Am I becoming my attendings?

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beyond all hope

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It's like the old "I'm becoming my parents" thought.

I'd started as a brand new academic with the idea that I'd be the attending I always wanted to work with: kind, teach a lot, not scut my residents, etc. I also try to see a lot of patients on my own to reduce their workload.

I'm very aggresive with dispo. I get annoyed when services ask for tests that I don't think are necessary. When other services ask for unnecessary tests before admission my response is "Come see the patient and get them admitted!"

I just had a long talk with my fellow attendings and I'm starting to wonder if I'm doing too much. I finish the resident's charts. I get dispo for them. I read their studies. I'm wondering if I should take a step back and let them do more.

I never wanted to be the attending who sat on his *ss, but I'm starting to wonder if that's not the best thing.

I'm also wondering if I'm respecting the other services' education by forcing dispo on them, when they should be more involved in the process of taking emergency admissions.

Thoughts? Which kind of attending do you prefer: the one who eases your workload or the one who just teaches and lets you do the work?

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depends on level of training.... as an intern and junior, should be teaching a ton, and force to be stretched.. as a senior, giver finer pointers, teach them everything that you can about what you would want to know before becoming and attending, and if they've proven they can move pts, then help them out and get off your butt, o/w you're just being lazy.
 
It's like the old "I'm becoming my parents" thought.

I'd started as a brand new academic with the idea that I'd be the attending I always wanted to work with: kind, teach a lot, not scut my residents, etc. I also try to see a lot of patients on my own to reduce their workload.

I'm very aggresive with dispo. I get annoyed when services ask for tests that I don't think are necessary. When other services ask for unnecessary tests before admission my response is "Come see the patient and get them admitted!"

I just had a long talk with my fellow attendings and I'm starting to wonder if I'm doing too much. I finish the resident's charts. I get dispo for them. I read their studies. I'm wondering if I should take a step back and let them do more.

I never wanted to be the attending who sat on his *ss, but I'm starting to wonder if that's not the best thing.

I'm also wondering if I'm respecting the other services' education by forcing dispo on them, when they should be more involved in the process of taking emergency admissions.

Thoughts? Which kind of attending do you prefer: the one who eases your workload or the one who just teaches and lets you do the work?

BAH --

I've always respected your comments on this board. As an extension, I think you would be great attending to work for.

Here are my thoughts which, I suspect, are much what you would have written during residency but perhaps after only a few months have become somewhat of a distant memory:

1. It's a nuanced approached. For the interns, it makes sense to teach as much as possible, to take up some of the cases as "attending only" to lighten the workload, and help out when off service people are being obstinate.

2. Conversations with off service admitting residents need to sometimes be performed by the senior residents. It's part of our training to be forceful and diplomatic at once, too.

3. Nothing wrong with reading studies. It's your name on the chart, afterall. But if there is a mechanism in your charting system for indicating when a study has been read, always try to ensure that the flag shows "not read" so that we, as residents, make sure to read them and don't accidently miss them.

4. Don't chart for us if you can help it. It is one of the things that we are weakest at as residents. Afterall, charting is synonymous with billing, and a s a resident, we don't worry so much about the former. If our charting is incomplete, let us figure it out. Most residencies will have a "flag folder" system where it will, inevitably, end up in our mailbox if we don't get it right. but do let us know when circumstances arise where we have DONE our charting but it is not up to snuff. i still remember when the billing guru in my department sat me down and showed me how my charting could not only be better, but must be better to be effectively billed! this will improve my perfomance when i'm out in the real world :)

5. Once again, I emphasize that the approach is best graded. interns love teaching, love when you pick up patients, love when you fight some of their turf battles. Us senior residents need the practice at all of the above so we can do your job next year... :)

At the end of the day, I bet you're doing a great job. Hell, just by asking for feedback ensures it. And if worse comes to worse, remember: a pint after work never hurt anybody:)

BTT
 
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Speaking of admitting services asking for unnecessary tests, I recently had a hospitalist attending ask me to do an LP on an elderly man sent in by the ECF for "confusion." The guy was alert, oriented x3, and was not in the least bit confused at all. The reason he was being admitted was because he had a pneumonia.

At any rate, when she asked me to do the LP, I asked her "did you even examine the patient?" "No." "Great, end of discussion. If you want the LP, you can do it while you're examining the patient."
 
depends on level of training.... as an intern and junior, should be teaching a ton, and force to be stretched.. as a senior, giver finer pointers, teach them everything that you can about what you would want to know before becoming and attending, and if they've proven they can move pts, then help them out and get off your butt, o/w you're just being lazy.

Looks like whasup had different advice regarding helping out as 'attending only cases'. I guess my rationale was that by 'helping out' around the edges, you could maybe let your interns focus more on working cases up, particularly interesting and/or bread and butter. I can see Whasup's point about having them get "stretched" a little, but maybe towards the end of intern year as they are preparing for their senior shifts. In any event, I don't think I've ever seen an attending "being lazy" or (being viewed as such) by not taking on their own patients; But I can think of LOTS of days where the senior most resident (especially after Christmas of final year! :laugh: ) gets a good healthy dose of senioritis and starts slowing down to the point of laziness...
 
i definitely have seen lazy attendings.... it sounds from other posts there are some/several at other programs as well...
 
For the interns.... teach, teach, teach... and be involved. For the seniors... let them do everything, but make sure they do it right. I like attendings that give me autonomy, but can tell me when I do something that they don't agree with. Just make sure you point out why. There is a big difference between opinion, preference, and fact (or evidence based). We all realize that everyone has their own style and can appreciate learning different points of view.... but I really appreciate it when my attendings tell me why they favor their particular method of doing something.

A lazy attending just lets you do whatever you want... a good attending only lets you do what you want when you're right!
 
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