Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

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institutions” and wouldn't “competitive trainees,” if they offer any genuine advantage over non-competitive trainees, be able <strong>to</strong> work their magic in institutions in more humble locations? I've interacted with finished physicians from a broad range of institutions and I'm constantly impressed with how alike they are. Physicians from Harvard, Yale and other Ivy League institutions are no great shakes and some of the most impressive come from the hinterlands. What was all the fuss about during education and training, then? 7. Illustrative anecdote which is more typical than it should be When I worked as a civilian in the ER of the military hospital, Fort Stewart, GA, my military supervisor, a Major in the Army Medical Corps, liked me pretty well at first but seemed <strong>to</strong> dislike me more and more as time went on, evidently because of conflicts that swirled around me. He criticized my handwriting, so I brought in a word-processor <strong>to</strong> write up my charts and make them optimally legible. He didn't s<strong>to</strong>p me from doing that but, long after I'd left there, I obtained copies of my personnel-records, including documentation of his commentary on the episode. Without explaining what he intended, he put an exclamation after the statement, “he brought in a word-processor!” I gather he disapproved of my constructive response <strong>to</strong> his criticism, yet he suggested no other alternative. What did he want from me? Did he expect me suddenly <strong>to</strong> develop handwriting like his? He never explained. In perhaps the emblematic episode of my tenure there, I pissed off one of his fellow Army-officers by calling him in at night <strong>to</strong> attend a female patient of his by admitting for her evaluation and moni<strong>to</strong>ring of her chest-pain that I suspected had a cardiac origin. He chewed me out for disturbing his sleep and wanted me <strong>to</strong> release her home without forcing him <strong>to</strong> come in and examine her. He claimed <strong>to</strong> know her so well that he KNEW that her chest-pain was not cardiac but, instead, was from her COPD. The rules, not of my making, required him <strong>to</strong> come in and examine a patient whom the ER-physician suspected of requiring admission. Under protest, he came in, chewed me out some more in front of nurses and other personnel and released her home. A few weeks later, her cardiac catheterization at Fort Gordon revealed severe coronary artery disease. I had committed an unpardonable sin: being right when an army-doc<strong>to</strong>r was wrong. It's not as if this were a diagnostic coup. It could hardly have been more stereotypical. She had chest-pain, reminiscent of cardiac chest-pain. It was bread-and-butter medicine. She needed admission for the sake of safety. The officer fulfilled his paper-duty under protest by getting out of bed and examining the patient. He failed in his duty <strong>to</strong> admit her for moni<strong>to</strong>ring. I pissed off a pediatrician by calling him in at night a few times <strong>to</strong> attend febrile infants who I thought might need admission, as a posted directive required me <strong>to</strong> do. Whether the patient's condition is serious enough <strong>to</strong> warrant admission is a matter of judgment and, if I think the patient needs admission, the pediatrician may disagree. I assumed that <strong>to</strong> be in the realm of disagreement among reasonable people. He evidently disagreed, even with that principle, probably because he was the pediatrician on call and fulfilling his duty required him <strong>to</strong> exert unwelcome effort. He impugned my “judgment,” as a tactic in his campaign. He sent all the patients I referred <strong>to</strong> him
home, possibly as a way of accumulating incompetence-points against me. Those incidents illustrate the principle, universal, in my observation, that hospital-personnel pay abundant lip-service <strong>to</strong> concern for quality of patient-care but their actions bespeak only concern for their own convenience. Thus, I accumulated “complaints” against me but the hospital never preferred any charges against me or offered me a peer-review hearing for me <strong>to</strong> rebut such charges, presumably because the notion would have been absurd, even <strong>to</strong> Army-brass. Hypothetical charge 1: diagnosing chest-pain as cardiac which later proved <strong>to</strong> be cardiac but pissing off Army-Officer in the meantime by calling him in at night <strong>to</strong> do his duty. Charge 2: complying with posted hospital-directive by calling in Army-Officers in relevant specialties “unnecessarily,” and thereby pissing them off, on nights when they're on call <strong>to</strong> attend patients, possibly appropriate for admission, and <strong>to</strong> render their opinions. Instead of taking a formal route, they chose a typical bureaucratic route: my supervisor completed consecutive evaluation-reports in secret and never discussed them with me. The personnel-records I obtained years later, exhibited an unmistakeable halo-effect: In all components, from “medical knowledge” and “rapport with staff” <strong>to</strong> “health” and “appearance,” the ratings descended in parallel from 9 or 10 of 10, steadily downward, <strong>to</strong> end at about 3 or 4 out of 10, under the influence of multiple complaints of pissing off Army-physicians by asking them <strong>to</strong> do their duty. That is, each evaluation-cycle, my supervisor assigned all components the same rating: all 9s, all 8s, all 7s, all 6s and so forth. Yet, my “appearance” and “health” were verifiably the same throughout that time: fine and stable. He presented not a scintilla of evidence of my deteriorating health, for example, yet he “documented” its deterioration in his numerical ratings. This person had an MD-degree! Thereupon, enough poor pseudo-ratings had accumulated against me <strong>to</strong> “justify” my termination and <strong>to</strong> provide an ironclad “paper-trail,” in case I should have decided, at some point, <strong>to</strong> contest my termination legally. LORs that I requested from Fort Stewart stated only the dates of my employment there but made no mention whatever of my performance, e.g., my thoroughness and my diligence, for the benefit of patients, against the odds of dysfunctional military-bureaucratic obfuscation. Those LORs illustrate a fundamental principle of all LORs: LORs accommodate the needs of the ambient power-hierarchy, not of the subject thereof. That makes them inherently inaccurate. If the academic is honest with himself, he will concede that academic power-hierarchies exhibit similar manifestations. I could provide other anecdotes with similar import but I've gone on far <strong>to</strong>o long already, so I'll s<strong>to</strong>p. When will decision-makers cop themselves on <strong>to</strong> the inherent unfeasibility of rating human beings?
Page 1 and 2: DR. ERIC N GROSCH - A new approach
Page 3 and 4: i. distortion from
Page 5 and 6: they were inferior. It is unfair, a
Page 7 and 8: Another Irving Langmuir? Can Americ
Page 9 and 10: deviations, as is the case when the
Page 11 and 12: method[11,12] for “objective” e
Page 13 and 14: than we now possess.[21] The progre
Page 15 and 16: 3. Descriptive, Not Evaluative. Use
Page 17 and 18: University, addressed merit-ratings
Page 19 and 20: etter than any of his contemporarie
Page 21 and 22: In the industrial setting, in which
Page 23 and 24: criteria did the evaluato</
Page 25 and 26: Is it true or false that for every
Page 27: and the results . . . have been goo

Eric Grosch, Letter to Dr. Morgenstern on LOR - Semmelweis ...

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