Attendings in Other Specialties...

[LucidSplash]

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Twice in the last couple weeks I have been in similar irritating interactions with attendings in different specialties. I recognize that this is largely due to a political situation between my attendings and these other attendings, and nothing to do with me specifically, but I'm wondering if this is just a rare situation or if others have encountered it and how they have handled it.

The first was a Peds ICU attending. Without specific details, there was a patient he thought we should be managing but one of my attendings had declined to be involved after the initial workup was complete. While we were seeing another patient in the unit, the attending told me to write transfer orders and put the patient on our service on the floor as the patient was ready to leave the unit and he wanted them transferred out that day to make room. I knew that my attending had declined to be involved in the patient's care and said I couldn't do that as we weren't seeing the patient and weren't involved in his care. The attending kind of threw a hissy fit and spent like 10 minutes loudly complaining about certain aspects of the way things are done between the Peds Surgeons and the PICU and then ended by telling me to "hop to and get it done, that's just all there is to it, put the patient on your list and get the patient out of my unit today."

What I DID was tell him I would double check with the attending and get back to him (still declined). I also suggested that he was expressing his concerns about patient care dynamics between the services to the wrong person as the resident doesn't really make policy.

What I THOUGHT was: "WTF. Please check my coat, it says SURGERY Resident on it. I only 'hop to' when a SURGERY attending says so and all respect accorded to attendings in all specialties aside I'm DEFINITELY not going to do something that is the exact opposite of what my attending instructed just because you are throwing your <super unimpressive by surgery-standards> temper tantrum. GTF over yourself."

Second situation was a Peds ED attending. Again, dynamics between departments at play. Came in from home (home call) to see two trauma consults my attending texted me about (our peds surgery attendings take first call from the ED). As soon as I show up and finish getting the story from the attending, he kinda sidles up and starts conspiratorially half-whispering "What's up with your boss? Why did he try and blow me off, what's his deal with seeing these patients?" and basically launches into this soliloquy about the dynamics of the situation - at that time I had no background on what went down in their interaction as I just received the text and went and didn't know what occurred beforehand. The irritating thing was that his tone was one of commiseration as though I would be on his side.

What I DID was tell him shortly I was just there to see the patients and report back to my attending and preferred to stay out of the interpersonal issues.

What I THOUGHT was "WTF. Please check my coat, it says SURGERY resident. Why are you acting like I am going to be on your side vs my attending? Why are you whispering/whining like a teenage girl? Grow up and GTF over yourself."

Again, maybe it is just the dynamics of the situation but has anyone else ever dealt with attendings in other specialties who try to get you to act/speak against your own attendings?

 

[ESU_MD]

Sounds like pretty typical scenarios for those involved in the pediatric sub-world of medicine. icu and er docs too scared to confront the surgeon directly so they try to bully the poor resident. makes me remember how much I hated pediatrics rotations!

You handled it pretty well. Like in the Godfather- never talk against the family.

do your time on the rotation and then go far, far away!

 

[filter07]

I have had attendings in other specialties try to be condescending and bullying over the phone. What they don't realize is that I don't let attendings from other specialties give me any crap. Some people think the word "attending" makes residents automatically fear them. It's interesting how surprised they are when their sarcastic BS gets bounced right back at them. Taste of their own medicine.

 

[Apollyon]

As an EM (not peds) attending, I have said that I "can crap on a resident". I don't, but I could. At the same time, where I am in the community, interestingly, when I have to transfer a patient, even to places covered by residents (wow, that is a LOT of commas), I NEVER speak to a resident. I can't remember the last time (if ever) I spoke to a resident here. The only time I've seen a resident was when I was a patient (that was ortho, and it was an ortho chief).

I can concur on the peds sub world, with the passive-aggressive thing of not wanting to speak to/confront the attending. Eh, I don't know what to tell you. I recall what a guy said to me back when I was in military college - "I won't stab you in the back - I'll look you right in the eye as I stab you through the heart". Fair enough.

