Advice on Bad Attending

[HemoglobinD]

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I’m currently on an outpatient rotation (my first rotation) where I’m working with a private practice doctor. The only thing I do is basically interview the patients and preform the physical exam and record findings in his electronic medical record system. He has a weird way of entering things in the EMR and expects me to know how to do this perfectly despite the fact that no one has ever sat down and taught me how to do it. Each day he comes up with something new I didn’t enter correctly in the EMR (that hes never showed me or told me about before--- if he did, I would have done it!!) He doesn’t spend time to teaching me after each patient (as attending are supposed to do) and he doesn’t ask me questions to evaluate my knowledge base but he is going to have to grade me on these things.
When I asked him about my performance and about on things I can improve on he told me “You tell me”. I said, “I’m not sure because this is my first rotation” and he went on to say something about how some students have trouble with the electronic medical record.

Anyway, my question is, how do I approach this situation in terms of receiving my evaluation. I feel like there is no way he can really constructively evaluate my knowledge base or performance. Should I defend myself during the evaluation? For example if he bases the whole thing on how I didn’t know how to use the electronic medical record system, how could I nicely tell him that no one even sat down and taught me the steps on how he would like things to be entered?? To make things worse, the nurse told me today that people only get good evaluations if they joke around and flirt with this doctor.

Should I talk to the clerkship director? It seems like all the other students are having a better time since they are actually rotating at the school (I got unlucky and got an outpatient private practice clinic).

 

[DrSnips]

I’m currently on an outpatient rotation (my first rotation) where I’m working with a private practice doctor. The only thing I do is basically interview the patients and preform the physical exam and record findings in his electronic medical record system. He has a weird way of entering things in the EMR and expects me to know how to do this perfectly despite the fact that no one has ever sat down and taught me how to do it. Each day he comes up with something new I didn’t enter correctly in the EMR (that hes never showed me or told me about before--- if he did, I would have done it!!) He doesn’t spend time to teaching me after each patient (as attending are supposed to do) and he doesn’t ask me questions to evaluate my knowledge base but he is going to have to grade me on these things.
When I asked him about my performance and about on things I can improve on he told me “You tell me”. I said, “I’m not sure because this is my first rotation” and he went on to say something about how some students have trouble with the electronic medical record.

Anyway, my question is, how do I approach this situation in terms of receiving my evaluation. I feel like there is no way he can really constructively evaluate my knowledge base or performance. Should I defend myself during the evaluation? For example if he bases the whole thing on how I didn’t know how to use the electronic medical record system, how could I nicely tell him that no one even sat down and taught me the steps on how he would like things to be entered?? To make things worse, the nurse told me today that people only get good evaluations if they joke around and flirt with this doctor.

Should I talk to the clerkship director? It seems like all the other students are having a better time since they are actually rotating at the school (I got unlucky and got an outpatient private practice clinic).

Talk to the clerkship director with any concerns, that is what they are there for. As for seemingly arbitrary grading, welcome to third year. I've been graded by attendings I've barely even seen, eg. after one 8 hour ER shift where I mostly worked with a resident). And as for being yelled at for something you were never taught how to do, that is basically a summary of your surgery clerkship (enjoy!).

If there seriously is some expectation of flirting for good grades (please don't just take that nurse's word for it in isolation), then that would be a good issue to bring up with the clerkship director or ombudsman if you have one. We have had a primary care attending who is banned from having students for a similar reason.

 

[evilbooyaa]

Have you tried asking him one time during any second that you're both not actively doing something, "Hey Doctor X, can you show me how to do 'x' in the EMR?" Don't ask "Can you teach me how to use the EMR". Instead, be proactive, look through the EMR for patients that have previously been entered or that he enters, and see what his system is. It's not an ideal situation, but most rotations like being proactive.

As for the "you tell me", he wants to see what your self-eval is before he gives you his. Give yourself an honest self-eval. Are you performing the HPI/PE well? Are you struggling with the EMR? How's this for a short self-eval: I think my History and Physical exam skills are improving d/t all the patients I'm seeing, but I think I still need some work on getting completely comfortable with the EMR.

If he's not asking you questions, be proactive, look up information/treatment options for patients that you don't know what to do. Look up an article on any 'controversial' treatments that you can bring up whenever he's not busy.

