It’s important to remember that we folk who do consults as a sideline can let it affect our relationships with our colleagues. Some of our colleagues will also be doing private consults and some will not. We need to be mindful of our relationships with both.
1) Don’t let your private practice interfere with your day work, as it so easily can.
This series is not directed at folk who are doing private consultations full time, or the entrepreneurs in our field who have set up private contract Medical Examiner offices. This is for folk who work full time at a ME office and who pick up the occasional consultation on the side. You may be building up a private practice with an eye to doing this full time, and God bless you for it, but right now you are doing this on weekends and at night, and using vacation time for testimony.
1.1) Be open with your boss about what you are doing, and make sure you know what is and isn’t allowed.
I’ve already mentioned that doing private consultations is the equivalent of a signed resignation form in the hand of your boss. Make sure your boss is OK with what you are doing. Be open (though not pushy about it). Know what you can and cannot do.
It’s important that your boss knows there will be no surprises. I know that when *I* was a Chief, I’d put up with a lot of stuff as long as I knew what was going on and I knew that I could modulate it if there were issues. What I would not countenance were the things that would impact the office that were going on behind my back.
1.2) Learn the lines at your office you can’t cross
Sometimes things come up and it seems stupid to jump through hoops to avoid some trivial use of jurisdictional resources. These include things like:
a) Taking a phone call during business hours
b) Using the office phone to make a phone call
c) Making a copy on a copy machine
d) Asking one of the secretaries/admin assistants to notarize a document
e) Having a short zoom meeting in your office
f) Using the conference room to meet with a client
g) Running off for 30 minutes to an hour now once in a blue moon to an off-site meeting or run an errand relating to a consult
… and on and on. All of these are pretty trivial. The basic justification for all of them is “If I’m getting my work done, and the resource is free or rarely used, what’s the big deal?” And I agree. Back in the day, when “long distance” telephone calls were a thing, making phone calls could be a significant expense to the office, and it made sense to limit them. That’s not the case now. I suspect a couple of folk, particularly the Chiefs who are reading this, had a little hesitation about using a conference room or even allowing clients to come see a pathologist for a quick meeting in their own office. Every office draws its own lines.
All of us work longer hours than the standard 40 hour week, anyway. So if you are doing long hours for the office, why should they object if you take five minutes here or 30 minutes there to get something done? Right?
Right. Unless they do object. Then you are screwed. On top of that, it’s a moving target. I’ve worked at offices that started out strict and then became more permissive, and I’ve worked at offices that started out permissive and then became more strict (the latter usually because of some complaint).
Make sure you talk to your boss before you do any of this stuff, and let him or her set the boundaries. If you are moving near the boundaries, talk to the boss before you cross them. I once worked at a place where the phone calls and such were OK, but I couldn’t have meetings in my office or use the conference room. However, one day I ran into a huge scheduling problem, so I went to my boss and talked to him about it. He said “Well, OK, but don’t make a habit of it.” Had I gone ahead and had that meeting, I would have been in trouble, not just because I broke a rule, but because it’s a form of disrespect to the boss. However, since I checked, it worked out. Of course, had he said “no,” then I would have obeyed.
I’ve known colleagues whose bosses who limit the kinds of cases they can do. For instance, they could not work for the defense in a neighboring state. Obey those rules. They may seem capricious or political, but that’s the world you live in, and it’s probably not the Chief who is really imposing them — it’s the Chief’s leadership.
I retired early from a previous academic job because I felt there were unreasonable demands made on me (not having to do with private consultation). When I left, I felt pretty bad about the way I had been treated, and let my Chair know. A couple of years later, I was invited to speak at a gathering of Pathology Chairs and my old boss was there. He invited me out to dinner and we talked a bit. He apologized for what had happened and told me that he had been forced to do what he did by his Dean, who had been systematically removing discretionary power from the Chairs. Everything had turned out great for me, so it was no big deal, but it struck me that bosses can be living under constraints we have no knowledge of. Your Chief might say “You can’t do deaths in custody.” or “You can’t work for the defense in this state” or whatever. It might sound capricious or silly. It may well be that this directive is not your Chief’s idea but comes from the Mayor or Governor or County Commissioner’s office.
2) Don’t be a burden to your colleagues.
One of the things that I’ve noticed about folk who get into trouble is that they’ve pissed someone off in their office who then decided to make a big stink about it. There was a recent news story about a Medical Examiner making a complaint of malfeasance against another for doing private work. The complaint was that the one doing private practice was running off to places to testify or do autopsies or whatever and leaving his colleagues to cover for him. The complainant said the pathologist was ducking his or her time taking call. The pathologist was not pulling his or her weight. Colleagues, already overworked, were pissed off about it, and eventually one of them ended up making a complaint, going to the press, etc.
