You Must Comply

Guess who graduated residency… but is still in training!?

So now I’m starting my toxicology fellowship. I’m now at a different large academic center, still on the West Coast, and am six weeks in.

Fellowship is going well, except that I wake up every day consumed with a blinding and violent rage – not toward my training program but toward the university’s HR department.

You see, when you work for a large healthcare corporation like mine, there is an insane amount of paperwork necessary to “onboard” a new healthcare provider. Regulations require that the hospital perform an intense, intrusive due diligence check for all hires. This supports a whole cottage industry of “analysts” and “support specialists” whose job it is to validate that we are, in fact, duly appointed physicians.  

After completing what seems like nine hundred pages of thoroughly redundant paperwork (“please input your complete education and work history, addressing any gaps”), you’re hired! And during the first two weeks, please complete the Necessary Onboarding Modules, designed to nominally educate you on important topics such as workplace violence, patient privacy issues, and sexual harassment.

What these modules really do is provide corporate cover if you act like an asshole. The company/university can just say, “See? We tried to train Nate, but he was too much of an jerk to fix. Our policy is clearly laid out in our modules. Don’t sue me.”

Fine. We live in the United States, everyone sues everyone and looks to inflict maximum financial punishment, these companies must protect themselves, fine.

I receive my email from the soulless, no-reply email address politely telling me to get my ass to a website that holds all of my modules, and that they are due within a month, and that my performance will be tracked. Fine.

I open the first module: Cyber Security Awareness. Naïve new employee that I am, I assume this will be a series of Powerpoint slides that I can quickly click through and then answer the inevitable quiz at the end to prove I know the material. Don’t share passwords, choose a ridiculously obtuse password that you instantly forget, don’t respond to emails from Nigerian princes or open links you don’t recognize – we all know the drill.

Oh. It’s a video.

Fine. I know how to deal with this. Let the video drone on in the background while I do actual wor-

Wait a second.

Before I explain what happened, let me first say that if I ever find the media/IT person who decided on this tactic, I will superglue their feet to a wind turbine in a sandstorm. I will spend my career genetically modifying a supermosquito to have a barbed, javelin-sized proboscis and leave them alone in a humid box with sixty of them. I will leave them alone in a pit of damp lobsters.

Yes, I made that from scratch. That is the coder who did this to me.

So anyway. When I clicked away from the screen playing this woefully insipid video, which used stock photos of smiling women pointing at computer screens, the playback stopped.

Oh, no.

If I tried to minimize the screen? Stopped. Put the window in a different virtual monitor? Stopped. Anything besides staring mindlessly like the white collar corporate cog I’m supposed to be? Stopped.

It dawned on me that the only way of completing this, short of a second computer, was to leave it alone. I couldn’t even walk away – each video clip was only a minute or two long, and then I’d have to click a “next” button THAT MOVES AROUND THE SCREEN so that you actually have to move your mouse.

With abject misery, I plowed through Cyber Security and its post-test, which featured three of the single stupidest questions I have ever seen on a quiz. For example,

“You are working in the hospital and need to take a bathroom break. You should:

  1. Leave your workstation unattended and shout “Hey! Come hack me, bro!”
  2. Leave your workstation unattended, but minimize the electronic health record
  3. Take the workstation with you while you take a shit
  4. Log out, moron”

I moved on to Compliance Briefing, which was thankfully of the single-long-extremely-boring-video variety and required no clicks. I did learn that if your screen saver turned on, the video stopped. This was solved by downloading a computer program that automatically wiggles your mouse a little every ten seconds to trick the video into thinking you’re still there and paying attention to the most bored HR narrator in human history.

After that came Conflicts of Interest, which was truly heinous and involved two hundred and eleven clicks. I know this because I decided to count, since I was unable to skip forward one single goddamn time.

Sexual Violence and Sexual Harassment was actually a bit interesting, in that they presented cases that were not clear-cut one way or the other. This is the only positive thing you will ever hear me say about compliance modules. It also did not force me to listen to recorded audio or watch videos. I was all ready to sing its praises when I finished the module in 28 minutes. Then, on the last slide before the requisite idiotic quiz, I was confronted with an error message:

WARNING: The [evil overlord health system I work for] requires two hours of dedicated time for this module. You have only completed 28 minutes. Please go back and review the cases until your full time has elapsed.”

Rage. Blinding, incandescent, Sith Lord level rage – the kind of consuming anger that renders you momentarily deaf as your neurons overload.

I decide to walk the dog to elapse some additional minutes.

Upon my return… my computer went to sleep, and the timer stopped. Sigh.

I proceeded, eventually, through:

  • Annual Compliance and Fraud: don’t steal from the university (2 hours)
  • Annual Professional Standards: I still don’t know what this was (45 min)
  • Workplace Safety: Lift with your legs not your back, you peasant dipshit incapable of taking care of yourself (1 hour)
  • Physician Responsibilities: don’t yell at staff or patients (30 min)
  • Medical Records: documentation is how we get paid so don’t screw it up (1.5 hours)
  • Risk Management: don’t get sued (1 hour)
  • Quality: do good medicine (30 min)
  • MD Role in Disasters: disasters are bad (20 min)
  • Sexual Identity and Orientation (1.5 hours): I will get canceled for commenting on this
  • Clinical Documentation Improvement: no seriously document better (1 hour)

You probably skipped over this entire list because of how long it is. Imagine actually having to sit through trainings on this. You got bored just reading it!

There was also a full required module, lasting 30 minutes, on “physician well-being.” I would explain how contradictory and absurd that concept is – they recommend outdoor activities and spending time with loved ones, neither of which are possible when you are tethered to a computer learning about well-being – but the dissonance would cause a dissecting aneurysm and I would die an instant death.

Completing these took the better part of a month, a month where I was supposed to be learning toxicology but was instead trying to avoid committing myself to an insane asylum.

Oh… but it gets worse.

Because of the weird role I have as a fellow, I am both a trainee (in medical toxicology) and a full attending (in emergency medicine). In the health system’s absurdly complex and opaque payroll system, which was designed by a malignant, cancerous hobgoblin with a Kafka obsession, this means I am actually listed as two separate employees.

To HR, this means I am two separate employees. I was thus assigned the full set of compliance modules… twice.

I only learned this fact a week after completing the first full set of modules. I emailed the HR person who sent me a message requiring me to repeat them, saying, “hey! Nice to e-meet you. I already did these.” She replied that the two systems – student HR and faculty HR – do not communicate, of course, and she has no way of documenting that I’ve completed these modules without me doing them again.

Over the grueling years of residency, I learned not to die on hills. I glumly completed the modules, again, tormenting my girlfriend on our long-distance phone calls by filling the time with my complaints about Sexual Harrassment 101 and Clinical Documentation Improvement.

I finally, toward the end of July, finished the repeat set of modules. Blessed am I! I am free! I can be a real doctor now!

July 22, email to all staff.

Subject: Annual Required Training FY 21-22

“This year’s annual required training for all team members is scheduled to roll out on July 28…”

No. No f**king way.

Here’s Otis.

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