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Denouncing my supervisor to the program manager

#1 · August 3, 2023, 1:38 pm

Quote from John Freeman on August 3, 2023, 1:38 pm
Hello,
I make it a thread instead of leaving it in my journal. I think it's more useful to do analyses outside of my journal instead of in it. I think I'll keep the journal more for self-reflection, thoughts, goals and updates on progress. It was on March 2023 in my journal. I don't quote it since I think it's more readable. I leave Lucio's input as a quote to make clear from whom the feed-back comes from.
------
Hello,
Denouncing my supervisor
I have 4 supervisors who have their own private practice in pediatrics. One of them is a 60ish years old female who's vaccine skeptic and antibiotics skeptic. She's all about homeopathy and this kind of medicine. When I started this rotation 5 months ago, I could see she was doing things that are considered bad practice:
Not giving antibiotics in perforated otitis media
Not undressing completely a baby to weigh him and look at the skin
Telling me only to check the belly when a child is vomiting
Not checking the ears and mouth at a well-child visit if the child is not sick
And others...
After 1 months I had a phone interview with 1 of the 2 training program directors. She asked me how the rotation was going and I told her the above as I was quite shocked. I also thought she should be informed because other pediatricians will be trained at her practice. If they are not so experienced or just trusting, they could learn bad practices. These bad practices could then have an impact on a child. That is why I told her. This woman has also a narcisstic side and working with her is difficult as she's overly dominant.
After I told her she said that I was not the only who complained about her and that she was going to talk about it with the other program manager. The problem is that I do have loyalty towards her: she welcomes me in her practice and she's teaching me stuff. Some of it has value, some of it I pretend to take it on board but it's garbage.
Then I told the PM to backtrack a little bit that the good thing was that I was still learning how to communicate with parents who think like her (vaccine skeptic, etc.). She told me that what she was doing was still wrong. She asked me if her colleague was as bad as her. I said "no" to protect her.
Afterwards I sent the PM an email asking her to wait until I finished my rotation in case they wanted to talk about it. She said alright.
So basically, I got a loyalty conflict, between:
My supervisor: she's teaching me things, we work on a daily basis together, she welcomed me in her practice
The program manager: has to know what is going on in the rotations where they send pediatric residents. The residents: they deserve the best training. The patients: they have the right to be treated the best possible and if residents get a bad training it can compromise it.
I still think that I did good in telling her. However in terms of strategy there can be consequences as the 4 pediatricians are related. So if 1 is scolded or excluded from the program, the other 3 will be in trouble. So for my own sake, I should have kept my mouth shut. I'm not sure they will be taking actions but now they have more info from me to do so. So if there is action taken, then they will know I was responsible for it and I will be chastised for it. Even more if I become a private practice pediatrician as I would have betrayed one of them. Now it's done anyway and there is no way to take it back.
I don't think they will do anything because they lack private practice pediatricians to train residents. But still...
Anyway, lesson learned. Next time I think I'll keep my mouth shut. I kind of regret having had spoken out. Performance reviews of higher ups only work if they stay anonymous to avoid reprisals. In this case I did not have this protection/guarantee.
Quote from Lucio Buffalmano on March 20, 2023, 8:38 pm
Interesting case John, and a tough one indeed.
Is it a sure thing that if consequences happen, they'd be able to pin it on you?
Some other ways to handle it off the top of my mind:
Give a honest performance review only once you left
Be straight with the narcissistic pediatrician (a risk but in some cases may work. Probably a minority of cases, though)
Say without saying it
I like the last option, very sociall strategic.
Here is how it goes:
You say that you prefer to talk about those matters in person.
In person, you say something like:
(positive, positive about her)
And now, look, honest talk, and put yourself in my shoes.
She's taking me under her wing and I feel bad to say anything bad about her.
So let's say that I personally believe in vaccines, antibiotics, and in XYZ and not so much in differenet and more alternative approaches.
(positive, positive about her)
Then if they try to be more explicit or accusatory, you say "look, I told you. She's teaching me a lot, taken me in her practice, and she's good at many things, and very good to me. I told you the positives, and if you read between the lines I've given you all the information about what I'd do differently as well".
Then, optional, you may say "if we meet again in the future in different circumstances, we can speak more clearly. For now, I think this is a honest and complete feedback.
Update
So what happened is that I got contacted via email by the program manager last week. He wants to hear me about these private practices. As I said they already had negative feed-back from other residents before.
I'm not going to write the details on his email nor mine here. I'll be brief: he's a very high power manipulator I think. His emails are always making sure to frame him as coming from very high above (which he is). For instance his email subject: "wanting to hear you" is really non-committal and vague. So he self-power-protects a lot. It's fine but the tone is always quite condescending in email: "John hello" is the introduction. You see the tone.
Anyway, he wanted to talk on the phone or meet me. I proposed to meet him in the hospital he's working 30min from my place.
I chose in-person because it's better for communication and clearing the miscommunications. It's also more rapport-building as he has a lot of influence and you never know. I worked a lot to improve our relationship and now he likes me (maybe you remember that he rejected me in the first place from the pediatrics training program).
I chose to come to him as to give him more power. That's also so he likes me more and might feel some reciprocity towards me due to the law of social exchange.
Off-topic
I noticed that if I'm giving power to my counterpart or be high-power or high-value I don't need to be so warm. Just like in dating with women, power dynamics accomplish a lot by itself. That reminds me when I had lunch with my financial counselor. I was actually not very warm. I offered her meal (normal for me, no biggie). And then she sent me a message she had a great time. She was very happy. I was surprised as for me this was an ok lunch, nothing extraordinary. So oftentimes high-power and power dynamics are enough. I was courteous but not overly nice. This does not invalidate the high warmth approach at all. What I'm sharing is that I'm finding that high power comes before warmth. And then you need little warmth to make people feel good.
/Off-topic
That's my social strategy.
Regarding the content, I'll make sure to use your feed-back Lucio as it is timely now. I thought I would not have to use it for this case. But hey life is full of surprises.
Thanks again Lucio, I'll make sure to give feed-back on the interview.