Now saying ALL of this is not an attack on you. Sometimes private practice docs (is this a FM rotation?) are constantly busy and pick up med students without plans to teach them in order to line their pockets. If he doesn't have time to teach or is busy constantly due to the fact he constantly has to see a never-ending revolving door of patients and verify everything you've done.

Does he let you present the patient to him before he sees them? I'd say at least he should let you do that so you figure out how to get your thoughts together.

I know you're venting so none of this is meant to bash you, but just ways to improve on what sounds like a crappy situation.

 

[hrandani]

Yeah welcome to third year, where people trip over themselves in their haste to blame the victim (med students).

I can't tell you how many times I've wanted to smack the **** out of an attending when they get this George W Bush "Who, me?" look on their face and then they say "Well, you never asked me that."

In their eyes, everything is your fault because they're obviously too busy saving lives to teach you something. They say you should be proactive, what this really means is they have never sat down and planned to teach you anything, or even thought about what you should know at this point. They assume you know everything they do, despite the fact it's taken them ten years to reach their current level of knowledge, and any lapse in that illusion is a massive failure on your part roughly equivalent to the exxon valdez disaster.

Obviously, your only role as a medical student is to save them time and hassle.

After all, when they were a medical student on their first day of wards, they walked off a golden chariot sent from a cloud upon Olympus and immediately scrubbed in for a 14 hour neurosurgery, taking over for the both the surgeon and anesthesiologist at different points in the case when their respective levels of fatigue became too much.

I agree with you that private practice is no place for medical students, especially if it's one of your first rotations. I have a few places in mind I plan to go back to in ten years and tell them that if they wanted a PA they should have hired a PA, not agreed to take on medical students.

Your only defense in these types of situations is to become as obnoxiously servile as inhumanely possible and just project deference and shame. If they tell you something hilariously wrong just nod sagely and thank them for their hard-won wisdom, and if it is literally going to kill a patient, you have to figure out a way to sabotage them without anybody finding out you had anything to do with it.

And people wonder why family medicine isn't very popular among medical students.

 

[VenusinFurs]

Question: when you did stuff on the EMR, did you ask questions whilst you were doing it about how to do it? Or did the attending just kind of peace out and you weren't able to talk to him while writing the note?

Some attendings are just more exacting than others and will always find something to criticize. Don't let it get you down.

And it's absolutely not true that all private practice docs don't teach. I had a great rural outpatient peds rotation where he made me look up a topic every day and then would teach me more about it. I mean, he didn't have the busiest office in the world and mostly took walk-ins, but still.

 

[thepoopologist]

If you are worried about a bad evaluation, focus on improving your skills at entering information into the EMR. Like a previous poster said, look through other entries and see how they were done. After you receive your evaluation, regardless of how turns out, go to the clerkship director and make your thoughts known in an objective way.

He sounds like a someone looking to save $80,000 on a good PA/NP and has settled on medical students instead. These types of doctors should be garrotted but then that would decimate 80% of the physician population in the country. Go buy a reference book, i.e. boards and wards and/or pocket medicine, and bring it to clinic if you insist on learning.

 

[Kadava Reviva]

I’m currently on an outpatient rotation (my first rotation) where I’m working with a private practice doctor. The only thing I do is basically interview the patients and preform the physical exam and record findings in his electronic medical record system. He has a weird way of entering things in the EMR and expects me to know how to do this perfectly despite the fact that no one has ever sat down and taught me how to do it. Each day he comes up with something new I didn’t enter correctly in the EMR (that hes never showed me or told me about before--- if he did, I would have done it!!) He doesn’t spend time to teaching me after each patient (as attending are supposed to do) and he doesn’t ask me questions to evaluate my knowledge base but he is going to have to grade me on these things.
When I asked him about my performance and about on things I can improve on he told me “You tell me”. I said, “I’m not sure because this is my first rotation” and he went on to say something about how some students have trouble with the electronic medical record.

Anyway, my question is, how do I approach this situation in terms of receiving my evaluation. I feel like there is no way he can really constructively evaluate my knowledge base or performance. Should I defend myself during the evaluation? For example if he bases the whole thing on how I didn’t know how to use the electronic medical record system, how could I nicely tell him that no one even sat down and taught me the steps on how he would like things to be entered?? To make things worse, the nurse told me today that people only get good evaluations if they joke around and flirt with this doctor.

Should I talk to the clerkship director? It seems like all the other students are having a better time since they are actually rotating at the school (I got unlucky and got an outpatient private practice clinic).

