As a medical student, how do I navigate situations where my resident and attending both tell me two different things?

[deleted1139416]

Got chewed out the other day because my resident and attending told me two different things. My patient had a positive test result and my attending was planning on treating it. My resident, however, thought the test result was not reliable and did not want to treat it. So during grand rounds I went with what my attending told me for the assessment and plan. My resident chews me out afterwards in the men's locker room and tells me that the attending is a "dumba--" and I should have known that my attending is a "dumba--".

In hindsight, I should have probably done some research on how often the test comes back as a false positive and the positive predictive value of it. But other than that - how am I supposed to navigate these kinds of situations as a med student? I understand having to work long hours and getting chewed out for a mistake I genuinely made out of my own fault, but this just seems downright toxic and honestly feels like the tension between my resident and attending is just getting thrown on me.

---

Members don't see this ad.

 

[Billiam95]

Look on your syllabus to see whose eval has a greater impact on your grade, then side with that person. Or preference your presentation with "per Dr. X's recommendation, I think we should treat Y with Z."

 

[AnonymousDoctorGuyPerson]

You'll get chewed out for making mistakes in your career, you'll get chewed out for doing nothing wrong at all.

Either way, your resident was wrong in this scenario - not for disagreeing with the Attending - but for chewing you out, a medical student, for listening to the attending.


Do what you think is right in the situation, at the end it wont matter as long as you think you're doing what's best for your patients.

 

[EthylMethylMan]

Get used to different members of the team (including and especially different attendings) having different interpretations and plans. They'll even sometimes think the other person is a "*******". But as stated above, the resident was totally out of line. In what world is a medical student supposed to go against an attending in a situation like this? It's just gonna piss off the main person grading you. For educational purposes, it's great to ask people with different opinions how they came to their conclusions. It helps you develop your own clinical accumen. But as a student (and really as a resident as well), virtually every time, you're going to be going with the attending's decision, even if you disagree. You did the right thing, though perhaps it could have been worded differently per @Billiam95 . With regards to the awkward situation the resident put you in, you can just say plainly that you had to go with the attending's plan, plus/minus brown-nosing the resident by agreeing with their conclusion. It's rough being at the bottom of the totem pole, sorry OP. It gets better.

 

[deleted1139416]

Get used to different members of the team (including and especially different attendings) having different interpretations and plans. They'll even sometimes think the other person is a "*******". But as stated above, the resident was totally out of line. In what world is a medical student supposed to go against an attending in a situation like this? It's just gonna piss off the main person grading you. For educational purposes, it's great to ask people with different opinions how they came to their conclusions. It helps you develop your own clinical accumen. But as a student (and really as a resident as well), virtually every time, you're going to be going with the attending's decision, even if you disagree. You did the right thing, though perhaps it could have been worded differently per @Billiam95 . With regards to the awkward situation the resident put you in, you can just say plainly that you had to go with the attending's plan, plus/minus brown-nosing the resident by agreeing with their conclusion. It's rough being at the bottom of the totem pole, sorry OP. It gets better.

Sometimes it all just feels like a Catch 22 - many times I screw up just because no one takes me seriously and because I’m at the bottom of the pole

 

[LunaOri]

The attending is ultimately responsible for the patient, so you should always go along with the attending UNLESS you think that following the attending’s orders will result in patient harm. In that case, speak with your resident, who should be the one to go back to the attending and discuss the issue. It is always okay to ask questions of the attending, but try to do it in a nonconfrontational way—“Why do you prefer test X to test Y?” “Should we do more testing to confirm that result?” “If this test result doesn’t match the clinical picture, what should we do next?”
While it is possible that the attending is, indeed, a dummy, it is more likely that he has valid reasons for his choices—perhaps the treatment is relatively benign compared to the danger of delaying treatment for that diagnosis.

 

[Angus Avagadro]

^^^^^Luna is absolutely right. The attending's name is on the chart and is primarily responsible for the patient. Sometimes decisions are made for medicolegal reasons, say offering a treatment that may not be that beneficial, but the risk and downside of not treating is worse.The Attending may feel the risks of not treating outweigh the risks of treating. A med Mal suit takes years, and is very demanding of one's time. There is learning to be had, even if you are witnessing non standard treatments., i.e., watching someone do it the wrong way. Ex. In the EU, they don't operate on a herniated lumbar disc, unless there are severe neurological defects. 85% will heal over time, 5 to 8 months, with rest and PT. Operating has the same outcome of success, but you get back to work sooner. So if attending operates, and resident thinks he is a dum a$$, who is right?
As the medical student, you will rarely be right as you are lowest in the bottom of the organizational chart. This won't last long, thankfully.

 

[aldol16]

You should present both sides in a politically sensible way. If there is a disagreement about the test, then you should look into the characteristics of the test and the population you're using it on. Then you present that data and outline the positive predictive value of the test. Nobody can argue with you over data. They might argue with the data itself, but then it becomes academic and not personal.

 

[DO2015CA]

If you are not trying to match at that program specifically then who cares what the resident thinks? I had medstudents that I did not care for and my thoughts mattered to absolutely no one except myself. It certainly did not affect their grade. If the attending took offense to them then it sure as heck could affect their grade.

There is also something to say about that resident. Even if they hate that attending, they shouldn’t put that on display to a med student. It’s just in poor taste. You don’t air out dirty laundry to your subordinates. Whether it be medicine, the military, or the business sector.

