Should I lie?

[Doctor Bagel]

I don't think anyone is afraid of that. But I can tell you from experience that there ARE some doctors out there (and some surgeons) who WILL fail students on rotations out of spite. It's never happened to me (thank god), but I've seen it happen to friends.

I know the arguments: a surgeon shouldn't be able to fail you just because you said you wanted to do psych. Yeah. I know. But, in some places, that can still happen. This may be more of a problem at certain schools and in certain rotation structures, and I think might be more of a problem at DO schools, like mine, where the doctor doesn't actually work for the school and there's very little actual contact between them and the school and very little way for the school to discipline someone who is abusive to students. The school is under pressure to have enough rotation spots for students to rotate at, so they might be "forced" to keep the horrible person...because a horrible teacher is better than none...at least as far as accreditation goes. It could also be a big problem in the situation someone described above, where the powerful mega-grant surgeon chair can't be questioned and is malignant.

The fear of failing a rotation is pretty strong. My rotation grades were 100% subjective, based on my attendings' impression of me. I know some schools blend the subjective grade and the NBME shelf grade, but our grade was 100% subjective + pass/fail shelf. So, if the attending decided to fail us, there's nothing you can do but retake the rotation...which isn't always possible if you've already burned your vacation month, for example.

An "interruption in your medical education" caused by a rotation failure (and even a lone rotation failure) can have a HUGE impact on one's career and match prospects. So, it's definitely a concern some of us have to deal with.

That being said, there are certainly much bigger things to worry about.

For the record, I was very upfront with both of my surgeons I worked with about my psychiatry interest and they were both very understanding and supportive, despite one being your "typical" surgeon. But by that point in the year, the end of 3rd year, I knew 1000% for sure. Much earlier in the year, I simply said that I really enjoyed my psych rotation (which was true) but that I was going to give everything a try before making a final decision (also true). Which is, I think, the best way to handle it.

That does make it hard, and you're right, actually failing a rotation will hurt you when you apply to residency. I went to a school where no one got failed for rotations ever -- I'm sure it could happen in cases of gross incompetence or for just plain not showing up -- but I never saw it happen. Getting a C was essentially the equivalent of failing. I think my experiences are not atypical for most allopathic (and probably osteopathic) schools, which might cloud some of the advice that we're giving here.

You also hear stories here about residents getting fired for pissing off one random attending. I kind of assume that there's something else going on there, but who knows.

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[whopper]

I wouldn't exactly say don't worry. I knew a few abusive attendings and residents that made life hell for residents and students...to the degree where it fit a legal definition of a hostile work environment and harassment.

Such things in some studies, if dealt with continually could develop signs and symptoms that could mimic PTSD, they could also lead to bad outcomes in treatment.

E.g. I was put on call 3 days in a row without sleep as a medstudent. The chief resident that did this to me told me he didn't give a damn that it was against the law. The attendings in the program did the same exact thing to him as a resident so I knew no one was going to bail me out of it. I could've crashed my car on the way home after it was over.

Of course medical training is difficult and it should be. Some of the stuff like a medstudent getting coffee for the attending, well I wouldn't do that to anyone under me (in fact I usually end up buying lunch or dinner for residents and students I've worked with) but that's not really bad if that's all it is. Like I said though, some of it truly is harassment, and several programs operate in violation of ACGME guidelines, just that medstudents and residents come to a notion that is not often unrealistic that they're better off just tolerating it than fighting it.

A few days of stuff like this, even weeks, I think most people can just say deal with it...it'll end. Years of it? That's to the degree where it could cause some serious harm.

A forum where people could at least vent with colleagues that have been through similar is IMHO a good thing, even vent from just working hard where there has been no egregious harassment.

 

[splik]

2nd year resident here, and I feel about the same way about my importance in the world. I think maybe I outrank med students and the people who work in the cafeteria, but that's about it. From the nurses who page me endlessly to order laxatives and bacitracin to an attending who just sent me a totally uncalled for scathing email, I have absolutely no power.

