my employee is disrespectful of patients, refused an assignment, and told us “nice try though”

by Alison Green on October 24, 2023

A reader writes:

Can you help me tell my employee that I am not harassing him as he stated by telling him to do his job and also to cut the snarky, un-professional comments?

For background, I am a mid-level manager for clinicians who go into patient homes and provide very essential, highly skilled needs.

“Ross” is an overall good clinician; however, he has a lot of personal drama that he brings to work, as well as somehow always managing to see less patients than everyone else in his territory. He also has a lot of sick calls and sudden short medical leaves of a few days and missed the last two mandatory meetings. Ross has a history of thinking if he says he doesn’t feel comfortable with a certain type of patient he can indefinitely get out of these types of home visits. He has been told at his previous annual reviews that these are things he needs to work on to feel confident. It is a common occurrence for the patient scheduler, “Monica,” to have an urgent need come up in the day, send a group Teams message to the clinicians working that day to see if any clinicians had something fall through/can pick up an extra visit/ would like overtime, etc. It is common for Ross to respond with comments like “Type X patients are scary and I don’t know how to do them.” Or “Oooh gross, I would vomit if I ever had a Type Y patient.”

Ross’s annual review is coming up and my plan had been to meet up with him prior and have him give me a list of patient types he doesn’t feel comfortable with, put it in the goals section of his review, and help him find patients to do co-visits for on-the-job training. He will also be getting more clear “needs improvement” marks in his attendance and assignment management/patient load sections.

Monday evening, as Monica was finishing scheduling, she sent Ross a Teams message as a courtesy letting him know she had to assign him a new rural “assessment” patient and that if he needed to offload some of his four other patients due to drive time for the rural patient, the clinicians’ assistants had a lot of room in their schedule for Ross to pass his non-assessment visits that are within their scope. His response was that he just emailed the on-call scheduler to remove the rural assessment patient because he would NOT be going, “Nice try tho.” I was cc’d in the response from the on call scheduler. Ross’s email subject heading was, “I will not be going to ‘Timbuktu.’” I responded early Tuesday morning, stating, “Sorry, we can’t remove the rural assessment but the clinician assistants will help with the four other non-assessment visits.”

What followed still blows my mind. Ross continued to respond via email/Teams with different excuses just refusing. First it was because Tuesday, Wednesday, and Fridays are difficult for him to be too far from home. I ignored that and repeated that this rural one was most urgent. Then he said he had already confirmed times with his other patients. I politely reminded him that in our line of work, certain patient care is a priority and we have to change things at a moment’s notice sometimes and I would be happy to call those patients and reschedule to different times to make room for his drive time to the rural patient. He then responded that he just couldn’t make it work because he had to be in his home town by 2 pm to pick up his child from school. I gently told him work days don’t typically end at 2 pm and we needed him to see this patient and repeated my other offers of help. When I reiterated he needed to go, he then responded, “Please stop harassing me.” And he again refused to go. I stopped contacting him at that point, removed the patient from the day’s schedule, and forwarded it all to HR and my boss.

They were also blown away and HR told me that I was in the right by expecting him to do his job and that he was using scary words to try and get out of the rural patient. HR said to have a sit-down with him this week after emotions calm down and make sure he understands that refusal is not acceptable and all the clinicians take turns with rural patients and our job is to take care of patients, no matter where they live. She also said to tell him there are no guarantees that he will be done by patient visits by 2 pm every day. She said let’s try for a coaching session but if ends up being belligerent, then it might end up a write-up.

Ross has since sent me a very long email titled “a little background” explaining about a lot of his personal drama and needing to always be close by his child’s school for … reasons. I did his job for years in the field before being a supervisor and had three young children myself when I did so, and I can say the reasons should have zero impact on seeing any patients, even rural. I haven’t replied yet but sent him a separate message stating we need to meet this week to discuss this situation.

I feel fairly comfortable being straightforward and matter of fact in that area. What I’m not sure how to tell him is how snarky and unprofessional his other communications are — the “nice try tho” and when he talk about patients being scary and gross. (Honestly I don’t know why Ross is in this profession if he feels that way about it.)

Whoa. Your HR person just thinks this warrants a write-up?

I’d say it warrants a clear and final warning about the requirements of the job, and a clear statement that if he’s not willing to meet those requirements, you’ll need to part ways.

Is this really the guy you want serving your patients? A person who calls their medical conditions “gross” and calls sick people “scary” and says they make him want to vomit?

Everything Ross is saying and doing says this isn’t the right job for him … and he is not the right person for you to employ.

To be clear, if it was just the thing about him insisting he needed to be back by 2 pm to pick up his kid, that would be different. Emergencies happen, and miscommunications happen. That might call for a conversation where you explain that while you can accommodate occasional emergencies, in general he should assume you’ll need to schedule him for the entire workday and can’t plan around a school pickup schedule unless that’s something that’s worked out in advance.

But that’s the least of this! The bigger problems are Ross being so adversarial with your scheduler (“nice try though”? what the hell?) and disrespectful in the way he speaks about patients (so basically just … a jerk).

Even before this latest incident, it sounds like you were being way too accommodating with him. You were on the right track with insisting he train for the patients he says he doesn’t know how to handle, but instead of that just being something you address in the “goals” section of his annual review, it needs to be accompanied by a serious conversation explaining that the job includes treating patients with the conditions he’s spoken pejoratively about, that you expect him to speak respectfully of patients at all times, and that not doing that is a firing offense … because it needs to be. Sample language: “It is a non-negotiable requirement of your job that you speak respectfully of patients at all times. Saying that certain patients are ‘gross’ or make you want to vomit is fundamentally out of sync with the values we expect you to display as a clinician, and it calls into question your ability to treat patients respectfully and empathetically. Can you tell me how you align that sort of comment with your responsibilities as a care provider?” … and then, “I need to make it clear that we will not tolerate any further occurrences of that way of speaking.” You can add that it’s a requirement of his job to speak respectfully to coworkers too.

But even if he stops because he doesn’t want to get fired, you’ve got to give some serious thought to whether it’s fair to your patients to saddle them with a clinician who was comfortable speaking that way about them. If you have to force Ross to handle their cases, are they going to get the type of empathetic and respectful care you presumably want them to receive?

In fact, the deeper I get into this answer, the more I question whether you can responsibly keep him on at all, even with a warning in place — not because he was a jerk about scheduling, but because the way he talks about patients is so unacceptable.

So I think the real conversation you need to have here is with your boss and HR about that piece of it. This is well beyond write-up territory.

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{ 574 comments }

{ 574 comments… read them below }

      1. Carl Dean*

        The worst of it is that it seems like Ross is dealing with vulnerable people who need help. It’s one thing to be a salty lazy “can’t even…” employee at the hardware store or whatever.

        But for a “clinician who goes into patient homes and provides very essential, highly skilled needs” – F this dude.

        Can you imagine being rural and in need of an “essential” in-home assessment…and you get this guy? Can you imagine how rude and detached and disrespectful and ineffective he is?

        He needs to be fired immediately. There is no scenario where he is serving people effectively.

        2. Christine*

          I absolutely would not want someone like that as a caregiver under any circumstances, much less alone in my own home.

    2. Where Wolf?*

      I read your statement as ‘shown the floor’ and was happily in agreement, like ‘heck yes, slam him into the floor for the disrespect he shows patients and management’

      1. cardigarden*

        hahaha honestly that too. Like, after he’s said all of that, you’re still okay having him with patients???? And that’s even before him being rude to the scheduler!

        1. Terry*

          At this point you have allowed him to act this way for long enough it may be hard for HR to stand with you on firing Ross. if he sues over termination his attorney will argue his behavior has been acceptable to this point and you have changed the rules without notifying him.

          I believe Ross should be terminated, but you are going to have to do more work to build a case to let him go. Notes in his annual review are not enough. He should have been written up multiple times by now…which would then justify his termination

          1. ad astra per aspera*

            IANAL, but I’m pretty sure that even if that *were* the case (changing the rules without telling him) wouldn’t be illegal unless there were contracts/unions/etc involved (or he’s in one of the few not-at-will states).

    3. Tio*

      Serious question, does HR have the whole picture here? Do they know about the refusals to see types of patients and everything else, or just this incident? Ebcause it sounds like OP has been treating this like a personality quirk, a note on his performance review and not the big, serious issue it is. The previous comments and other issues need to be brought to HR before this sit down, so that HR understands what the actual scope of the issue is. I suspect right now they think this is just a guy trying to avoid a rural patient day – in part because OP was not escalating and treating the other issues as serious enough before!

      1. HonorBox*

        This. In a situation where Ross just refuses to drive to see a rural patient, perhaps a write up is the correct course of action. But all the additional details need to be shared with HR so they can understand the reality. HR should understand that the approach Ross is taking may end up causing larger issues for the entire business.

        1. Bunny Lake Is Found*

          I’m not sure the refusal itself warrants a write up–but the refusal PLUS the rudeness and calling having to do his job “harassment” definitely does.

          If he just said “I cannot do that assignment”, then that feels like a discussion about Ross understanding the requirements of the role.

      2. Grumpy Elder Millennial*

        Exactly. If HR and OP’s boss aren’t aware of the larger problems with Ross, it makes sense to be super clear about it now. Tell them that there are X, Y, and Z issues, this is how you’ve been trying to handle it, and now you’re increasingly concerned that he can’t do the job you need even with serious coaching.

      3. Momma Bear*

        Agreed. I think OP needs to lay out how this has built up and his refusal to do this job is just one part of his overall problems with attendance, scheduling, accepting all job assignments, etc. This is not just being snarky with one scheduler one time. I really think he needs to go find a different job. I wonder about his professionalism with patients and the quality of care they are receiving. If he can’t even respond to a scheduling request professionally, what other corners is he cutting to get home by 2? I’d be looking very closely at his work. I think HR needs to take this much more seriously.

        1. Princess Sparklepony*

          LW said that he does less home visits then her other clinicians. So I’m guessing that child pick up is eating into his work time. And he picks up his child at 2 pm – then what? Does he take child home, get them a snack, and then hang out until the other parent comes home? I’m just wondering.

      4. Rose*

        I think it’s clear from the letter that HR knows what is going on and is just as negligent as OP.

        They suggested a conversation where OP explain to Ross that he can’t refused to do work he doesn’t like, he can’t expect to be available in the middle of the day when he is scheduled to be working and refuse to do work based on that, he can’t push all of his less desirable work off his plate and force his colleagues to do it, and if he’s belligerent when receiving this mind numbingly basic feedback, *maybe* he will be written up.

        Oh, and on top of all this he should get time to calm down because he’s worked up from extremely rudely telling the person who’s job it is to schedule his work that he’s not going to do what he was scheduled for.

        Literally every one of these behaviors is a firing offense or at best “this is your first and last warning” offense on their own.

        HR and OP have both dropped multiple balls here.

      5. Aitch Arr*

        This.

        If HR doesn’t have the whole story, give it to them now.
        I bet they’d change their tune about just giving a write-up.

        Ross is a glassbowl.

        1. Reluctant Mezzo*

          He needs to be fired. Now. He’s impacting patient care. If a patient goes south because of his failures, and HR is aware of his awfulness, lawsuits can be bad.

      6. Manglement Survivor*

        Make sure you get all the details to HR. The combination of the awful things he’s saying, his refusal to work as directed, and his general attitude all seem to be grounds for dismissal.

    4. Laser99*

      I’m also side-eyeing HR. He used “scary words”? This isn’t fourth grade, it is very serious matter. The scary words here should be “You’re fired.”

      1. Silver Robin*

        I think the “scary word” here is “harassment”, not the way Ross is talking about patients or doing his job. Ross is trying to frame OP doing their job as OP harassing Ross so that he can put OP on the defensive, since an accusation/investigation into workplace harassment is a serious thing.

        1. MigraineMonth*

          That was my understanding as well. He’s pulling some DARVO shit, but HR is saying that they understand that he is in no way the victim here.

          1. Irish Teacher.*

            And he sort of did the same to Monica, in a much less serious way. “Nice try though” implies “hah, you tried to take advantage of me/pull a fast one, but I see what you did there.” The reference to harassment takes it into scary territory, but I get the feeling that implying he’s the victim and that everybody else is making unreasonable demands of him is a regular ploy.

            And it’s one that often works, if only because of the shock factor here. It’s bizarre enough to have somebody straight up refusing to do their job, but to have them claim their boss is harrassing them by asking them to do it. That’s not something most of us expect to have to deal with.

        2. Tio*

          That’s how I read it too. I mentioned above – I don’t think OP has even brought the way Ross is treating the other patients outside the rural issue up, so I don’t think that’s even on HR’s radar.

        3. GythaOgden*

          Yeah. Lucy Letby used it to try and stall the investigation into the babies dying on her shift. She also tried to play the anxious victim during her trial but thankfully there was documentation to put her away.

          Ross is NOT doing what she did, but I can definitely see why HR might be nervous. However, they also need to do their job, and the case against Ross needs to be solid.

        4. MCMonkeyBean*

          I agree that is what HR meant. They need to ignore that entirely though I think–aside from the fact that people often use “harassment” in a way that does not fit the legal protection definition–literally no one would agree with him that his boss insisting several times “no, we do actually need you to do your job” qualifies as any kind of harassment. HR should not factor that into the equation at all! This is way beyond “maybe a write-up” territory, and he needs to be fired yesterday!!

      2. MellyBel*

        Considering he’s a clinician he must be regulated by a state college or AMA. Are there not guidelines that he must follow?

        You said you OP mentioned they also did his job before, implying they are also a clinician, and may also have a duty to report Ross. This is impacting patient care and there need to be bigger consequences than just a write up…

    6. B*

      I wonder if he’s getting handled with kid gloves partially because staffing this kind of work is very hard these days.

      1. MigraineMonth*

        Unfortunately, keeping an employee this toxic is going to cause the good employees to leave. I’m betting that everyone’s lives will improve once he’s gone, even if the caseload does increase a bit.

        1. Where’s the Orchestra?*

          I am living this right now. We have two crappy folks on my team right now, and the rest of the staff is really getting sick of picking up their slack (and I as the team lead who has to keep triple checking every thing these people touch am also annoyed). We’re in the document the issues phase of getting rid of the worst of the two now. And I’m hoping we don’t loose anybody while we finish the process of getting rid of these two.

      2. Seeking Second Childhood*

        Patients find new providers to avoid staff like this. In places where patients have no options, some will skip medical care to avoid staff like this.

        Ross is in the wrong profession.

        1. TJ Morrison*

          Agreed, I once changed offices I go to because I overheard someone making fun of a patient loud enough I could hear it in another room through a closed door.

    7. MtnLaurel*

      Yes please. I would NOT want him providing in-home care for my parents (or really, for any other human being).

      1. No Longer Working*

        I really wonder how he treats patients! He has a terrible attitude and is extremely disrespectful and downright disdainful of them, so I can’t imagine he is caring and kind with any of them, actually. And the patients are probably afraid to speak up and complain about him to the clinic.

        1. MassMatt*

          “Ross” is an overall good clinician;…”

          No, he really isn’t. LW mention tons of awful behavior he is engaging in to his SUPERVISOR, and to his colleagues. His behavior towards patients, away from scrutiny, is undoubtedly far, FAR worse.

          Ross needs to be fired.

    8. goddessoftransitory*

      Why is Ross-elby the Scrivener even in this line of work? It sounds like he actively despises it, and it would be better for all concerned if he found more fitting employment.

      1. Dust Bunny*

        I wonder if this is a) one of the few job sources in the area and/or b) one of the few industries desperate enough to not have fired him already.

        1. metadata minion*

          Yeah, this type of position is desperately short-staffed in a lot of places. I’m still vaguely baffled that there isn’t anything else for him out there, but maybe he got the training thinking he could get a job easily and didn’t really think about the reality of dealing with sick people and bodily fluids all day. (Which is not to excuse his behavior! He needs to either learn to deal with the reality of his job or find a new one. But I can see how someone could end up stuck in that situation.)

      2. Princess Sparklepony*

        I also thought of that. Although saying “I would prefer not to” at least isn’t as rude as what Ross does.

    9. Cat Tree*

      Just based on the headline I was thinking he probably needs to be fired. Then I read through and it was worse than I imagined!

    10. Heck, darn, and other salty expressions!*

      If this person is a healthcare provider they have a code of ethics they are compelled to follow. The disrespect he is showing his coworkers and clients is a clear violation of pretty much every healthcare profession’s code of ethics and if reported to the licensing board for his profession he would be looking at disciplinary action that could include suspension or revocation of his license.

      1. MK*

        No, he would not be suspended or revoked for this.

        He needs to be fired. No other consequence is relevant.

      2. Burger Bob*

        You have a wild overestimation for how strictly licensing boards enforce “professional ethics.” They definitely do not take people’s licenses for being rude. You’re lucky if you can get them to take someone’s license for actual malpractice. Licensing boards usually try to err on the side of giving people second chances and re-education. You usually have to screw up really flagrantly and demonstrate little to no remorse to get them to go through with de-licensing you.

        Employers, however, are often far less lenient, as is perfectly acceptable. Repeated demonstration of contempt for clients in a care-providing profession is definitely a reason many employers would choose to fire an employee, and that is what should happen to Ross if he doesn’t make an immediate turn around.

    12. Random Dice*

      Are they waiting for him to ACTUALLY stab a patient before firing him?!

      Oh, it was just stabbing the hand, let’s put a mildly rebuking comment in his personal file.

    13. LinuxSystemsGuy*

      I have to think that this is one of those situations where replacing Ross is going to be incredibly difficult and scheduling/patient care is going to suffer in his absence so everyone handles him with kid gloves. To which I say you need to fire him anyway and it sucks.

      No matter how much trouble firing him will cause, he’s creating more trouble as it is.

    14. Anne*

      I am HR in Behavioral Health. Any staff who treated their job and our clients this way would be termed.Period. Full Stop. If they are licensed – LMSW, LPC etc., there is a good chance we would report them to their board for client endangerment for refusing to see a client in crisis. I don’t know Ross but he makes my skin crawl – he should not be in this profession.

  2. Dust Bunny*

    Fire him. He’s so far out of line he’s in the next county.

    Even if his caseload lands in everyone else’s lap, I bet they’ll like it better than listening to him be rude and shirking duties.

    1. Czhorat*

      His caseload is already landing with other people. The problem is that it’s just the BAD part of his caseload.

      This is TERRIBLE for office morale. In every job there are tasks which are less pleasant than others; imagine taking your share of those AND part of Ross’s share because he’s been too much of a jerk about it for the boss to force it on him.

      1. goddessoftransitory*

        Exactly. He’s modeling “office jerk who gets away with everything,” and his coworkers will have all the incentive they need to bail and find other jobs without Ross.

        1. Where’s the Orchestra?*

          Or they won’t bail and will turn into another Ross because they see him getting away with it.

      2. Rose*

        Totally agree this is killing moral whether OP knows it or not. I’ve been in this situation more than once and everyone sees it for what it is.

        I disagree on one thing: he’s not too much of a jerk to be made to do anything. He’s a jerk, and OP is choosing not to stop it.

        There is no reason to entertain his 100 excuses every time he doesn’t want to do something. There’s no reason to justify to him why he needs to do his own job. This isn’t a debate or a negotiation. He can do his job, or he can leave the company, voluntarily or otherwise.

        To OP and anyone else in OPs shoes: your smart employees see you as the problem for allowing this person to decline to do their work and letting the responsibility fall on other staff members.

        1. Where’s the Orchestra?*

          The only thing I wonder about is what is the firing documentation process at this medical agency. I’m medical adjacent and there is a very formal process to fire anybody at our agency, it wouldn’t surprise me if there is also a formal process where OP and Ross work.

          What OP needs to do is get HR on board with starting that process on Ross now.

          1. Annie E. Mouse*

            That’s probably true, but it doesn’t excuse the fact that OP has let it go on for this long without managing it.

        2. SopanoH*

          I’m seeing a lot of weaponized incompetence in his statements. I’d almost guarantee he knows how to do everything he says he can’t. If he really didn’t know, he’d learn. That’s how it works in healthcare.

    2. Margaret Cavendish*

      Definitely. In addition to not doing his work, being rude to the admin staff, and being disrespectful to patients – he’s also bringing down the morale of the rest of the team. Guaranteed they’ll be happy to see the back of him as well.

      1. Chauncy Gardener*

        Came here to say this! His behavior is just unacceptable on every level
        He needs to be fired immediately.

      2. MigraineMonth*

        We know he’s disrespectful talking about patients behind their backs, which requires more investigation. OP, have you reached out to his patients to find out if he’s being disrespectful to their faces as well? Someone who feels comfortable being this rude *to his own boss* is probably not treating people in his care that well.

          1. Jasmine Tea*

            Many years ago I went to a chiropractor recommended by a friend. On the second visit I was sitting in the waiting room when the doctor came out and checked the list to see who was next. She said, “ Oh Mrs. X is coming in. We all know there’s nothing wrong with her.” That was my last visit to that chiropractor!

    3. MD_dog mom*

      I could have written this. I am in the middle of my own HR nightmare with an employee. Their performance has fallen well below their peers. After an awful meeting I attedned with them , where they were unpreppared, rude and just unprofessional with a client, I had a call with them. I phrased it as “is everything OK, because your performance in the past few months has been belwo whee I need you to be”. What followed was defensiveness, told me they were the best one on the team, their performance was great what was I talking about.

      So I called in HR and we had a call. Then it became that my expectations were too high (even though their 7 colleagues had no trouble meeting them) and that they were never sure what they should be doing. So I made a list of expectations and went over it with my team. All was quiet for a few weeks, and then I asked them to perform a task for an angry client. A very common ask that I most of my team does pro-actively. I was formally reported to HR for harrassment. Now there is an investigation I have to go through,a nd I can;t talk to them without HR present. Their performance still sub-par, but we have to get through the investigation first. It’s infuriating

      1. Grumpy Elder Millennial*

        Ugh, that sucks. Hopefully having HR present for all your interactions with this will mean that HR gets an accurate read of the situation.

