Hi everyone, I really need some advice. . .
I just started 3rd year about 2 weeks ago--my 1st rotation is Medicine. So far I've been pretty lost about a lot of things, and I've been trying really hard to immerse myself and become more "helpful" on the team. But so far, I think I've been more of a burden, since I don't know much and can't really make medical decisions yet (at least, not good ones. . .). Anyways, I'm trying to ask a lot of questions to find out how my expert team members (e.g. the resident and interns) make certain medical decisions, and I think I may have been misunderstood in my intentions in asking those questions. For example, I got this patient with CHF and a pmh of DVT and PE, and well the experts on my team know that he/she has CHF and aren't too worried about her having a PE or DVT. Well, at first I wasn't sure whether or not we were going to rule out PE anyways, and so I kept suggesting like all these tests and plans to do that. When I finally got it that we aren't worried enough about the PE to even rule it out, I had to go present that patient to the chief of medicine, who was all asking me about why I wasn't doing more to rule out PE. So then, totally confused, I went back to my resident and (for about the 4rd or 5th time today), asked him why we're not ruling out the PEs (just out of interest in what I should have said to the chief of medicine). But I think by that time, my resident might have started thinking that I was questioning his expertise, which wasn't my intention at all. . .My resident is such a genius, I could never compare to him. even when I'll be a resident, I'm sure I won't ever know as much as he does.

So I guess my question for you all is: do you all think my resident took it that way? I really want to set things straight. Should I bring it up, and say that the reason I asked was b/c the chief asked me and I didn't know what to answer? Or should i just leave it alone and not bring it up anymore (because God knows I must have brought up those PEs about 50 times today)

Sorry for the length. this is really hanging on my conscience and depressing me, and I'm not sure what the right thing to do would be. Please help a really insecure med student. . .

:(

Thanks much.

you're spazzing out dude. Just chill out. At this rate you'll be in a mental institution before you even finish your 1st rotation. (Don't you have like 5 more to go after this?)

hi there. ok, first of all, TAKE A DEEEEEEEEEEP BREATH and R-E-L-A-X!!!!

although we have certain protocols for many things in medicine, you will soon find out that nothing is written in stone. despite the fact that you are still a student, perhaps you were 100% right about your patient and ordering a certain test. and perhaps your "genius" resident was 100% wrong, yes, WRONG.

as an intern i've realized that back when i was a student (which wasn't that long ago), i was always amazed at how my residents could order this and check on that so much faster than i...but it's not magic. it really is doing the best you can with your knowledge, asking for the help of your senior and trying to 'get it right'. i guess by 'right' i mean getting the patient better; not ordering the perfect battery of tests.

so if you feel that your resident may have neglected to look at a certain aspect of patient care, just remind him/her. if they take it the wrong way, well, they are practicing bad medicine! attendings, residents and students should all be able to teach each other throughout their career.

if you really think that your resident getting upset will affect your grade, take the issue up with your clerkship director and just let them know what happened. i think they will understand...that way, you are not punished for fighting for your patient.

all that said, there is also a fine line between being helpful and inquisitive as a student and being annoying (i remember this one guy from med school that we all hated for asking way too many questions). if you are constantly nitpicking and asking questions about irrelevant things (e.g. why is this patient's hairline receding? or hmmm, i think there's a 0.0000025 mm ST segment elevation in lead III), be assured that your resident will be pissed off. he/she certainly has tons of things to take care of. but if your resident is plain rude, ask to switch teams or residents.

i hope this helped. good luck!

Hi Gwen and snaggle tooth, thanks a lot for replying and trying to help me out. I guess I made it sound like my resident was mad at me, but it was nothing like that. He is such a cool guy, and did not give even a hint of annoyance at me bringing up those darn PEs so many times.

It was just that after the fact, I started thinking that by asking so many times about ruling out the PE, I might have come across as suggesting that I know better than he does, when my only intention was to understand for myself why exactly it was that we weren't worrying about those PEs.

Thanks again for the encouragement. I do think I've been overly worried about things I shouldn't be. That usually happens to me when I'm sleep-deprived. . .

There are just things in this world that will only come with experience, and 3rd year is all about that. The first couple rotations you just wont know jack ****, same with everyone. The key is to get by these rotations, read as much as you can, and ask as many questions as you can to people who WONT be evaluating you if possible (ie. if you ask attending or residents too many basic dumb questions they might think you are a dumbass and grade you down, etc. but definitely ask some semi-intelligent questions to show you are interested, and ALWAYS offer to look things up and get back to them.) Practice your presentation every night before you go to bed on patients who you will see the next morning, and have people who wont be evaluating you give you some honest feedbacks, and practice, practice, practice! Your presentations on AM rounds will go a long way in your 3rd year evals and beyond. You will find that you will get pretty good at basic things like that, and consequently, 3rd year will be much easier at the end of the year.