 

[dynx]

As an EM (not peds) attending, I have said that I "can crap on a resident". I don't, but I could. At the same time, where I am in the community, interestingly, when I have to transfer a patient, even to places covered by residents (wow, that is a LOT of commas), I NEVER speak to a resident. I can't remember the last time (if ever) I spoke to a resident here. The only time I've seen a resident was when I was a patient (that was ortho, and it was an ortho chief).

I can concur on the peds sub world, with the passive-aggressive thing of not wanting to speak to/confront the attending. Eh, I don't know what to tell you. I recall what a guy said to me back when I was in military college - "I won't stab you in the back - I'll look you right in the eye as I stab you through the heart". Fair enough.

Yeah and we can crap on attendings (non-surgical). And believe me, when an attending is getting yelled at by a resident in front of nurses on thier floor/ER they look stoooopid. Everyone expects attendings to yell at residents, attendings take a big ego hit when it gets flipped. Worth every single writeup. As long as the resident is right, I say let the attending have it.

 

[Apollyon]

Yeah and we can crap on attendings (non-surgical). And believe me, when an attending is getting yelled at by a resident in front of nurses on thier floor/ER they look stoooopid. Everyone expects attendings to yell at residents, attendings take a big ego hit when it gets flipped. Worth every single writeup. As long as the resident is right, I say let the attending have it.

I guess it's good that we're not in the same circles, then, because I wouldn't give you something for which you would yell at me (as I don't yell in any regard, so that is #1 strike against you), and, if you did indeed rise up against me, I would do the professional thing (which isn't publicly berating someone, in case you weren't clear on the concept), let you dig your hole, and then tell your boss. Even if you think/know you are right, if you were such the expert, you wouldn't be a resident - but you're still in the hierarchical structure. And, as the saying goes, "**** rolls downhill".

Then again, I don't know if you are going academic or community. If you are going into the community, and you yell at people calling you, either you will change your attitude, you will get dropped from the call list, you will get booted from the medical staff, or the group (if part of one) will cut you loose. That is a given, and it is irrespective of your surgical skill. Academics may coddle a personality disorder or other anger/rage issues.

 

[SLUser11]

If you are going into the community, and you yell at people calling you, either you will change your attitude, you will get dropped from the call list, you will get booted from the medical staff, or the group (if part of one) will cut you loose. That is a given, and it is irrespective of your surgical skill. Academics may coddle a personality disorder or other anger/rage issues.

Quoted for truth.

 

[filter07]

Yelling is bad, but there are often times that I just stick up for myself in a calm and rational manner, and the attendings are just so shocked that anyone wouldn't just automatically assume a BOHICA position, that they get really infuriated no matter how reasonable the resident is being. And also they would make a complaint to the surgical attending, only they would lie or exaggerate about how verbally inappropriate the resident was, etc.

 

[LucidSplash]

On the rare occasion I've had a disagreement with an attending from another specialty (one particular conversation with an adult ED attending comes to mind... and the above-mentioned examples), I've usually just headed any particular complaints off at the pass by telling MY attending about it first. "Hey, in case you hear anything, I had a disagreement with so-and-so. I tried not to sound argumentative but you probably know me well enough by now to know it came off that way." Seems to mitigate any kerfluffle if they hear it from me first. Also helps when you're RIGHT.

 

[Smurfette]

Honestly, by the time I was a senior resident, I KNEW if I had a disagreement with a non-surgery attending, my attending would have my back. This was because I had been around long enough to know attending X would never admit this patient, or that attending Y always wants 1/2/3 done before he will consider doing 4/5/6.

It's not worth getting into a loud argument with another specialty's attending....it's not hard to tell the other attending "no, my attending does not want to/will not want to do that" and tell them they can call your attending to confirm this if they object. 90% of the time they will NOT want to talk to them and will leave you alone. The other 10%, you call the attending and briefly explain things, then hand the phone to the person giving you a problem. Don't become "that guy" who other specialties think has an "anger management" or "attitude problem". That reputation can come back and bite you later on.

