Attending/resident from hell horror stories

[Jorts]

Wow. There is a lot of misunderstanding packed into a small body of text here.

You're right in that I am an attending at Mayo Clinic in Rochester, Minnesota.

I have worked in "less resourced" settings throughout Washington DC, in Jacksonville, in Ohio, etc. I can guarantee that I have never let an intubation occur on one of my patients without me or my colleague (attending) being present. I don't care if the person is homeless, or a CEO, or a famous actor / actress. Your implication that attendings will care less about the safety of a patient when it comes to life threatening procedures like intubation is generally disappointing. I am sure there are individuals who live down to your portrayal but in general every institution I have worked no matter how small or under resourced or underprivileged the patients I have seen will get the same level of attention from me during an intubation.

As for Mayo Clinic….We do care for "Rich" people. We also care for not so rich people. We care for people with insurance, we care for people without insurance. After all we have a 2200 bed hospital in Minnesota with the largest resident force in the country (probably the world) and 20-40 medical students per class. You're probably fair in saying that medical students some times don't get the same procedural opportunities because there are many residents there to step in, but its not because the attendings and hospital have unusual expectations that the attendings should see everyone to protect our standing with rich people…thats entirely the wrong motivation. Every hospital i have worked at has an expectation that an attending is intimately involved in the care of the patient. I believe this is part of Medicare reimbursement that an attending has seen and examined the patient (could be wrong on that).

Residents get a lot of decision making opportunities. Considering in our ED we have over 60 beds, and we turn them over at an average one per three hours, the resident doesn't have to transport patients, place foleys (once they demonstrate they can), place IVs (once they demonstrate they can) etc…they are only making physician level decisions. They do it over and over and over because we don't board the same patient in the ED, we don't take them away from care to do nonphysician level tasks.

About your learning opportunities being best when "resident runs the show," etc. This is again misunderstanding that getting to do procedures and make decisions with little oversight is somehow better. A resident who was taught by another resident who was taught by another resident is likely not practicing at a level of mastery. Probably they know enough to get by, but when you have an expert whose entire passion is for the case you are about to see, the procedure you are about to do, the discussion you are about to have as your coach…thats when true learning happens. Don't worry so much about procedures…they are overrated…the true art of medicine is in the way you establish rapport rapidly with someone who has never met you, the way you can distill what they may tell you in an hour long story (hopefully not in the ED) into a concise and coherent medical description, you can consider a wide but thoughtful differential and perform directed physical assessments and serum, urine, and radiographic testing to confirm or refute your hypothesis and you can communicate the findings in a way that everyone (even someone distant from medical terminology) can understand and then explain to their loved ones who ask them about it. If you can build a useable foundation of these skills in medical school (not expertise because we are always in pursuit of expertise in these things), I can teach you how to suture up a wound, place a chest tube, central line, power up an ultrasound machine…those are easy to teach someone who has put in the investment to master the more important aspects of care. I mean every word of this.

Mayo Clinic is a unique place with lots of resources but the thing that makes it special is not the resources or the rich patients…its the fact that we believe our focus should be on the needs of our patients. Every person lives this philosophy even though it may sound cheesy or unbelievable…its true, and its amazing. Because of that people (even poor people, homeless people) travel from around the country and world to come here to be seen and cared for. I routinely see people who spent everything have to travel here to get evaluated and happily do so. If you ever really want to know what its like, please have more faith in people and come visit as a rotating student and see for yourself.

Again, I hope you can stop spreading such misinformation…because my friend, you are very misinformed.

I'm sorry you are so sensitive. There was no misinformation in my post, and I was not bashing Mayo as you obviously thought that I was. Its a fact that they cater to more of the upper echelon of society (yes I understand Mayo still treats some undeserved patients, but the vast majority are not) which is why I specifically said Mayo. I interviewed there and spent a few days exploring the clinic and Rochester. It is a great place, and doing amazing things, although not my cup of tea. I simply said in my (yes limited) experience when you treat patients of lower SES students are generally more involved in their care. I've had multiple examples of attendings not letting me examine or even interview "VIP" patients (although this is rare) and patients refusing to allow medical students to interview/examine them (never had a patient of lower SES kick medical students out).