      2. Sloanicota*

        Unfortunately, is some fields there’s such a shortage of people capable of the work (and I’d guess the medical field is one such, right now) that jerks get away with a huge amount of accommodation, because they know and management knows that likely no competent replacement is available.

        1. The Cosmic Avenger*

          But if the job market in that sector heavily favors the employee, then they’re almost definitely going to lose more than one high performer if they keep the one malcontent!

          1. Where’s the Orchestra?*

            This right here – the folks with options and good performance reviews will bolt at their first opportunity to get away from Ross and the management that won’t do anything about him.

      3. NotAnotherManager!*

        Why do your worst performers always think that they’re doing great despite routine feedback to the contrary? It always blows my mind when, after doing three after-action reviews – and clearly stating that their current performance is not acceptable for X/Y/Z reasons and cannot continue, how can I help them improve, and that performance must improve – that they are shocked, SHOCKED when HR shows up for a final notice meeting and gesticulate wildly about being caught off guard and having no idea it was coming.

        1. Irish Teacher.*

          That’s why they are the worst performers; they make no attempt to improve because they think they are already perfect. Most people who realise they are underperforming are likely to make some effort to improve and while it is definitely possible to be trying your best and just not be in the right role or to have other issues (health issues, family problems, etc) that prevent one from doing their best, there is a level of bad that is hard to attain if you are making any effort whatsoever.

      4. Boof*

        This is wild, is there no way for HR to see they’re being used and put the breaks on punishing you for properly managing a bad employee? Can’t they take one look at the evidence and see there’s no harassment??!

        1. New Jack Karyn*

          There’s probably a very formalized, lock-step process for dealing with a harassment claim. Imagine a scenario where a worker isn’t the greatest employee, but actually does receive genuine harassment (completely unlike MD’s situation above). HR still has to go through their process, even if their initial impression is that it’s hogwash.

        2. Burger Bob*

          For legal reasons, HR will usually still go through the process of investigating reports of harassment, even from a disgruntled employee who they suspect is making things up out of spite, because if the employee inevitably winds up fired, the company wants to be able to show that they did in fact follow all of the same procedures with them as they do with any other employee and gave a full investigation to their harassment reports. If they don’t do the process and document the findings, they are leaving themselves open to a potential lawsuit, because they won’t have any documentation to support the true version of events.

      5. Firefighter (Metaphorical)*

        I know this feeling very well! You might want to check out Martin Smith’s work on “extreme and difficult behaviour” as a lot of what you’re saying here resonates with some of his framing. I’ve found it really useful, even though I am still quite stuck with my own difficult employees.

        Good luck.

    4. Momma Bear*

      And even if his cases end up with others, at least they get seen. This patient ended up being taken off the schedule that day because he refused and it went back and forth too long. If I were that patient or their family, I’d be livid to have an appointment and then…not. What is the consequence to that patient now? I realize that OP wanted him to do that job, but I would have reassigned it much sooner and written him up for the refusal.

      1. Bunny Lake Is Found*

        I was thinking the same thing. What to do with Ross is an issue, but in the meanwhile, LW needs to focus on the client care (and the morale of her other staff) rather than how to best get Ross to do what he doesn’t want to. It seems like LW is going to end up accommodating Ross anyway, so why waste all this time and make it harder on everyone else?

    6. ENFP in Texas*

      “He’s so far out of line he’s in the next county.”

      …or Timbuktu.

      I really wish I knew that telling MY BOSS “I don’t want to do it so I’m not going to, stop harassing me” was an option.

      Oh, wait, that’s because it’s not…

    7. Where’s the Orchestra?*

      “ Even if his caseload lands in everyone else’s lap, I bet they’ll like it better than listening to him be rude and shirking duties.”

      They are already pulling his case load – it will be easier without Ross’s dead weight.

    8. Rachel 2: Electric Boogaloo*

      Just reading the title of this post, my first thought was “And why is he still your employee?” He definitely should be fired.

    9. EvilQueenRegina*

      He’s so far over the line, he can’t even see the line. The line is like a dot to him!

      1. miss_chevious*

        Thank you for this, my MOST FAVORITE Friends quote, that I thought no one knew but me. And so apropos in this situation!

  3. A. Nonymous*

    This is a great reminder to a lot of commenters here that a sassy, movie-ready attitude very rarely translates into professional behavior.

    OP, fire this loser.

    1. Sloanicota*

      Yeah I always think about House – a show I actually enjoyed! – dodging clinic hours and sassing his supervisors, or The Mentalist – a show I also enjoyed! – sassing … everyone all the time. Lots of other examples out there. A lot of things are funnier on TV when you’re imagining being the character versus real life where you’re the coworker or boss.

      1. ferrina*

        To be fair, the Mentalist was a fake psychic to start with, and presumably self-employed. If you’re going to make a career of being sassy to supervisors, that’s probably the best career move to make.

          1. Sloanicota*

            True, and this makes me realize the “sassy consultant” is a whole genre of its own, like back to Sherlock and probably earlier (I forgot the Mentalist didn’t work for the police when I named him). Still, House gets a W-2 and there are plenty other examples.

        3. gyrfalcon*

          Wait, the Mentalist was a fake psychic? (Naive and gullible, that’s me.). Well here’s a good reason to hunt up all the episodes and watch the whole series start to finish.

              1. Relentlessly Socratic*

                OMG, I absolutely adore Shawn! He’s handsome, funny, and if I met him in real life, I’d never give him the time of day. (See also Bruce Willis in Moonlighting and Bill Murray in every role he’s ever played.)

            3. Nobby Nobbs*

              AND characters besides The Main Dude are occasionally allowed to be right, which is the main reason I start craving Psych after about three episodes of The Mentalist. It’s such a low bar, and yet…

          2. AnotherOne*

            the whole idea of the show was that he was a mentalist- it’s a type of magician.

            it’s one of those where it was all in the title except most people didn’t know what it meant and i think it only got explained in the first episode. (or that might have been the only one i watched.)

            as opposed to psych- where he was a fake psychic. there is a slight difference between mentalist and psychic.

            1. Bruce*

              Back before Harry Anderson was on Night Court he and his first wife Leslie Pollack toured around, they came to my school and did an show in the student lounge where he did sleight of hand and she did a mentalist stunt. She picked a group of people from the audience, had them go out and drop off a person somewhere on campus. When they came back she stepped outside with them and just by observing them was able to hunt down the person in their hiding place. _Assuming_ she did not have a shill it was pretty impressive, though she made no claims at all that she was actually psychic, just very observant.

          3. Burger Bob*

            It’s a good series for the first handful of seasons. Then you start to really wish they’d wrap up the main villain story already. Then they finally do and it’s very clear that they didn’t really have a plan from the beginning, so the reveal kind of leaves something to be desired. And then I gave up on it because it just wasn’t as interesting to me once the Big Bad had been dealt with. But yeah, I did really enjoy that first handful of seasons.

      2. JamieG*

        What I appreciated about House is that he didn’t always get away with it. There were definitely times he had real repercussions for being awful.

        1. Dahlia*

          Yeah, House went to prison. And was constantly being sued. And pretty much couldn’t get a job anywhere but the one hospital he worked at.

          1. Bunny Lake Is Found*

            And was legitimately a genius who got results. The problem is too many people think they are so good at what they do they can get away with acting like a jerk–when they are just middle of the road.

        2. Bunny Lake Is Found*

          Agreed. I also think because having a fellowship with him was presented as a career making opportunity, it made a lot more sense why it was tolerated. When the original 3 left, there was a line also where House said “I can’t believe I had the same 3 fellow for 2 years” or something, so it was clear that most doctors held the fellowship for only a short time before moving on to other roles. Additionally, it seemed his fellows often wrote and published articles about the cases, which would boost the profile of the hospital.

          Interestingly as well, on one random re-watch of a set of episodes, I clocked that House’s fellows did a surprising range of procedures–it seemed like House didn’t trust nurses and most of the other doctors in the hospital wouldn’t work with him. So if only the fellows really had to deal with him, and making it through a year with him would basically “make” their career, it kind of makes sense his behavior was tolerated.

          1. Batty Winged Bat*

            Yeah, that was the gist of it. It did make their career to survive working with House, so that’s why the fellows all grit their teeth and did it. And House was not on good terms with anyone else in the hospital (apart from Dr. Wilson and, somewhat, Dr. Cuddy).

          2. Nightengale*

            There is nothing in the way House portrayed fellowship that even remotely represents how medical fellowships work in the US. Fellows are generally just out of residency and so specialty trained and are now getting trained in a subspecialty. The program has to be accredited and have multiple faculty and the training experiences are pretty codified, with decreasing supervision over time. Most programs last 2-3 years. Fellows do not do their own patient transport, MRIs or DNA testing.

            1. Bunny Lake Is Found*

              I mean, it was pretty clear that NOTHING in that whole department functioned like a normal department.

              But the original fellows did already have specialties. Foreman was a neurologist, did a residency in California. I believe Cameron was actually an immunologist. I kind of can’t recall about Chase, but I swear somewhere in the first few episodes they mentioned some sort of speciality.

              Can you tell I may have binged this show while studying? It makes fantastic background.

              2. Nightengale*

                Nothing in that hospital functioned like actual health care or health edcuation. The diseases were a lot closer. That is I yelled “hospitals don’t work like that” more than I yelled “Disease whatever doesn’t work like that.”

                To be really pedantic, they already had subspecialties or at least some of them did. Cameron would have gone med school, residency in internal medicine, fellowship in immunology and then this fellowship. Internet tells me Chase trained in both cardiology and intensive care, which means med school, then residency in internal medicine, than 2 fellowships before this one. Foreman would have done a neurology residency (which includes one year of internal medicine and 3 of neurology). And they were all shown as both young and as experts in their fields. . . Grey’s Anatomy is even worse about this though. One of the (supposedly young and conventionally attractive) doctors is supposed to be the foremost expert in 3 areas of medicine that require 6 years each of training after medical school.

      3. Batty Winged Bat*

        To be fair, Patrick Jane/The Mentalist was sassy, but he was also heartfelt and had an incredibly tragic story, so he was still pretty likeable. House…is another story lol.

    2. Mangled Metaphor*

      “Sassy, movie ready” has a lot going on behind the scenes (pun intended). There are teams, legions of writers and script editors working to ensure just the right level of sass is believable and (more importantly) just likable enough. Knowing when to display vulnerability so the character doesn’t become a hate sink is key too.
      And all this is done by knowing exactly how *every other character* thinks and feels. Something no real human is capable of.

      Oh, and the best witty one liners almost never happen in real time – that’s what showers several hours later are for.

      1. goddessoftransitory*

        Or snortling awake at 3 a.m. as your brain suddenly declares “Oh! You shoulda said THIS!”

    3. Stuckinacrazyjob*

      I would like to submit that what we say online is not what we do irl. me online: yea! twirl on them bosses! me irl: ( my dislike of my work nemesis started because she complained too much about our pay to our boss during work tacos)

      1. Sloanicota*

        I was thinking specifically “nice try tho” is sassy (it’s also rude, obviously). I can imagine a lovable rogue character saying it on one of these types of shows and having it come across more favorably than it does in this story, and was thinking this employee may also think they’re getting away with it with panache.

        1. Bunny Lake Is Found*

          Yup. Can literally hear Hugh Laurie in my head now…hell, I can hear Donna from “The West Wing” saying “Nice try, though” if Josh was trying to get her to do something she thought was ridiculous (but she would never say that about something that was actually part of her job).

        2. talks about running too much*

          As a clinician – his behaviour towards his patients is disgusting. In a good department, he would have been issued a ‘first and last warning’ the very first time he said something like this. I’m a little concerned that HR wasn’t already aware of this!

    6. goddessoftransitory*

      The entire point of TV and movies is that it’s fantasy–even when presented as “in the real world.” Unfortunately too many people seem to think that behaving like you have a staff of writers and are the star of your own show is cute and funny.

      Mimi on The Drew Carey Show? On the show, a hit comic actor. In real life, unemployable.

      1. Clare*

        And that’s why it’s funny! Because it’s unrealistic. Babies are hard wired to laugh at unexpected and new things. This encourages them to seek out novelty and therefore learn. As we get older, peekaboo isn’t new anymore, but behaving appalingly in social situations is. There’s a reason why it’s unexpected though…

  4. Siege*

    Ross needs to be fired. I cannot imagine sending him to interact with vulnerable people he thinks are scary and/or gross. I also can’t imagine assuming he provides good care with all the demonstrated hostility and unprofessional behavior.

    1. ferrina*

      Yes! This cannot be understated.

      Ross is refusing to provide patient care.

      Refusing to do work that’s clearly in scope, been assigned to you, and has serious health ramifications for your clients….that’s a really, really big deal. Frankly, someone who refused work this way would be fired at my firm.
      If he’s actively refusing patient care to your face, what is he doing behind your back?

    2. Esti*

      I never comment but I feel compelled to on this one. My mother just went through a medical issue that required some home visits from a nurse, and I would be absolutely livid if I found out the agency knew the nurse talked and thought about patients this way and still sent them into her home to care for her when she was incredibly vulnerable. OP, this situation stopped being a Ross problem a long time ago and is now a You problem: you are failing in your responsibilities to your organization’s clients, and to the other clinicians you manage who are being forced to pick up Ross’ slack and deal with his attitude. As soon as you deal with the immediate situation with Ross, I suggest you spend some time reviewing how things were allowed to fester for so long and thinking through what interventions you should have made earlier and how you’ll make sure you handle it differently next time.

      1. Marty J*

        Yes yes yes – this. I really hope OP reads these comments and internalizes them. My heart hurts thinking of vulnerable patients being put in this guys care.

      2. Kindred Spirit*

        Yes! This made my blood boil. I, too, have had a couple elderly family members who needed in-home services for a time. One of those family members had dementia, and that certainly adds a layer of challenge for the visiting clinician. I expect nothing less than professional conduct, respectful behavior and compassion (!) from service providers. If they can’t do that, they need to find another line of work. Period.

      3. Velociraptor Attack*

        Absolutely, the comment that Ross is a good clinician really raised my hackles. No. He absolutely is not. And OP is doing patients a huge disservice here.

      4. sometimeswhy*

        Yep. If I learned someone like this was caring for my parents, i would go after them, their boss, their boss’s boss, the head of their organization, and their board, if they had one, and all of their licenses. Just absolute scorched earth.

        1. AnonForThis*

          I had an elderly relative who was neglected by a similar health care company and ended up having to have a leg amputated. $12 million later…I bet the company wished they had paid more attention to the people they employed. (3 other families had a similar issue…and I proudly can state that this is a FORMER health care company).

          The company really needs to pay attention. There are serious consequences for them if they keep sending Ross out to half-@$$ his job. There are also serious consequences for the patients and families. (My relative was dead within 2 months of amputation – and it was entirely preventable had she received reasonable standard of care).

          1. sometimeswhy*

            Just tragic. I’m so sorry you and your family and your family member went through that.

            My parents just moved into a transitional (independent > assisted > nursing > hospice) living facility. They’re still on the independent end of that sequence but they’re both older than all my grandparents were when they stopped being able to care for themselves so it’s on my mind a lot.

          2. Polly Hedron*

            My relative was dead within 2 months of amputation – and it was entirely preventable had she received reasonable standard of care

            They should be in prison for manslaughter.

    3. Collarbone High*

      And it sounds like he’s seeing them in their homes with no other medical personnel observing his interactions with the patients, making them even more vulnerable.

    4. sulky-anne*

      I suspect the groups of people he finds “scary” and “gross” may also be people who are already marginalized by the medical system, whether because of their medical conditions, other structures of oppression, or both. I would not want to force those people, who may already have significant medical trauma, to be treated by someone who is so outspoken in his contempt for them, possibly alone in their homes. I feel for the letter writer because I imagine there is probably a lack of qualified practitioners, but Ross is likely causing harm to patients.

      1. Relentlessly Socratic*

        I am resisting writing fan-fiction, but I could hazard a few guesses at who he finds scary and gross.

        And I got news for ya, as someone who I’m pretty sure falls on his gross list, his attitude will be palpable to his patients.

        1. AnonForThis*

          There is a zero percent chance that his patients don’t pick up on his disgust.

          The sad part is that not all of them realize Ross is the problem.

    5. Hks*

      yeah I’m just imagining how upset my elderly parent would be if the visiting nurses that come to them were this rude.

  5. king of the pond*

    “If you have to force Ross to handle their cases, are they going to get the type of empathetic and respectful care you presumably want them to receive?”

    The patients Ross finds “gross” or “scary” are just the ones you know he doesn’t care for — I would be concerned about the quality of care he’s delivering even to those he hasn’t shown open disdain for.

    1. BubbleTea*

      I used to know someone who worked in a care capacity for people with significant care needs due to disability and the way he talked about them was disgusting (made even worse by the fact that the group we were part of contained the parent of a disabled child, and the spouse of a disabled adult – he wasn’t even spouting his vile views to people who he could assume agreed with him, he KNEW he was talking about loved ones). If I’d known who he worked for, I’d have reported him.

      1. Georgia Sands*

        Sadly this is very, very common with people who work with disabled people – you think that spending more time with a group of people would make you less bigoted towards them, but for some reason this attitude is everywhere with care providers, disability advocates, etc

        1. goddessoftransitory*

          Weirdly, I just watched the X Files episode Elegy, that dealt with this very subject. A nurse who’s a veteran at her hospital has started stealing a patient’s medication, tells him she’s poisoning him, that he’s hideous and unlovable…just a nightmare (and that’s not even getting into the terrible rash of murders part of the show.)

        2. Kella*

          This is why when I call someone out on ableism and they say “What?! I’m a caretaker for disabled people!” that I am immediately 10 times more distrustful of them. People who are responsible for the well-being of disabled people often see them as objects and tasks to complete, not humans to support and enable.

    2. Random Bystander*

      Very good point. Just another reason articulated as to why Ross needs to be fired immediately. Between the blatant insubordination and the refusal to do actual job duties, I’m struggling to see why he is being kept for any further chances.

    3. Spero*

      Or that he wasn’t expecting to fall into his ‘gross’ category. Ex if he expects that x patient does not have a type of disability he objects to and then shows up and x patient’s mom DOES have that type of disability how is he treating x and x’s mom?

  6. Fluffy Fish*

    ““Ross” is an overall good clinician”

    It never ceases to amaze me that so many LW start with a version of this and then immediately list all the reasons the individuals is in no way good at their job.

    OP Ross may be “good” with certain clients but the body of his work is most certainly not good. He is not a good employee and he is not good at his job. Once you reframe that, and remove the “but he’s a good clinician” what to do becomes a whole lot clearer.

          1. SHEILA, the co-host*

            I am fine with you being evil from home as long as I continue to receive regular reports of your evil doings.

    2. kiki*

      Yes! I was going to say that there are so many seriously bad things shared in this letter, I don’t see how this is possibly true. Unless the bar for clinician performance is on the absolute floor.

      1. ferrina*

        The technical skills for clinicians are more important than at a lot of other professions. For example, if someone has low technical skills at my job (consulting), the worst that happens is a corporation makes a weird decision that they may or may not have been planning to make anyways.

        If someone has low technical skills as a clinician, there are misdiagnoses (causing delays in medical treatment, which can be terminal), there are treatment issues, including wrong dosage, wrong administration, or treatment interactions (which can range from mild to terminal), and those are just the common, every day mistakes.

        So technical skills are really important. However, when a clinician is actively refusing to see patients, the technical skills are irrelevant cuz they aren’t using them anyways.

        1. Bunny Lake Is Found*

          Exactly. I remember when this letter happened: https://www.askamanager.org/2023/05/i-cant-fire-my-bad-employee-so-how-do-i-manage-them.html

          People kept being like “fire the guy” and not understanding that “Clinician isn’t completing their notes and so we can’t bill” is a problem….but when the alternative is “No clinician, so fewer patients get treated” or “Clinician with poorer clinical skills takes over and people may get poorer treatment”, you are not firing the dude who sucks at paperwork. You just aren’t.

          Ross, however, is not Grover. Ross may be a good clinician when he chooses to be, but he is actively choosing to NOT see certain clients, avoiding dealing with certain ones he finds distasteful, and (worst in my opinion) he is clearly demonstrating his contempt for both the patients and his colleagues. Ross knows you can’t likely easily replace him, so this behavior is going to get worse.

        2. Kyrielle*

          Yeah. I hate to say it, but as someone who needed in-home care when in recovery from a medical event, I’d rather have a skilled asshole than a polite idiot…but I’d *rather* have someone who is skilled and not actively rude, and definitely rather have someone who showed up. When you need the help – especially if you need it badly – the assessment and intake being delayed is scary, especially if you’ve just been released from a hospital or facility stay and have gone from “I can’t even sleep because they check up on me in the middle of the night” to “radio silence for a week”.

          (NOT the fault of the providers, in my case…I was always going to have a quiet weekend, which would have been fine if not for the *historic ice storm* that hit before they could get to me the next week…and also delayed all their *other* patients. Sheet ice is better than black ice, but I don’t want to make anyone drive on either for even high-priority routine care. It was still stressful for me, though, and I can’t imagine if it had been just…for no reason, as far as I could tell – which I assume is what that rural patient knows about why their intake was canceled/rescheduled.)

    3. Dust Bunny*

      Seriously.

      At best he takes good notes and knows what he should be doing, but he’s crap at applying it, even when given the easiest patients, and his attitude is garbage. He’s not good at his job.

    4. Frickityfrack*

      Seriously, why does that always happen? I swear, it’s like 99% of letters that start out that way, I end up internally screaming “FIRE THEM!” halfway through. I feel like so many people work in places that are so dysfunctional that they entirely lose perspective on what’s ok. This man is not good at his job and management should’ve had him on a PIP already, if not just outright getting rid of him.

