for Students with Disabilities, VCU Medical Center; Contact: Ruth Dennis-Phillips, Academic Skills Coordinator, Student Academic Support Services, Room 301, VMI Building, 1000 East Marshall Street (10th & Marshall Streets); Phone: 804-828-9782, TTY: 804-828-4608, Fax: 804-828-4609; [E-mail]: rdennisp@vcu.edu.)

  • In the best of all situations, the student would talk to the resident. However, the concern about the impact on his/her grade is common. There are many resources the student could use if talking to the resident is a concern. These include counseling from the clerkship director, M3 rotation coordinator, Curriculum Office, Office of Student Academic Support Services and the Office of Student Affairs. Counseling through one of these resources may help the student to overcome the concerns about approaching the resident, or plan for how to get better organized.

    (Information/comments from: Isaac K. “Ike” Wood, M.D., F.A.A.C.A.P., Senior Associate Dean for Medical Education and Student Affairs, Associate Professor of Psychiatry and Pediatrics, Director of Undergraduate Medical Education in Psychiatry, VCU SOM; Phone: 804-827-1262; [E-mail]: iwood@vcu.edu.)

 

Case 2: Heal thyself?

A fellow resident has been having a lot of personal problems lately and seems to have become very depressed. She is often absent and cannot be reached by beeper, but when confronted by the attending has been clever at making excuses for this. The other residents are angry and resentful that this person is not doing her share of work but no one has talked to her directly. When you asked another resident if someone should talk to her about getting some help, the resident said, “Doctors need to learn how to handle their own problems. Besides, if it gets on her record that she has been depressed that could hurt her career. She’ll get it together soon.” What, if anything, should you do?

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Discussion:
  • We know that the incidence of depression is elevated among medical students compared to peers of similar age and educational backgrounds. Many medical students who experience depression, anxiety, substance abuse concerns and stress-related symptoms do not seek psychological care. Often, students are concerned about issues related to confidentiality and how seeking treatment may affect their professional standing.

    Medical students are sometimes surprised to learn that seeking assistance not only resolves their mental health concerns but also increases their capacity as an emerging physician. They develop a greater capacity to be aware of, and utilize, their feelings and emotional responses. They display greater empathy towards human suffering. They have a greater appreciation that, in order to provide intensive care for others, one must care for self.

    University Counseling Services (UCS) is a resource available to medical students who are experiencing psychological or personal concerns. We are committed to creating an environment that fosters student growth, development and psychological well-being. UCS services are provided at no cost to enrolled students.

    Confidentiality is taken very seriously at UCS. Clinical records at UCS are NOT part of any other university record. Information disclosed in clinical sessions is confidential and may not be released voluntarily to anyone outside of UCS without the student’s written permission. UCS adheres to professional, legal and ethical guidelines established by professional organizations and state law. Legal and ethical exceptions to confidentiality include: (1) when there is a clear and present danger to oneself or others; (2) when there is knowledge or suspicion of abuse or neglect of children or elderly persons; (3) when a court subpoenas clinical records; (4) when an individual cites his/her treatment/clinical record in a legal proceeding; (5) as otherwise required by law.

    Initial appointments are scheduled in advanced by dropping into either of our offices (Medical Campus or Monroe Park Campus) and completing paperwork.

    University Counseling Services
    • Academic Campus

      University Student Commons
      907 Floyd Ave., Room 225, Box 842525
      Richmond, Va. 23284-2525
      Phone: 804-828-6200
      Hours: 8:00 a.m.–5:00 p.m. Monday–Friday; Summer Hours 8:00 a.m.–4:30 p.m.

    • MCV Campus

      Hunton Hall
      323 N. 12th St. (12th and Broad streets)
      Box 980238
      Richmond, Va. 23298-0238
      Phone: 804-828-3964
      Hours: 8:00 a.m.–5:00 p.m. Monday, Wednesday–Friday; 11:00 a.m.–8:00 p.m. Tuesday; Summer Hours 8:00 a.m.–4:30 p.m.

    (Information/comments from: Charles Klink, Ph.D., Director, University Counseling Services, Division of Student Affairs & Enrollment Services, VCU.)

  • First and foremost, our obligation is to the safety and well-being of our patients. If, for whatever reason, a physician is impaired in his or her ability to provide a professional level of care, we must intervene. The biggest misconception is that it is a sign of weakness to ask for help. Contrary to this belief, the literature demonstrates that healthcare providers who ask for help when in distress function more effectively. The resident may seek mental health care from any private or public provider. HIPAA guidelines are very strict about the confidential nature of this information. Licensing boards are very enlightened now about the need to encourage healthcare providers to seek help when they have a mental health problem, rather than acting in a way that would be detrimental to the resident’s career.