I do agree with your assessment about the art of medicine. Its better to be taught by attendings who are great educators (disagree about the expert comment, there are many experts who blow at teaching and many less academic oriented physicians who are great teachers and educators. Same hold true for residents.). However, I learn best when I do the initial assessment and then hear from the attending their thinking process and what they agree with and dont agree with. The reality is (at least where I go to medical school, which is vastly different than Mayo) often medical students are pushed to the side and we dont not feel like a member of the team.

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[Venko]

I'm sorry you are so sensitive. There was no misinformation in my post, and I was not bashing Mayo as you obviously thought that I was. Its a fact that they cater to more of the upper echelon of society (yes I understand Mayo still treats some undeserved patients, but the vast majority are not) which is why I specifically said Mayo. I interviewed there and spent a few days exploring the clinic and Rochester. It is a great place, and doing amazing things, although not my cup of tea. I simply said in my (yes limited) experience when you treat patients of lower SES students are generally more involved in their care. I've had multiple examples of attendings not letting me examine or even interview "VIP" patients (although this is rare) and patients refusing to allow medical students to interview/examine them (never had a patient of lower SES kick medical students out).

I do agree with your assessment about the art of medicine. Its better to be taught by attendings who are great educators (disagree about the expert comment, there are many experts who blow at teaching and many less academic oriented physicians who are great teachers and educators. Same hold true for residents.). However, I learn best when I do the initial assessment and then hear from the attending their thinking process and what they agree with and dont agree with. The reality is (at least where I go to medical school, which is vastly different than Mayo) often medical students are pushed to the side and we dont not feel like a member of the team.

It is in fact misinformation to believe that most of Mayo Clinic Rochester patients are "upper echelon," (most of our patients are farmers, and mayo clinic employees and families, and elderly folks on medicare). Furthermore, your portrayal of the motivation for the care we provide was wrong. We do not staff all patients as attendings to protect the interests of wealthy people. Your statement that residents and students don't get to make decisions (I believe, "no way in hell," was used?) is wrong. The, "heat," attendings feel to guard financially well off patients…I've never (NEVER) encountered anything like this at Mayo. In fact, I felt it when I was in Washington DC, but never in Rochester, Minnesota. Again all this is misinformation. Its a lot for a short post.

For someone who has devoted their life and career for the care of patients in need, and values an institution that, like no other, has embodied a patient first mentality, I do take great offense (or yes, I was sensitive) to your posting of misinformation. Furthermore, referring to anyone as entitled has a negative connotation to it (see the reaction of the OP) and as someone who hold his patients in the highest regard, I take offense to this too.

Because you visited for a few days to interview does not mean you know the culture or the practice.

 

[neutropeniaboy]

I realize this may be politically incorrect, but it's absolutely true in my experience that if you train at a place with lower SES patients then medical students (and even residents) do more.

In your limited experience of 1 (or 1.5y) doing various shadowing as a student?

I find no evidence for this at all. I've worked in 11 different hospital settings, including 3 VA hospitals over my career. The only hospitals where it was assumed that residents "run the show" is at the VA hospitals. There are various fraudulent reasons for this, but most consulting physicians at the VA hospital sign off on care with minimal intervention. (But, that's another discussion.) Of the remaining 8 hospitals, 7 of them services a high percentage of charity, Medicaid and self-pay patients. One of those hospitals catered to well-to-do and 5x Medicare payers. In my experience, it was quite the opposite. At the 1 hospital, the fellows and residents ran the show. At the other 7, the attendings (including myself) are very closely supervising of all patients, including the "poor."

You really should think a little more about the assumptions that you are making.

Rich, privileged people feel entitled to the "best care from the best specialist" and hence no way in hell a medical student and even sometimes a resident is doing any procedure on them or caring for them in any way.