Obviously, I don’t know the details or the truth in such an accusation, but all of these things are cover for the most important one. If you piss off your colleagues, eventually you will pay the price.
How can you piss off your colleagues? There are two basic ways.
First, you don’t pull your weight at the office. It’s one thing to take a private call in your office. It’s another to not do your work and dump your responsibilities on others in order to make time for your private work. If your colleagues think they are having to work harder to provide you with extracurricular income, they will come to resent you. Eventually you will need them, and they may not be there for you. The Book of Proverbs tells us “Whoever is slack in his work is a brother to him who destroys.” The Gods of the Copybook Headings will not be mocked.
Second, you can lord your income over them or otherwise disrespect them. Many, if not most, of your colleagues will not be doing private consults and may have other obligations that require their time and resources. Perhaps they have sick parents, or large families, or have huge debts. If you walk in and make a big deal out of what you are doing, folk may come to resent that as well.
Back when I was a young tyke in college, there was a federal research lab a few miles from my home. I got a gig for a summer driving a truck that held measuring equipment that we took from site to site, set up, and took samples for a study. My truck route was through Oklahoma, Arkansas, Louisiana, Texas, and back to Oklahoma. I was one of a small group of people on the project. We were all pretty low-level employees and didn’t make much money.
Most people on the road crew were temp workers like me, but a couple were long term GS employees. One of the other team members clearly had more money than God. He drove a big fancy car. He wore flashy jewelry. He occasionally took the whole crew out for a fancy dinner when we were on the road and paid for the food, drinks, etc. He always had a wad of cash in his pocket. When we stayed at a hotel, he always upgraded to a deluxe room.
I asked him what was going on. He told me that during his off hours he was a contractor. He specialized in high money millionaire/celebrity homes. Since this was a sideline for him, he only built a couple of these things every year, but they were (apparently) much sought after high-craftmanship things. That meant that his total income was many times that of the paltry sum he made as a low level GS employee. He didn’t need the job, but he kept it because government service came with great healthcare benefits, a pension,and other perks. He said that this gig was his safety net. The housing market might crash, he might fall off a ladder and break his back, or whatever, but he would always have the perqs and pension of his government job.
But it was clear that he didn’t need it. And he acted like it. He was always a borderline insolent to our supervisor. He didn’t play the game that employees have to play with their superiors.
Our supervisor hated him for it. He hated that this guy’s car cost more than he made in two years. He hated the fact that he couldn’t intimidate the guy. He constantly belittled the employee. He gave him the shit jobs. And on and on. But… the guy was a long term government employee and knew just how to get close to the line of doing something that would get himself fired, but not cross over it. The game they played was amazing.
I’ve heard of similar scenarios at ME offices where somebody made lots of money doing private work and started acting like he or she was “better” or “smarter” than his or her coworkers or even boss. Eventually, it got to the point that accusations of misappropriation, poor work attendance, etc. were made.
Remember that in government work, which is what most of our day jobs are, those kinds of accusations can cost you your job whether they are true or not. Your Chief may simply decide that it’s not worth the hassle of protecting you. And when that happens, you are toast.
It’s not just losing your job. Remember that every blot on your record will come up in court. Every time you left under a cloud. Every time your name ended up in the papers because of some accusation. Each will make you a little less attractive to clients, even if the accusations are false. Sure, you can address them in court, but do you really want to have to do that?
Plus it makes for an unpleasant work environment — that you’ll be spending most of your time in. The math is simple. Most of us, when we worked full time, spent at least 50-60 hours per week at work. Let’s say 55 hours. Let’s add an hour a day commuting, for 60 hours If one assumes 8 hours a day sleep, that leaves 112 hours in a day. That means we spend 60/112 = 53% of our waking hours at work. That’s a long time to spend under unnecessary stress.
The Apostle Paul was wise when he advised his congregation in Rome that followers of Jesus should “Rejoice with those who rejoice, weep with those who weep. Live in harmony with one another. Do not be haughty, but associate with the lowly. Never be wise in your own sight. Repay no one evil for evil, but give thought to do what is honorable in the sight of all. If possible, so far as it depends on you, live peaceably with all.” That doesn’t mean that you should not stand up for what you believe. Sometimes conflicts over such things are inevitable. Those of you who know me know that I am no stranger to conflict. This is particularly true if you are a Chief. It’s impossible to please everybody. That’s why Paul added the conditional “so far as it depends on you…” Some folk just choose to be butthurt. But this sideline stuff should not be a cause. Just live your life. Proverbs also tells us “The vexation of a fool is known at once, but the prudent ignores an insult.”
