Are these reasonable?

[SpoiledMilk]

How common is it for patients to tell a MS something and then with the attending present, say something completely different? Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

---

Members don't see this ad.

 

[IMGASMD]

How common is it for patients to tell a MS something and then with the attending present, say something completely different? Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

Patients remember things differently all the time. We all know that.

Bad mouthing happens. You will realize that we are all humans, and attendings are people too. When you work together all day long, every day there will be conflicts. I am not excusing this doctors behaviors, but it happens.

Writing notes, this is the hardest question to answer. I would say just suck it up and write it. I don’t imagining you have more than few notes to write everyday. If you’ve seen the patient and/or the attending discussed and taught you something about the patient, I don’t see anything wrong with doing scut work. Also the team may be sharing the patient load differently than your understand. Or when they’re cross covering each other, it may become your patient. However, if you don’t know anything about the patient, all he wants you to do is scribe for him, then that can be problematic.

I will be honest, I’ve was not accustomed to take directions from attendings as M3. Most of daily work is handed down by residents. Either you have a very small programs or residents don’t exist at your hospital. Can be a little overwhelming at times. You’re there to learn about patients, learn to work with patients, how different members of the team interacts and hospitals have different cultures. Being this is your first ever rotation, I would just learn as much as possible and enjoying finally being in the hospital for now.

Good luck

 

[deleted480308]

Patients constantly tell people different stories, I’m generally suprised at consistency

 

[akwho]

I was surprised as a medical student how often it seemed the patient would change the story or "remember" something new when the attending walked into the room. I thought this was so unfair and made me look bad even when I took as comprehensive of a history as possible. I wasn't sure what this magical attending power was.

Now that I've been a resident for the past 5 years and have gotten infinitely better at history taking, I realize that part of the problem doing the patient interview as a medical student is you don't know the clarifying questions to ask a patient, you aren't as experienced at building up rapport and you don't know when to call a patient out for giving you a BS answer. Now as a 5th year resident, I can't remember the last time I've had a patient change their story when the attending walks in the room -- this is because I've already asked the necessary follow up, clarifying questions and moved past the BS answers.

This is a skill you have to build like any other. Sounds like your attending wasn't impressed with your history taking skills and it's something you need to work on.


Writing notes as a medical student is great experience. I rarely let medical students write notes because it slows me down to much. Your attending is doing you a favor letting your write those notes, especially if they go over the notes with you after and show you what you got right and wrong. It doesn't matter so much if it's "your patient" or not -- just ask clarifying questions to the attending about what they want you to write.

 

[Chemist0157]

How common is it for patients to tell a MS something and then with the attending present, say something completely different?

Not terribly unusual.

Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

Depends. Are the stories different because the patient answered the same questions differently, or are they different because the attending asked better questions and got closer to the truth?

Some of it can certainly be from the patient forgetting/remembering a piece of information, but the patient is not generally out to get anyone. The patient is not out to get the student. In my experience now, I have noticed that I can get a different story than a trainee by avoiding leading questions, asking appropriate follow up questions, etc. There is good and bad interviewing technique.

Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

Seems like there is more to unpack here...No, it's not *reasonable* (though it will happen) for anyone to bad mouth anyone else. No, I do not see why students would be writing notes on patients they did not see.

This post is a bit of a vent, no? Seems like you had a bad experience with an attending. Some of it might be on you, but some of it appears to be on the attending as well. It is difficult to tease out these kinds of situations with limited information and one side of the story.

 

[Doctor Bob]

How common is it for patients to tell a MS something and then with the attending present, say something completely different?

All the time.

It's called historical alternans.

 

[SpoiledMilk]

Thank you all for responding.

Logged over 22+ patients with this attending during the rotation. Other than the usual follow-up questions about patients during presentations, the attending never commented directly that I gave them inaccurate info other than this one incident with the historical alterans.

To put into further context, 3 other MS at the site also got the "vibe" from this attending and none wanted them to do their final evals. Other attendings gave higher ratings on the HPI portion of the final eval.

Should the below expectations rating on the final evaluation be contested or just bite the bullet and move on?

How can the comments be explained if they ever came up during residency interviews to lessen the negative impact?

 

[Dave1980]

do better next time

 

[Tangerine123]

How common is it for patients to tell a MS something and then with the attending present, say something completely different? Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

1) Normal. I even forget some details when I'm a patient myself and go over them when somebody asks me again. Just take your histories more thourougly and sistematically to avoid it as much as possible. Asking if a patient takes any medication, even though he/she just said that they don't have any other current diseases might yield interesting answers sometimes.

2) I never really saw attendings talking bad about staff. It's usually the residents/medical students that do so. Rude, tasteless and innapropriate in any case.

3) My attendings never, ever, ever wrote notes. Medical students always wrote the followup notes. Residents only did so with really critical or special patients (or when being punnished, a PGY4 having to write 30 followup notes 3 times a day because of reasons.. Eh)

With writing notes, I used to hate it, it consumed so much time. However, you will appretiate it later on. Being able to properly describe the status of a patient (in their given context i. e. Neuro/Surgical/Peds/Psych/OB/ER/ICU, etc) is essencial. If you aren't able to summarize what happened with the patient and what the theurapeutical plan/goal is, then you are doing it wrong. In my IM totation thry even asked us to write a small summary (1 page) at the end of each followup note about a relevant topic. If the patient had Lupus then we would write about the diagnostic criteria or diferential diagnosis or therapy, etc.

 

[doyouhaveaflag]

How common is it for patients to tell a MS something and then with the attending present, say something completely different? Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

I'll echo what most others said - it's very common for patients to say something different on initial interview then change it when the attending comes in.

However, I disagree with the general consensus that it's appropriate to write notes on patients you didn't see (if I'm interpreting that correctly). If you didn't see the patient, how can you write an exam? However, if you did see the patient, it's totally appropriate for you to write the note. Get fast at writing notes in med school, you write a ton of them in residency. One of my seniors always likes to say that it should take you less time to write the note than the time you spent with the patient.

 

[deleted645092]

the other day I apologized to the attending for telling them a patient denied something to me and then admitted it to the resident and attending when we all went in. The attending laughed and said his only job as the attending is to get the patient to tell the truth. Patients constantly change their story, as long as the nursing note agrees with what they told you then the attending is gonna believe you lol

 

[holdthemayo]

1. How common is it for patients to tell a MS something and then with the attending present, say something completely different? Is it reasonable for an attending to hold the MS responsible for presenting what the patient said, then after being told something different by the patient, to comment in the final evaluation that the MS needs to work on correctly taking an accurate history and giving the MS a below expectations rating?

2. Furthermore, is it also reasonable for an attending to bad mouth nurses/staffing to the MS, and additionally, 3. directly ask the MS to write their notes even when the MS was working with another attending and did not even see their patients?

And it all happened in the first ever rotation with the same attending.

Thank you.

1. Patients do this frequently. Usually it is something small, but sometimes not. I had a patient deny chest pain to me, then describe classic angina symptoms to the attending. It sucks, but everyone knows it happens. If you have proven you are reliable, the attending won't hold this sort of thing against you.

2. I've had attendings and residents bad mouth people to me. It happens in any workplace. The only thing that matters is that you DO NOT badmouth anyone. It can only go bad for you.

3. You are going to write a lot of notes as a student. It's good practice and is one of the few ways you can actually contribute to the team. If you are like me, it will drive you to a field where you don't have to round or write long notes. If not, at least you no what is coming your way. That said, you shouldn't be writing notes for patients you haven't seen. I would not be comfortable doing that.