Show me the data. In my experience, the rich and the poor are equally tolerant of students and residents; they are also equally intolerant of them. I've taken care of plenty of "poor" people who don't event want students in the room (the term "student" is broadly applied by many to include residents). If anything, I find the "poor" to be a little more thankful and honored to be treated by so many people. The "rich" tend to be more annoying when it comes to needing the attending there at their beck and call. Nevertheless, I have never had a "rich" person who refused to be cared for by a resident or student. I'm sure techniques differ, but I tell all my patients that I will have residents and students working with me and participating in their care. I tell all patients that I make the significant decisions and that residents make the day-to-day decisions.

...rich, entitled patients are more likely to sue and also the hospital system as a whole...

This is true, but this is more likely due to access to attorneys and monetary resources. While the poor or less likely to sue physicians and hospitals, I can tell you that I've been sued twice, both by Medicaid patients. (Both cases dismissed...)

Some of my best learning experiences were on the poor, underprivleged patients because the vast majority of them don't care if a medical student is doing a procedure or resident running the show making decisions as they are happy to get care.

Show me the data. This is such a ridiculous claim.

In summary, I think the type of patients (poor, middle class, rich) one is caring for plays a big role in how much hands on learning/decision making one is afforded. Yes, all patients should be treated equal, but this is the real world.

I don't deny that you think this, but I can tell you that it's a wrong assumption. When you actually get into the real world (i.e., get a job as a practicing teaching physician), you might have a surprising number of revelations about how wrong you were when you were a medical student.

 

[VisionaryTics]

I have done rotations at the Mayo Clinic as well as an urban VA, Cook County, private and public hospitals throughout Chicago.

The amount of hands-on learning I received and observed at the Mayo Clinic was outstanding, and compared favorably with my experience at County (although at County I was often by myself seeing patients and doing small procedures, while I often had a resident or attending with me at Mayo). I also noted that >90% of the patients were normal folks from the upper Midwest, with the remainder as travelling patients.

In my n=1 one-month experience in a surgical subspecialty, I think it is ridiculous to say that VIPs make up a large # of the patients at Mayo or that resident/medical student learning is compromised. In fact, I think the quality and quantity of hands-on operative training is far above the average.

Furthermore, in my experience with some of the poorest and wealthiest patients in Chicago, SES was NOT the factor that decided how much resident/student autonomy there was. It was the culture of the attendings or institution.

I remember being surprised during my Ob/Gyn rotation. I did most of my core rotations at hospitals on the west and south side with typically a lower SES patient mix. Then I did ob/gyn at a wealthy private hospital in a wealthy neighborhood on the north side. I had a tremendous amount of involvement in patient care, superior to my classmates who did rotations at the other hospitals. Why? It was the culture of the residency program and attendings.

 

[Winged Scapula]

Agreed about the role lack of correlation between SES and student/resident involvement.

With the exception of some infamous "doctor's wives", I've found great acceptance of students and residents amongst all socioeconomic classes. I'd like to think that VT's comment applies to myself and my colleagues here as well, that the culture we promulgate encourages acceptance of students and young physicians.

 

[SouthernSurgeon]

With the exception of some infamous "doctor's wives", I've found great acceptance of students and residents amongst all socioeconomic classes.

Agree with one exception: The VA. My experience remains anecdotal, but I've had so many vets who are so open to the teaching culture.

I looked apologetically at this one vet as my M3 struggled to draw an ABG...he just laughed and said "got to learn somewhere..." and let her keep going.

 

[neutropeniaboy]

Just to clarify my VA experience: the patients for the most part are as SouthernIM says. I would say the older ones more so than the younger ones, but as a group, the majority of them are accepting of the teaching structure. I have concluded that this is because they are used to a hierarchy structure having been in the military.

The VA is a great learning environment, but I think there are many staff and attending physicians who really are there to just collect a paycheck.