      1. Fluffy Fish*

        Dysfunction certainly plays into it a lot.

        I think to, from my own experience, that most people behave like normal, rational, decent people. And most of us think, naturally, well of others. So when the Ross’s of the world pull this crap, people try to justify and rationalize it because they can’t fathom that some people are just crappy.

        2. MigraineMonth*

          As storytellers, I think people naturally want to understand the “why”. Surely this is just a puzzle, and if we figure out the right answer, the other person’s behavior will a) make logical sense and b) improve. Jerks take advantage of this by insisting that they have a reason, and you’re the bad person for not being sufficiently empathetic.

          As Alison has pointed out in the past, it can be fun to speculate on why that person acts the way they do, but in the end the only question is if they can do their job well with reasonable accommodations that they request.

        3. Uranus Wars*

          Yes, I had a Ross once and just kept seeing one-offs. And overall I want people to succeed…
          I was actually writing a letter to Alison that made me realize what a train wreck it was. When you start listing the one-offs you start seeing a pile of pebbles that have managed to construct a mountain that can be hard to get out from under quickly.

      2. Sloanicota*

        Well honestly, if you’ve had a sweet employee who just doesn’t have the technical abilities, you start thinking a good attitude doesn’t count for much if they miss diagnoses or can’t administer medication correctly. I do think it’s possible Ross does certain parts of the job well while having an overall crappy demeanor; it’s up to OP and the org to realize that’s not enough.

    5. Observer*

      ““Ross” is an overall good clinician”

      It never ceases to amaze me that so many LW start with a version of this and then immediately list all the reasons the individuals is in no way good at their job.

      Yup. He’s not only bad at his job, he’s a bad clinician, if he can only handle a subset of your typical patient load.

      OP, I realize that this is probably a hard position to fill. Keeping on someone like this is going to make it harder to keep your other positions filled -and also harder to keep decent back office / admin / patient facing staff. Because one person like this can tank morale and make a lot of people’s lives MUCH harder.

    6. Kimmy Schmidt*

      “They’re good overall!” *proceeds to list 8369 reasons why they are, in fact, The Worst*

      1. MigraineMonth*

        “Yes, he dropped trou and pooped on the CEO’s desk, but at least he didn’t smear the feces on the computer!”

    7. Dek*

      It reminds me of the “Well, Sally’s a good person without a criminal record (aside from her stealing this jacket)” thing.

      Like. What metric is being used here?

      2. OyHiOh*

        The metric: Home clinician services are woefully underpaid and grueling and keeping liscened/certified high skill clinicians in cars is the most demanding part of the job for the OP and therefore, anything short of a literal zombie is a “good clinician.” Also, probably, low morale type attitudes are endemic and until the “nice try tho” episode the car full of bees probably pegged merely on the low end of the low morale spectrum, not as actively harmful.

        1. MK*

          Exactly. Home care is so, so underpaid. Hours are erratic, mileage doesn’t cover the cost of your car, there is travel in bad weather, and many safety hazards. Understaffing means NO service in many rural areas. It takes a lot to get fired. This guy needs to be fired, but make no mistake, it’s not an easy decision. Health care is in absolute crisis in the U.S.

    8. Not Tom, Just Petty*

      Dear Abby,
      My partner is a wonderful person, very smart and fun to be around. It’s only when (partner is asked to do anything outside of a predetermined list of acceptable activities) that problems arise. I’ve tried explaining how I feel and what I need, but my partner says this is manipulation or an attack. Please tell me how to make my otherwise great partner want to take an active role in our relationship and to be happy about it.
      Signed, Will Try Harder
      Dear WTH,
      Just don’t.
      Best wishes,
      The Commentariat

      1. Richard Hershberger*

        Dear Penthouse Forum, I never thought I would be writing you…

        Oh, wait! Different sort of letter. Never mind.

      2. Laser99*

        If anyone ever visits uexpress, there are many letters of this type. “My partner is SO GREAT and everything is PERFECT except for this one little thing. How can I make him stop shouting and breaking things after he has a bad day at work?”

        1. goddessoftransitory*

          There was one to Dear Prudence where a woman wrote in and said her husband was a good man except for being a stone cold racist who tormented her and her kids constantly (she was Asian.)

          My reaction was “what on earth is your definition of a BAD man?” Then I realized she’d probably met far worse in her life and wanted to cry.

          2. Grizabella the Glamour Cat*

            Oh, I know the letter you mean! That one was a trip (and not a good one, either).

          3. Irish Teacher.*

            And there are some letters (I haven’t read either of those columns but I’ve seen others) where they bury the lede. “My partner is a good person and the perfect partner except for one little thing: they leave everything in a mess and never help tidy up. I’ve tried to talk to them about this but whenever I do, they insist I am being unreasonable, that I need to get help for my perfectionism, that I will harm our future kids by not permitting them to make the slightest mess and then they stop talking to me for days on end. Is there any way I can get them to be tidier or should I just put up with them being a slob and be glad that’s their only flaw?”

            And you’re just thinking, “dude, the untidiness is not the biggest issue here!”

            (I made that up, but I’ve seen similar versions of “my partner/employee/coworker/friend is great except for one minor issue” and then it becomes clear the “one minor issue” is not the biggest problem at all.)

    9. AD*

      That line, and what follows it in the letter as you described, is so incredibly disappointing. I know commenting guidelines ask us to be respectful to letter writers here, but I CANNOT imagine being a manager of health care workers or clinicians as the OP is and just blithely skating over the fact that one of your staff is using insulting, degrading language to describe MANY patients — and somehow that’s not the main thing you’re writing in about.

      OP — what are you doing?

    10. The Original K.*

      I was thinking the same thing. “Ross is an overall good clinician.” Me: [keeps reading] “Um … he absolutely is not. Why is he still employed?”

      1. Rex Libris*

        I’m always amazed by the number of letters that basically go “X is an overall good employee… Now here is several paragraphs about why they should have been fired yesterday, if not sooner.”

        The difference between can’t do the job and won’t do the job is negligible, in the end.

        1. Bunny Lake Is Found*

          I think it has more to do with LW’s not really being able to explain what % of the job the “thing” that is the issue actually is.

          Like, when your employee, Susan, refuses to use System X, which everyone uses, every day…well, that sounds super vital and firing worthy! But when your employees are using System X to communicate with teammates about scheduling time on the “big fancy computer”, and the Susan is responsible for editing massive quantum physics equations, which she is very good at. Well, then, yeah, Susan IS overall a good employee. A potential new hire who would be killing it on System X but is only 60% the physicist Susan is would NOT be a better choice for the role than Susan, who nails the physics, but will only use System X like, 50% of the time.

          1. Relentlessly Socratic*

            However, when Susan decides that some of the massive equations are icky and gross and refuses to do them? Susan can take a long walk off a short pier and I’ll hire someone else.

          2. Wintermute*

            Thank you! We have this human tendency to want to see people as good or bad, not some of each. it’s very very possible that someone can be a skilled jerk but the skill is the important part.

            In this case, being diligent with medication, skilled at performing difficult techniques and having good clinical judgement **CAN SAVE LIVES**. being “difficult” is utterly irrelevant when the being nice and pleasant part is not the part that could get people killed. Even if he refuses to see half the people you assign, you can get other people for them, firing him might mean denying care to patients or having medically significant delays in treatment.

            I think what’s throwing us is him refusing “difficult” cases– Unpleasant cases I get, no one wants to drive for hours and no one wants to do bowel care but is he refusing people that need a high level of care because he finds the responsibility “scary”?

            I think overall we should take at face value that his clinical work is beyond reproach and he is not putting patients in danger. That changes things, especially in a field where overwork and underpay are the norm and you can face terrible choices between not serving patients at all, having people who have personal issues and soft skill problems, or people who have poor clinical judgement and are prone to accidents that could hurt someone seriously. The list of things that are true dealbreakers in this context are not being unsurly or even insubordinate.

      2. Dezzi*

        People like this are still employed because there’s no one to replace them. Full stop–the alternative to “Ross provides care to 60% of the patients we need him to see and is a complete asshole to his manager/coworkers” isn’t “we hire someone better and everything is awesome,” it’s “there is no one to care for these two dozen patients.”

        Everyone screaming OP needs to fire Ross needs to sit down and stop saying that unless they’re volunteering to take his job.

    11. Grumpy Elder Millennial*

      For sure. I think that in a lot of those cases, “good” means that they have a lot of knowledge about the relevant topics. The bits about not being an insufferable jerk don’t factor into the assessment, when they really should.

      It’s certainly possible that Ross is good with clients he likes or whose cases he’s interested in, while being awful about other people or conditions. But I wouldn’t bet on it.

      1. But what to call me?*

        I suspect this is exactly it.

        And the thing is, maybe there are roles where he could specialize in the patients he likes and be a reasonably good clinician in that role (if only in the technical rather than interpersonal aspects). There are certainly things in my scope of practice that I want nothing to do with – which is why I avoided that branch of my field. But he chose a job that requires working with patients he doesn’t want to work with and driving farther than he wants to drive, and instead of either finding a different job or sucking it up and dealing with it he decided to keep the job but only do the parts he wants, expecting everyone else to pick up his slack and put up with his attitude.

      2. MsM*

        Yeah, I strongly suspect Ross is the kind of health care professional who doesn’t bother digging deeper if he’s already formed a bias about a particular patient.

      3. Not Tom, Just Petty*

        “he sees 1/4 the clients his coworkers do.”
        Nothing about spending 4 times the amount of time with each one.
        So no. Nothing outstanding with this guy.

        1. Project Maniac-ger*

          Well he spilled the beans on himself that he stops working at 2pm every day to pick up his child so that tracks.

          1. Not Tom, Just Petty*

            OP, please not this. check his records and let HR know if he’s really been doing this. That HAS to be actionable beyond this writeup nonsense.

    12. Antilles*

      <i?Ross may be “good” with certain clients
      I’m skeptical of even this.
      I find it VERY hard to believe this guy refuses to meet patients, calls them gross, talks about how he’d vomit dealing with them, etc…then when he’s talking with them directly, the same guy is listening intently to patients, providing empathetic support, really considering patient objections, and so forth.

    13. Kate, short for Bob*

      it’s reminiscent of the “but he’s a great father” I used to hear when I volunteered in domestic violence. you’re not a good father if you hit their mother in front of them, you’re not a good clinician if you despise sick people.

    14. Ranon*

      OP is staffing for a position that is both wildly understaffed and wildly underpaid (and yes these are related but no one is stepping up to pay more either) so, on the scale of available employees, he could very well be more middle of the road than we as readers understand

      1. Fluffy Fish*

        It’s long so I may have missed it but I did not see OP indicate that they were understaffed or underpaid but ultimately that doesn’t matter.

        Nothing OP described is middle of the road. I get that there’s shortages every where, but especially in healthcare “better than nothing” can’t be a thing and especially with vulnerable populations. A clinician that actively avoids clients causing the client to suffer is not better than nothing. A clinician with an attitude problem that almost certainly carries over to clients is not better than nothing. Ross’s behavior is actively harmful.

        1. SparklePlenty*

          Having worked in health care for decades I’m here to say that sup-par care is overlooked, tolerated and Really Really Bad. Of course it’s gotten exponentially worse in the past few years. Sadly those in management are not dealing with it. Infuriating.

      2. Observer*

        on the scale of available employees, he could very well be more middle of the road than we as readers understand

        No. Because *especially* in underpaid jobs, you have to look at impact on other staff. And let’s be clear – he is having a *terrible* effect on other staff. As well as making it clear that the OP’s management doesn’t actually much care if people do their jobs. So who is going to stick around?

      3. Not Tom, Just Petty*

        I’m slightly ill at the thought of “middle of the road” meaning not actively harming people, just refusing to see people and by doing so, preventing others from seeing them.
        He wouldn’t “go to Timbuktu.” Someone had to. Others were rescheduled.
        He needs to go.

    15. 1-800-BrownCow*

      I was scrolling through looking for this same response. The whole time I’m reading this, I’m very curious where the “good clinician” part came into the story, but nothing I read would make me agree that he’s a good clinician. I see red flags all over. If Ross treats his colleagues this way and makes comments like this about his patients, I don’t even want to begin to imagine how he actually acts towards his patients when no one else is around. He shouldn’t be allowed to continue interacting with patients alone starting immediately. Honestly, I don’t even think he should continue with his job at all. He might improve his behavior with his colleagues after a strong warning, but a warning isn’t going to change his personality altogether.

    16. Shirley You’re Joking*

      Agreed but… if the service is something like running IVs in someone’s home and Ross is technically great at that, then he is actually good at the technical part of the job.

      Of course, there’s more to the job than that.

      Reminds me of a nurse who was expert at putting in tricky IVs — she got the IV in me after others couldn’t but said horrible things to me about my “sh*%y veins” and I’m still pissed off, years later. The other nurses told me she was the best at IVs. Technically, yes, but I wish I’d never met her.

      1. Bunny Lake Is Found*

        But if they just could never get the IV in, what would have been the consequences? I think that is where it comes down sometimes. If there are going to be significant injuries or deaths potentially if no one can insert an IV, then you need the person who can do it, regardless of their temperment. Even if some patients wish they never met her. Because you want people who survive and are healthy enough to recall how much they are still pissed off at the Shitty IV Nurse.

        Ross, however, is not Shitty IV Nurse. Shitty IV Nurse stepped up and did the job, bad attitude and all. Ross is doing 25% of the work of the other clinicians and being a jerkwad–and nothing LW wrote indicates Ross has some sort of exceptional skill in any area that merits maintaining him despite all the negative aspects of his job performance.

    17. Batman*

      Yes! Ross is rude and unkind in his bedside manner. He refers to patients as gross and scary and refuses to provide care or, through his scheduling shenanigans, delays their care. Ross is not a good clinician. Ross is the kind of clinician who makes patients less likely to seek care in the future.

    19. StrikingFalcon*

      I seriously doubt anyone with this attitude can be a good clinician. I see a lot of doctors for a lot of conditions, and I am confident in saying that medical professionals who have contempt for their patients cannot do their job correctly. There were the ones who ignored my symptoms because they thought I was exaggerating. The ones who got visibly irritated when I asked questions because I didn’t understand their instructions, and then treated me like a difficult patient at all subsequent appointments. The ones who did simple procedures in the most painful and uncomfortable way because they couldn’t be bothered to slow down and do it properly or didn’t listen to me tell them what doesn’t work when I’ve been through this before. I’m sure their notes looked fine, and like they’d done everything right. But I didn’t get the care I needed. And I usually had the power to just go elsewhere next time – home health patients may not have that choice. This behavior is horrifying.

    20. L*

      Reminds me of all the times a letter to an agony aunt starts with “My spouse is a good person…” and then they go on to detail that their spouse beats them.

  7. Richard Hershberger*

    ““Ross” is an overall good clinician” No, he isn’t. He may be a good clinician for those patients who meet his conditions, but he is certainly not a good *overall* clinician.

  8. Need Motivation and Mulch*

    He needs to go. Don’t be that person that keeps a bad employee because “reasons”. Tolerated bad behavior will bring down the good employees.

    1. Reality Check*

      Seconded. OP please know that the other employees are watching this, taking notes, and seething.

    2. Sara without an H*

      +100. LW, your other employees can see this happening and are drawing conclusions that you’re not going to like. Ross needs to go.

    3. Not Tom, Just Petty*

      Not piling on OP, but your comment just struck me. OP writes that Ross refused an assignment for “reasons,” and is clearly frustrated about that. And yet, you hit the nail on the head with how Ross is still there because clearly talking is the only thing that happens there. *See: HR will give him a write up. Which will go on his permanent record like the time he skipped out on study hall, I think.

  9. GirlBob*

    Good lord. If he’s being this aggressive to people who are above him in the hierarchy, what do you think he’s doing to the patients he clearly has so much distaste for, when nobody’s watching? He needs to be out of this job for reasons of general safety.

    2. OrigCassandra*

      This is what I was thinking too. I recently had a brief interaction with home health care — I was just out of the hospital, exhausted, shaky, trying to recombobulate myself — and I cannot imagine having to deal with Ross.

      And what I’ve been dealing with is pretty simple!

    3. not nice, don't care*

      I wonder if OP’s company has any kind of risk management department. Imagine the lawsuit/bad publicity if mistreatment of patients went public.

  10. Nea*

    It doesn’t matter what your background history includes; that background still doesn’t excuse sustained insubordination.

    I hope that writeup serves as a PIP and the first step towards pushing Ross out the door and out of that career.

    1. Cemetery Birder*

      A PIP should not be a step in pushing someone out. A PIP should be a good faith opportunity for someone to improve. If an opportunity to improve is not the right step, then document the problems in accordance with process and fire the person. Pushing people out is avoidance, and it’s bad management.

  11. M2RB*

    I understand that people need to be able to blow off steam about their work in a safe environment so they can continue doing a good job. HOWEVER. There is a big line between blowing off steam and being outright disrespectful to the clients/customers/population being served. I would not want Ross providing care to me, to any of my friends or family, to ANYONE. How can he be trusted to provide a full, thorough range of care for his patients with this level of disdain and disgust for people??

    1. kiki*

      Yes! And this isn’t even something he said in private or off the clock! It’s what he’s saying to his coworkers and bosses in work chats. This isn’t somebody being secretly recorded venting to their best friend after a long day, this is what he’s saying when he knows folks are listening! I have no doubt his negative attitude is seeping into patient interactions. He needs to be let go yesterday.

    2. Silver Robin*

      My team has “shade and shout outs” at the beginning of our weekly meeting where folks can complain about the frustrations inherent to our work and also give kudos. Shade is never cast internally or against clients, but there is plenty of other structural stuff and annoying people we have to deal with outside of those groups. That is “blowing off steam at work”. Not whatever the f*** Ross thinks he is doing.

    3. Elbe*

      Any kind of care-related job can be incredibly hard, and I try to give people the benefit of the doubt when they need to discuss the not-so-pleasant aspects of that work.

      But I agree that the tone of Ross’s comments go above and beyond the standard for blowing off steam. He’s just dripping with judgement and condescension. And combined with all of the other issues, it seems like it’s pretty clearly an ongoing attitude problem as opposed to a need-to-vent problem. It’s one thing to struggle to deal with difficult feelings, it’s another to look down on sick patients for things that they can’t control.

    1. Miette*

      This is a good idea, particularly if OP encounters any road blocks with HR or their boss about getting Ross gone.

    4. Grumpy Elder Millennial*

      Yes, 100%. And make it clear that identifiable information won’t be shared with Ross. Vulnerable clients may not want to risk pissing Ross off, given the power he has over them and their treatment.

      1. Jack Straw from Wichita*

        Thank you. As someone who has needed specialized home healthcare at multiple points in my 47 years, I’d like to think I get good care because I’m a human deserving of it not because I’m someone’s mother.

    3. AnonORama*

      Even if they’re not (because their family is deceased/estranged/etc.) every patient is a vulnerable person!

  14. HonorBox*

    LW says they took the rural client off the schedule for the day since Ross refused to go. That is a HUGE problem. Ross is not a good clinician because if a patient is not seen at the time they’re scheduled, simply because a clinician refuses to drive to them, you’re not treating your patients with the appropriate care. Ross may be a selectively good clinician, but you don’t get to pick and choose the patients you see and provide care for. Add that to Ross talking about patients the way he does and treating a coworker with disrespect, and Ross needs to go.

    1. Starscourge Savvy*

      That actually horrified me. The *urgent* patient gets completely taken off the schedule for the day, after Ross has already been told that can’t happen, because he…… what, threw enough of a tantrum about it? I sincerely hope they were able to get care from another provider, but honestly if this place still employs a clinician like Ross, how are the other providers? Are they all “good clinicians” too?

    2. MHA*

      LW says they took the rural client off the schedule for the day since Ross refused to go. That is a HUGE problem.

      I’ve worked in home health rehab in a pretty damn toxic workplace that was understaffed and served a rural area with the resulting difficulties in attracting new workers, and yeah, even in that system this would have been a firing offense.

      Like… he’s disrupting your patient’s plan of care over “don’t wanna.” Come on, OP. You know how bad this actually is. Fire him and pony up for a traveler until you can attract a permanent replacement.

    2. Ssssssssssssssssss*

      We enjoyed watching house and we invited my then 17-yr-old to join us. Halfway thru one episode, she turned to me and said, “He’s an a$$!” Yep, he is. Which is why we watch him. In real life, no one would put up with him. Never saw why his friend Wilson remained his friend.

    4. goddessoftransitory*

      I’ve talked before about how my dad would just FUME over that show and how House should have been fired and lost his license and ended up digging ditches.

  17. Another Ashley*

    Ross needs to be fired yesterday. I wouldn’t trust him to provide care to sick people no matter how technically skilled he is at his job. If he talks to his boss and coworkers like that how do you think he treats vulnerable sick people?

    1. Observer*

      If he talks to his boss and coworkers like that how do you think he treats vulnerable sick people?

      LW, I hope the answer to this is obvious, now that the question has been asked. But in case it’s not, or in case you need to clarify this to your HR department, the answer to this question is “like garbage”.

    2. SHEILA, the co-host*

      This. If Ross were caring for me or a family member, I would have been requesting a different clinician yesterday. If I somehow got wind that this was going on (even if he was kind to us), I’d be asking a LOT of questions about the agency that chose to employ someone like this.

      1. goddessoftransitory*

        But I’d be afraid to, because then I’m the “complainer” and bumped to the bottom of the care list and who knows when somebody will be free?

