It’s important to remember that we folk who do consults as a sideline can let it affect our relationships with our colleagues.\u00a0 Some of our colleagues will also be doing private consults and some will not.\u00a0 We need to be mindful of our relationships with both.<\/p>\n
1)\u00a0 Don’t let your private practice interfere with your day work, as it so easily can.<\/strong><\/p>\n 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.\u00a0 This is for folk who work full time at a ME office and who pick up the occasional consultation on the side.\u00a0 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.<\/p>\n 1.1)\u00a0 Be open with your boss about what you are doing, and make sure you know what is and isn’t allowed.<\/strong><\/em><\/p>\n I’ve already mentioned that doing private consultations is the equivalent of a signed resignation form in the hand of your boss.\u00a0 Make sure your boss is OK with what you are doing.\u00a0 Be open (though not pushy about it).\u00a0 Know what you can and cannot do.<\/p>\n It’s important that\u00a0 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.\u00a0 What I would not countenance were the things that would impact the office that were going on behind my back.<\/p>\n 1.2) Learn the lines at your office you can’t cross<\/strong><\/em><\/p>\n Sometimes things come up and it seems stupid to jump through hoops to avoid some trivial use of jurisdictional resources.\u00a0 These include things like:<\/p>\n a) Taking a phone call during business hours<\/p>\n b) Using the office phone to make a phone call<\/p>\n c) Making a copy on a copy machine<\/p>\n d) Asking one of the secretaries\/admin assistants to notarize a document<\/p>\n e) Having a short zoom meeting in your office<\/p>\n f) Using the conference room to meet with a client<\/p>\n 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<\/p>\n … and on and on.\u00a0 \u00a0All of these are pretty trivial.\u00a0 \u00a0The 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?”\u00a0 \u00a0And I agree.\u00a0 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.\u00a0 That’s not the case now.\u00a0 \u00a0I 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.\u00a0 \u00a0Every office draws its own lines.<\/p>\n All of us work longer hours than the standard 40 hour week, anyway.\u00a0 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?\u00a0 Right?<\/p>\n Right.\u00a0 Unless they do object.\u00a0 Then you are screwed.\u00a0 On top of that, it’s a moving target.\u00a0 \u00a0I’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).<\/p>\n Make sure you talk to your boss before you do any of this stuff, and let him or her set the boundaries.\u00a0 If you are moving near the boundaries, talk to the boss before you cross them.\u00a0 \u00a0I 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.\u00a0 However, one day I ran into a huge scheduling problem, so I went to my boss and talked to him about it.\u00a0 He said “Well, OK, but don’t make a habit of it.”\u00a0 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.\u00a0 However, since I checked, it worked out.\u00a0 Of course, had he said “no,” then I would have obeyed.<\/p>\n I’ve known colleagues whose bosses who limit the kinds of cases they can do.\u00a0 For instance, they could not work for the defense in a neighboring state.\u00a0 Obey those rules.\u00a0 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.<\/p>\n 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).\u00a0 When I left, I felt pretty bad about the way I had been treated, and let my Chair know.\u00a0 A couple of years later, I was invited to speak at a gathering of Pathology Chairs and my old boss was there.\u00a0 He invited me out to dinner and we talked a bit.\u00a0 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.\u00a0 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.\u00a0 Your Chief might say “You can’t do deaths in custody.” or “You can’t work for the defense in this state” or whatever.\u00a0 It might sound capricious or silly.\u00a0 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.<\/p>\n 2) Don’t be a burden to your colleagues.<\/strong><\/p>\n 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.\u00a0 \u00a0There was a recent news story about a Medical Examiner making a complaint of malfeasance against another for doing private work.\u00a0 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.\u00a0 The complainant said the pathologist was ducking his or her time taking call.\u00a0 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.<\/p>\n 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.\u00a0 If you piss off your colleagues, eventually you will\u00a0 pay the price.<\/p>\n How can you piss off your colleagues?\u00a0 There are two basic ways.<\/p>\n First, you don’t pull your weight at the office.\u00a0 It’s one thing to take a private call in your office.\u00a0 It’s another to not do your work and dump your responsibilities on others in order to make time for your private work.\u00a0 If your colleagues think they are having to work harder to provide you with extracurricular income, they will come to resent you.\u00a0 Eventually you will need them, and they may not be there for you.