Sent via Tapatalk

 

[Libertas]

I think what makes intubation different from a lot of other procedures is the progressive difficulty of each additional attempt, as well as increasing the difficulty to ventilate. When suturing a wound, attempting an LP, putting in a line, drawing blood, doing a paracentesis, etc, this isn't usually the case. While I don't believe its formally included in the difficult airway algorithm, I've always been taught that attempts at intubation should be limited to 3 total tries.

And Mayo having the largest number of residents? Really? My system, for example, matched 20 more residents in the 2013 match than Mayo did.

 

[SouthernSurgeon]

And Mayo having the largest number of residents? Really? My system, for example, matched 20 more residents in the 2013 match than Mayo did.

I have no idea whether the Mayo having the most residents thing is true or not, but just looking at the number of matches in a given year doesn't give you a complete answer.

If an institution were skewed towards having more slots in longer residencies, they could easily have more total residents than a system with a lot of IM/peds/etc. It's analogous to incidence vs prevalence.

 

[Libertas]

I suppose, but almost 10% of mayo's match is non designated surgery prelims....hmm...

 

[Kaustikos]

Kaustikos, this is what you said in your first post. This isn't confidence; it's arrogance, and it is a classic manifestation of narcissism and entitlement.

You proudly state you cannot be wrong and that if you are imperfect it is someone else's fault. You go on to state that you can learn only in one manner (live v dummy). That's narcissism.

You go on in several other posts to demonstrate that because you have done X you should be able to do Y. When you do so in the immature and melodramatic manner that you have, you have fulfilled every definition of the word "entitlement" that is used to broadly label your generation.

Your attitude doesn't impress me, and your type never will. You give the loads of hard working medical students a bad name, and you make our entire profession seem like a bunch of whining entitled rich brats.

Well,
I can't say anything else about it when you completely misinterpret everything I say into that kind of mentality. I'm guessing you also work at Fox News as a side job, too? And that you also work as the ad campaign manager for politicians? Because it certainly takes a certain amount of narrow-minded persona to say all of that from what I've said in the past several pages. I read that entire post and I don't even know where you even came up with 100% of it.

But that's fine. You can continue to judge me on how you think I'm coming off because I want to learn more/train myself. Considering what's being said on here is the complete opposite from what people on my service tell me... I'd say there's certainly a fair amount of subjective bias from a lot of people on here. I feel sorry that confidence and determination is a bad thing on here. It sucks that someone wanting to practice more/become better is a wrong thing... especially when the opportunities are there. Whatever makes you guys sleep better at night. Considering my post wasn't even entirely a rant about a horrible experience but just a minor complaint, I can only find fault in my initial statement. Which I've rectified already.

Also:
"You give the loads of hard working medical students a bad name, and you make our entire profession seem like a bunch of whining entitled rich brats."
Seriously? In what part of the world am I not a hard working person? Is it calculated by the hours? Or the time spent being quiet, awkward, emotionally labile people? Because if it's the latter; then I fold. But I'll be damned if you make that kind of assumption about myself. The truth of the matter is that med students are okay with what's required and nothing more. A lot of them just want to get by surgery and move on because they have no interest in that field. Some of them are okay with learning how to do these things during intern year. I don't judge that attitude. That's how they are. I'm not like that. I'm trying to take any opportunity to learn how to do these things whereever/whenever they happen. And I can guarantee I'm not the only one who thinks that.

But I guess when you hide behind a keyboard and monitor, it's easy to make these accusations and insults to a person. Like the people who smile and nod but then stab you in the back. I know your kind and it's why I can't stand people like you. People in the OR are more blunt and less passive aggressive for the most part - which is what I like. Not this cowardly nonsense you're doing.

 

[neutropeniaboy]

You give the loads of hard working medical students a bad name, and you make our entire profession seem like a bunch of whining entitled rich brats.

Seriously? In what part of the world am I not a hard working person? Is it calculated by the hours? Or the time spent being quiet, awkward, emotionally labile people?

Nassim, I say that because of what you've said elsewhere in your blog:

I don't care about patient care. I just want to be done with it and start doing surgery.

