So my attending is WAY wrong in managing this patient

[KeyzerSoze]

To the OP: Don't frown or go have a talk with your university dean if someone ends up giving you a "Pass" in your current rotation because it's highly possible it will happen. Next time, just watch patiently, politely ask the doctor why are they following this path, recommend other treatments but not enforce your view and don't stir trouble. You don't know if these residents you've been with were genuinely backstabbing you just because they don't like you. I've met people like that.

As always, some very good advice from you, vasca. If I may paraphrase, here's a step by step checklist for dealing with the OP's situation.

1) Politely ask the attending why they are doing something WAY wrong.
2) When they explain it it to you, firmly let them know that you disagree, and explain what they really ought to do in this situation.

Do not proceed to step 3:

3) Force the attending to do things your way.

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[Bacchus]

Vasca, are you returning to the US to practice?

 

[smq123]

It's true, attendings aren't always the greatest geniuses on Earth. I remember a memorable OB/GYN case where a woman with eclampsia had 8 cm dilatation and despite her high blood pressure was in good conditions to give live birth (she was 90% conscious and highly cooperative) and the attendings all wanted to do a c-section with all of the risks involved and didn't want to give her oxytocin which can be a valuable opinion, but this was her second pregnancy, fetal heart rate was normal and she could give birth in just 10 minutes if they'd just give her the drug. The residents weren't agreeing with their superiors opinion and asked me to "secretly" give them a bottle of the drug which I did because I agreed with them. 5 minutes later a healthy baby was born behind the back of the attendings and she was shipped to the ICU and went home 2 weeks later fully recovered. The attendings never scolded the residents thinking the birth was spontaneous. Let's keep them thinking that way.

Wait, you went behind your attending's back to expectantly manage a pregnant woman who had full-blown eclampsia? Who ended up in the ICU later?

Multip or not, 8 cm or not, that was REALLY dangerous to just make your own decision to let an eclamptic who had a seizure wait to deliver vaginally. And go behind your superior's back to do so!

 

[DarknightX]

Wait, you went behind your attending's back to expectantly manage a pregnant woman who had full-blown eclampsia? Who ended up in the ICU later?

Multip or not, 8 cm or not, that was REALLY dangerous to just make your own decision to let an eclamptic who had a seizure wait to deliver vaginally. And go behind your superior's back to do so!

What happens in Mexico stays in Mexico.

 

[fleetgoddess]

delete

 

[fleetgoddess]

First: Do not do what vasca did and go around the attending. they have a lot of experience and may have done something a certain way on purpose and you with less experience don't understand. Plus .... he/she whatever could have gotten their asses sued doing something without orders and such.

If you really think that an attending is compromising patients... we had an elderly attending who was very well known in his field, but he just was really not with it but no one reported it as its really hard to make docs retire. At our med school we have a meeting with someone on faculty in a group and reflect on our rotation. Two of us brought up the same attending in our reflections and our faculty member was very concerned about what she was hearing. She helped us talk to the clerkship director and they had the man go on a long vacation and were going to reevaluate if perhaps he needed to retire.

I had an attending who put the entire service on gabapentin. 100%, they didn't even all have the same problems but it evidently solves everything. Psychosis, sleep problems, anything else. We had psych consults on some of them and he took them all off their recs and put them on ridiculously high doses of gabapentin. (lower doses were given if they weren't psychotic at the time)

Evidently its just this amazing drug that he said should be in the water and you can't kill anyone with it so you can give as high a dosage as you want according to him.

I thought it was a bit crazy but since he gave us speeches on its wonders every day i didn't think he'd be very responsive to my questioning... especially since a lot of the patients had psych recs that he ignored anyway. I have no idea what his reasoning was for some of them... other than that it should be in the water.

But sometimes attendings do make mistakes and you can just ask them nicely. I remembering asking why one doc was prescribing a strange dose of a child's medication then they realize they were using lbs instead of kgs or something like that.

 

[CATrtb]

So what happened with this patient? What happened with you and the attending? What grade did you get? Finish the story.

 

[ACSurgeon]

....we had an elderly attending who was very well known in his field, but he just was really not with it but no one reported it as its really hard to make docs retire. At our med school we have a meeting with someone on faculty in a group and reflect on our rotation. Two of us brought up the same attending in our reflections and our faculty member was very concerned about what she was hearing. She helped us talk to the clerkship director and they had the man go on a long vacation... .

Did you get this from scrubs?