Do you think that being a woman makes things worse for you? As a man, I found that a bit of careful flirting with the nurses and some baked goods at the beginning of the rotation kept things sweet. I would get asked to do far less ridiculous stuff by the nurses than my fellow interns and even when I shouted (and I will shout if I feel patient care has been poor or things aren't happening fast enough) I would be forgiven. In fact when on call the nore curt and shouty I would become the nicer the nurses were to me! They would sit me down, give me chocolate, offer to make me coffee etc. In contrast one of my female co-interns who was extremely sweet got sh@t on by the nurses and they made her cry! Even when she was being nice some of the nurses complained that she was patronising and would not always follow her orders.

I think that the older nurses in particular find it hard to take orders from female residents, especially if they are younger, prettier and thinner than they are!

 

[notdeadyet]

I would get asked to do far less ridiculous stuff by the nurses than my fellow interns and even when I shouted (and I will shout if I feel patient care has been poor or things aren't happening fast enough) I would be forgiven. In fact when on call the nore curt and shouty I would become the nicer the nurses were to me!

Are you really shouting at nurses? I'm having trouble imaging a time when it would be appropriate for someone to shout at their nurse. Wouldn't it just contribute to the idea that there's something special about the medical environment that makes some people think it's acceptable to insult, yell at, or verbally demean people? Or are you shouting in the sense of just making your voice heard above the milieu?

 

[splik]

it was an infrequent occurrence (I am usually quite nice otherwise I don't think it would've been forgiven after all nurses can make our lives difficult if they really want) but I did tend to get a bit stressed out when on call for medicine and if a nurse happened to call me about a patient who was about to crash, i arrive and she happened to say 'i am just going on my break' you can bet I would shout. I did my internship (this is in the UK where it is not usually acceptable to shout at nurses) at one of the worst hospitals (in fact I believe it is being closed down) and the nursing care was terrible. Lots of agency staff, laziness, pressure ulcers, contractures, starvation, MRSA, c.diff etc, patients left in their own blood/sh it very common - it would make me very angry. Was it appropriate to shout? probably not. Did it make a difference? definitely not (except fewer silly requests). Was it understandable? definitely so.

 

[notdeadyet]

Ah, got you. I have no idea about how the culture works in the U.K. In the U.S., nurses may operate on teams with doctors, but they have a reporting structure within nursing. A resident or junior attending yelling at a nurse would just have the opposite goal of anything you were hoping to accomplish. If a nurse is really useless and you're worried he or she is going to be a problem for your patient's care, you go to the Charge Nurse or such and get it resolved.

Yell at most nurses here and you can expect to get paged q15 for clarification of Tylenol orders and "patient's looking odd" for a long time with little support from your higher ups.

Sounds like your internship site was pretty rough, condolences... On to bigger and better pastures...

 

[splik]

Ah, got you. I have no idea about how the culture works in the U.K. In the U.S., nurses may operate on teams with doctors, but they have a reporting structure within nursing. A resident or junior attending yelling at a nurse would just have the opposite goal of anything you were hoping to accomplish. If a nurse is really useless and you're worried he or she is going to be a problem for your patient's care, you go to the Charge Nurse or such and get it resolved.

Yell at most nurses here and you can expect to get paged q15 for clarification of Tylenol orders and "patient's looking odd" for a long time with little support from your higher ups. Sounds like your internship site was pretty rough, condolences...

You wouldn't normally get away with it. I think I mainly did because I was nice most of the time and largely on friendly terms with the nurses and baked! I remember one weekend things were really quiet on the respiratory ward (which was usually the worst for silly pages) and so I went down and the charge nurse said 'my nurses are too scared to call you!' I said 'that's what I like to hear!' (although it is just as bad when they dont call you about a patient until they're dead). There may have been a cultural component - many of the nurses were Nigerian and there is I gather a more hierarchical structure there.

I wouldn't trade my experience for anything. Having to look after 270+ patients (and this meant anything from siteing IVs, blood draws and catheters to acute abdomens, septic shock, ARF, arrhythmias etc) and being pretty much it except for the ICU was not ideal for patient care but it has certainly left me prepared for anything!