I guess I really am not surprised that you've missed the point of medical school.

BTW: I said this 11 years ago on SDN:

Come to think of it, I didn't do many procedures as a student, and I'm pretty competent now as a surgical resident. I don't think your medical school experience will have much bearing on how you turn out as a resident. Of course, if you do a lot during your medical school years, that will help. But, I don't think having done few will burt [sic] you.

 

[Kaustikos]

Nassim, I say that because of what you've said elsewhere in your blog:


I guess I really am not surprised that you've missed the point of medical school.

BTW: I said this 11 years ago on SDN:

And I've been saying that I'm only feeling this way because of what I have seen. And because I see the mistakes physicians have made and I don't want to be that person.

I don't understand how wanting to be competent is a bad thing... or feeling a shred of confidence in what I can do. But I guess its subjective. Or it apparently is because my preceptors wanted confidence and competence. If anything; its been the environment that's made me this way. Which I take responsibility for because it makes sense to me.

But its fine. I hate medicine anyways. I'll just play this game until I can gtfo of this academic setting.

 

[Kaustikos]

I apparently HAVE missed the point. Or I had a different expectation.

But now I know. No one gives a damn about your knowledge if you're an ms. Just like at Eli Lilly. Its arrogant and rude for a lower level to even open their mouth.

 

[neutropeniaboy]

I apparently HAVE missed the point. Or I had a different expectation.

But now I know. No one gives a damn about your knowledge if you're an ms. Just like at Eli Lilly. Its arrogant and rude for a lower level to even open their mouth.

The problems that arise with Boomers/Gen X and Millenials is that there is frequently a misunderstanding of both sets of generations.

The boomers and xers are more likely to respect the hierarchy, while the y's feel progress, change, development and advancement should be merit based. I respect that, because I don't believe senior members should receive special treatment just because they are senior.

As a group, Y's are highly educated, but they lack experience, direction, appropriate management skills and don't know how to navigate out of a crisis. Their confidence as a group results in making decisions that aren't always based on experience and with the understanding of untoward events. This is particularly bad in medicine because it can result in injury or patient death.

I admire your enthusiasm to learn and the fact that you're a person who questions the status quo; however, you generally have a bad attitude about patient care and instead of a desire to move up, you want to start up and move sideways.

I recommend you rethink your attitude.

 

[syncrhodes]

share!!

I had a surgical attending who would pimp me on whatever random classic rock song was playing in the background of the OR. I never listened to classic rock. I didn't know @#%@. I really think his evaluation of me was based on how many times I didn't know questions...given that all his questions were about classic rock...I therefore GOT ROCKED by the rotation. The one time I knew the song was a Johnny Cash song, and he called me out on only knowing it because i had watched "Walk the Line". So, basically, he counted that as yet another wrong answer. What a greatttttttt month that was.

 

[DermViser]

This kind of attitude is beyond depressing. Not a single resident in my program has this mindset. Med students may be "clerks," but scutting them out to scribe notes or get you coffee is ******* ridiculous. Residents and attendings can have a direct effect on what field a student goes in to. I had two very influential attendings steer me into my specialty. After they did that, the residents are what made me choose the program.

If I were your co-resident, or even a resident in another program at your institution, I would be speaking up on behalf of the student you're treating like ****.

You were there not too long ago. Don't forget that. Make a good lasting impression, not one that will possibly keep students from applying to your program.

Edit: Would have never guessed you're in FM.[/quote]

I would have.

 

[DermViser]

The problems that arise with Boomers/Gen X and Millenials is that there is frequently a misunderstanding of both sets of generations.

The boomers and xers are more likely to respect the hierarchy, while the y's feel progress, change, development and advancement should be merit based. I respect that, because I don't believe senior members should receive special treatment just because they are senior.

As a group, Y's are highly educated, but they lack experience, direction, appropriate management skills and don't know how to navigate out of a crisis. Their confidence as a group results in making decisions that aren't always based on experience and with the understanding of untoward events. This is particularly bad in medicine because it can result in injury or patient death.