 

[deleted1139416]

If you are not trying to match at that program specifically then who cares what the resident thinks? I had medstudents that I did not care for and my thoughts mattered to absolutely no one except myself. It certainly did not affect their grade. If the attending took offense to them then it sure as heck could affect their grade.

There is also something to say about that resident. Even if they hate that attending, they shouldn’t put that on display to a med student. It’s just in poor taste. You don’t air out dirty laundry to your subordinates. Whether it be medicine, the military, or the business sector.

Thank you for acknowledging that. Although, may I ask what things med students do that make you not care for them? Just so I can be more self aware to make sure I don’t go making more residents angry.

 

[DO2015CA]

Thank you for acknowledging that. Although, may I ask what things med students do that make you not care for them? Just so I can be more self aware to make sure I don’t go making more residents angry.

It’s usually arrogance. Things like a 3rd year resident, taking the time out before rounds to listen to their presentation, and feed them the correct answer and explain why. Then on rounds they think they know better than the senior resident and present their original thought. Then the team has to listen to a 10 min “educational talk” which is actually just a reiteration of what I told the student before rounds. So not only did time get wasted on rounds, my very busy prerounding time was wasted.

I kid you not, I had a med student (a 4th year medical student) present on rounds that the admitting resident misdiagnosed asthma and it was “just a uri”. The patient was wheezing from across the room, with a hx of multiple exacerbations, and was responsive to albuterol. The attending just looked at them like they had 3 heads… plot twist, I’m the one that admitted them. And told the med student what to present.

 

[Angus Avagadro]

Thank you for acknowledging that. Although, may I ask what things med students do that make you not care for them? Just so I can be more self aware to make sure I don’t go making more residents angry.

Constantly on their phone, especially when the resident or attending is speaking. Shows up late and wants to leave early, disappears frequently, and unable to find. May not know the right answer, but never in doubt about the answer they give me, then proceeds to argue. Do they really think I would ask a question that I didn't know the answer to? The last one really triggers me. Thankfully, these behaviors are not that common, but seen more than we want.

 

[Dral]

Constantly on their phone, especially when the resident or attending is speaking.

This is a tough one. Since phones are little computers now, they are educational aids and students could be looking up something about what the attending/resident is talking about. Yes, we can always say look it up later, but when it's on the student's mind there and then and they are trying to keep up with everything, it can be helpful to look up something on up to date to solidify their learning.

It almost takes some extra effort on our part. We can ask ourselves 'Is this student constantly on their phone, smiling sometimes at their phone, etc?' (more likely texting with someone off topic) or 'Is this student checking their phone briefly at appropriate times and likely using their phone as an educational tool?'.

However, overall it is better for a student to come up with a way to remember topics and look them up later after rounds to eliminate the issue altogether.

 

[Billiam95]

This is a tough one. Since phones are little computers now, they are educational aids and students could be looking up something about what the attending/resident is talking about. Yes, we can always say look it up later, but when it's on the student's mind there and then and they are trying to keep up with everything, it can be helpful to look up something on up to date to solidify their learning.

It almost takes some extra effort on our part. We can ask ourselves 'Is this student constantly on their phone, smiling sometimes at their phone, etc?' (more likely texting with someone off topic) or 'Is this student checking their phone briefly at appropriate times and likely using their phone as an educational tool?'.

However, overall it is better for a student to come up with a way to remember topics and look them up later after rounds to eliminate the issue altogether.

Agreed - looking at your phone leaves too much up to interpretation. I'll only take mine out if the resident/attending is asking for a lab value, and I angle my phone so everyone can see I'm on Haiku and not groupme or something else.

 

[DO2015CA]

Agreed - looking at your phone leaves too much up to interpretation. I'll only take mine out if the resident/attending is asking for a lab value, and I angle my phone so everyone can see I'm on Haiku and not groupme or something else.

Ya unfortunately medstudents are under sooo much subjective judgements that really are unfair

 

[Dral]

Yep, this is harder in a larger group when the med student uses their phone but then keeps quiet.

When I am with fellows and residents (a lot of times in non-rounding situations) it is usually just a few people and fairly low key. I will see the resident or fellow on their phone, but then say something like "Ok, up to date says this and that about that condition". Thus, I know they are focused on what we are doing, not on texting or something else.

That's actually a positive to me. It shows they can navigate the system, knowing where they can go to get good information to help make better medical decisions, as long as they don't say "So I just went on webMD and..."

 

[Angus Avagadro]

This is a tough one. Since phones are little computers now, they are educational aids and students could be looking up something about what the attending/resident is talking about. Yes, we can always say look it up later, but when it's on the student's mind there and then and they are trying to keep up with everything, it can be helpful to look up something on up to date to solidify their learning.

It almost takes some extra effort on our part. We can ask ourselves 'Is this student constantly on their phone, smiling sometimes at their phone, etc?' (more likely texting with someone off topic) or 'Is this student checking their phone briefly at appropriate times and likely using their phone as an educational tool?'.

However, overall it is better for a student to come up with a way to remember topics and look them up later after rounds to eliminate the issue altogether.

Agreed, phones provide instant feedback. I believe its a bad look and often is more of a distraction for the student and the speaker. It's most likely a problem when it is associated with the other behaviors I described. The occasional Uptodate query was not really what I meant, but I appreciate your point.

 

[annoyedpsychiatrist]

You follow chain of command, attending supersedes resident and then you apologize to resident for not following their direction and you try your best to make it a non personal thing.