Hello,

I make it a thread instead of leaving it in my journal. I think it's more useful to do analyses outside of my journal instead of in it. I think I'll keep the journal more for self-reflection, thoughts, goals and updates on progress. It was on March 2023 in my journal. I don't quote it since I think it's more readable. I leave Lucio's input as a quote to make clear from whom the feed-back comes from.

------

Hello,

Denouncing my supervisor

I have 4 supervisors who have their own private practice in pediatrics. One of them is a 60ish years old female who's vaccine skeptic and antibiotics skeptic. She's all about homeopathy and this kind of medicine. When I started this rotation 5 months ago, I could see she was doing things that are considered bad practice:

Not giving antibiotics in perforated otitis media
Not undressing completely a baby to weigh him and look at the skin
Telling me only to check the belly when a child is vomiting
Not checking the ears and mouth at a well-child visit if the child is not sick
And others...

After 1 months I had a phone interview with 1 of the 2 training program directors. She asked me how the rotation was going and I told her the above as I was quite shocked. I also thought she should be informed because other pediatricians will be trained at her practice. If they are not so experienced or just trusting, they could learn bad practices. These bad practices could then have an impact on a child. That is why I told her. This woman has also a narcisstic side and working with her is difficult as she's overly dominant.

After I told her she said that I was not the only who complained about her and that she was going to talk about it with the other program manager. The problem is that I do have loyalty towards her: she welcomes me in her practice and she's teaching me stuff. Some of it has value, some of it I pretend to take it on board but it's garbage.

Then I told the PM to backtrack a little bit that the good thing was that I was still learning how to communicate with parents who think like her (vaccine skeptic, etc.). She told me that what she was doing was still wrong. She asked me if her colleague was as bad as her. I said "no" to protect her.

Afterwards I sent the PM an email asking her to wait until I finished my rotation in case they wanted to talk about it. She said alright.