    (Information/comments from: Isaac K. “Ike” Wood, M.D., F.A.A.C.A.P., Senior Associate Dean for Medical Education and Student Affairs, Associate Professor of Psychiatry and Pediatrics, Director of Undergraduate Medical Education in Psychiatry, VCU SOM; Phone: 804-827-1262; [E-mail]: iwood@vcu.edu.)

 

Case 3: Grief

A third-year student has recently lost her father to a stroke, which involved a long hospitalization and multiple complications. She has been on the neurology rotation for a week and try as she might, all she can think about is her father, and sees him in every patient she cares for. She is not sleeping at night, and consequently is tired and distracted at rounds, and unable to study in the evenings because she falls asleep or her mind wanders. She’d like to talk with someone about this but is unsure who to turn to. She is afraid she will fail the rotation because of her inability to pay attention and to study. Her friends encourage her to talk with the clerkship director. She does not want to because she is afraid she will make her take time off, and she wants to graduate with her class.

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Discussion
  • The Office of Student Affairs is another underutilized resource for a student who is having this type of difficulty, particularly if the student has trepidation about talking with her clerkship director. We can provide assistance in terms of academic counseling, referral for grief counseling and, in particular, developing a plan whereby if the student needs to take time off in the third year, this can be recaptured during the M4 elective period so the student graduates on time.

    (Information/comments from: Isaac K. “Ike” Wood, M.D., F.A.A.C.A.P., Senior Associate Dean for Medical Education and Student Affairs, Associate Professor of Psychiatry and Pediatrics, Director of Undergraduate Medical Education in Psychiatry, VCU SOM; Phone: 804-827-1262; [E-mail]: iwood@vcu.edu.)

  • Many individuals experiencing bereavement benefit from the support they can receive from counseling. Having a place and a space to express and explore feelings about one’s loss is often very therapeutic.

    Dealing with loss is a pivotal professional theme for many medical students in their clinical work and over the course of their professional lives. Understanding one’s emotions can be critical when working with dying and difficult patients.

    (Information/comments from: Charles Klink, Ph.D., Director, University Counseling Services, Division of Student Affairs & Enrollment Services, VCU.)

 

Case 4: Toughing it Out

A fourth-year student doing his AI in the ED has invariably been assigned to work with an attending that is well known for his bad behavior with students and residents. True to form, the attending is irritable, condescending and impatient with the student. The student does not think it would look good for him to complain, as he has to work almost every shift with this attending, who is a senior member of the department. He doesn’t want to talk to his friends about him, or to the M4 coordinator, as he thinks they will see him as a complainer who isn’t tough enough to take this attending. Yet, he is really having a terrible experience and learning very little. He has even had an episode of having to excuse himself to go to the restroom to avoid people see him crying.

Developed by Kathy Kreutzer and Laurie Lyckholm, Bioethics and Humanities, VCU School of Medicine.

Discussion
  • The School of Medicine Professionalism Committee can serve as a resource in this situation. The Committee provides an informal process for addressing School of Medicine concerns regarding professionalism. If you perceive or experience instances of personal abuse or some other form of what you view as unprofessional behavior on the part of your teachers or colleagues, you are encouraged to report such incidents through normal channels for counsel and possible rectification. If this route is awkward for you, an alternative approach is consultation with a member of the SOM Professionalism Committee. For a full description of the process and the current members of the SOM Professionalism Committee, please see: Professionalism/Reporting Concerns.

    (Information/comments from: SOM Professionalism Web site, Professionalism Section.)

  • The fear of getting involved in a situation where anyone is acting unprofessionally just perpetuates the problem. It is extremely difficult, and perhaps inappropriate, for a medical student to confront a senior attending about this type of behavior. However, the student has other resources to deal with this. Again, the Office of Student Affairs can be a resource. As the AI is an elective, we are responsible for the experiences of the students during this time. If this is prototypical behavior for the attending, we can provide counseling to the student about not taking this personally, alternatives to staying on the rotation and how to make the experience more worthwhile. We can also be a resource to act as an advocate for a student who is having these types of problems. Last, we can intervene though consultation with the attending and/or his/her supervisor.

    (Information/comments from: Isaac K. “Ike” Wood, M.D., F.A.A.C.A.P., Senior Associate Dean for Medical Education and Student Affairs, Associate Professor of Psychiatry and Pediatrics, Director of Undergraduate Medical Education in Psychiatry, VCU SOM; Phone: 804-827-1262; iwood@vcu.edu.)