So! You're are officially his scutt monkey. You cannot graduate without being one in at least one rotation. Seriously, though; you should talk to your clerkship director.

 

[HemoglobinD]

Thank you all for your advice. As you guessed, yes this is a family medicine rotation.
I have tried to ask him to show me how to do X in EMR, but he just clicks through quickly WHILE inside the patient room and says "see thats how you do it!" rather than actually teaching me how to do it. Since I'm a fast learner, I usually pick up on what hes doing however, everyday, it's something different that I did "incorrectly" that he never showed me before.

For example, all of a sudden, today, after 2 weeks of working with him, he yells at me for not copying the HPI into the ROS... wtf..... this is not the standard and I'm supposed to know that this is what he wants???

Anyway, i only have two more clinic days until my eval so I guess im essentially screwed. His eval is only 15% of the clerkship grade so hopefully it wont destroy my grade too bad. I think I am going to try to negotiate my grade during the evaluation since he fills it out in front of me. What is the most diplomatic way to say, YOU DIDNT TEACH ME how to do the EMR from the beginning (even though he thinks rapidly clicking through the EMR while in the patient room and I'm standing behind him and can barely see= teaching me how to use EMR). OR what do I say when he comes to grade me on oral presentation skills when I havent even had a chance to present anything to him!!!

 

[Perrotfish]

I’m currently on an outpatient rotation (my first rotation) where I’m working with a private practice doctor. The only thing I do is basically interview the patients and preform the physical exam and record findings in his electronic medical record system. He has a weird way of entering things in the EMR and expects me to know how to do this perfectly despite the fact that no one has ever sat down and taught me how to do it. Each day he comes up with something new I didn’t enter correctly in the EMR (that hes never showed me or told me about before--- if he did, I would have done it!!) He doesn’t spend time to teaching me after each patient (as attending are supposed to do) and he doesn’t ask me questions to evaluate my knowledge base but he is going to have to grade me on these things.
When I asked him about my performance and about on things I can improve on he told me “You tell me”. I said, “I’m not sure because this is my first rotation” and he went on to say something about how some students have trouble with the electronic medical record.

Anyway, my question is, how do I approach this situation in terms of receiving my evaluation. I feel like there is no way he can really constructively evaluate my knowledge base or performance. Should I defend myself during the evaluation? For example if he bases the whole thing on how I didn’t know how to use the electronic medical record system, how could I nicely tell him that no one even sat down and taught me the steps on how he would like things to be entered?? To make things worse, the nurse told me today that people only get good evaluations if they joke around and flirt with this doctor.

Should I talk to the clerkship director? It seems like all the other students are having a better time since they are actually rotating at the school (I got unlucky and got an outpatient private practice clinic).

My only real advice is that, when you talk to your clerkship director, stick to what you know. Unreasonable expectations, poor training on the EMR, poor feedback, no teaching, etc. Don't repeat hearsay to strengthen your case. 'The nurse told me he only gives good evaluations to girls who flirt with him' is both an incredibly serious accusation and not something you have yet directly observed. Obviously if he does harass you then you should report that right away.

 

[Dr Love]

Talk to the clerkship director with any concerns, that is what they are there for. As for seemingly arbitrary grading, welcome to third year. I've been graded by attendings I've barely even seen, eg. after one 8 hour ER shift where I mostly worked with a resident). And as for being yelled at for something you were never taught how to do, that is basically a summary of your surgery clerkship (enjoy!).

If there seriously is some expectation of flirting for good grades (please don't just take that nurse's word for it in isolation), then that would be a good issue to bring up with the clerkship director or ombudsman if you have one. We have had a primary care attending who is banned from having students for a similar reason.

What is an ombudsman? He seems almost mystical, and I am not even sure my school has one.

 

[duckie99]

OP, I think you are freaking out over nothing. I doubt his eval will be bad. At worst he'll just give you "average" scores. And look I am sorry to inform you but not everyone gets an A in medical school. I know it sucks getting "subjectively" evaluated and being told how you need to improve when you've been told your whole life up to this point how smart you are but that's the system you signed up for.

Also to think someone is supposed to sit and take time out of their day to lecture you on each patient while they have 10 others in the waiting room... is well pretty naive. It's your first rotation. You'll soon learn most of the learning is done on your own and you pick up tidbits during the day and study at night. That's just the way it is.