So basically, I got a loyalty conflict, between:

My supervisor: she's teaching me things, we work on a daily basis together, she welcomed me in her practice
The program manager: has to know what is going on in the rotations where they send pediatric residents. The residents: they deserve the best training. The patients: they have the right to be treated the best possible and if residents get a bad training it can compromise it.

I still think that I did good in telling her. However in terms of strategy there can be consequences as the 4 pediatricians are related. So if 1 is scolded or excluded from the program, the other 3 will be in trouble. So for my own sake, I should have kept my mouth shut. I'm not sure they will be taking actions but now they have more info from me to do so. So if there is action taken, then they will know I was responsible for it and I will be chastised for it. Even more if I become a private practice pediatrician as I would have betrayed one of them. Now it's done anyway and there is no way to take it back.

I don't think they will do anything because they lack private practice pediatricians to train residents. But still...

Anyway, lesson learned. Next time I think I'll keep my mouth shut. I kind of regret having had spoken out. Performance reviews of higher ups only work if they stay anonymous to avoid reprisals. In this case I did not have this protection/guarantee.

Quote from Lucio Buffalmano on March 20, 2023, 8:38 pm
Interesting case John, and a tough one indeed.
Is it a sure thing that if consequences happen, they'd be able to pin it on you?
Some other ways to handle it off the top of my mind:
Give a honest performance review only once you left
Be straight with the narcissistic pediatrician (a risk but in some cases may work. Probably a minority of cases, though)
Say without saying it
I like the last option, very sociall strategic.
Here is how it goes:
You say that you prefer to talk about those matters in person.
In person, you say something like:
(positive, positive about her)
And now, look, honest talk, and put yourself in my shoes.
She's taking me under her wing and I feel bad to say anything bad about her.
So let's say that I personally believe in vaccines, antibiotics, and in XYZ and not so much in differenet and more alternative approaches.
(positive, positive about her)
Then if they try to be more explicit or accusatory, you say "look, I told you. She's teaching me a lot, taken me in her practice, and she's good at many things, and very good to me. I told you the positives, and if you read between the lines I've given you all the information about what I'd do differently as well".
Then, optional, you may say "if we meet again in the future in different circumstances, we can speak more clearly. For now, I think this is a honest and complete feedback.

Update

So what happened is that I got contacted via email by the program manager last week. He wants to hear me about these private practices. As I said they already had negative feed-back from other residents before.

I'm not going to write the details on his email nor mine here. I'll be brief: he's a very high power manipulator I think. His emails are always making sure to frame him as coming from very high above (which he is). For instance his email subject: "wanting to hear you" is really non-committal and vague. So he self-power-protects a lot. It's fine but the tone is always quite condescending in email: "John hello" is the introduction. You see the tone.

Anyway, he wanted to talk on the phone or meet me. I proposed to meet him in the hospital he's working 30min from my place.

I chose in-person because it's better for communication and clearing the miscommunications. It's also more rapport-building as he has a lot of influence and you never know. I worked a lot to improve our relationship and now he likes me (maybe you remember that he rejected me in the first place from the pediatrics training program).

I chose to come to him as to give him more power. That's also so he likes me more and might feel some reciprocity towards me due to the law of social exchange.

Off-topic

I noticed that if I'm giving power to my counterpart or be high-power or high-value I don't need to be so warm. Just like in dating with women, power dynamics accomplish a lot by itself. That reminds me when I had lunch with my financial counselor. I was actually not very warm. I offered her meal (normal for me, no biggie). And then she sent me a message she had a great time. She was very happy. I was surprised as for me this was an ok lunch, nothing extraordinary. So oftentimes high-power and power dynamics are enough. I was courteous but not overly nice. This does not invalidate the high warmth approach at all. What I'm sharing is that I'm finding that high power comes before warmth. And then you need little warmth to make people feel good.

/Off-topic

That's my social strategy.

Regarding the content, I'll make sure to use your feed-back Lucio as it is timely now. I thought I would not have to use it for this case. But hey life is full of surprises.