        That’s exactly how the Rosses of the world thrive. Making sure the people who depend on them are too scared to say anything (mainly because he tells them stuff like if you complain, you’ll go on a waiting list, and we both know your kids have used up their PTO/sick days taking care of you already, and there’s no nearby neighbors…)

        1. Observer*

          Making sure the people who depend on them are too scared to say anything (mainly because he tells them stuff like if you complain, you’ll go on a waiting list, and we both know your kids have used up their PTO/sick days taking care of you already, and there’s no nearby neighbors…

          LW, please keep this in mind. If anyone thinks that “lack of complaints” means that “everything is ok”, then you need to point this out. Lack of complaints may mean that things are ever WORSE than they look because not only is Ross being terrible, he’s also intimidating clients / patients.

  19. Nightengale*

    I (a health care provider) also wonder if the patients Ross does not want to see only have medical problems he finds distasteful or if he also objects to them based on other traits such as class, race, religion, sexual orientation. . .

        1. Nightengale*

          Oh yes I meant this would be additional ammunition to bring to HR as to why he cannot continue to provide patient care – if he is also discriminating against patients for non medical reasons.

          1. GlowCloud*

            I’d argue that it’s also discrimination to pick and choose which medical patients to see based on their conditions. In fact, I don’t even need to argue. This is blatant discrimination.

        2. Hello123*

          How is it your place to say it’s not worth exploring?? That’s rude and pisses me off as a Black woman which is a demographic prone to medical neglect.kick rocks

          1. Ess Ess*

            Wow… this was a hostile response for a reasonable comment. No matter which reason (medical problems or racial issues), the guy should be fired. Why explore if he only hates patients due to color, or hates them due to their affliction? Either one is unacceptable so finding out specifically which one wouldn’t change what the outcome should be, which is firing him. So that is why is doesn’t need “exploring” because the result of the exploration wouldn’t change the rightful result.

            1. bamcheeks*

              Because the (extremely well-documented) poor care that patients from marginalised groups experience isn’t just the result of individual bad actors, but the systems which support and enable those bad actors. The organisation should be looking at the impacts of Ross’s behaviour on patients and working out whether their systems need to change so that any future Rosses are identified and managed out much faster.

              1. goddessoftransitory*

                And the Rosses of the world are dog-whistling to other biased/bigoted bad actors that it’s okay to be more and more overt and cruel in their own behavior, because HE never got in trouble.

                1. Check the box*

                  What if Ross was a black trans woman who was pagan? It doesn’t change the fact that he’s not doing his job and people’s health may be endangered.

                2. bamcheeks*

                  Right, and it also doesn’t change the fact that as well as firing him, you need to look at the impact on patients and figure out whether you need to change your systems because patient care is the priority.

            2. SHEILA, the co-host*

              What bamcheeks said. It is absolutely a relevant question. If someone like Ross is able to exist within this system, openly mocking/complaining about patients, imagine what other, unstated prejudices may have been allowed to slide. Hello123 is absolutely right that this needs to be explored, and there’s nothing wrong with the way she chose to express herself.

              I agree with bamcheeks that we don’t need any additional details to fire Ross, but even once he’s gone, they need to take a hard look at themselves and their processes.

            3. Katherine*

              Nothing was hostile about that comment except for maybe the “kick rocks”. Bias in healthcare is well documented and has real and tragic consequences. Identifying and addressing it is extremely important. Incidentally black women have some of the worst health outcomes in the US healthcare system so the person you are replying to is probably basing her comment on her lived experiences so your reply is particularly hurtful and dismissive. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8020496/

          2. learnedthehardway*

            I don’t think the previous poster is saying that issues of discrimination are unworthy of being investigated. If the OP NEEDS to do that investigation to find additional evidence for why Rob should be terminated, sure, definitely do that. But if the OP can move forward to terminate him based on general insubordination and unprofessional behaviour, then that is the best and fastest approach.

            It would certainly make sense to review the hiring process to understand how this person slipped into the org. and why they have managed to stay as long as they have, though.

            1. GythaOgden*

              This. They’re worth exploring in general — a lot of good generally comes out of the worst scandals — but Ross needs to be given the boot immediately.

          3. Pink Candyfloss*

            I think they meant it would be better to just fire Ross ASAP rather than go through an exploration of more things. there’s plenty to fire him on.

            however I think it’s worth going through because if harm has been done to patients like this, it needs to be made right.

        3. Margaret Cavendish*

          I would say it’s worth exploring after the fact.

          Step 1: Fire Ross, preferably from a cannon into the sun.
          Step 2: Do some analysis into what went wrong, including patient demographics.
          Step 3: Figure out if any of his former patients need additional support – not just medical care for their presenting issue, but do they have any concerns with the way they were treated? What can you do to remedy that situation?
          Step 4: Figure out how to prevent all this going forward.

          So the short-term immediate need is to fire Ross, no exploring necessary. But in the bigger picture – yeah, there’s some work to be done here.

          1. Tupac Coachella*

            I like this approach, because I do think it matters overall, just not to the outcome with Ross specifically, who is a problem regardless. In addition to the overall poorer healthcare outcomes and increased instances of medical neglect of marginalized people in general, we also know from the letter that OP’s agency serves rural areas. Those patients likely don’t have a lot of healthcare options to meet their needs, so they may not report issues out of the assumption that nothing will be done because Ross is obviously what’s available. If you’re perceived as a “problem” patient and don’t have much choice when it comes to healthcare providers, things can get bad for you fast. OP definitely needs to know if there are patients who have been holding their tongues, and if there’s a pattern on who those patients tend to be in their service area. OP, if you have clinicians qualified to have those conversations with clients who share their identities (BILPOC, rural background, low SES background, etc), they may have more luck than other people in getting the full story from Ross’ (hopefully former) clients.

          2. Keymaster of Gozer (she/her)*

            I *really* like this approach, you’ve laid out the appropriate actions perfectly.

    4. Seeking Second Childhood*

      And since we know this site skews female…. would he respect & follow the same instruction from a male supervisor & scheduler?

    5. WantonSeedStitch*

      This is what I was thinking. Given how some of my trans friends have been treated when seeking medical care for anything other than actual gender confirmation-related medicine, that was the specific thing that occurred to me. But I was also thinking about mentally ill people or people with dementia.

    6. Liz the Snackbrarian*

      I was also thinking that, and that it could be factoring into his refusal to do certain jobs. Also age. But he needs to be fired, even if he’s not objecting to them on those traits, he’s already way over the line.

    1. OrigCassandra*

      It’s possible. I got stuck for an extra day in the hospital recently because home health care couldn’t fit me in. I’m in a mid-sized Midwestern city with a ton of health care outlets. Understaffing is real.

    2. Constance Lloyd*

      There is unfortunately a huge staffing crisis in in-home healthcare right now. Ross still needs to be fired.

    3. Ssssssssssssssssss*

      I think it also depends on what kind of service is needed.

      While I can easily book my home care appointment (which is done at their clinic, not at home – I don’t ask questions) for my chemo bottle disconnect, my FIL found the wait list for toenail clipping service to be too long.

    5. Left Turn at Albuquerque*

      The letter indicates at least some of Ross’ territory is rural. I live in rural Kentucky and not only is health care coverage hard to find, but many of the people needing care from people like Ross are sicker in general or coping with the consequences of years without adequate health care. There’s a reason why Remote Area Medical holds many of its weekend clinics in areas like mine.

    6. Burger Bob*

      Healthcare in America is kind of in a tailspin right now. Pretty much every branch of it is understaffed and short on good applicants to hire. Add into that that home healthcare has always tended to be kind of a tough, underpaid position, and it’s very, very possible that they really are that hard up for clinicians. I see it in my own line of work (pharmacy). There are several people currently employed with my district who ordinarily would have been written up and fired long ago, but there is simply nobody to replace them at this time. Many healthcare sectors are scraping the bottom of the barrel these days.

    7. Innominata*

      It’s very possible ! I think where I’m at this would be over the line and would get him fired but…not as far over the line as you’d think.

  21. New Senior Mgr*

    His bad behavior is so stark, it’s almost entertaining. If you can’t let him go asap, definitely an ironclad PIP. I will not be going to Timbuktu… nice try tho. Wow, I’m shaking my head in disbelief at his audacity.

  22. desk platypus*

    Definitely drop any form of “Sorry, but-” language in any future sit downs. I understand the impulse but it takes the ball out of your court.

  23. Snax*

    As someone who recently met a rotating door of in-home hospice care nurses for a terminally ill family member, the Ross-es were immediately obvious to patients and their families. The ones who cringed and shied away from the patient, who cut visits short – yeah, it was pretty clear who wasn’t cut out for this kind of work. And I mean no shade – it’s incredibly hard work! – but that just means they aren’t the right people for the job.

    Ross-es were not the ones we called back when my family member needed increasingly specialized care, and they weren’t the ones we recommended to friends. You’re doing your company a disservice by keeping this creep around.

    1. Observer*

      You’re doing your company a disservice by keeping this creep around.

      Yes. LW, if your HR doesn’t care about the clients, they just might care about the company’s reputation.

      1. NotRealAnonForThis*

        Yep.

        Slightly different field (not hospice nursing, just general home care nursing), but with home nursing care when my youngest was seriously ill, I dreaded a particular “Ross”. She-Ross was difficult, my child was never happy about seeing her (because her dressing changes hurt with this nurse…no other nurse…), she always “forgot an extra mask” so I had to leave the room for dressing changes, and in two cases, we wound up in the pediatric ER because the dressing change had gotten that effed up that it required emergency care by the infectious disease docs in charge of her case. The first case I’d notified the company that I wanted it in records that we had incurred costs due to their clinician. The second time it happened I notified the company that that particular clinician would not be permitted access to my sick child because it was the second incident in a month. My child’s doctor filed a similar notice with the company.

      2. She of Many Hats*

        Or the liability if Ross made any inappropriate comment or action in regards to a patient in a protected class.

    2. Mellie Bellie*

      This. My mom needed in home health care the last year and a half of her life and if I had ever had even an inkling that they thought she was “gross” or made them want to vomit (!!!!!) I’d have raised all kinds of holy hell. What in the actual…

      Fire Ross. Right now. He’s … not cut out for this job.

    3. Mrs. Hawiggins*

      I came here to say almost this exact same thing. We’ve been on the receiving end of Ross-es, too, to the extent I asked one to leave while taking said family member’s blood pressure. When asked why I told them that if they rolled their eyes one more time they might not be able to see their own way out. When others asked who we used, I made sure to steer them from the Acme XYZ company because of the attitude we kept getting. It was that simple.

      This is not an easy job, patients are not easy people, but this behavior is egregious. I’m not unsympathetic to the health care industry in any way but when you have someone like this that flat out refuses to treat and is mean spirited and judgemental, they’re not meant for the job and it begs the question why they took it in the first place.

    4. learnedthehardway*

      When my Mum was dying, most of the PSWs were amazing, fabulous people. However, there was one “Rossette” – my Dad marched her to the door and told her he would call the police if she came back. They were reassigned to another service provider company as a result of the issue. With our health system, the contracts are administered by the regional health authority. The case manager said they were definitely going to make a note in the file, which would affect the next round of contract assignments.

      Even with a staff shortage, the OP should consider that Ross is damaging the reputation of the company, and that word will get around.

  24. Jarissa*

    How has he not already caused your employer to be sued for malpractice?

    This twerp is so accustomed to microaggressions and pointless little power trip intimidations of his work colleagues, that there is no way he has not also done that to patients more than once. The fact that he was willing to do it in an email that could be seen by other people, tells me he no longer cares whether the patient he is mistreating has a witness present. Or a smart home system that might be connected to a camera.

    I promise you that he has made patients’ lives worse. He is also making the lives of where other nurses and your scheduler worse.

    In your shoes, I would point out to my superior and human resources that given how he freely denigrates patients, we not only need to get rid of him now — we need to go check up on his ongoing patience and possibly the most recent closed cases to make sure that he did nothing which could lose our entire business its licensed to operate.

    1. Observer*

      How has he not already caused your employer to be sued for malpractice?

      Yes, I was thinking about this.

      The fact that he was willing to do it in an email that could be seen by other people, tells me he no longer cares whether the patient he is mistreating has a witness present. Or a smart home system that might be connected to a camera.

      Yes. Also, if, or rather when, you get sued, your email and messaging systems are subject to discovery. Which means that someone is going to see all of these messages and say that you KNEW that this guy was terrible, and should have taken action even if no one ever lodged a formal complaint.

      I would point out to my superior and human resources that given how he freely denigrates patients, we not only need to get rid of him now — we need to go check up on his ongoing patience and possibly the most recent closed cases to make sure that he did nothing which could lose our entire business its licensed to operate.

      Agreed. LW, this is not hyperbole. There is a really good chance that this guy has done stuff that could shut you down. The only way to protect yourself is to proactively shut HIM down.

    2. Legally Brunette*

      Seconding this after working in medical malpractice litigation! Given Ross’ commentary on patients and general attitude, I am strongly inclined to believe his care is as lacking as his bedside manner. OP, it’s worth considering whether you’re opening up your employer (and any of Ross’ supervising clinicians) to liability – and whether that warrants his removal.

    3. CheerfulGinger*

      Right, can you imagine being in court, reading aloud his messages, and explaining why you continued employ him?

    4. New Jack Karyn*

      “How has he not already caused your employer to be sued for malpractice?”

      Because people who need in-home health care in rural areas are often desperate. They’re likely low income, possibly VERY low income. They also know there’s a shortage of providers. The fear is that if they complain, they will lose what care they are getting.

      1. Irish Teacher.*

        I also wonder if the “good clinician overall” comes from him being careful around people who are better able to complain – the better off, the straight white males with illnesses he doesn’t look down on, those with contacts. If he’s polite and helpful to the rich white elderly man whose son and daughter and lawyers, but nasty to the woman with a history of addiction and mental health problems, living in poverty…well, he’s likely to get good reports from the former and the latter is far less likely to to report him or sue as she may not expect to be believed.

        Yeah, this is getting a bit close to AAM fanfiction, but there are some indications that he is particularly targetting those who are marginalised and those are the people least free to speak up.

  25. Pool Noodle Barnacle Pen0s*

    Every week I see a letter on here that renews my wonderment over the gulf between “people who are terrified to lose their jobs over something trivial” and “managers who are too spineless to fire genuinely incompetent employees for a long list of valid reasons.” Life is truly a rich pageant.

    3. Generic Name*

      Not to mention the gulf between those who are “terrified to lose their jobs” and the Rosses of the work world. In my experience, the people who worry most they’ll be fired are the stellar employees going above and beyond and the Rosses are subpar at best.

    4. Helewise*

      As someone firmly in the “people who are afraid to lose their jobs over something trivial” camp, very much same. Just… HOW? How do they keep these jobs?

  26. Ane*

    His disrespectful and neglectful attitude is gonna kill people. You don’t want to be his employer when that happens.

  27. Dasein9 (he/him)*

    If this were an ordinary office where people’s lives and quality of life aren’t on the line, Ross’ behavior would be bad enough to get him fired. In a medical care setting, it’s absolutely inexcusable that he’s still there.

    1. AnonORama*

      Yeah, honestly someone who refuses work, smack-talks clients (to their face or behind their back, especially in writing), and gives snotty attitude to admin folks should be getting hustled out the door even if their job is to make widgets or push paper. This guy is legit dangerous in addition to being an ass-hat and he’s got to go!

    2. goddessoftransitory*

      It reminds me of the letter where the med student kept demanding that the LW be nicer and kinder in her critiques of his work. Like, dude, this stuff is literal life and death. You don’t get to be soft pedaled on your ability to perform these tasks.

  28. el l*

    “Ross, you’ve demonstrated a pattern of disrespect. Disrespect to your colleagues is bad enough, [examples]. Even worse, stronger disrespect to patients, [examples]. This isn’t the right place for you. We’re going to need to part ways.”

  29. CB212*

    I cannot imagine using this service to provide care for my mother, and finding out that this is the person they sent into her home. Even if he puts a civil face on during the appointment, to hear that he went in and came out calling her “gross”?! That’s an appalling thing to inflict on vulnerable people.

  30. Elizabeth*

    I’m guessing you operate a home health agency of some flavor in a rural area. I know that getting clinicians in that environment is difficult, so I understand your reluctance to fire him.

    I don’t think you can keep him. His attitude towards patients is terrible. He is jeopardizing patients by delaying their care. He could eventually jeopardize your entire agency if he continues to reject patients and/or provide substandard care.

    You can’t force him to be a professional. He has shown you who he is. Believe him.

  32. brjeau*

    I said “fire him” out loud at least 5 times reading this letter. This is so many kinds of unacceptable, as any kind of employee but especially as someone who works with patients.

    If the process to initiate a firing with HR is in any way onerous where you work, getting that ball rolling (and keeping it moving) should be your #1 priority

    1. Observer*

      If the process to initiate a firing with HR is in any way onerous where you work, getting that ball rolling (and keeping it moving) should be your #1 priority

      This. 1million times over. This guy needs to go.

  33. DVM*

    I am just sitting here imagining how horrible I would feel as a coworker to Ross in the Teams chat witnessing him call our clients “gross,” and this not being shut down immediately by management. That is cultivating an awful culture and work environment in what I am sure is an already challenging field. I would be looking for another job if I saw this happen twice, and it seems like it has happened MANY more times that that. To not address this behavior immediately seems unethical to me. How degrading to everyone involved.

    1. cardigarden*

      Has ANYONE spoken up in the Teams chat? I’d hope I’m not an outlier, but I don’t think I’d have any problems responding with a “yo wtf, Ross” in the chat as a peer clinician.

      1. Relentlessly Socratic*

        If higher ups refer to Ross as a ‘good clinician’ it’s really difficult for peers to raise the issue, and they themselves may view the company’s tolerance of his BS as approval.

    2. STLBlues*

      This is a really excellent point. Management is passively condoning all the bad behavior from Ross. You probably have other clinicians who think you and other managers agree that these things are “scary” and “gross.” How demoralizing!

    3. Kez*

      This is an excellent point. LW, you definitely need to move Ross out of this role ASAP, but as you work on that I think it would also be beneficial to the whole team for you to check in on your other employees’ sense of confidence in the team and the organization as a whole. I would not be surprised if you were losing good employees and even job candidates because of the kind of reputation this attitude can foment in an organization.

      Also, do not only check in with other clinicians and clinicians assistants. That email to the scheduler? Huge red flag that Ross could be bullying the administrative team far more aggressively than with the kind of nonsense he’s been pulling in the group chat in front of you. Make sure the person who brought the email to you and the entire scheduling/support staff know you are grateful when they raise issues and that you won’t tolerate their being treated like adversaries by their (more powerful and better-paid) colleagues. Otherwise you’re going to lose their trust in you as a manager.

      I really hope that you can get this sorted out, and I am so sorry that you and your team have had your culture poisoned by this jerk for so long.

    4. Seven If You Count Bad John*

      And this being healthcare, unless this employer has some kind of stellar pay/benefits/culture that makes them the only game in town, any decent clinician can pretty much just walk to another job.

    5. Celeste*

      Yes! It’s very weird that no one has shut this down, and he’s just been able to say these things like they’re normal.

  34. justpeachy86*

    I would die of mortification and in no way want to be seen by a clinician who behind closed doors said I or my condition was “gross” or “scary”. He really has to go.

    1. Dinwar*

      I wouldn’t be so concerned, as long as it’s behind closed doors. I’ve been around medical people, and some of the stuff they deal with IS gross or scary. The mental toll is tremendous, and they’ve gotta vent to stay sane. If seeing the fundamental fragility of the human body doesn’t affect you somehow, you lack empathy.

      The issue for me is that this person is allowing it to directly impact his willingness to do his job. It’s one thing to think something’s gross, it’s another thing entirely to say “…and therefore I’m not doing it.” Good doctors, nurses, EMTs, and paramedics say “This is gross and scary–so let’s fix it.”

      1. Seashell*

        Yeah, I am not in the medical field, but I would expect medical folks to say things behind closed doors that they wouldn’t say to patients’ faces. The fact that Ross is dodging work that’s been appropriately assigned to him that the problem.

        1. bamcheeks*

          I don’t know, there’s “behind closed doors, verbally, to a trusted colleague” and “electronically, to the whole team, on the extremely discoverable employer-owned Teams system”. The former is pretty normal in healthcare, the latter is *extremely* bad judgment.

          1. GythaOgden*

            Agreed. I’m in healthcare, and yeah, there are people who have been physically injured by patients to the point of having to give up clinical work and go back to the desk jobs. But even they wouldn’t be so extravagant in their contempt for patients as Ross is being.

          2. Bunny Lake Is Found*

            Yeah. This is also not over a few glasses of wine with friends after a rough week.

            Like, I am sure there are many fantastic health care providers who have called various medical conditions “gross” or certain patients “scary” when having a bitch fest with friends (while maintaining their clients’ anonymity) who are excellent providers and are warm and compassionate when they perform their work.

      2. The Unspeakable Queen Lisa*

        You’re conflating 2 different things. It is not venting to refuse to work with a patient and cite the reason as “they are gross and scary”. Venting would be doing the job and then complaining about it later.

        IME, medical professionals do not think things are gross and scary – that’s for civilians. And it is 100% inappropriate to refer to the *person* they are treating as gross. That’s dehumanizing and leads to poor patient outcomes. Since you’re randomly insulting people, you are the one lacking empathy if you sympathize with Ross instead of the patients who are not getting care.

      3. sulky-anne*

        There’s a difference between finding a specific task gross or scary and labelling a whole group of people that way. And also refusing to treat them.

      4. MCMonkeyBean*

        I would have room for someone after the fact being like “oh gosh, that went really badly, there was so much blood and it was gross/scary” but a pre-emptive “all people with X condition are gross” or whatever is pretty concerning!

        1. Irish Teacher.*

          That was my thought too. As a teacher, people do say, “gosh, that kid is scary. I worry he’s bullying classmates and they are too scared to tell us. I bet they wouldn’t say anything because he is really intimidating” or “it was so gross when students would come in during the height of the pandemic wearing the same mask day after day without it ever being cleaned,” but that strikes me as a lot different from “students from X group or with Y disability are gross and scary and I refuse to work with them.” The latter would be crossing a line.