3) Share the wealth when it comes to referrals
If you work at an office that allows private consults, some of your colleagues will not be doing private consults, but some probably will. Most of the folk doing private consults will have calls for cases they can’t take because of workload or because they don’t like that kind of case. Many of my colleagues don’t like to do deaths in custody cases because of the politics involved. I’ve written elsewhere about the attempts to lynch Dr. Dave Fowler because he had the audacity to work for the defense in the George Floyd case. Politics has begun to poison the justice system more openly nowadays, and many folk simply will not take cases that open them up to lawfare — justice be damned. Other people have certain kinds of cases that they just don’t like. I know a number of people who won’t take child abuse cases, because they are always a problem. I know another person who doesn’t like wrongful death cases in nursing homes simply because he doesn’t want to spend the rest of his life going though tens of thousands of pages of nurses notes.
For whatever reason, there will be cases you can’t take. Be quick to refer those cases to your colleagues. As the Apostle Paul told his congregation in Phillippi “Let each of you look not only to his own interests, but also to the interests of others.” And as the author of the Letter to the Hebrews writes ” And do not forget to do good and to share with others, for with such sacrifices God is pleased.” I keep a list of all the folk I know who do private cases in my state, and whenever I can’t take a case, I’ll offer to send my list. And I know that others do the same for me. Usually I don’t know who referred the case to me, but the mere fact that we are doing this makes us all more collegial.
This accomplishes two things. It generates goodwiill. Goodwill is goodwill, and the more of that going around, the less likely there will be problems. The second thing it does is generate more constant opportunities to do consults so that when you *do* have an opening in your schedule, you will likely get a call soon.
4) Share interesting cases
About 80 percent of the private cases I get are fairly mundane, but 20% are really fascinating. The fascinating parts come from unusual circumstances and from unusual presentations. In particular, I get a lot more interesting surveillance videos and such in my consult cases than I do in my work cases. Thus, because of my consult work I see much more of how things actually happen. In my work, I rarely get a chance to look at the surveillance videos in accidental deaths and homicides, usually because I have to sign the case out before everything is collected. These consult cases, on the other hand, often come to me a year or two after the event, and all sorts of data have been collected that are not available within the 30-60 days I have to sign a case out at work.
Also, I have a lot more *time* to go over this stuff in a consult case. As you well know, when we do a case in the office, we are under significant time pressure to get the case out within NAME standards. That means 30 days for a homicide and 60 days otherwise. And, we are all overworked. We really can’t spend 20 hours watching surveillance videos and listening to interviews and interrogations on every case. In private consults, you have that time. I usually get cases months and months before a trial date, and have plenty of time to carefully review videos and interviews and medical records.
Watching these videos has radically changed how I look at cases, both when consulting and at work. One of the things that I never really considered, for instance, is how quickly death or incapacity occurs in real world situations. Even we forensic pathologists can get into the trap of having a cinematic view of how altercations occur or how rapidly injuries become incapacitating. This leads to some very bad thinking about cases. I’ve seen forensic pathologists who clearly have never (or rarely) fired a gun opine about what “likely” happened in a firefight, clearly relying more on television action shows they’ve watched than real life. It’s one thing to read about corrections officers kicking a prisoner to death. It’s another to watch it happen.
One of the more interesting examples of this is the study of hanging. When I was a young pathologist, we looked at historical accounts of hanging and such and came up with all sorts of ideas about the mechanism of death. Some of it was right, but some of it was wrong. In the past decade or two, videos of hangings became much more common. Researchers reviewed those hangings and came to some very surprising conclusions. For instance, in many, if not most cases, the movement of the body is not “struggling” to breathe; it’s decorticate posturing because the noose closes the carotid arteries and the decedent becomes unconscious very quickly.
I’ve also had the opportunity to see interesting artifacts and other findings that would likely not have passed in front of me because of their rarity. When this happens, share it with your colleagues. We do this in my office at peer review meetings. They will find it interesting and are more likely to consider your work a benefit to them.
5) Mentor a younger pathologist
If you are a more experienced pathologist who has spent some time doing consults, you are obligated by God to help younger pathologists if you believe this is your calling. This means that you should be quick to teach from your experience, help younger men and women avoid the mistakes you’ve made, and help encourage the private consultation careers by referral, advice, and education to the degree you have the opportunity. It’s not just business advice. Younger (and sometimes older) pathologists often come to me, for instance, for help finding articles in the literature since I seem to have a knack for it. It’s part of the larger mentoring process that every older pathologist should do. One of the greater disappointments of my life is that my career choices often made it difficult to do this. On the occasions where I’ve had that opportunity, it has been as much a blessing to me as a help to the younger person I could encourage. As the Bible says “Iron sharpens iron,So one man sharpens another.”
Remember that being a mentor doesn’t mean being “the” mentor of a young pathologist. God may make your role simply to help in one small circumstance. In that, you are part of a collective that is shaping this younger man or woman. As Solomon noted, “Where there is no guidance, a people falls, but in an abundance of counselors there is safety.” You can be one of them.