Hey meddit, I have a few problems that I would really appreciate some feedback from other medical professionals. I am a travelling contract echocardiographer and I am currently at an IAC accredited hospital which I have found serious concerns about the diagnostic quality of the echoes preformed and the lack of professionalism in the workplace.
Multiple cardiologists at this location have asked me how to improve the echo lab. To do so, I gathered data on 52 patients that I scanned and compared my work to the previous echo and evaluated the technical aspects, completeness of information, timing and quality of the workup in situations of disease. What I found was alarming.
41% of the studies I found serious technical concerns that potentially misdiagnosed, improperly diagnosed or failed to diagnose a significant finding, which was attributed to poor quality information or lack of information. 3 of those cases the patients were re-hospitalized for cardiac concerns. One case, the patient almost died from pulmonary edema post circumflex STEMI and acute severe MR. The MR was poorly evaluated on the initial echo and under-diagnosed based off the poor quality available information. That patient remained hemodynamically unstable for 4 days until a repeat echo was ordered that I preformed, which showed severe MR. The patient was transferred for emergent MVR surgery that day and survived.
25% of the cases I found significant concerns, however the studies were overall diagnostic. 34% of the studies I had no significant concerns with. I presented this data to the cardiologists and they were not too surprised. They all agreed that the echoes preformed were overall very poorly done. Now, one would think that if a cardiologist orders the quality of something to improve, it would improve. However, this issue segways into my other problems which stem from lack of professionalism in the workplace.
The echo techs, save for one, are very arrogant and rather incompetent. If you have seen the movie Mean Girls, these folks are basically like that. They frequently critique the cardiologists for minor mishaps, and will not hesitate to write a formal compliant if they feel a cardiologist did something wrong. They do not take constructive criticism or feedback well. They often call the cardiologists idiots, stupid, wrong and other, more unprofessional expletives. I think these cardiologists are fantastic.
There is also a culture of rampant sexual harassment, inappropriate sexual touching, inappropriate sexual conversations, jokes, innuendos and stunts. In addition, these people enjoy also making fun of patients for odor, weight, disease status and physical appearance. They are also loud and obnoxious, and the patients in the exam rooms can hear this and will comment about it. On top of all that, they are lazy and disorganized and will look for excuses to not scan a patient, when there is no real reason to delay that patient's care. Basically, it is like my high school experience, but at work. I read the employee code of conduct and these folks have committed multiple violations and I am documenting it.
What compounds this problem is similarly incompetent and arrogant management. The echo lab supervisor protects these echo techs and has on multiple occasions stopped changes ordered from the cardiologists to improve the echo quality. The manager above the echo lab supervisor does the same. Some of the cardiologists no longer want to sign their name on the echoes for fear of malpractice.
There is a meeting planned to address these technical concerns of the echoes where the cardiologists and myself will explain the technical failures of the lab and each individual tech. When that happens, I will be put into a position where I will fear workplace retaliation, slander/libel/defamation and possible physical harm, however unlikely, though I wouldn't put it past one person, who is one of the worst offenders.
I guess, after this super long post, what should I do to protect myself? The cardiologists are going to use my data to force much needed reform at this place. I know I can go to HR , get protection from retaliation and report the unprofessional workplace environment and sexual harassment, but in my experiences with HR, those are last people I want to go to. The bottom line is that patients harm is occurring. I have never seen such a terrible place and honestly am at a loss to what to do.
Any advice on how to proceed? Thank you so much in advance for any feedback. I hope that everyone isn't on call over the upcoming holidays!
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