\u00a0 The Book of Proverbs tells us “Whoever is slack in his work is a brother to him who destroys.”\u00a0 The Gods of the Copybook Headings will not be mocked.<\/p>\n Second, you can lord your income over them or otherwise disrespect them.\u00a0 Many, if not most, of your colleagues will not be doing private consults and may have other obligations that require their time and resources.\u00a0 Perhaps they have sick parents, or large families, or have huge debts.\u00a0 If you walk in and make a big deal out of what you are doing, folk may come to resent that as well.<\/p>\n Back when I was a young tyke in college, there was a federal research lab a few miles from my home.\u00a0 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.\u00a0 My truck route was through Oklahoma, Arkansas, Louisiana, Texas, and back to Oklahoma.\u00a0 \u00a0I was one of a small group of people on the project.\u00a0 We were all pretty low-level employees and didn’t make much money.<\/p>\n Most people on the road crew were temp workers like me, but a couple were long term GS employees.\u00a0 One of the other team members clearly had more money than God.\u00a0 He drove a big fancy car.\u00a0 He wore flashy jewelry.\u00a0 He occasionally took the whole crew out for a fancy dinner when we were on the road and paid for the food, drinks, etc.\u00a0 He always had a wad of cash in his pocket. When we stayed at a hotel, he always upgraded to a deluxe room.<\/p>\n I asked him what was going on.\u00a0 \u00a0He told me that during his off hours he was a contractor. He specialized in high money millionaire\/celebrity homes.\u00a0 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.\u00a0 That meant that his total income was many times that of the paltry sum he made as a low level GS employee.\u00a0 He didn’t need the job, but he kept it because government service came with great healthcare benefits, a pension,and other perks.\u00a0 He said that this gig was his safety net.\u00a0 The housing market might crash, he might fall off a ladder and break his back,\u00a0 or whatever, but he would always have the perqs and pension of his government job.<\/p>\n But it was clear that he didn’t need it.\u00a0 And he acted like it.\u00a0 He was always a borderline insolent to our supervisor.\u00a0 He didn’t play the game that employees have to play with their superiors.<\/p>\n Our supervisor hated him for it.\u00a0 He hated that this guy’s car cost more than he made in two years.\u00a0 He hated the fact that he couldn’t intimidate the guy.\u00a0 He constantly belittled the employee.\u00a0 He gave him the shit jobs.\u00a0 And on and on.\u00a0 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.\u00a0 The game they played was amazing.<\/p>\n I’ve heard of similar scenarios at ME\u00a0 offices where somebody made lots of money doing private work and started acting like he or she was “better”\u00a0 or “smarter” than his or her coworkers or even boss.\u00a0 Eventually, it got to the point that accusations of misappropriation, poor work attendance, etc. were made.<\/p>\n 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.\u00a0 Your Chief may simply decide that it’s not worth the hassle of protecting you.\u00a0 And when that happens, you are toast.<\/p>\n It’s not just losing your job.\u00a0 Remember that every blot on your record will come up in court.\u00a0 Every time you left under a cloud.\u00a0 Every time your name ended up in the papers because of some accusation.\u00a0 Each will make you a little less attractive to clients, even if the accusations are false.\u00a0 Sure, you can address them in court, but do you really want\u00a0 to have to do that?<\/p>\n Plus it makes for an unpleasant work environment — that you’ll be spending most of your time in. The math is simple.\u00a0 Most of us, when we worked full time, spent at least 50-60 hours per week at work.\u00a0 Let’s say 55 hours.\u00a0 Let’s add an hour a day commuting, for 60 hours\u00a0 If one assumes 8 hours a day sleep, that leaves 112 hours in a day.\u00a0 That means we spend 60\/112 = 53% of our waking hours at work.\u00a0 That’s a long time to spend under unnecessary stress.<\/p>\n The Apostle Paul was wise when he advised his congregation in Rome that\u00a0 followers of Jesus should “Rejoice with those who rejoice, weep with those who weep.\u00a0 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.”\u00a0 That doesn’t mean that you should not stand up for what you believe. Sometimes conflicts over such things are inevitable.\u00a0 Those of you who know me know that I am no stranger to conflict.\u00a0 \u00a0This is particularly true if you are a Chief.\u00a0 It’s impossible to please everybody.\u00a0 That’s why Paul added the conditional “so far as it depends on you…”\u00a0 \u00a0Some folk just choose to be butthurt. But this sideline stuff should not be a cause.\u00a0 Just live your life.\u00a0 Proverbs also tells us “The vexation of a fool is known at once, but the prudent ignores an insult.”<\/p>\n 3) Share the wealth when it comes to referrals<\/strong><\/em><\/p>\n If you work at an office that allows private consults, some of your colleagues will not be doing private consults, but some probably will.\u00a0 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.