Also regarding the evaluation, after many years of having students attendings get good at evaluating students simply based on their interactions with them and how they present a case. But again it's your first rotation so you have a lot to improve on. Sounds like he's letting you do all the things a medical student should do so I actually think from what you wrote he's doing a decent job. It's actually kinda funny how obsessed he is over the EMR. Why don't you just ask for help??? It's not hard to say "hey think you could show me how to do that?"

 

[seelee]

It's been said, but it bears repeating: Welcome to effing third year!

1. Definitely talk to the clerkship director but wait until after you are done working with him. Otherwise, the CD would send him an email and say "your third year student thinks you aren't doing a good job" and that would make your life unbearable. When you do talk to the CD, stick to the facts. Don't get emotional. They may not factor in his eval into your grade, they may stop sending students to him, but most likely they will do nothing.

2. Stop sweating the subjective evaluation. You have very little control over it. You can do everything right and work your ass off and some people with think you are a horrible medical student, and others will think you are the greatest thing since sliced bread.

3. Study your ass of for the shelf. Your shelf is the one thing that you can control. Bust your ass off for it and get an A.

In the long run, it doesn't matter a whole lot.

 

[mvenus929]

I agree with you that private practice is no place for medical students, especially if it's one of your first rotations. I have a few places in mind I plan to go back to in ten years and tell them that if they wanted a PA they should have hired a PA, not agreed to take on medical students.

I disagree. My school sends us out twice a year to mostly private practice clinics, and I think it's important for our education (not everyone is going to be able to work in academia). I worked with an internal med doc and a family medicine doc last month, and they were both great teachers; they just didn't want to work in academia due to their lifestyle desires. Most all of the physicians my school sends people to are great teachers.

After you receive your evaluation, regardless of how turns out, go to the clerkship director and make your thoughts known in an objective way.

1. Definitely talk to the clerkship director but wait until after you are done working with him. Otherwise, the CD would send him an email and say "your third year student thinks you aren't doing a good job" and that would make your life unbearable. When you do talk to the CD, stick to the facts. Don't get emotional. They may not factor in his eval into your grade, they may stop sending students to him, but most likely they will do nothing.

I disagree. I think you should go to the course director before the clerkship is over. If you don't feel comfortable going to the CD, go to your dean of student affairs. My school also has a student advocacy committee that responds to all reports of mistreatment; if your school has something similar, go to your rep.

If you make your concerns known before the end of the clerkship, something may change. It sounds like you only have a couple days left anyway, but if this had been a serious concern in the beginning, I've heard of students being removed from the practice halfway through a rotation because of mistreatment. If this is an ongoing concern from students, the school needs to know about it so that they don't continue to send students there.

In the end, don't sweat the eval. Unless you're a horrible person, most of your evals will be good or neutral. If there's one bad one in the bunch, people will realize it's the preceptor, not the student, that's the problem. It's also your first rotation, so it's expected that you won't perform like a rock star. Also, some people will be really hard on you to test you throughout the clerkship, but when it comes time to do evals will give relatively good evals.

 

[seelee]

I disagree. I think you should go to the course director before the clerkship is over. If you don't feel comfortable going to the CD, go to your dean of student affairs. My school also has a student advocacy committee that responds to all reports of mistreatment; if your school has something similar, go to your rep.

It really depends on the institution and the clerkship director. If you go now, then they might be able to intervene, but probably not (I wouldn't categorize this as abuse). They also might (inadvertently) make things worse for the OP. If he waits until after then it might not help his grade (which we both agree this won't make much of a difference on), but it is less likely to hurt him.

I don't think that the clerkship director would sell him up the river, but I think that a lot of clerkship directors are ****ty at handling these things.

 

[seelee]

I disagree. I think you should go to the course director before the clerkship is over. If you don't feel comfortable going to the CD, go to your dean of student affairs. My school also has a student advocacy committee that responds to all reports of mistreatment; if your school has something similar, go to your rep.

It really depends on the institution and the clerkship director. If you go now, then they might be able to intervene, but probably not (I wouldn't categorize this as abuse). They also might (inadvertently) make things worse for the OP. If he waits until after then it might not help his grade (which we both agree this won't make much of a difference on), but it is less likely to hurt him.

I don't think that the clerkship director would sell him up the river, but I think that a lot of clerkship directors are ****ty at handling these things.