  35. AvonLovesBlake*

    How many of Ross’s patients are going onto patient message boards and writing “If you can possibly avoid it, don’t go with [your clinic], the home visit person I got [Ross] was awful!” ?

    I strongly suspect that some of them are – and that costs your clinic business and reputation.

  36. Nia*

    He should have been fired the second he responded to an order with ‘nice try though’. There’s no need for a final warning.

    1. londonedit*

      Yep. I’m in the UK and I know there’s often the perception from the US that it’s difficult to fire someone here/in other parts of Europe, but seriously, I’d expect Ross to be out of the door forthwith. You’d obviously have to go through a disciplinary process with an escalating series of warnings, but I’d have expected that to start when he started being rude and disrespectful about patients and refusing to do his job – i.e. go and visit the patients he’s being assigned to visit. Surely refusing to work with certain patients means he isn’t doing the job he’s employed to do, and that’s without all the other awful behaviour. I presume that if the OP is in the US, they could have fired Ross at any point without even needing to give him a warning. ‘You have made disrespectful comments about patients, you have consistently refused to work with patients in groups X, Y and Z, you have refused to travel to visit patients as assigned, and you have responded to emails from management with “nice try tho”‘ is more than enough to justify getting rid of him.

      1. Seashell*

        Regarding the US, the laws vary by location. There was no mention of a union here, but that might also factor into being fired from some jobs. The biggest issue is likely that HR will be trying to avoid/minimize likelihood of a lawsuit from Ross after he’s fired.

  37. morethantired*

    LW, I know it’s hard to find clinicians these days, and I’m so sorry that it seems like Ross knows that and thinks it means he can act however he wants and not get fired. But it’s better to be short staffed than to have someone like this on the payroll.

  38. BatManDan*

    I’m hoping it’s not representative of the world in general, but there are SO many letters (IMO) too which the answer is so CLEARLY – “fire ’em” that I’m starting to wonder what makes it so hard for managers to see that? I mean, this guy should have been gone a LONG time ago. So weird to see stuff like this.

    1. Dinwar*

      There are a number of reasons.

      The Sunk Cost Fallacy comes into play. “If I push just a LITTLE harder maybe they’ll turn around!” also does. Hiring and onboarding aren’t easy or cheap, after all; the cost of dealing with a bad employee may be less than the cost of going through that process.

      Risk of not having staff is another. Some roles are notoriously hard to fill, so if you fire someone you’re stuck short-staffed for a long time. This can drastically alter the equation a manager needs to balance.

      Most importantly, though, at least to my mind: Firing someone should be hard. You’re taking away their income, putting them at tremendous risk. The decision to do so should be one that is difficult for a manager to arrive at, from a humanitarian standpoint. And if managers fire people too easily workers notice, and people don’t work well when the risk of being fired is constantly hanging overhead. Fear can motivate you to act, but it usually makes you act badly (ask any firefighter). So by and large people default to not firing people, until there’s really no choice in the matter.

    2. pally*

      Sometimes I wonder if this is where folks who haven’t managed very long (or haven’t been thoroughly trained in management) get the notion that reports like Ross have to be endured and not managed out. Because, after all, managing is difficult, but no one ever says exactly why. Now we understand why.

      That’s an unhelpful HR dept there. Part of the problem as well.

    3. Jaybeetee*

      Part of it is the difficulty of hiring/maintaining staff in certain industries. A number of medical jobs, especially at the lower levels, do have chronic shortages and high turnover. This can lead to a culture where you put up with all manner of “quirks” from the people you can get a hold of for the job who have the necessary qualifications. It’s a systemic issue that leads to toxicity on multiple levels, and it’s a known issue in fields like nursing homes and homecare. OP seems to realize now that they need to use bigger guns to deal with Ross, but I can understand how, in their context, they were willing to ignore a lot of free-floating snarkiness from him as long as he was more or less doing the work. That’s likely also why OP was more focused on the scheduling issues and him being unwilling to see certain patients, rather than his attitude.

      The reality is, Ross *needs* to be fired – but the other reality is, it’ll probably be easy for him to pick up another medical job regardless.

    4. Sparkles McFadden*

      My OldJob had very strict rules to follow when you wanted to fire someone. That was a good thing because you couldn’t fire someone on a whim. That, however, meant that the manager had to put in a good deal of work and most managers didn’t want to do that work. They’d think “If I have to put this much time in and then put in more time to hire someone new, I can just figure out how to work around this person.” They’d also be afraid that they’d hire someone worse or that upper management might take away someone from the headcount saying “If that guy was so bad, you can do without that spot.”

      Other reasons include:
      – Bad upper management or HR that won’t back you up so now you’re stuck with someone just like Ross who knows he can do things like everything listed and get away with it.

      – Thinking firing someone means that you have failed as a manager. This is at the root of this letter, I think. That and probably “We have so much trouble finding clinicians and firing this guy will make it worse.”

      – Feeling sorry for the person and worrying about taking away their job.

      – Being afraid other people will think you’re mean and be mad at you, or that firing someone makes you a bad person.

      – Inaction is easier than action, and if the manager isn’t suffering directly from the person’s horribleness on a daily basis, they work to ignore it or say “I’ll address this at review time.”

      1. higheredadmin*

        Adding to the refill point: where I work, if there is a vacant position it means that at any point they can decide for budget reasons they are going to cut it, so you end up with nobody. People will put up with 10% of somebody rather than risk having the position cut when it becomes vacant. Result is: good people leave and find other jobs, bad people stay and put in 10%. I’ve had multiple conversations with a manager about just letting a significantly underperforming employee go, and they still can’t manage to pull the trigger because of all of the above plus the fear of losing the position forever. (And this is on top of an environment where it is easily a year of work and performance management to be able to fire someone.)

    5. Irish Teacher.*

      I think in addition to what others have said, it’s easier for us to say that as we don’t know the person nor do we have to be the one to do it. If you know that somebody has kids and a mortgage and they really need the job, it’s a lot harder, especially if say, you know there is a risk the person could end up homless if they lost their job or that they have a sick child who might not get the care they need if the parent loses their healthcare coverage.

      And yeah, it would be the result of their own actions and you can’t care more about somebody’s needs than they do themselves, but…it’s still hard to be the one to have to make the decision.

  39. gif*

    it’s scary that your company is still allowing this guy to go into vulnerable patients’ homes after the comments he made about them

  40. STLBlues*

    He just needs to go.

    Here’s my thought exercise… if you or your loved one had a condition that needed support, would you want Ross to do it? Imagine it was one of the conditions Ross things is “gross” or “scary.” Would you want Ross to be alone with your loved one at, presumably, a vulnerable time?

    I wouldn’t. To me, that means he is completely and totally unfit for the job. I don’t know that there’s any level of warning or training that he could be put through.

    Also, if you absolutely MUST keep him on for some reason, I’d find a way to check whether he’s cutting out before 2pm every single day for his kid. Is he shortchanging patient hours? Skipping admin work? Etc? Based on everything else you’ve written about him, it sure seems like it should be a concern.

    1. HonorBox*

      Your thought exercise brought this to mind, too: Even if you get a list from Ross about what he finds “gross” or “scary” you’re basically empowering him to do as little as he wants. He may find that he can make the list so restrictive that your ability to schedule him is extremely limited.

      1. Momma Bear*

        I also wonder if he’d actually even go, knowing they were on his “ugh” list, and then what impact would it have on the person who was supposed to work with him, let alone the patient? I don’t think he’d accept the training. If he did go, I could see him standing in the corner being unprofessional while the other person did all the real work.

    2. Hush42*

      I was thinking the same thing about his kid. Based on the information that was given it sounds like Ross is not carrying a full case load to start with and I would question if it’s partly because he intentionally scheduling his patients around school pick up time so he can pick up his kid.

      1. Momma Bear*

        Or shorting them to be available at that time. And what happens after that? Is he always off at 2 or is he bringing his kid or…?

    3. Wintermute*

      Your thought experiment isn’t quite complete though–

      given the state of healthcare in America the question you need to ask is “would you rather ross be alone with your loved one at a vulnerable time, or have your loved one in a hospital because no home healthcare is available, or have to be shipped to a rehabilitation facility that is FULL of Rosses and so far away you cannot regularly visit?”

      It’s tough to convey how desperate healthcare hiring is, and the potential consequences of being understaffed.

  41. Not Tom, Just Petty*

    OP, you are playing checkers; he is playing Global Thermonuclear War.
    How do you win Global Thermonuclear War?
    By not playing Global Thermonuclear War.
    “Sorry, this role is not for you. Best of luck.”

  42. Margaret Cavendish*

    Just to follow this line of thinking for a bit, OP – what exactly makes him “an overall good clinician?” What parts of his job is he genuinely good at? How do you know this?

    You don’t need to answer here obviously, but it’s worth giving it some thought. Do a little cost-benefit analysis – what’s he good at, what benefits does he provide? What is he not good at, what are the costs or risks of keeping him? Not just financial costs, but the impact on team morale, the impact on your morale and the scheduler’s, the time you spend capital M-managing him instead of doing the other parts of your job. Having done all that, do you still think he’s an overall good clinician?

    Most people like to give others the benefit of the doubt in cases like this – it’s really normal to think he’s overall good other than these one or two things. So don’t beat yourself up about how you’ve handled this so far – it’s obvious you wanted this to work out for him! But I think it’s time to take a different perspective, and figure out what your *next* decision needs to be.

    Good luck, and I’d love an update when you have one!

    1. Caliente Papillon*

      Yes, if this guy is considered “overall good” what on earth are the bad ones doing?’! I shudder to think about it.

  43. ZSD*

    As soon as I read the headline, I thought, “Well, fire him.” And by the time I got to the part where he *said he would vomit* over a certain type of patient?! Fire him fire him fire him.

    Question: Am I right that “clinician” indicates that he has an MD? If so, I don’t understand how he got through residency, etc., with this attitude being apparent.

    How desperate is your hiring situation, LW? Do you have such a shortage of clinicians that it’s this guy or no one? If so, I can understand that you might feel your hands are tied. But if the provider shortages are so great that you absolutely can’t fire this guy, then he needs a SERIOUS talking-to about the necessary changes in his attitude and behavior.

    1. Unkempt Flatware*

      No I think Ross can be a social worker, home health aid, speech language pathologist, etc. I didn’t read that he’s an MD at all but I’ll tell ya, that honestly wouldn’t surprise me. I’ve had terrible doctors.

      1. Nightengale*

        Doctors (and other health care providers) have a long history of saying derogatory things about patients when they think the audience is just other clinicians. About illness and disability, mental health, class, race. . .

        Source: am doctor

        1. And the Skeletons Are… Part of It*

          They do, and can definitely be jerks, but there’s a class difference in the way a jerk doctor would behave vs a jerk lower-wage worker. (In the shape and details of their awfulness.)

          Neither is acceptable, but there are usually notable differences. Ross’s vibes are not “jerk doctor”.

    2. Devo Forevo*

      It sounds like he’s a home care aide. Clinician is just a general term. They go through a training program and are licensed, but nothing close to medical school.

      1. OyHiOh*

        The “high skill” part of OP’s description could be a home visit RN, occupational therapy, physical therapy, or speech language pathologist.

      2. Old and Don’t Care*

        I don’t think someone in the industry would refer to a aide as a “clinician”. He could be a visiting nurse, physical therapist, occupational therapist; I’d assume someone at that level.

        1. Chocolate Covered Cotton*

          Someone trying to maintain anonymity might use a less specific term like clinician.

    3. HonorBox*

      The hiring situation may be desperate, but I’d argue that if Ross is doing less than others and taking the attitude he is with coworkers and about patients, it is probably going to be a relief to everyone else to pick up an extra patient or two rather than have to work around him.

  44. AvonLovesBlake*

    I’ve received awful, disrespectful, clinically-unsafe, treatment as a patient.

    Sometimes I made formal complaints.

    But I also told my general practitioner, who said “That’s awful! I’ll make sure I never refer any more of my patients there!”

    I also told my friends and family members to avoid a particular nurse/doctor/hospital.

    I also went onto patient message boards for people with my medical condition in my city and shared my experiences.

    Trust me, for every formal complaint you get, there are 100 negative stories being told about Ross [and your clinic] informally that you’re not seeing.

    1. Constance Lloyd*

      As a teenage girl I got my whole family to switch general practitioners because of the way he treated me, and I didn’t even tell them the worst of it. People talk, and the audience often listens.

    2. Sara without an H*

      Trust me, for every formal complaint you get, there are 100 negative stories being told about Ross [and your clinic] informally that you’re not seeing.

      This. LW, Ross is creating a reputation for your company, and it’s not a good one.

  46. Up and Away*

    I’m curious if “Ross” signed a job description, and if so, if the job descriptions are thorough in terms of position requirements and expectations.

  48. Unkempt Flatware*

    Your hands seem tied here. When he does pop off and say out of control things like, “nice try tho”, can you remove his patients and let him lose work that day by sending him home? If someone were acting so shitty like this, I think I’d tell them they need to clock out and leave.

    1. pally*

      As long as there’s a corresponding loss in pay along with this.
      Otherwise, it might be seen by Ross as a reward to get off early. Regardless of how it’s phrased to him.

    2. beanie*

      Right?! It looks like the OP just said “Sorry, we can’t remove the rural assessment.” Why are YOU apologizing to HIM after he just spoke to both the scheduler and his supervisor like this?! He’s being quite direct. Please be quite direct back. Right now it seems like his actions and words have zero consequences. A polite email back saying sorry is NOT a consequence. Neither is a timidly worded “needs improvement” to “build confidence” in a performance review.

      If you can’t fire him today, what other tools do you have to deliver consequences? You need to at least be super direct and clear about what is acceptable in your company and then hold him to it with actual consequences.

      1. I Have RBF*

        For starters, if he’s hourly, but refuses to go see patients, he should just not be paid for hours in which he does no work. If he knocks off at 2? Then he loses his pay on those days from 2 to 5. No work, no pay. Your business is patient care.

        If he’s not doing patient care and directly related work, he should not be paid. Note: charting, required paperwork and in-house training are patient care related work. Sitting around and bellyaching about “gross” patients is not. Refusing assignments is not. Skiving off to play taxi for his kid is not.

        No, I’m not in medical care, but I have worked in a “billable hours” type field, and it’s not hard to figure out what is billable and what is not.

  49. Alex Rider*

    Ross needs to go. Being rude to the scheduler is ridiculous and unacceptable. The rural patient he refused to drive through was removed from the schedule that day? So that person did not get the care they needed which is unacceptable. Ross needs to be fired, I’m sure your other employees are very annoyed by this.

  50. Delphine*

    Fire him. He should have been severely reprimanded when he first began making comments about “gross” patients. Y’all have let him get away with way too much. He should not get a second chance.

  51. FashionablyEvil*

    Yiiikes. Ross needs to go. Immediately.

    I think it’s worth thinking about why you haven’t seen these things as being more serious or requiring of immediate action (because they’re pretty egregious from where I’m sitting–denigrating patients, refusing direct instructions, rude and dismissive language to colleagues, etc.)

    1. And the Skeletons Are… Part of It*

      Yes this kind of “traveling clinician” setup (e.g. home health aide, traveling phlebotomist, etc) is often treated like low-level retail, where companies just trawl for whoever they can get and a lot of unprofessional behavior is tolerated. But these people are by definition serving vulnerable populations in important roles. OP’s company really needs a total perspective check.

  52. Zzzzzz*

    I have an incredibly hard time believing his crappy attitude toward patients is being confined to complaining about them to his coworkers. Imagine being sick enough to need home care AND you get this jerk coming to your home and not being able to complain or push back bc you are literally unable to do so or feel you have no options. I can’t imagine how I would feel knowing someone I cared about was being treated this way. GET RID OF HIM, stat.

    1. Elbe*

      100% agree.

      Unfortunately, I recently had to go to the ER in my city and I was absolutely floored at how blatantly rude some of the staff were. It was like they were on a power trip and were going out of their way to make me feel small… when I already was at my most vulnerable.

      There is a HUGE power imbalance in medicine that doesn’t get talked about enough. I couldn’t stand up for myself or push back in a way that I normally would, because I was depending on these people for medical care. I literally just had to let these people be jerks to me and it felt terrible.

      I would be willing to bet that Ross feels enabled to act like this because he is used to dealing with people who can’t put him in his place. Healthcare (and all positions of power, really) seems to attract bullies, and the only thing to do is to just get rid of them.

    2. learnedthehardway*

      The thought of this person being responsible for the care of vulnerable patients horrifies me, quite frankly.

  53. AllieJ0516*

    No reason whatsoever to keep him. The insubordination ALONE should have at the very least put him on a PIP, but he’s pushed his luck far further than acceptable with that attitude. Dump him. You’ll be doing yourselves AND your clients a huge favor.

  54. AJ Crowley*

    Is this clinical work something that Ross needs to be licensed to practice? Because the level of supervision LW is recommending for the types of patients he doesn’t feel comfortable with, in my field of licensed clinical work, would be a limitation placed on independent practice by his employer and therefore reportable to the board governing his license. If he knew that was something coming down the pipeline at his annual review, it might make him leave the job of his own accord. Which is not to say it’s a replacement for letting someone go when they desperately deserve to be let go.

    Either way, LW, something to consider is whether any of this rises to the level of making a report to his licensing board.

  55. Naomi*

    I think you’re trying too hard to treat Ross like he’s operating in good faith, because he has many problems but lack of confidence doesn’t seem to be one of them. I’m sure some clinicians genuinely lack confidence with certain types of patient and just need training on how to treat them, but Ross is using “I don’t know how to handle them” to mean “I don’t want to,” which fits his pattern of trying to Bartleby the Scrivener his way out of work he doesn’t like. Between that and the dismissive attitude towards both patients and colleagues, I really don’t see a way you can keep him in this job.

    1. Angstrom*

      Yes. Someone who genuinely wanted to improve would be saying things like “This type of visit is difficult for me” or I feel unprepared for this kind of visit, and that makes me nervous. I think I need more training.” They would realize that it was THEIR problem. They would NOT be blaming their patients/clients for being “gross” or “scary”.

    2. Elbe*

      Agreed. This isn’t good faith, this is weaponized incompetence.

      He’s saying he “doesn’t know how” to treat these patients because he knows that the responsible people in charge cannot send him to do work that he’s not able to do. It’s just another way of trying to get out of the things he thinks are gross or beneath him.

  56. Common Sense Not Common*

    Ross needs to be fired! Possibly a very strict PIP for a very short duration if your company is worried about possible lawsuit.

    You need to contact all of his patients and ask questions about how he treats and cares for them. Many patients don’t speak up because they worry about who will care for them if the current person doesn’t, it’s a legitimate fear. You may find by contacting them that Ross doesn’t provide the quality care your company expects to any of his patients.

  58. Engineer*

    Either your HR majorly sucks or you’ve been waaaaaaaay underreporting Ross’s issues to them. Either way Ross sucks, is in *no* way a good clinician, and frankly is going to cost your company a lawsuit for medical malpractice at this rate.

    And once he’s been shown the door, you need to some *serious* reclaibrating of what a “good clinician” is.

  59. Box of Kittens*

    We DEFINITELY need an update on this one! I am flabbergasted that anyone feels like it’s okay to behave like this toward patients.

    1. AnonORama*

      I wish I was! Having witnessed all manner of terrible behavior in multiple workplaces including healthcare, some people seem to enjoy testing the waters of what they can get away with and will keep escalating forever if they keep getting away with it. Meanwhile, I’m in the corner cowering about how I’m going to immediately be fired because my 600-page proposal had one spacing error or something. (Someone above said there are two kinds of people who write into AAM — I’m the other kind, lol.)

  60. But Not the Hippopotamus*

    I would not want Ross involved in my healthcare. I wouldn’t want him involved in my worst enemy’s healthcare.

  61. She of Many Hats*

    Yeah, Ross needs to find a new career. Besides his verbal (and mental) attitude toward the people that are the whole reason for his job, his refusal to get the needed skills to do his job and outright aggressive refusal to do that job should be the deal-breaker. Your clients deserve better and there are still too many heartless jerks in healthcare without him adding to the problem.

    He is NOT cut out for any job that requires empathy, kindness, or respect especially for vulnerable people. He might fit best as a rock smasher at a quarry.

  62. Storm in a teacup*

    As someone based in the UK I used to work as a clinician and managed a team.
    Questions:
    How are you judging that overall he is a good clinician? Field visits? Supervisory training? Patient and colleague feedback. Clinical knowledge or time in role leading to that assumption?
    I think you need to start from scratch with your perceptions.
    You have someone who refuses to fill the basic requirements of the role, is resistant to training and development and has such an unprofessional attitude to patients I would go so far as to say this person doesn’t just need to be managed out of the organisation but potentially even reported to their professional body!
    In my twenty year career in healthcare I only had to do this twice, both times it would have been negligent of me to continue to allow the person to practice without saying something.
    OP for the sake of your patients please act now with decisiveness and courage

  63. Jojo*

    As someone who has been a patient way more that I would like over the past year, I have to say this letter makes me really sad. LW, please fire this guy. As a patient, you are already in a vulnerable position because of your health, but when you are being treated by a healthcare worker, you have to make yourself even more vulnerable. You have to share personal information that you may not even want to share with your loved ones. Often times, you have to do it partially or totally unclothed. You may literally be placing your life in this person’s hands. And, they have nothing but contempt for you? Yikes.

  64. AvonLovesBlake*

    Also: even if you do manage to get Ross to do rural visits, if he turns up to rural visits radiating impatience and resentment (and a desire to leave ASAP), patients are going to be very reluctant to ask him questions about their medications or their healthcare needs, which could potentially cause serious health problems.

  65. Alex*

    The thing is that if he had been behaving a polite, professional, team-playing kind of way and asked for some grace because of some personal circumstance with his kid, I bet you would have made an effort to accommodate him! But this guy is not doing anything to make you want to help him out–being rude, obstinate, and an overall jerk isn’t earning him any favors. Why would you go out of your way to help this guy? Fire him.