I admire your enthusiasm to learn and the fact that you're a person who questions the status quo; however, you generally have a bad attitude about patient care and instead of a desire to move up, you want to start up and move sideways.

I recommend you rethink your attitude.

That's probably because boomers got pretty good jobs just for graduating from college, which were relatively well-paying, which one could raise a family off of, with pensions on retirement. Not surprisingly, Boomers have become one of the biggest entitlement leaches, saddling future generations with their debt.

 

[DermViser]

Agree with one exception: The VA. My experience remains anecdotal, but I've had so many vets who are so open to the teaching culture.

I looked apologetically at this one vet as my M3 struggled to draw an ABG...he just laughed and said "got to learn somewhere..." and let her keep going.

So true. Vets are one the most awesome when it comes to letting a medical student learn. One of the most thankful too. Personally I think it's crap that they have to get their medical care in the VA (I'm talking about VA nurses here).

Compare this to your typical entitled Medicaid patient.

 

[DermViser]

I have done rotations at the Mayo Clinic as well as an urban VA, Cook County, private and public hospitals throughout Chicago.

The amount of hands-on learning I received and observed at the Mayo Clinic was outstanding, and compared favorably with my experience at County (although at County I was often by myself seeing patients and doing small procedures, while I often had a resident or attending with me at Mayo). I also noted that >90% of the patients were normal folks from the upper Midwest, with the remainder as travelling patients.

In my n=1 one-month experience in a surgical subspecialty, I think it is ridiculous to say that VIPs make up a large # of the patients at Mayo or that resident/medical student learning is compromised. In fact, I think the quality and quantity of hands-on operative training is far above the average.

Furthermore, in my experience with some of the poorest and wealthiest patients in Chicago, SES was NOT the factor that decided how much resident/student autonomy there was. It was the culture of the attendings or institution.

I remember being surprised during my Ob/Gyn rotation. I did most of my core rotations at hospitals on the west and south side with typically a lower SES patient mix. Then I did ob/gyn at a wealthy private hospital in a wealthy neighborhood on the north side. I had a tremendous amount of involvement in patient care, superior to my classmates who did rotations at the other hospitals. Why? It was the culture of the residency program and attendings.

That's bc at higher SES places, the attendings tend to be happier. Mayo vs. Cook County, for example.

 

[neutropeniaboy]

That's bc at higher SES places, the attendings tend to be happier. Mayo vs. Cook County, for example.

Show me the data.

 

[DermViser]

Show me the data.

You're really going to make the argument that doctors are happier at places, in which their hospital receives less reimbursement (i.e. Medicaid)? Really?

 

[neutropeniaboy]

You're really going to make the argument that doctors are happier at places, in which their hospital receives less reimbursement (i.e. Medicaid)? Really?

This statement shows your ignorance, furthermore that's not my argument.

Some physicians are paid based on RVU productivity regardless of the collections. Some physicians are paid a straight salary regardless of RVU productivity or collections. Some physicians are paid solely based on collections. Still others are hybrids.

So, I don't make any assumptions here about physician happiness.

You made the claim; show me the data.

My assumption - and I have only anecdotal data - is the physician happiness is achieved by multiple factors, but primarily when they have the right salary, see patients within their scope of practice, sufficient administrative support and a harmonious working group. This is balanced by adequate work - home life separation.

 

[james.dellolite]

seriously its a fair point

 

[neutropeniaboy]

seriously its a fair point

¿Que?

 

[alisepeep]

I just had a pt. at a county hospital tell me that he didn't want a student draining his butt abscess. This guy had HIV too..I was like "pleaseeeee go tell that to my resident"

 

[Kaustikos]

Why did you bring this thread back??????

 

[evilbooyaa]

Why did you bring this thread back??????

B/c it's entertaining, and this forum is dead.

Can't really complain much more about my attendings since it's 4th year now.

Although I will say that having overly political attendings ('Obama is a Muslim devil!' straight from the mouth of one of the more senior attendings) is kind of annoying. Nothing that is unamanageable, however.