\u00a0 Many of my colleagues don’t like to do deaths in custody cases because of the politics involved.\u00a0 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.\u00a0 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.\u00a0 Other people have certain kinds of cases that they just don’t like.\u00a0 I know a number of people who won’t take child abuse cases, because they are always a problem.\u00a0 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.<\/p>\n For whatever reason, there will be cases you can’t take.\u00a0 Be quick to refer those cases to your colleagues. As the Apostle Paul told his congregation in\u00a0 Phillippi\u00a0 “Let each of you look not only to his own interests, but also to the interests of others.”\u00a0 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.”\u00a0 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.\u00a0 And I know that others do the same for me.\u00a0 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.<\/p>\n This accomplishes two things.\u00a0 It generates goodwiill.\u00a0 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.<\/p>\n 4) Share interesting cases<\/strong><\/em><\/p>\n About 80 percent of the private cases I get are fairly mundane, but 20% are really fascinating.\u00a0 The fascinating parts come from unusual circumstances and from unusual presentations.\u00a0 \u00a0In particular, I get a lot more interesting surveillance videos and such in my consult cases than I do in my work cases.\u00a0 Thus, because of my consult work I see much more of how things actually happen.\u00a0 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.\u00a0 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.<\/p>\n Also, I have a lot more *time* to go over this stuff in a consult case.\u00a0 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.\u00a0 That means 30 days for a homicide and 60 days otherwise.\u00a0 And, we are all overworked.\u00a0 We really can’t spend 20 hours watching surveillance videos and listening to interviews and interrogations on every case.\u00a0 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.<\/p>\n Watching these videos has radically changed how I look at cases, both when consulting and at work.\u00a0 One of the things that I never really considered, for instance, is how quickly death or incapacity occurs in real world situations.\u00a0 Even we forensic pathologists can get into the trap of having a cinematic view of how altercations occur or how rapidly injuries become incapacitating.\u00a0 This leads to some very bad thinking about cases.\u00a0 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.\u00a0 It’s another to watch it happen.<\/p>\n One of the more interesting examples of this is the study of hanging.\u00a0 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.\u00a0 Some of it was right, but some of it was wrong.\u00a0 In the past decade or two, videos of hangings became much more common.\u00a0 Researchers reviewed those hangings and came to some very surprising conclusions.\u00a0 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.<\/p>\n 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.\u00a0 \u00a0When this happens, share it with your colleagues.\u00a0 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.<\/p>\n 5) Mentor a younger pathologist<\/strong><\/em><\/p>\n 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.\u00a0 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.\u00a0 It’s not just business advice.\u00a0 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.\u00a0 It’s part of the larger mentoring process that every older pathologist should do.\u00a0 One of the greater disappointments of my life is that my career choices often made it difficult to do this.\u00a0 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. \u00a0As the Bible says “Iron sharpens iron,So one man sharpens another.”<\/p>\n Remember that being a mentor doesn’t mean being “the” mentor of a young pathologist.\u00a0 God may make your role simply to help in one small circumstance.\u00a0 In that, you are part of a collective that is shaping this younger man or woman.\u00a0 As Solomon noted, “Where there is no guidance, a people falls, but in an abundance of counselors there is safety.”\u00a0 You can be one of them.<\/p>\n","protected":false},"excerpt":{"rendered":" It’s important to remember that we folk who do consults as a sideline can let it affect our relationships with…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,148,1],"tags":[28,137],"class_list":["post-2079","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-private-consultation","category-uncategorized","tag-pathology","tag-practice"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2079","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=2079"}],"version-history":[{"count":15,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2079\/revisions"}],"predecessor-version":[{"id":2181,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2079\/revisions\/2181"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2079"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2079"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2079"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}