  66. Kai*

    LW, please fire this person immediately & send word out to everyone you can to blackball him from ever seeing patients again.

    This is exactly why I rarely seek medical help. Already vulnerable people being treated like this.

  67. That wasn't me. . .*

    You need to get him out pronto, before he poisons your whole crew. They know what he’s doing, because they are picking up the patients he is refusing to care for. If Ross can refuse patients because they are unpleasant or inconvenient in his eyes, surely they can refuse a few of the worst as well. And so it goes, first Ross, then one or two others, then the whole crew thinking they have the right to refuse care to people they don’t like -and since all the crew are avoiding the same patients, who do you assign them to? the new person? There goes youe retention! As scheduler, you have to keep control – everyone gets some easy, some hard; some nice, some nasty; some clean, some gross. That’s the job! But to keep it that way, Ross has to go!

  68. Observer*

    LW, I want to point out something that has not been directly mentioned, although a lot of what is being said links to it.

    In general, when a company gets sued, there are various levels of liability. But one thing that’s pretty universal is that if you should have known about a problem, you are going to be on the hook, whether or not someone actually complained about a person.

    Here you have ample evidence of some problems with his behavior. Some of it points to a high likelihood of malpractice. Some of it points to a high likelihood of illegal discrimination. (Or maybe definite discrimination, depending on the particulars of who he finds “scary” – like if he finds people who “look like they are xx ethnicity”.) *All* of it is just bad behavior, even if not legally problematic.

    The day you get sued (or a regulatory body comes after you), all of this is going to come to light. And you – as in your company and possibly you personally – are going to get nailed to the wall. Someone complains about discrimination? You won’t be able to say “we didn’t know” – because you *should have known* given what he has said *in writing*. Someone complains about substandard care, or inaccuracies / lies in his reporting and record-keeping that had a negative effect? You’re not going to be able to get away with “we carefully monitor our clinicians’ work”. Because you already *know* that he has been lying about his schedule. And you already know that he’s disdainful of his patients and acts like they are garbage. Unless someone is reviewing *every single* patient record AND regularly following up with most of his clients AND following up with every single complaint you get, you will be on the hook. When you know someone is this sloppy anything less than that level of oversight is total complicity. And even that level of oversight may not get you off the hook.

    It makes me sad that I even need to say this. But it sounds like no one has been taking the problem seriously enough, nor has been willing to deal with this the way to needs to be dealt with. Perhaps if people realized the level of risk to the organization as a whole, action might happen.

    1. AJ Crowley*

      This!

      I also pointed out above that if this is clinical work requiring a license, some of this could be reportable to a licensing board. Certainly if he’s put on any type of supervisory plan limiting independent practice. If that happens and Ross is * not* reported to the licensing board, it’s going to be more fuel for any type of legal action.

    2. Capt. Liam Shaw*

      I agree with what you said here, only thing to add is… does the LW have the authority to fire Ross. Hopefully he does, but yeah the liability here with Ross is off the charts.

  69. M. Magpie*

    I messed up my own earlier comment, so will try again. I’m retired now, OP, from the DoN level. I’ve inherited your guy before, and he’s giving off those “got you over a barrel” vibes in tsunami sized waves.

    I won’t speculate too much, but if the reticence stems from not having enough clinicians to service an already underserved area, that can’t be a reason to keep this guy. If he feels protected because of this, it’ll only get worse.

    I won’t list all the liabilities that could be at play that he’s opening your org to, but they’re there. Additionally, the rest of your staff see and are noting how he’s being handled. Your patients are at risk, he’s not a good clinician, I’ll guarantee your other employees see it and morale is suffering, and frustrations mounting—including yours as witnessed by writing in.

    Ross *is* the infection, and it’s insidious, creeping into every aspect of work. You’re heading into multi-system organ failure as a practice, and the only real answer is to apply the broad spectrum antibiotics now: Fire Him. Let the rest of the team see that one guy like this will be handled appropriately. Show him the door, for the sake of your clients, and staff, and the overall health and safety of the business.

    1. AngryOctopus*

      And to add to your point about the rest of the staff: they’ve seen Ross go unchallenged in the group messages. They may not feel able to push back (because what if they need to trade patients and he’s the only one available? They feel like they need to be on good terms with him. This is another problem, frankly), but they also don’t see anyone above them pushing back. That’s not good, and many of your staff may be looking for an out because they don’t just see a problematic employee. They see a problematic employee who is seemingly sanctioned by management. I’d be having a meeting with your staff ASAP to have them report issues with Ross to you, and show that you’re at least doing something about it.

  70. Lady CFO*

    Fire him. Yesterday.
    Aside from being an insubordinate jerk, he thinks your clients are gross and make him want to vomit and is so comfortable expressing that, he does it in group Teams exchanges!
    You have a responsibility to your clients. That comes first.

  71. Captain dddd-cccc-ddWdd*

    Wow! Ross certainly thinks a lot of himself. He is such a superstar clinician (in his mind) that if he deems a patient case worthy of his attention, it’s as if a minor celebrity showed up… People like schedulers and managers (and HR probably) are just roadblocks to be sidestepped and blown off, because they will try to get you to see patients who are gross and not clinically interesting. Nice try but no cigar if they try to get you on the schedule to drive out to the unglamorous backwater of ‘Timbuktu’.

    He is anxious about dealing with certain types of patient, probably because he doesn’t want to so hasn’t taken the time to learn (I’m assuming it is something he could learn to do, rather than that he finds them intimidating because of a legit reason etc).

    Other comments have covered the clinical and patient care aspect of this, but even if this was a job in a non-patient-facing job (software engineer or whatever) a lot of the same principles apply. Fundamentally he is trying to cherry pick the aspects of the job he wants to do, leaving the ones he deems beneath him to other people, won’t go out of his way, wants a special schedule because of nebulous school pickup issues, etc and is insubordinate when called on it by management.

    I think this is a case for one difficult conversation and then (because he won’t change) to end up being fired.

  72. Writer Claire*

    >> “Ross” is an overall good clinician; however…

    This reminds me of letters to Captain Awkward that start off “my partner is overall a wonderful person” only to add “except when they’re cheating on me.”

    Ross is not a good clinician. He’s disrespectful, belligerent, and often doesn’t even do his job. He needs to go.

  73. Elbe*

    Honestly, I think the LW should be reaching out to some of Ross’s patients and seeing if everything is okay with the care they’ve received from him. I would be willing to bet that, even if they are not actively complaining, they are very unhappy with how they are being treated. Who knows how he is acting and what he is saying when no coworkers are around!

    I agree that his horrible attitude will seep through in his interactions with patients, even if the LW can manage to get him to do all aspects of his job. I have no idea why he would specifically choose a career path that requires empathy and understanding if he was judging those in his care so harshly.

  74. And the Skeletons Are… Part of It*

    Especially if this is a home health aide or similar, it’s an indictment of your organization that this didn’t scream “fire immediately” to you ages ago. Tolerating this kind of trash attitude when you have vulnerable patients who may not be able to speak up for themselves is horrifying.

    1. Elbe*

      Yes! “Ross, you thought you could get away with shirking your duties and being rude about patients. You can’t. Nice try, tho.”

  76. NerdyKris*

    I love the weaponized therapy language here. I want to believe that if LW shut down the “harassment” comment, his next letter would have been to HR: “I have clearly stated my boundaries and Manager has refused to respect them”

  77. Nook Nook*

    Unless you are in Montana (assuming also in the US), all other US States are At-Will. He can go at anytime, so keep that paper trail going until the end. It sounds like he should’ve been gone long ago. Can’t wait for this update!!

    1. Engineer*

      Even Montana would fire this guy, provided the proper paperwork was in place – and if it’s not, that’s a failure of management. And this whole situation is absolutely a failure of management.

  79. Cthulhu's Librarian*

    In the healthcare system where I’ve worked, Ross’s behavior (as far as how he speaks about patients) would warrant a call to patient safety. He’d be placed on administrative leave while they investigated, then likely fired immediately upon conclusion of that investigation, because someone with his attitude cannot be trusted to see and care for his patients responsibly.

    As his manager, you would likely end up with a retraining scheduled, for not catching on and calling him out.

  80. Bad Batch*

    I know healthcare is really hurting for staff but I can’t see how OP’s patients are being helped by someone like Ross. They’re probably better off with OP’s crew being one person down instead because at least there’s no longer the chance of Ross actually going to a patient he finds “gross” and being his charming self :-/

  81. Empress Ki*

    I would like to be a fly on the wall to hear how Ross speaks to the patients he visits. I am even a bit surprised there was no patients’ complaints at all. Would it be possible for a supervisot to contact some of these patients and ask how satisfied they are with Ross’ treatments ?

    1. AvonLovesBlake*

      Yes. If you’re not seeing formal complaints about Ross from his patients, it could be

      a) because he has hinted or outright stated that complaints will lead to him retaliating in some way

      b) because he has told his patients “Oh, if I get pulled off your home visits, you won’t be able to get home visits from ANYONE ELSE at [clinic]”

  82. Julie*

    He needs to go. It’s not fair to the people who get your services. They need staff who show empathy. It’s also not fair to other clinicians who have to pick up the slack for someone else.

  83. Falling Diphthong*

    Hot take: Ross is doing all this stuff because he can get away with it.

    Thus far he is correct in that assessment.

  84. YTA*

    I have literally called my (ex-)grand-boss an a**hole to his face, and even I wouldn’t be as disrespectful towards management and customers as Ross.

  85. H.Regalis*

    You know how in fiction there’ll be a character who’s a raging asshole, fucks over their coworkers, has a ton of personal problems that bleed over into work, and so on; but the boss/chief/commissioner will be like, “Dammit, So-And-So, you’re the best [whatever] we’ve got”? That’s not a real life thing, Ross.

    1. Bad Batch*

      Especially since there doesn’t seem to be a strong case for Ross being the best whatever that LW has. At this point, someone with no training or certification whatsoever would probably be a better fit if they could at least mimic basic empathy and courtesy.

  86. Abogado Avocado.*

    OP, please convince HR that it’s time to rip off the band-aid and fire the guy already. He’s not cut out for this work.

    And if you’re worried about what Ross will do, remember: it’s never too late for him to take up welding.

  87. DramaQ*

    Ross needs to go. I worked for a teaching hospital/university on the university side and it was made clear even to us if we referred to patients in a disrespectful manner while on the clock that would at minimum result in a serious warning but could go all the way up to termination. I am floored the OP considered Ross a good clinician. Maybe he is on the technical side, I’ve encountered a lot of doctors with really poor bedside manner BUT it sounds like in this case these patients don’t have the option to fire Ross for his attitude. They have to take who they can get. That makes a good bedside manner even more critical because you are treating a population who already deals with a lot of dismissal and respect from the medical community. HR either does not have the entire picture or is incompetent. The OP needs to forward all communications and Monica should be told to do the same and talk to HR herself. I would be livid if Ross was treating my elderly loved one and I found out about this. I’d be escalating and also out for the manager’s head if I ever found out that s/he was treating Ross as “quirky” and not addressing it beyond a note in his annual review.

    1. H.Regalis*

      I’ve been the person seeing a clinician with a terrible bedside manner—he wasn’t even who I had an appointment with; dude literally wandered into the exam room while I was getting a PAP smear—and I did not go to the doctor for a long time after that because of how awful the guy was.

      These patients are in worse place than I was because they have to be seen by Ross if he gets sent out to take care of them.

      1. goddessoftransitory*

        Good Lord, people were allowed to wander into the room during your Pap smear? When you are in the most physically vulnerable position imaginable? And then this person decides to get vicious about a procedure he wasn’t even doing???

  88. fire this guy!!*

    As a disabled person with a healthcare background, I’m disgusted and horrified you KNOW he feels this way about patients and he is able to talk about them like this at work and you still think its okay to keep him. You’re complicit in this ableism too.

    1. Jessica*

      Yup.

      The fact that the LW writer describes this monster as a “good clinician” is a pretty clear indication that they’re not much better than he is.

    2. Pierrot*

      100%. This is upsetting. It seems like his refusal to complete the assignment is being treated as a bigger issue than the bigotry. I’m concerned about how he is treating vulnerable patients in their homes, and the LW should be concerned too. Also, this is a major liability issue that could blow up in LW’s face since she is the manager.

      1. Observer*

        It seems like his refusal to complete the assignment is being treated as a bigger issue than the bigotry.

        Yes. It’s upsetting. I think that a lot of people have been calling out the liability issues because we think that the OP’s company doesn’t really see that that’s such a big problem. But if it puts the company at risk, they will do something.

        I’m a pragmatist, so I want them to do the right thing – take Ross of patient care – even if they do it for purely selfish reasons rather than because it’s the *right* thing to so.

  91. Happy Pineapple*

    Doctors who don’t respect their patients are the reason it took me nearly six years to be diagnosed with a debilitating chronic illness. They did not care about my pain or my wellbeing. They dismissed my symptoms and hurried on to the next patient. Doctors like this can cause negligent death. Ross is a malpractice lawsuit waiting to happen.

    Get. Rid. Of. Him. He should not be around vulnerable people. And be very, very clear about why with any future references.

    1. Keymaster of Gozer (she/her)*

      Sincere sympathies, the same happened to me.

      I just finished a piece of embroidery for the one doctor who actually listened and agreed that yes, I had a right to be concerned about my symptoms and ordered tests instead of fobbing me off with ‘weight loss is good!’

      The one good doctor doesn’t heal the wounds from the bad ones though.

    2. H.Regalis*

      Same: My problem still isn’t fixed; and my best friend spent over a decade getting fired from job after job for being sick all the time because her doctors kept telling her that the pain was all her in head and that she was too young to get a hysterectomy. Nothing changed until she switched doctors. Her health problem is common and not even slightly obscure. It never should have gone down like that.

    3. Starscourge Savvy*

      This happened to me as well. Cheers to the doctor who wrote off an immunocompromising chronic illness as “probably allergies” for an entire year (and that wasn’t even the worst of it). His practice is still going, years later.

      OP, don’t let this be you.

    4. 14*

      Fourteen here

      Fourteen and a half years of screaming agony, vomiting with pain, rolling on the floor, crouching, twisting, writhing, sobbing, begging for relief. I know a lot about pain. It has to go pretty far before it makes you vomit, trust me.

      They actally wanted to wait even longer to let my organs stick together so they could see the evidence on ultrasound first. It’s easer to justify the surgery then (:

      1. 14*

        Oh and don’t anybody DARE to read this and think ‘Well if somebody’s not as bad as that then it’s not such a big deal and they’re overreacting’.

        My point is: if even I was ignored, whoever you’re thinking of is probably suffering way more than you realise. The bar for getting help is shockingly high.

  92. Carmichael Lemon*

    When you’ve written an essay with this amount of WTF behavior from your employee, just fire them.

  93. Boof*

    I say this as a physician – seriously consider firing Ross. At best, have a clear discussion that they WILL be fired if they do not immediately change their behavior, and if they do agree to change, put him on a PIP / probation for at least a few months to prove they actually do change, and consider firing or immediate consequences for any backsliding for a long time.

  94. No Medical A-Holes Please*

    As someone who has been mistreated, misdiagnosed, and disrespected by medical professionals who can barely hide their personal feelings about me (as a fat woman, that means most of my life), PLEASE FIRE HIM IMMEDIATELY. Why the hell is he even in this line of work??

    I guarantee you he is not hiding his feelings from his patients very well (or at all!) even if he claims otherwise or puts on some kind of phony “fake nice” manner in your presence, and that makes an already uncomfortable experience of being in your most vulnerable state with a stranger even more stressful and unbearable. People like Ross have made it hard for me to seek even preventative medical care because I’m always anxious about whether I’m going to be talked to/treated like a human being or faced with someone full of judgments about me and very comfortable letting me know in their tone of voice, the way they handle me, the way they look at me, and the comments they make that they dislike me. It’s awful.

    Don’t put your vulnerable patients through this. Fire him.

  95. Keymaster of Gozer (she/her)*

    If you keep Ross, one or more of the following will happen:

    – His words about certain people being ‘gross’ and refusing to see them will get out to the patients and you’ll have a fun time with discrimination laws.
    – His coworkers get so sick of picking up the work he refuses to do that they leave. I get the field is short of qualified people but you’re risking losing a lot of others by keeping one.
    – A medical malpractice suit will crop up. I seriously doubt he’s not mistreated a patient up till now.
    – Word of mouth starts to spread about this rude lazy entitled boil on the backside of a clinician and your company’s reputation goes downhill fast.
    – You’ll find his attitude is covering some seriously BAD if not illegal behaviour.

    I’ve BEEN the patient that a nurse or doctor has said they don’t want to see because I’m ‘gross’ and both times it’s been because of my weight and disabilities. Want to see inhumanity? Rock up to a new doctor while fat, not white, visibly disabled, mentally ill, female and over 40.

    Your entire company is at risk of going under because of Ross. I don’t care what his issues are or personal dramas – if he wants the pay he has to behave. He isn’t. I’d fire him straight away for gross misconduct alone.

  96. GythaOgden*

    Even here in the UK with labyrinthine employee protection a lot of those situations on their own would be gross misconduct — more than enough reason to sack someone. HR should be down on this guy like the proverbial ton of bricks, and should empower management to deal with this kind of ridiculousness.

    I’m flabbergasted by this. I am so sorry this is happening in your clinic, OP, and I am sending you good thoughts that you can deal with this head on, because it must be so aggravating for everyone except for, it seems, Ross and HR. I am a fly on the wall at a clinic now occupying former administrative rooms and the patients are by far the most important and least officious, stuffy and out of touch people. We’ve been trained to recognise their underlying needs; they’ve come for physiotherapy, but they are also individuals with a range of backgrounds and some are struggling with their injuries and getting back on their feet (literally), some are vulnerable, some just need a cup of tea and a listening ear. It sounds like HR are insulated so much from the day to day biz here that they’re clueless that Ross is so aggressively incompetent and oblivious to his obligations to his patients, both formal and informal.

    I understand the need for systematic discipline, and I’m not going to dogpile OP because I know firsthand how much you can be paralysed in the face of something like this and what you should do (that you realise in hindsight) is not often what you’re able to do. The NHS has not been known for its agility when dealing with people like Lucy Letby, who were able to con people into dropping legitimate investigations into outright murder. Once or twice isn’t a big deal (except when it involves patient deaths) but sometimes while a pattern emerges we can be busy trying to juggle everything else and not notice for a while. We had to call the police non-emergency number yesterday because of suspicious squatters in the car park and it was terrifying to approach them, not because I feared repercussions either for me or them, but because trying to explain something rationally in the moment is hard when confronted by the audacity of the person who saw stuff happen firsthand but insisted it was my job to ring the police. The squatters had a dog that was off the leash — it was behaving itself but with patients — two different clinics operate in the building — we need to be more careful than we might if we were still purely an office building. (They left of their own accord when asked to move on. The police wouldn’t come out unless they were actively threatening, and they weren’t, but I was more afraid of having to tell the cross tenant that they weren’t coming out than the actual intruders, and my boss was able to do that for me.)

    So I can sympathise with being aghast and stunned in the moment and don’t want to use the privilege of hindsight to berate the OP.

    I can also sympathise with having to work through trauma — I did turn down one job with equipment services because it came too close to home, and my trauma spot is hospice procurement because syringe drivers, while necessary parts of the palliative care process, are nasty instruments that in our case had to be poked into the arm of a dying man, and I have to take 5 minutes after calls involving either that or the hospital in which he was treated. My new WFH is hospital facilities in the same region, and part of my training will be to visit many of the sites my team is responsible for — but at the same time, I think I need to talk to my new manager (who knows about the situation and is 100% supportive of my mental health needs — this is her way of bridging my experience gap and I’m infinitely grateful to her for taking a chance on me) and sort it out before I need to go near the hospitals my husband was being treated by.

    But this isn’t a sudden spike in deaths happening to vulnerable patients and a puzzle to work out what’s happening; it’s flat out obvious Ross can’t do his job properly. He needs to either put up or shut up. He needs to face his trauma/disgust head on and work through it (and I’d imagine a health service might help with that, or he can seek therapy, or find assistance through professional organisations) or he needs to leave the healthcare field altogether and retrain into something less triggering. He can’t be dog-in-a-manger here.

    It breaks my heart to see people in medical services that don’t care about their patients. Even in the overworked, underfunded NHS, the patients are never the ones who are to blame for the mess and deserve the most support. We’re not right at the frontlines and dealing with difficult people in pain or under stress or being held for mental health treatment against their will (and there are people who have been seriously hurt on duty and have had to give up nursing and go into administration). But Ross is in serious trouble here and I look forward to the update when he’s kicked to the kerb.

  97. Jessica*

    please fire this guy yesterday. i can’t imagine being a patient and having him show up. having a work plan for someone to practice and develop the skills they’re weakest at is reasonable in an office setting, but not when the task list is other human beings and the skill is treating them with minimal respect, dignity, and human decency.

  98. CLC*

    I have to assume Rob was hired and subsequently not fired due to a lack of staffing. That’s a problem but he needs to go. He doesn’t understand the nature of job and feels entitled with respect which parts of it he chooses to do. His comments about patients are beyond. There are other jobs that are more flexible and don’t require patient care and he can get one of those.

  99. SMH*

    is it possible for you to call or visit patients he’s visiting to get feedback. Could be more issues you are not aware of.

  100. The Username Lost to Time*

    Seems like an airtight case of an employee with poor performance and misconduct issues.

    I am a little concerned that Ross is the type who will say that he is being discrimination against because of a medical condition. Consider leaving attendance issues out of his performance evaluation since 1) there is so much other stuff to fire him for and 2) Ross could try to push a case for needing medical accommodations.