 

[DermViser]

B/c it's entertaining, and this forum is dead.

Can't really complain much more about my attendings since it's 4th year now.

Although I will say that having overly political attendings ('Obama is a Muslim devil!' straight from the mouth of one of the more senior attendings) is kind of annoying. Nothing that is unamanageable, however.

http://whatshouldwecallmedschool.tu...-call-on-one-of-my-last-rotations-of-3rd-year

How is it annoying? He believes Obama is destroying Medicine. He is.

 

[Kaustikos]

Well,
I have another one that happened a couple months back on my heme/onc subspecialty.
Attending was making some questionable calls and refuted some of my suggestions.
First: He didn't listen to my caution that his kidneys were injured and at risk of AKI/ATN. He disagrees and starts running multiple contrast studies in a week (four studies). End of the week his kidneys = ATN. He acts surprised looks at me like I didn't catch it early enough. I was pissed.
Second: We run a brain mri to look for Mets from his melanoma. Like a clever Med student, I call the radiologist to get their initial impression. I had seen some concerning findings and he confirmed it. First was the lesion in his orbit which had doubled in size in a week. He was also found to have vascular compromise confirmed by optho. I bring it up and the attending looks at me like I'm an idiot and says "Melanoma never goes there."
I respond "I've always been told to never say never about cancer... And the radiologist even said it was suspicious for it."
He dismisses it and walks into the patient and says "Good news! No new Mets!"
I leave. It was my last day and I wanted out. I didn't even say goodbye or anything. I wrote my final note and then saw the radiologist had the final read stating just that and also there were expansive masses in his bone. I didn't care... I should have told someone else in charge about it but I didn't. I tell this to my dad (doctor, too) and he said I should've reported him for negligence. I didn't.

Fast forward today and I decided to see how the patient did. They had discharged him despite never treating his initial complaint. Not only that, they let him go despite his ongoing hematuria. Not only that: He had returned three times in the past two months with hematuria and N/V.... I wish I hadn't looked. I also felt bad that I didn't tell anyone else.

 

[DermViser]

Well,
I have another one that happened a couple months back on my heme/onc subspecialty.
Attending was making some questionable calls and refuted some of my suggestions.
First: He didn't listen to my caution that his kidneys were injured and at risk of AKI/ATN. He disagrees and starts running multiple contrast studies in a week (four studies). End of the week his kidneys = ATN. He acts surprised looks at me like I didn't catch it early enough. I was pissed.
Second: We run a brain mri to look for Mets from his melanoma. Like a clever Med student, I call the radiologist to get their initial impression. I had seen some concerning findings and he confirmed it. First was the lesion in his orbit which had doubled in size in a week. He was also found to have vascular compromise confirmed by optho. I bring it up and the attending looks at me like I'm an idiot and says "Melanoma never goes there."
I respond "I've always been told to never say never about cancer... And the radiologist even said it was suspicious for it."
He dismisses it and walks into the patient and says "Good news! No new Mets!"
I leave. It was my last day and I wanted out. I didn't even say goodbye or anything. I wrote my final note and then saw the radiologist had the final read stating just that and also there were expansive masses in his bone. I didn't care... I should have told someone else in charge about it but I didn't. I tell this to my dad (doctor, too) and he said I should've reported him for negligence. I didn't.

Fast forward today and I decided to see how the patient did. They had discharged him despite never treating his initial complaint. Not only that, they let him go despite his ongoing hematuria. Not only that: He had returned three times in the past two months with hematuria and N/V.... I wish I hadn't looked. I also felt bad that I didn't tell anyone else.

 

[evilbooyaa]

http://whatshouldwecallmedschool.tu...-call-on-one-of-my-last-rotations-of-3rd-year

How is it annoying? He believes Obama is destroying Medicine. He is.

It's one thing to criticize a man man for his policies, it's quite another to criticize a man based off what you heard about him on TV. If the attending said "Obama is destroying medicine", I wouldn't have posted it here.