The sudden resignation of White House staff secretary Rob Porter got me to thinking.
Let me say up front this post isn’t about politics. And by the time it gets uploaded, our national ten-minute news cycle will probably have moved on to some other world crisis or titillating disclosure and people will be saying, “Rob who?” But whether you are liberal, conservative, or somewhere in between, I’m guessing you were, like me, horrified to learn that someone against whom multiple credible allegations of spousal abuse had been lodged and who was unable to obtain a full security clearance was still working in the White House, in a position of trust and handling classified information.
I was most fascinated by how Mr. Porter’s bosses defended their actions (or inaction). We heard that Mr. Porter was excellent at his job. That White House Chief of Staff John Kelly had come to depend on Porter as his right-hand man. Called him “a friend, a confidante, a trusted professional.” President Trump said “he did a very good job.” People close to the White House have suggested that Porter was valued by his bosses because he was very good at organizing and controlling the flow of information to the President and helped bring a sense of calm and order to the White House.
Apparently, he had exceptional skills and filled a crucial niche; and presumably his bosses believed they’d have a hard time finding someone else just as good to fill that job if Porter wasn’t there. This justified keeping him on, despite (alleged) behaviors that should have disqualified him for the job.
Before we rush to judgment, though, let’s look at what happens all too often in the private sector, including healthcare and – specifically – hospital medicine. Have you ever had a provider in your group who was clinically competent but who flew into rages and verbally abused nurses (or fellow hospitalists)? How about someone whose negative attitude and constant complaining rubbed off on co-workers and eventually infected the culture of the whole hospitalist group? Or someone who disappeared for hours at a time while on shift, who habitually came in late or left early, failed to leave a sign-out, or otherwise created real inconvenience for co-workers who had to clean up after her? Maybe it was someone you suspected was abusing alcohol or drugs, or whose marriage or other personal problems were affecting their attitude, interactions, and work performance? I’ve run into these situations and more during my work with hospitalist groups around the country.
How do these toxic people stay employed in the same hospitalist group month after month? In most cases group leaders (or hospital administrators) are so concerned about having holes in the schedule or being unable to recruit a replacement that they are willing to tolerate really bad behavior. I can’t tell you the number of times a hospitalist leader has justified their failure to act by saying “but he (or she) is a good clinician, and we need him (her) right now.” One leader told me “I’ve already invested so much; it took me over a year to find this person and it’ll take me another year or more to find a replacement.” Even though the clinician in question was working in a position of sacred trust, caring for patients at their most vulnerable and handling sensitive information.
For myself, I’ve failed to act soon enough on toxic personalities simply because I was afraid of the confrontation and wasn’t sure how to handle the situation. Easier to kick the can down the road and hope nobody else notices. Sometimes we’re all just a little like White House Chief of Staff John Kelly.
Of course, we want to counsel and mentor these troubled clinicians to help them overcome their behavior deficits and improve their performance, and when it’s appropriate, we should bend over backward to do so. But sometimes the only right choice is just to rip the band-aid off and deal with the consequences. Believe me, your fellow hospitalists will usually thank you for it. Most of the time, they’re willing (not necessarily happy, but relieved and at least willing) to shoulder the extra load for a while if it means they can be rid of the toxic personality in their midst and feel more confident that the trust hospital leaders, fellow medical staff members, and their patients place in them is well-founded.
This article originally appeared on February 26, 2018 in: The Society of Hospital Medicine’s Official Blog, The Hospital Leader