    “He also has a lot of sick calls and sudden short medical leaves of a few days and missed the last two mandatory meetings” – see, you might not be able to catch him on this particular piece if he goes an ADA or family/medical leave route. You also don’t want him claiming that he already told you that he has a medical issue and that you dinged him on performance anyway.

    1. Observer*

      see, you might not be able to catch him on this particular piece if he goes an ADA or family/medical leave route.

      True. But on the other hand, if he does go the ADA route, you STILL have standing on the other stuff. And you most definitely *can* ask for appropriate documentation of condition and medically recommended accommodations. Keep in mind that accommodations need to be *reasonable*. And “reasonable” accommodations never include permission to be terribly disrespectful and horribly rude to and about clients and staff.

      And “picking up his daughter from school” is just not going to be an ADA accommodation, either.

      1. The Username Lost to Time*

        Totally in agreement. I’m suggesting to just steer clear of any whiff of ADA/FMLA stuff altogether. Work like a sharp knife and not like a blunt object that will eventually get the job done.

        So just say that he was disrespectful to colleagues and clients. Don’t say that he called in sick too often or with short notice. The medical stuff can get dragged out much further than the other issues.

  101. Jessica*

    LW is a great example of why our medical system fails so many people: the contempt in which care providers hold patients.

    ““Ross” is an overall good clinician.”

    No. Someone who holds people in need of medical care in open contempt is not a good clinician, and if you didn’t hold them in the same contempt–even if it’s less overt on your part–you’d never call him a good clinician.

    1. Former RN LNP*

      in the same way that certain types of people are drawn to professions where they have access to children for not great reasons, certain types of people are drawn to healthcare positions for similar not great reasons. think about the type of job where you are actually allowed to hurt people or treat them certain ways without repercussion. it’s the worst kept secret in healthcare that once in awhile you come upon a person who should not ever be allowed anywhere near a patient.

      1. Jessica*

        I feel like it’s way more than once in a while.

        Finding a doctor who doesn’t get offended if you ask basic questions like “hey, I have a family history of XYZ, could you test for that?” if they didn’t think of it on their own is… a challenge.

    2. Dinwar*

      “…and if you didn’t hold them in the same contempt–even if it’s less overt on your part–you’d never call him a good clinician.”

      That’s extremely harsh, HIGHLY speculative, and totally unwarranted.

      One can be good at certain aspects of the job–diagnosis, the physical procedures, documentation, and the like–without being good at others–people skills. The callous but effective doctor is a stereotype for a reason. If that’s the case, it’s easy to see why someone would say Ross is a good clinician but has problems. This has nothing to do with the LW holding patients in contempt.

      Possibly it’s systemic. “Nice” and “Effective” often seem to be in opposition in medicine. Setting a broken bone is absolutely going to hurt the patient, but it’s also the best thing you can do for them, for example. Once you’ve become used to making such calculations it will necessarily affect the relative importance you assign to bedside manner, medical knowledge, and aptitude at the procedures. It starts to make sense to say things like “Sure he’s a jerk, but I’d rather have my life saved by a jerk than to be killed by someone politely.” That’s basically how most of the civil engineers I know keep their jobs–they view people as problems to be solved, and quite often extremely stupid problems to be solved, but civil engineers are really good at solving problems.

      1. Jessica*

        If you lack compassion for your patients, you’re not a good clinician.

        Full stop.

        Real life isn’t “House.” The brilliant asshole doctor is a misogynist myth. Doctors kill patients primarily by *not listening to them.*

        The fact that you’re comparing medical care to engineering is deeply telling.

        1. Observer*

          The brilliant asshole doctor is a misogynist myth. Doctors kill patients primarily by *not listening to them.*

          Yes! Good diagnostics and disrespect for patients are mutually exclusive.

          The fact that you’re comparing medical care to engineering is deeply telling.

          The irony is that *good* engineers actually do not look at people as just idiots that need to be “solved.” Sure, sometimes they conclude that the requests are stupid, etc. But they understand that their work is there to serve people, not the other way around. And they understand that failure to do their work properly has real world repercussions for people, who deserve to NOT be put in danger by sloppy work.

        2. Dinwar*

          “The fact that you’re comparing medical care to engineering is deeply telling.”

          The fact that you have not provided a coherent counter-argument against my statements is deeply telling.

          Discussing a TV how I have not referenced is not a counter-argument; I never made that argument, and happily agree that “House” is a poor model for any medical treatment.

          Stating that you don’t personally consider engineering a good model isn’t really valid for two reasons. First, personal beliefs aren’t universal–I could easily find doctors who DO view engineering as a good model (I’ve had a few work on me). Second, it’s merely a re-statement of your conclusion, which is already known, and therefore adds nothing to the conversation.

          You haven’t actually given a reason to support your conclusion. The only stated reason is a vague “But people!” emotive reasoning. Can you provide concrete arguments to support your conclusion? If you’ve nothing better to offer than what has so far been presented, skepticism for your position remains viable.

          1. Clare*

            Jessica did provide a counter-argument to your statement. It’s highlighted by asterisks.

            Doctors kill patients by not listening to them.

            The same way you’re not listening to Jessica. If I tell a doctor my stomach really hurts and they think I’m making it up for attention; or they decide it’s an anxiety bellyache even though I say I’m not stressed; or they do a poor job of pressing my belly because they think I’m ‘gross’; or laugh when I try to say I have a family history of appendicitis; they’ll miss my ruptured appendix and send me home to die.

            1. The Reconciler*

              Exactly. And I would never want to see a clinician who considered themselves an engineer, because I am not a robot or computer that works identically to other robots or computers of the same model. I am a human being. We are all a little different and all worthy of basic respect and care. It takes much more than anatomical knowledge and technical skills to make a good clinician. It’s an art as well as a science. If that viewpoint is too “emotional” for you and therefore not valid, I guess all I can say is I’m glad you’re not a clinician!

      2. Observer*

        One can be good at certain aspects of the job–diagnosis, the physical procedures, ~~SNIP~~–without being good at others–people skills

        That’s actually not true. You cannot do good diagnostics if you have no decency or respect for the people you are dealing with. If you’ve already made your decision about a person, you’ll never get the information you need to do a proper diagnosis. If you think your patient is a piece of trash who you can’t look at because you would vomit, you can’t and won’t be able to do even the most basic of diagnosis. And your records are going to be trash.

        This is NOT about the “people skills.” This is about basic fundamental respect for other human beings.

        It sounds to me like you’ve been fortunate to have never experience medical care from someone who is bigoted against you or “people like you”. I have, and I’ve watched at least one head of department at a major hospital (someone with all sorts of accolades) utterly and totally botch someone’s medical care, making HUGE and life threatening medical mistakes because of their prejudice against people “like” the patient.

        Someone this disdainful and disrespectful of whole classes of patients is not and CANNOT be a good diagnostician.

        1. Dinwar*

          “It sounds to me like you’ve been fortunate to have never experience medical care from someone who is bigoted against you or “people like you”.”

          You would be wrong.

          1. Observer*

            You would be wrong.

            I’m sorry to hear that.

            And it still does not change the fundamental point that bigotry and disdain for patients *is* going to affect the care provided. Sure, there are a lot of other ways to negatively affect people’s care as well. But it’s just not possible to be a good diagnostician if *you are contemptuous of your patients.

            *generic you

      3. Pumpkinhead*

        It’s concerning to me that this kind of mindset is being perpetuated. Even in medical schools now, empathetic care and patient rapport are core competencies being evaluated as part of the training. Being clinical (in the sense of being stoic) in your delivery of care is not the same as being contemptuous of your patients.

      4. Kara*

        The problem with that logic is that in studies, the nice doctor’s patients do better and have a higher survival rate. It turns out that in real life, the effective jerk isn’t a thing.

        Given our long cultural obsession with the effective jerk, when evidence says it isn’t true, i wonder if it’s a case of people buying into the jerk’s arrogance to some degree? He says he’s great, so he must be?

    3. Bunny Lake Is Found*

      I don’t think it is fair to interpret LW’s claim “Ross is a good clinician” as a sign they are contemptuous of those in need of medical care. It seems like LW is trying to draw a distinction between the technical aspects of the job and….the rest of the job.

      I’m a lawyer, so maybe it is because I see it often, but there are many lawyers I have encountered that have far made more egregious comments about their own clients than Ross has, but do an excellent job of representing their clients’ best interests and succeeding in achieving their clients’ objectives. They are good lawyers, despite their distaste for the actual people whose interests they are advocating for.

      I think the problem is more that LW doesn’t see how Ross refusing to treat certain patients, and shirking off attendance and appointments mean that it doesn’t matter if Ross WOULD do a good job at the actual medicine–Ross won’t do it. Which is no different than if Ross went to to these appointments and assessed/treated people by rolling 20 sided-dice to determine how to proceed. Those patients are not getting the benefits of Ross’s “skill” either way.

      1. Observer*

        They are good lawyers, despite their distaste for the actual people whose interests they are advocating for.

        In theory this *might* be possible in medicine. In practice, though, this simply cannot be. I’m serious. People who are dismissive and contemptuous of their clients are unfailingly bad diagnosticians of those people.

        I think the problem is more that LW doesn’t see how Ross refusing to treat certain patients, and shirking off attendance and appointments mean that it doesn’t matter if Ross WOULD do a good job at the actual medicine–Ross won’t do it.

        That is ALSO true – assuming that there is a subset of clients that Ross actually treats with the basic respect required to provide decent treatment.

      2. New Jack Karyn*

        I think there’s a difference in how a doctor views & treats their patients (on one hand), and how a lawyer views & treats their clients, in terms of whether their disrespect affects the outcome of the case.

        But I’m a little too tired to carry that thought much farther.

  102. Gemma*

    I’m a clinician. It’s a testament to the professionalism of the people that I work with that these situations don’t happen a lot more often. We’re locked into a bad marriage with our employers: they treat us horribly because they know they can exploit our altruism (and it’s like this everywhere) and we know they won’t fire us because we’re the only ones qualified to produce the revenue they need and we’re not easily replaced. That’s why this manager can’t see her way to the obvious solution.

  103. Margaret*

    I’m posting this comment as a patient who has occasionally used Home Health services. why does this man still have a job? how is he treating patients out in the field? and before you answer that, are you sure? are you really sure? are you sure enough to bank on it because this man is a walking lawsuit waiting to happen.

  105. Eagle*

    You stated that Ross sees less patients than other clinicians. I suspect you could get the exact metrics and then piece together if Ross is even working his full day but still getting paid for it. That sounds like fraud or time theft. You have so many red flags waving at you, that if you plan to keep himon, the PIP needs to start today!

  106. Self Employed Employee*

    A human being needing patient care did not get it because of this employee’s behavior? That seems like such a serious failing.

    When this employee tries to keep his job, feel free to say, “no, nice try tho”.

    1. Ink*

      I think they swapped in someone else, but it definitely sounds like care may have been delayed. (If Ross has however many care needs he refuses to handle, how crammed are everyone else’s schedules? Who else has space to take on urgent needs near-immediately with Ross’ swiss cheese schedule!)

  107. Pierrot*

    LW, if HR doesn’t get it after you present them with the totality of the circumstances, including the fact that he has called patients disgusting in emails/messages and has falsified records, you need to spell the liability issue out for them.

    “I am very concerned that Ross’s attitude of disgust and disdain towards our patients, coupled with his refusal to do assignments or prioritize emergencies has the very real potential to harm patients, if it has not happened already. I cannot in good conscience allow him to continue working with patints. This exposes us to reputational harm and legal liability.”

    Then you tell them that you are going to fire him, and if they veto that, tell them that at minimum he needs to be suspended while you go through the process of preparing to fire him.
    This is serious. You cannot normalize Ross’s behavior. Peoples’ safety and wellbeing are at risk.

  108. Crencestre*

    Retired special ed. teacher here: Ross is in the wrong profession. His contempt for the patients and his refusal to rise to the occasion to meet emergency needs makes him unfit to be a clinician. Frankly, I don’t see him succeeding in ANY field in which he must be a contributing member of a close-knit working team…which lets out a LOT of jobs for him!

    He should have been fired LONG ago. He needs to be put on a very strict PIP as of now and not given more than one chance to “straighten up and fly right”. The patients’ well-being is at stake and Ross is not the right person to provide compassionate care for them/

  109. Garlic Microwaver*

    Forget firing. He is refusing to give medical care and being discriminatory toward patients and their medical conditions. He should be behind bars with his medical license revoked. Also, OP should acknowledge their part in this for being way too tolerant for presumably way too long.

  110. Caz*

    No, no, no, no, no.
    OP, I’ve worked in healthcare for nearly 20 years. I’ve worked with good clinicians that I got on with, and good clinicians that I didn’t get on with, and with bad clinicians. I was having a conversation yesterday with a clinician who I find very frustrating, but if my family member was under his care I’d be delighted because he is a good clinician and his empathy takes over every part of him. (He also expresses his admin needs poorly, which is where I come in and find him frustrating.)

    Ross is a bad clinician. He has no respect for his patients or their ailments, never mind for his colleagues and what additional pressures his choices put on them. This situation requires a much, much stronger response. If I saw someone like this at my workplace I would expect them to be on a PIP.

  111. Home care patient*

    I need home care and I don’t want this guy in my house, much less helping take care of me.

  112. Bunny Lake Is Found*

    Ok, I am going to assume that you cannot easily replace Ross. Like, you know his actions are fire-worthy, but you are only considering a write-up? You are letting Ross get away with terrible behavior and the only logical reason I can see to do that is because if you fire Ross tomorrow, it would be a struggle to replace him with a clinician of similar technical abilities for this type of role.

    But you need to fire Ross. This isn’t going to get better if Ross knows you aren’t going to get rid of him even if is insubordinate, rude, and underperforming. Start recruiting for someone new. If it is truly a difficult role to fill, Ross will have plenty of time to improve if he wants. Give him clear directives, tell him his job is on the line, but don’t let his behavior drive down team morale this much.

    And, for context, I almost NEVER encourage firing someone. Especially if they are good at the technical substance of the job. But this isn’t a case where Ross just happens to have attendance issues, or chronically is 5 minutes late everywhere, or just refuses to do Type X clients (but will happily take on any others)–he is a hurricane of insubordination, rudeness and a clear belief that he is untouchable. This is not an attitude you want in the field. If he makes an error in the clinical component of the job, I promise you it will be a nightmare to get him to understand and improve.

    1. Ink*

      Even if he’s really difficult to replace, it sounds like there are a fair number of clinicians in the company AND he isn’t pulling his weight anyway. That’s a morale issue, and losing multiple clinicians because they can’t take it anymore and have lost all faith in and respect for management won’t be any easier to replace than one Ross. I’d look into being able to move the money currently comprising Ross’ salary over keeping him on. Unless they’re already too severely understaffed, $X bonuses to acknowledge that they are (and have been) taking on extra work while a replacement is found might be better than wasting time trying to fix Ross.

  113. Ellis Bell*

    Flexing your power and threatening Ross’ job isn’t going to work here, because even if you get him to knuckle under, he’s going to be going into the homes of people who don’t have the power to boss him when he’s lazy/rude/lying. You need to get that bar raised right up from the floor.

  114. phira*

    Agreeing with everyone here about the level of egregiousness here, and that Ross really isn’t a good clinician.

    Something a friend and I are talking about (because you’d better believe we IM each other when there’s an AAM post like this one!) is how your scheduler Monica must feel! Not just how disrespectful and sexist Ross’ behavior towards her is, but also how much anxiety she must have every day when she comes to work, knowing she has to deal with him. Even if she doesn’t quit or wouldn’t quit because of Ross, can you imagine how she feels? This must wear on her so much and affect her life significantly, and the only way to alleviate the damage is to get Ross out of your organization permanently.

    1. Ink*

      Ooo, that’s a good point. How does she think it’s affecting her performance reviews, too? Her job is to get clinicians in appointment slots as efficiently as she’s able… and she can’t. Every time she tries to schedule Ross, it’s a whole thing. He goes to fewer patients than anyone else! Pulling the schedule alone, sans emails and so on to explain it, she’s not doing her job. I don’t know whether the LW is Monica’s manager, but whoever is, I’d be scared in her shoes! Has it been made clear that you all know it’s a Ross thing and doesn’t affect how her performance is seen? Because the difference between her performance with that explanation considered and without… isn’t small.

    1. I Have RBF*

      Same here.

      I have avoided getting a new primary care doc after mine retired years ago because trying to find one that doesn’t blame everything on being fat or born female is very, very difficult. I’m in a major metropolitan area, and finding doctors that are a) taking new patients, and b) not assholes about weight or being non-feminine AFAB, is actually very difficult and daunting.

  116. An Australian In London*

    While I don’t know if this is in the USA or in a right-to-work state, as an outsider I am constantly boggled that workplaces can on the one hand fire employees for wearing a disliked colour of socks, but on the other hand managers and HR people wring their hands and wonder if it’s time to give someone like Ross a write-up.

  117. Ink*

    How is he speaking to patients? What is he saying when there isn’t a written record? Obviously, we don’t know what kind of care he’s supposed to provide, but people who need in-home visits are often ill enough that they stop being taken seriously. If they reported him saying something awful, how confident are you that they’d suffer no blowback? How limited are their care options? If push came to shove, do you have any competitors they could switch to? Would insurance cover those competitors? Would they feel safe asking for someone else to be assigned to them? Are you proactively clear that you’d take such a complaint extremely seriously? Would they have good reason to think a new clinician would be respectful, or have cause to fear being considered a problem patient ANY clinician would be a pill with because they complained? Are your patients vulnerable enough that having some care, any care outweighs needing courtesy and respect? What would the burden on them and their loved ones be if they parted ways with your business?

    If Ross was making extremely sexist comments, but you were only aware of instances where no women were around to hear, and no one formally complained, you would take a look at ALL his interactions on the assumption that someone willing to say those things at all probably has had interactions with female coworkers that they maybe didn’t *quite* feel they could report, but which formed a big picture pattern of unacceptable behavior. And you’d protect everyone who told you about things he’d done from retaliation from Ross OR his friends, and keep those people in their jobs unless/until THEY decided it was time to leave and had time to get another offer instead of feeling pushed out with no plan. I think you need to approach his behavior with the patients he DOES deign to visit the same way. He isn’t in your office. He isn’t anywhere you can just happen by to listen in. You need to be extremely proactive about checking up on that, because you have no way of knowing what he’s like then. You just know that in speaking to you, *his boss*, he’s terrible. If he talks to YOU like this, what does he say to people he feels don’t have even the slightest power over him?

  119. MAW*

    I can’t help but feel that Ross says he would “just vomit” if he had a “certain kind of client” isn’t necessarily just about a health condition but about biases against some group of folks who are (nonexhaustive list here), intellectually disabled, trans, sex workers, some kind of racial or class grouping, or something else.

    and frankly, no about of diagnostic/clinic skill is worth someone who belittles patients and clients. his quality of care to a portion of the population will be abysmal. The physician’s oath of “do no harm” is absolutely being violated here, in spirit even if not in letter (since it’s unclear that the oath applies to his area/level of work, technically). And if you, the manager, allow him to cause harm by letting it slide, then you, too, bear responsibility for that harm.

  120. Brain the Brian*

    “Nice try, tho” is the icing on the cake for me. Using that particular phrase in work communications — especially about serving patients and clients! — is an immediate red-flag.

  122. Heyheyheygoooodbyyyyyyye*

    Maybe the potential (inevitable?) lawsuits will get through to them. Seems like a ticking bomb.

  123. Relentlessly Socratic*

    I work in healthcare and patient safety. People like this make my blood boil.

    Ross is NOT an overall good clinician. He is a bad one. Good clinicians care about their patients.
    That’s not to say that they universally want to care for any and all patients. If a clinician isn’t a fan of, say, babies, feet, weird skin conditions, looking in ear canals, or whatever, then they do not go into a field where they encounter these things with regularity. Not a fan of babies? Gerontology is right there! Don’t like visiting patients in their homes, well, go get yourself a clinic job. Good clinicians don’t accept roles where they then actively avoid their patients.

    He needs to go.

  125. Retired Vulcan Raises 1 Grey Eyebrow*

    Fire him. Right now.

    You can choose to tolerate slacking, lack of respect etc when your business is just about inanimate objects e.g. producing teapots or media; however, when your business is treating patients then you have a duty of care to them which means never knowingly sending a Ross to them.
    Those patients he finds “scary”/inconvenient are probably getting a substandard service from you and may well find Ross “scary”.

  126. DefinitiveAnn*

    I’m guessing that they are handling Ross this way because health care in the United States is broken. Perhaps this isn’t a US-based letter, but if it is, I kind of get the reluctance to toss this dude back into the job-hunting fray.

  128. Not that other person you didn't like*

    OP, there are a lot of comments on how terrible Ross’ performance is (and it is!) but it’s worthwhile for you to step back and look at your own performance. As a manager, your job is threefold: supporting your employees, supporting your company, and supporting your customers. Balancing these things can be hard, but OP, with all kindness, you are failing at all three right now.

    First, you are failing your employees. By putting all the effort and energy into coddling your lowest performer, you are letting all your good staff down. You’re allowing an unpleasant work environment (I wouldn’t want to hear Ross’ comments), you are impacting morale, and you are potentially driving away your best people. If these positions are hard to staff and underpaid (which is common) then you have an even stronger responsibility to care for your staff who are stepping up, doing their work, and not being terrible.

    You are also failing your employer. Employee retention is one of the issues (what will you do when everyone leaves BUT Ross?) but the other is reputational / bottom line. If patients and family are unhappy with Ross’ care (and they are, OP, even if you don’t hear about it) they will go elsewhere if they can and recommend against if they can’t which means less money for your company. There’s also potential legal risk here, both because of his inflammatory comments and his potentially shitty care. If he is suggesting that certain KINDS of patients are gross, that’s a very risky position for your company (it is old people, it is certain demographics, is it certain disabilities?). None of that is OK and even the appearance of bias can open your company to an ethics complaint or lawsuit.