Thanks again Lucio, I'll make sure to give feed-back on the interview.

Emily and Roberto have reacted to this post.

#2 · August 3, 2023, 7:18 pm

Cool, thank you for the update, John.

I may not remember everythig and mine is only the point of view of someone who's not awre of the full dynamics.

But I personally may not have gone to meet him.

Sure, he's powerful and with good connections, but that may as well be a good reason to have a powerful person invest a bit more to meet you.

HE needs something from you, so I wouldn't go to his place.

If he needs something from you, it shouldn't be done at his full convenience.

Instead:

Sure, happy to share that.
I'm working at XXX hospital, so we can grab lunch together at XYZ (<---- now people may even see you with a high-flyer coming to meet you, great PR!)
If you can't, just let me now and also happy to find a time for a lunch or dinner during the weekend (<----- and now you're meeting out of working time. Higher committment from him, stronger tie)

As usual, you know the situation better, so you're better placed to make the best decision.

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#3 · August 3, 2023, 7:38 pm

Quote from John Freeman on August 3, 2023, 7:38 pm
Thanks a lot Lucio,
I see your point and I agree. That's why here it's intentional from my part. I give him more than he should get so I increase his social debt: "so now you owe me". I know it's manipulative/machiavellian. That's how I view it.
Looking from your POV, it's true: if I would make him come to me it would rebalance the power dynamics which is far unbalanced towards him as the most powerful party.
Practically he's working in another city 4 days a week. So he comes to the University hospital only 1 day a week. And when you work at the hospital you cannot really get out of the hospital for a long period he cannot leave for an hour as he pleases. He has appointments so it's tricky. Plus he's also almost 65 so I don't like to make him move too much as respect to an elder. My hospital is 1 hour drive from his. If he has to move or meet at the week-end (that is higher effort) he would choose the phone and I would lose the possibility of getting closer in person.
Finally, I want him to think that I'm naive. He thinks I'm naive and I prefer to keep it this way. He sees me as a "do-gooder" probably (doing associative work can still frame me like this not forcibly as power-aware). Me showing this high submissiveness is keeping it that way. So I can feed him whatever I want and then he will believe that it is all I have to say. I have more control of the situation if I stay under his radar and he sees me as trustworthy due to being too honest. So he trusts me more.
If he would be a normal person, I would do as you said. But him being a high-mach I give him all the power so I can maneuver within his frame. I go on his territory to give him information: he will feel at ease. I'm not naive he knows I navigated political stuff and work in hospitals so I know a bit of politics. However he's too sure of himself so it's doable (not easy: he's very very smart and experienced) to make him under-estimate me. And during the interview I can also set a mentor-mentee frame with a quick question. He will ask me questions about my current hospital and my career plans that is 100% sure (they always do).
The whole frame is: "I bring you this gift my king I cannot say more but I hope this helps you in any way".
So the other option was the phone which I don't like if not 100% necessary.
So for all the reasons above I chose to come to him.
I don't know what you think about this if it sounds nonsensical or not. Anyway cool if you feel like commenting more. Cool if not. :)
Thanks a lot for your comments as always it inspired me to think more/further and structure my thinking.

Thanks a lot Lucio,

I see your point and I agree. That's why here it's intentional from my part. I give him more than he should get so I increase his social debt: "so now you owe me". I know it's manipulative/machiavellian. That's how I view it.

Looking from your POV, it's true: if I would make him come to me it would rebalance the power dynamics which is far unbalanced towards him as the most powerful party.

Practically he's working in another city 4 days a week. So he comes to the University hospital only 1 day a week. And when you work at the hospital you cannot really get out of the hospital for a long period he cannot leave for an hour as he pleases. He has appointments so it's tricky. Plus he's also almost 65 so I don't like to make him move too much as respect to an elder. My hospital is 1 hour drive from his. If he has to move or meet at the week-end (that is higher effort) he would choose the phone and I would lose the possibility of getting closer in person.