    Finally, you are letting down the customers, which is particularly problematic because your customers are vulnerable patients. Ross can have some reasonable clinical skills, but that’s not enough to do a good job. He has a terrible attitude toward your customers and it’s impacting his ability to serve them (in ways that you are aware of, but also certainly in ways that you aren’t).

    If you can step back and look at all this objectively OP, you’ll see that Ross isn’t the only one not doing their job. The good news is that by doing yours, you solve both problems.

    1. Starscourge Savvy*

      This. Absolutely. OP, it seems like right now you can’t see the forest for the trees. Which, in a forest of red flags like these, is understandable, but also really troubling. A step back and a hard look are both warranted and necessary.

  129. Holly*

    As a chronically ill and disabled person, I want to underscore how much worse and more grief and trauma filled my life has been because of doctors like Ross, as if becoming ill and disabled wasn’t hard enough already. It’s always glaringly obvious who doesn’t give a shit and no matter how many times it happens, it’s always deeply upsetting – not to mention the impact on, y’know, the whole point of having a doctor, which is attempting to get decent care (and it IS only an attempt because of doctors like this). These doctors should be fired on the spot. They have no business caring for vulnerable people. Please be part of the solution and get rid of this asshole. I also wonder, like other commenters, what his current patients would say about him if they could speak freely. I also wonder how many things he’s done/not done that are reportable offenses to whatever ethics body you report to.

  131. Colonel Gateway*

    OP, while I’m glad you’re trying to do something about Ross, the gravity of what he’s doing doesn’t seem to come through your letter. Imagine yourself in the patient’s shoes for a moment. Would you want Ross as your in-home care provider?

  132. Jellyfish Catcher*

    I was in health care for decades.
    Ross clearly gets his kicks from being abusive to his employer and fellow clinicians. That is very likely just the surface of how he treats the patients, especially those physically or mentally unable to fend him off.

    He needs to be dismissed asap. Your clinic is sitting on a mountain of possible lawsuits. I wouldn’t be surprised if the patients’ pain meds get “misplaced,”
    or if there has been criminal level abusive behavior.

  133. anonymouse*

    As a chronically ill person: you need to fire Ross immediately. Being rude to his coworkers is bad, but potentially fixable. But the biggest issue by far is that he is a healthcare worker who expresses disrespect and outright disgust for his patients. I am not going to mince words here:

    If you allow Ross to stay on your staff, he is going to kill somebody.

    I’m not saying he’s going to stab someone or shoot them or something. I’m saying that one day, a patient will try to tell him they’re having a health issue, and he is going to dismiss them, and the issue will turn out to be fatal, and they will die.

    I have been active in communities of chronically ill and disabled people for over a decade now. I have seen this happen many, many, many times before. My own sister nearly died when she was twelve because a doctor dismissed an issue she was having and tried to dismiss her without doing any kind of test or treatment; if it hadn’t been for a nurse who insisted they test her before they sent her home, she would have died.

    And maybe I’m misunderstanding the nature of your profession—maybe the type of issues your clinicians work with can’t be fatal. But even if that is the case and Ross isn’t at risk for outright killing patients, I guarantee you he is not giving his patients the care he deserves. I have had many interactions with healthcare workers who talk about their patients the way Ross does. They do not see ill and disabled people as human.

    You need to fire Ross.

    1. WorkingClassLady13*

      I 100% agree.
      Trying to put myself in the patients’ shoes….
      I have elderly relatives who have depended on these types of health workers. I myself have seen doctors about medical issues and have been in a scary, vulnerable spot.
      The idea that this guy cares for sick, disabled, or otherwise vulnerable people is absolutely terrifying.

      He needs to be fired …. yesterday.

  134. Starscourge Savvy*

    If this is how Ross acts when he’s around colleagues and people *above* him in the hierarchy, how do you think he’s behaving when he’s unsupervised? You absolutely cannot allow someone to treat patients like this.

    He is not a good clinician. He actively hates his patients, maybe his entire job. It’s a miracle someone hasn’t already suffered immensely or died under his care (as far as I can tell by the letter, anyway, who knows?). Ross is *going* to cause damage and trauma. Not might. He is. People’s medical care is absolutely not to be trifled with.

    Fire him. Immediately. You don’t get to treat human lives this way and keep your career.

  135. Former Red and Khaki*

    Look I know recruiting is incredibly tough in the medical industry right now, but as has already been said here, this is all so far out of line I’m shocked HR didn’t show him the door that very day. I would rather there be less doctors/clinicians/etc but those few are 100% all in, then have to deal with this cluster fluff when I have a medical thing going on. People are already so wary of medical care, especially in the US – anything that reinforces that wariness is a hindrance to all of you.

  136. Caryn*

    This is more than speaking disrespectfully, this is ableism and bigotry and should be named as such. And it should be a fireable offense, just like every other form of bigotry in the workplace.

  137. Mothman*

    I was about to say “can you imagine hearing a teacher talk this way about students?”

    Then I remembered what some of my teachers said when I was growing up. It didn’t give us a great view of education. (I *became* a teacher because of it, but a lot of people grew up to consider teachers the enemy.)

    This one guy could impact how a client sees the entire industry. And he seems proud of it.

  138. Ex-prof*

    I’m really confused by the LW saying that Ross is a good clinician.

    If he’s a good one, what’s a bad one look like?

    I wonder if this is partly about the difficulty of replacing Ross. I can’t think of any other reason why anyone would want to keep him.

    And even at that, it seems like coworkers might start quitting over him.

  139. tinybutfierce*

    If he’s talking this way to his peers and BOSS, imagine how he’s dealing with patients. Fire this ass.

  140. LifeBeforeCorona*

    Ross needs to go now. Patients don’t need someone who “vomits” at the thought of providing them care. It sounds like he’s in the wrong profession.

  141. Hedgehug*

    I feel sick reading this.
    All I can think about are my rural grandparents, and if they needed homecare someone like this visiting them.

  142. Airy*

    “Ross is an overall good clinician,” then a description of why he’s actually a dreadful clinician reminds me of all those relationship advice posts on Reddit that begin like “Overall my partner and I have a great relationship! It’s just that whenever we disagree they give me the silent treatment for days, destroy my favourite possessions and hide my car keys. How can I gently let them know that this hurts me?”

  143. Ms. Murchison*

    “He has been told at his previous annual reviews that these are things he needs to work on to feel confident.”

    Ross has been getting away with this for years. No wonder he felt comfortable outright refusing to work and accusing his manager of harassment.

    1. goddessoftransitory*

      Exactly. His problem is not his confidence level. He’s confident as hell. It’s his ableism, rudeness, refusal to do his job and all around horrible levels of performance that are at issue.

  144. JaneDough(not)*

    LW, after binge-reading most of this website and its archives over the past few weeks, I’m urging you to start using your power as a manager to say, after two or three occurrences of something unacceptable, “Your actions A and B are highly problematic. Your job prohibits actions A and B. From today onward, you can’t do A and B; if you continue to do A and B, that’s grounds for dismissal. Let’s talk about why you think A and B are acceptable, with the goal of making sure you understand what is acceptable/unacceptable at this workplace, and let’s also talk about what is required/non-negotiable at this workplace.”

    * I can’t understand why you never addressed earlier problems in a firm, “this must stop” way (seeing fewer patients than his peers; missing two mandatory meetings).
    * I can’t understand why you responded to his previous “I’m not gonna see certain types of patients” with “You need to work on [this] to feel confident” rather than saying outright, “You can’t refuse to see certain patients. Starting next week, you’ll shadow other clinicians who see such patients for __ weeks; after that, you’ll be expected to see such patients on your own. It’s a condition of keeping this job. If you think you can’t or won’t comply with this condition, then tell me now so we can part in a way and on a timeline that works for the co. and for you.”
    * And I can’t understand why you didn’t, at any point in the long exchange you cited, write or say to him, “Seeing these particular patients is non-negotiable, as is seeing a broad range of clients.”

    Please stop being a wishy-washy manager! Managers who allow the loudest complainers to get their own way lower morale among everyone else, which leads to turnover, which further lowers morale. You can be firm and direct while still being pleasant and well-liked! “Firm and direct” are *not* synonyms for “mean” or “unpleasant.”

  145. Tiger Snake*

    While Ross may be quite skilled at the technical aspects of his job, he does not sound like he’s been a good employee in any capacity. That means he is NOT good at his job.

    He has been downright insubordinate. He has been rude and petty at the expense of his other colleagues who, I have no doubt, are ALSO quite skilled and significantly better at their jobs.

    The more you indulge and let him push the line, the more he will do so. If him actively REFUSING to do his job isn’t your limit, what is?

  146. LAURA H*

    It’s me, Ross’s supervisor!! So many GREAT points and some of the comments made myself and my boss and co -supervisors crack up, which we needed! THANK you Allison and all commenters!
    I haven’t been able to meet with him yet as he has called in sick every day since I told him we needed to meet up!!!!! NO JOKE!

    I should have been more clear of a few things, but my original letter was already so lengthy:
    A) the instances with Ross staying certain patients were gross/scary I was just recently made aware of and they also happened in private chats with Monica and other schedulers. Never among other clinicians. (I agree it’s unacceptable & will for sure use the great script advice from Allison for that one because in our line of work…hello-you kind of sign up for gross and scary when you enter healthcare!)
    B) HR was also NOT aware of him saying those things (as a few commenters theorized) as I only briefed her on the assignment refusal/him telling me to stop harassing him aspect which REALLY freaked me out for a bit. I’m extremely lucky as our HR dept is amazing and very supportive and fair. When I said he has a history of saying he’s not comfortable with a certain type of visit and gotten out of them, it was because I was just recently made aware of it but apparently it’s been going on for sometime and Monica would just trade his patients with other clinicians.)
    C) I’ve never had a patient complain about Ross and in fact his patients love him and request him back. There has NEVER been an issue with poor care.
    D) a few people brought up that he’s not a good clinician if he’s saying those things about patients/refusing assignments and I should have fired him long ago. However, I disagree. There is a saying in our line of work that you could be a great clinician, but a terrible employee. I wouldn’t have called Ross a terrible employee before the last few weeks but now he’s definitely turned into a terrible employee. Before he was a good clinician, but mediocre employee. With the extreme staffing crisis in our medical field right now; as long as you were doing good patient care and being respectful and professional, You’re going to have a job.
    E) there were comments about how he probably drags other employee morale down and they’re working harder and covering his load. Luckily the clinicians never really have the capability of seeing how many patients their co-workers have/where they are driving to. However, I really believe in fairness and that’s why I was going to address all this at his annual, but then this other issue happened, which will definitely be addressed before his annual (if he does return to work!) As I agree, this just doesn’t seem to be the right job for Ross! Thank you all again! I’ll let you know if there’s an update!

    1. OrigCassandra*

      Thanks, OP. As someone who is currently relying on home health care, I’m very glad you’re taking this seriously. Thanks also for being willing to update!

    2. Observer*

      OP, I’m glad you are taking this seriously.

      But I have to point something out to you. You say that “ I’ve never had a patient complain about Ross and in fact his patients love him and request him back. There has NEVER been an issue with poor care.” Except that despite some patients asking for him back, you simply CANNOT know that there has never been an issue with patient care. Because, as others have noted there are a LOT of reasons why people won’t complain. Keep in mind that you haven’t even been looking. And in general, depending solely on whether people complain to know what’s going on is asking for trouble.

      What makes this a bit of a catch 22 is that as long as he was getting only the kinds of clients he preferred, he might be mostly doing reasonably good care. But if you push him to care for the clients he doesn’t want to care for – whether he considers them “gross”, “scary”, “too far away”, or whatever the chances of his providing poor care go through the roof.

      1. Holly*

        I have had many horrible experiences with clinicians, including being seriously misdiagnosed, insulted, been left without care or dignity, and being given the run around for eight whole months which impacted my medication.

        And I have not complained about a single one because I am afraid that if I do I will be removed from the patient list and be unable to find another doctor.

        I’ve heard many stories like mine, and even worse, where people didn’t report the doctor because they were afraid they’d do something worse.

        I’ve also worked in care myself, with people like Ross, and trust me, the patients pick up on it. Maybe not all of them – people like Ross have favourites – but a great many of them have substandard care.

    4. NothingIsLittle*

      Thank you for the update! Having worked adjacent to the health field (admin for a health sciences university) and needing frequent appointments due to chronic health problems, I completely understand the problem with being understaffed and just keeping anyone who can at least competently see patients.

      That said, as a patient I would be very uncomfortable being treated by someone who thought I was gross or scary. I was obese for a long time and I could tell when clinicians had written me and my pain off because of it, but I didn’t feel comfortable complaining because if the clinician felt comfortable enough to be openly dismissive of my condition then why would the practice care? As I said, I understand that he’s good with the patients he’s “comfortable” with and that your office needs clinicians, but I doubt the patients outside of his “acceptable patient” group would be receiving competent care due to his open and obvious bias against them. And the fact that he is open about it to the people who he has seniority/authority over (schedulers), but not with the other clinicians or managers tells me that he knows he’s behaving badly and just doesn’t care to change that.

    5. An Australian In London*

      Thanks for a helpful update, and wishing you well!

      One things: when you say:

      > Luckily the clinicians never really have the capability of seeing how many patients
      > their co-workers have/where they are driving to.

      I assure you everyone in your workplace knows. Issues of unfairness and injustice are discussed more widely and quickly than any other workplace topic. And Ross is not making friends and inspiring loyalty among the admin staff – precisely the people who have the best insight into how many patients every clinician has.

      This is why everyone is talking about the effects on morale in your workplace. Ross at this point is a negative number for staffing: your team will get more work done and do it better if he was fired and not replaced.

    6. LisaD*

      It sounds like Ross would be happier in practice on his own, where he can choose his own patients as he pleases. Of course, then he’d have to face the consequences himself if he could not find enough of his preferred sort of patient to pay his bills, and he’d have to do the work of operations/management himself or hire and pay an office manager… which might give him some appreciation for the benefits of a job where your biggest problem is occasionally having to drive to a rural area!

    7. goddessoftransitory*

      I haven’t been able to meet with him yet as he has called in sick every day since I told him we needed to meet up!!!!! NO JOKE!

      *Pikachu shocked face*

      I think somebody knows they may have pushed too far.

      And LW, I am so happy for this update. I’m glad everybody, including HR, is taking this seriously, and that it hasn’t been going on too long or harming your patients. And that you’re not letting this stuff slide!

  147. Rinn*

    I have worked with “Ross” many times over my long clinical career. PLEASE deal with him. Your good employees are begging you.

  149. Coin Purse*

    I’m an RN who did home care for years. Ross’ attitude would be an instant firing. I have seen men get preferential treatment in the clinical arena but not to that extent. He needs to get the boot.

  150. Cleopatra's Sidekick*

    I have to say this blows my mind. I work in health care, and that kind of attitude is NEVER tolerated, and would result in being fired after the first offense. Think how much money your company is losing from tolerating this kind of behavior. Good clinicians are not that hard to find, and I bet morale will improve with him gone.

  151. Just...*

    I provide direct, hands on care to patients. If I saw my boss allowing another care giver to be a primadonna about what patients he takes (leaving me with the more difficult patients) and allowing him to be so disrespectful about patients, I would be looking for a new place to work. Keeping Ross sends a clear message to your other employees.

  152. Kella*

    OP, your patients can tell that Ross thinks they are disgusting. They know. Some of them are going to believe that he’s right. Is that what you want?

  153. Moonstone*

    I honestly don’t understand how Ross still has this job. Why hasn’t he been fired yet? He’s immature, disrespectful, and insubordinate. Fire him now.

    1. Moonstone*

      Also I would be pissed if Ross was my coworker. He’s allowed to be disrespectful of patients and flippant toward management and colleagues? He appears to get preferential treatment because he’s allowed to opt out of whatever he chooses and stay close to home to pick up his kid from school for reasons?? The longer you keep him employed, the lower your morale will rank among the actual good clinicians you have. And they will find another job.

  154. WorkingClassLady13*

    I’d be incredibly uncomfortable leaving this guy with patients. He needs to be shown the door immediately and shouldn’t ever work in a medical setting again.

  156. hold firm -- there's light at the end of the tunnel!*

    I just made it through a very difficult and exhausting three months in which I dealt with two seriously underperforming employees. You can do this! And you definitely need to do this.

    Mainly, you need to set clear expectations of conduct and call him on it/document it every time he doesn’t meet them. That will either lay a paper trail to his firing, or make him feel so uncomfortable that he’ll leave of his own accord.

    Long story short: I had two employees whose work was subpar but who thought they were doing a great job. Like Ross, they hadn’t received adequate feedback (someone else was previously their manager). I laid it all out in the annual review, making it extremely clear that they were not meeting expectations and detailing why (organized by each competence required by their role). I said we’d need to implement a PIP. (All this was coordinated with my HR team.) Starting immediately after the annual review, I started being painfully explicit in setting out my expectations and giving them feedback on their work, mostly via email, which made it easier to deliver. They both got the message that they were being scrutinized and would need to step up, and—happy ending!—they both left before we had to implement a PIP. YAY! One took another job, and the other chose to exit when we offered him a one-time separation amount as an alternative to the PIP (the purpose is to make sure they don’t waste everyone’s time on a PIP if they don’t seriously want to improve). I’m so relieved, as you will be when Ross is outta there.

  157. Sleeve McQueen*

    OP, I am not sure you will read this far and I say this with love: please use this as a learning experience. It’s great that you know it is a problem and are trying to figure out how to solve it, but resolving this is very overdue. Maybe your workplace is so dysfunctional it reset the bar for acceptable behaviour, or maybe you need training on the tools you can use to manage employees, but please reflect on how Ross continued to keep this job.

  159. Yikes Stripes*

    Holy crap, OP, please fire this guy. I work as a home based caregiver, and while there’s certain groups of clients I am uncomfortable working with (specifically Alzheimer’s) it’s because I’m not trained for it and don’t feel that I can provide a high enough standard of care. If I’d ever, even once, used the kind of language he’s used to describe a client, my butt would’ve been out on the sidewalk before I could blink. The disrespect you and your company are treating your patients with by allowing him to work for you is pretty notable and uncool.

  160. Sagegreen is my favorite color.*

    I have the feeling a lot of other stuff is going to come out about ole Ross once he is no longer there. Fire him Op! Your patients deserve better and so do his coworkers.

  161. Dog momma*

    If this guy is a nurse, refusing to see patients means you will or should get fired. it could be considered patient abandonment. . They are giving him every opportunity to do his job ( covering his other patients so the new patient is a priority)and he’s basically saying.. f you.

    1. Aeryn*

      Speech like this would get you reported to the NMC in the UK (nurse incensing board), and you would be highly likely to lose your registration.

      Sacking is seriously too good for him. If he is in a licensed profession, and you have these conversations in writing (sounds like they were over slack or some kind of messaging services), report him. He should not be in practice.

  162. River*

    I can’t help but to think if and when he does “help” his patients, how much of his job is he doing. Is he actually following through the entirety of the process? Is he doing the bare minimum or?? This makes me uncomfortable knowing that someone like Ross is handling other people’s lives. He is in the wrong industry. I hope you’re not keeping him because it takes time to hire and train a new person. There’s plenty of people out there with experience already so you could focus on experienced applicants when it’s time to re-hire. But I agree with the consensus. Considering the industry you’re in, you don’t want to risk patients lives. It’s time to let him go.

  163. RaginMiner*

    Ross is going to get y’all sued. More importantly, Ross is going to continue to provide poor care. Are the people you serve really deserving of such treatment?

  164. Quill*

    There are a lot of things that are disqualifying opinions in health care, and Ross’ thoughts on your patients are definitely one of them. Ross needs a new line of work.

  165. FattyMPH*

    Ross sounds like the kind of clinician who kills patients by negligently dismissing their symptoms when they already have a stigmatized diagnosis in their record.

  167. Autumn*

    So I get that it’s sort of scary when you have to decide if a patient should go to the ER…if you are wrong the best outcome is the patient gets charged several thousand dollars for an unnecessary ER visits and the worst outcome is…

    But that’s why I wouldn’t do visiting nursing.

    Ross is so far out of line…

  168. Chris Hogg*

    Okay, three questions about Ross:

    1) He wasn’t fired 6 months ago because…?

    2) Has the poster (and apparently several others in the organization) been scheduled for immediate training on the difference between supervising / managing and being supervised / being managed, and if not why not…?

    3) Do you have your employment attorney and defense attorney on speed-dial…?

  169. Lenora Rose*

    Some letters are hard, and it’s difficult to tease the best course of action out of it, because some details that make a huge difference are missing.

    Some are shockingly easy. Ross should have been fired and the hardest part of this letter is what exactly HR thinks they’re doing by giving him further chances to refuse to care for patients and insult them behind their back.

  170. Calamity Janine*

    late to the party here, but as a disabled person – a professional patient, if you will – for the love of all things bright and beautiful, THIS PERSON NEEDS TO NOT BE WORKING IN HEALTHCARE.

    the amount of damage he can do to patients cannot be overstated. please look up statistics about how bigotry from providers conclusively makes for worse patient outcomes, from improper care, to wrong diagnoses, to straight up sabotaging someone’s care by labeling them as a “faker” or “drug seeker” because of prejudice, to causing patient deaths by minimizing and dismissing their concerns.

    an otherwise good clinician does not do these things. this is the sign of some one who is in the wrong industry and must exit it immediately.

    i would say to go flip burgers but he has the sort of attitude that makes someone go “well she’s lying about being allergic to that. you know how people like that are, they just lie, all the time. i don’t need to hold that ingredient at all. …i don’t know why she’s yelling for somebody to call an ambulance because her epipen isn’t working! she’s just being dramatic! oh and now she’s pretended to faint and stop breathing? what an idiot… she’ll snap out of it if we all ignore her.”

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