Finally, I want him to think that I'm naive. He thinks I'm naive and I prefer to keep it this way. He sees me as a "do-gooder" probably (doing associative work can still frame me like this not forcibly as power-aware). Me showing this high submissiveness is keeping it that way. So I can feed him whatever I want and then he will believe that it is all I have to say. I have more control of the situation if I stay under his radar and he sees me as trustworthy due to being too honest. So he trusts me more.

If he would be a normal person, I would do as you said. But him being a high-mach I give him all the power so I can maneuver within his frame. I go on his territory to give him information: he will feel at ease. I'm not naive he knows I navigated political stuff and work in hospitals so I know a bit of politics. However he's too sure of himself so it's doable (not easy: he's very very smart and experienced) to make him under-estimate me. And during the interview I can also set a mentor-mentee frame with a quick question. He will ask me questions about my current hospital and my career plans that is 100% sure (they always do).

The whole frame is: "I bring you this gift my king I cannot say more but I hope this helps you in any way".

So the other option was the phone which I don't like if not 100% necessary.

So for all the reasons above I chose to come to him.

I don't know what you think about this if it sounds nonsensical or not. Anyway cool if you feel like commenting more. Cool if not. :)

Thanks a lot for your comments as always it inspired me to think more/further and structure my thinking.

Lucio Buffalmano and Roberto have reacted to this post.

#4 · August 17, 2023, 9:45 am

I just got out of the interview. I aced it. More later when I’m on the computer.

Lucio I know I thank you a lot but that’s what I owe you. So I’ll simply say thank you very much. You helped me and the residents therefore the patients I think.

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#5 · August 17, 2023, 2:39 pm

Rock on, John! :)

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#6 · August 17, 2023, 7:55 pm

Quote from John Freeman on August 17, 2023, 7:55 pm
So what happened is that :
He was not in his manipulator mode, still a skilled politician but he was agreeable to deal with
I told him something along these lines:
And now, look, honest talk, and put yourself in my shoes.
She's taking me under her wing and I feel bad to say anything bad about her.
So let's say that I personally believe in vaccines, antibiotics, and in XYZ and not so much in differenet and more alternative approaches.
I told him the truth but every time I was thinking before speaking looking for my words as subcommunicating: "I want to be fair to all parties involved".
At some point he asked me direct questions:
Should we stop sending residents to their practice?
So he was asking for my direct recommendation a proof that he trusts my judgment, so a mark of respect. I said "no" because even though they're not the best pediatricians, I think it's important for the resident to actually see bad pediatricians in private practice to understand why some pediatricians do what they do in town. At the hospital the standard is higher. Also, it's important to see other ways of practicing: homeopathy, vaccine-skeptics parents. Even if you don't believe in it, many people do. So it's good to understand what they believe and why. So it's a bad practice but it's good to see a bad practice. Of course I did not say it in these words. I talked about that it opens one's mind (I think it) and that they have things to teach. So I could prevent being the source of the failure of the contract and still say that there are things that could do better
Is she a bad teacher?
On this one it's a direct attack on her and her capacity. To be honest, I think she's not a good teacher. But I could not answer so directly to such a question. It's more grey area. Again she's not a good teacher but it's good to see a pediatrician like her as there are others. Otherwise one thinks every body is a scientist with an honest talk and has the patient's best interests in mind.
I was being diplomatic about it because if they remove the teaching spot at this private practice it means that they would lose a huge proportion of their income. And I don't think they deserve it. She's not that malevolent. So the harm would be disproportionate to the injury done.
So he's going to talk to them to see what's going on. I think that's a reasonable success. What is important is that they know they're being watched and that they have to be careful.
Highlight
Bragging moment, I hope you'll excuse me: I was proud of myself. At the end I said:
My loyalty goes to you and the residents. It's normal and important that you know what is going on and that the residents get the best training possible. And at the same time they welcomed me and trained me so I don't want to be the one who says bad things about them.
I owe this frame to you Lucio: this dichotomy. Because it was clear in my head thanks to our conversation I could express it clearly. I was proud because I could see in his eyes: "WTF? this guy is able to think like that?!?" (To him I'm the "engineer" and I guess some stereotypes that come with it which I have no clue). He was mindfucked. PU alumnus and TPM member, bitcheees. Ego mode off. It's good sometimes to be happy of one's achievement and progress.
He answered:
Don't worry about it.
He meant: "I'm not going to rat you out". I answered: "thanks".
Machiavellian analysis
He was very grateful for me coming and having had this interview. So my strategy about giving value (coming to him to give him insider information) to build an ally worked. I think now I have an ally in him. As a reminder 5 years ago he did not want me to become a pediatrician. I don't plan on "using it" (transaction) however it's better to have an ally than an enemy.

So what happened is that :

He was not in his manipulator mode, still a skilled politician but he was agreeable to deal with

I told him something along these lines:

And now, look, honest talk, and put yourself in my shoes.
She's taking me under her wing and I feel bad to say anything bad about her.
So let's say that I personally believe in vaccines, antibiotics, and in XYZ and not so much in differenet and more alternative approaches.

I told him the truth but every time I was thinking before speaking looking for my words as subcommunicating: "I want to be fair to all parties involved".

At some point he asked me direct questions:

Should we stop sending residents to their practice?

So he was asking for my direct recommendation a proof that he trusts my judgment, so a mark of respect. I said "no" because even though they're not the best pediatricians, I think it's important for the resident to actually see bad pediatricians in private practice to understand why some pediatricians do what they do in town. At the hospital the standard is higher. Also, it's important to see other ways of practicing: homeopathy, vaccine-skeptics parents. Even if you don't believe in it, many people do. So it's good to understand what they believe and why. So it's a bad practice but it's good to see a bad practice. Of course I did not say it in these words. I talked about that it opens one's mind (I think it) and that they have things to teach. So I could prevent being the source of the failure of the contract and still say that there are things that could do better

Is she a bad teacher?

On this one it's a direct attack on her and her capacity. To be honest, I think she's not a good teacher. But I could not answer so directly to such a question. It's more grey area. Again she's not a good teacher but it's good to see a pediatrician like her as there are others. Otherwise one thinks every body is a scientist with an honest talk and has the patient's best interests in mind.

I was being diplomatic about it because if they remove the teaching spot at this private practice it means that they would lose a huge proportion of their income. And I don't think they deserve it. She's not that malevolent. So the harm would be disproportionate to the injury done.

So he's going to talk to them to see what's going on. I think that's a reasonable success. What is important is that they know they're being watched and that they have to be careful.

Highlight

Bragging moment, I hope you'll excuse me: I was proud of myself. At the end I said:

My loyalty goes to you and the residents. It's normal and important that you know what is going on and that the residents get the best training possible. And at the same time they welcomed me and trained me so I don't want to be the one who says bad things about them.

I owe this frame to you Lucio: this dichotomy. Because it was clear in my head thanks to our conversation I could express it clearly. I was proud because I could see in his eyes: "WTF? this guy is able to think like that?!?" (To him I'm the "engineer" and I guess some stereotypes that come with it which I have no clue). He was mindfucked. PU alumnus and TPM member, bitcheees. Ego mode off. It's good sometimes to be happy of one's achievement and progress.

He answered:

Don't worry about it.

He meant: "I'm not going to rat you out". I answered: "thanks".

Machiavellian analysis

He was very grateful for me coming and having had this interview. So my strategy about giving value (coming to him to give him insider information) to build an ally worked. I think now I have an ally in him. As a reminder 5 years ago he did not want me to become a pediatrician. I don't plan on "using it" (transaction) however it's better to have an ally than an enemy.

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#7 · August 20, 2023, 2:56 pm

Rock on, John!

Look at that turnaround in a short few years, pretty amazing.

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#8 · August 22, 2023, 12:25 am

Great, great example. Lots of things to maneuver indeed, and glad you nailed it, John. I'm learning a lot from this :)

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#9 · August 22, 2023, 5:10 am

Thank you very much Lucio and Emily.