 

[dynx]

I guess it's good that we're not in the same circles, then, because I wouldn't give you something for which you would yell at me (as I don't yell in any regard, so that is #1 strike against you), and, if you did indeed rise up against me, I would do the professional thing (which isn't publicly berating someone, in case you weren't clear on the concept), let you dig your hole, and then tell your boss. Even if you think/know you are right, if you were such the expert, you wouldn't be a resident - but you're still in the hierarchical structure. And, as the saying goes, "**** rolls downhill".

Then again, I don't know if you are going academic or community. If you are going into the community, and you yell at people calling you, either you will change your attitude, you will get dropped from the call list, you will get booted from the medical staff, or the group (if part of one) will cut you loose. That is a given, and it is irrespective of your surgical skill. Academics may coddle a personality disorder or other anger/rage issues.

Not sure why it's good we're not in the same circles. If you didn't give me anything to yell at you for then I wouldn't yell...fairly simple. And "telling my boss" has never been a problem, if I'm right they back me up, if I'm wrong (rarely) I get ****. I've never gone off on an attending and been wrong, I make sure if I put myself out there like that I'm clearly on the correct side of the issue. Regardless of resident/attending status some attendings know more than me, and some know less. Just the way it is.

 

[SocialistMD]

...Even if you think/know you are right, if you were such the expert, you wouldn't be a resident...

While I think going off on anyone is poor form, I do understand the frustration experienced when I, the PGY-7 surgery resident, am "told" how one manages "surgical problem x" by a non-surgeon and receive pushback when my mangement plan doesn't agree with their perceived management plan. This is especially difficult now, as many medicine and EM attendings were my junior residents/medical students/ATLS students and now feel that, since they are attendings, they automatically know more than me. That said, the advice of bumping it up is the best way to handle it, as it isn't your place as a resident to get in fights, especially with attendings.

 

[Apollyon]

Not sure why it's good we're not in the same circles. If you didn't give me anything to yell at you for then I wouldn't yell...fairly simple. And "telling my boss" has never been a problem, if I'm right they back me up, if I'm wrong (rarely) I get ****. I've never gone off on an attending and been wrong, I make sure if I put myself out there like that I'm clearly on the correct side of the issue. Regardless of resident/attending status some attendings know more than me, and some know less. Just the way it is.

Wow...I am amazed. It seems to bounce off of you. First, yelling at someone - raising your voice in an angry manner, when you can be heard at a lower volume - is disrespectful. Being disrespectful is unprofessional. Professionalism is one of the six core competencies. If you are actively, affirmatively being unprofessional, that is, by definition, showing that you are incompetent in that area. That you don't get that is remarkable.

Now, on the same tack, it's one of two things: either you've done this more than once, which shows a systemic problem, or it's just wishful thinking. However, you wrote that it was "...(w)orth every single writeup". Really? Do you intend to be a problem for your program? Because, I can tell you from my anecdote (and to which someone above alluded), if, when you show up, you are regarded as "the yelling guy", you have already poisoned the water. I mean, I thought "A little rudeness and disrespect can elevate a meaningless interaction to a battle of wills and add drama to an otherwise dull day." was just a saying - I didn't realize that you actually lived it.

And I think that we're on different pages as far as "crap on a resident". Can you "crap on" a non-general surgery attending, or just someone that doesn't fall under the "surgical" aegis? What about interventional rads, or a neurologist that coils aneurysms? Can you crap on them, too? See, I meant "assign an onerous task that someone will have to do"; you assumed it to be "treat someone badly".

The last I'll give you is a story that is my residency location specific. I have to preface this, because there is a lurker that e-stalks me, who I fully expect to pop in and say something if I mention where that was. In any case, I was at Duke. What do you think of Duke Surgery? Generally considered to be pretty high level, right? And the chair of surgery at Duke - the tip of the spear? In the line of Sabiston, and Sabiston Jr., and all that? The current chair is a CR guy, and he's still active in patient care. Back in 2004 or 2005, one of his patients with a colostomy came into the ED. I saw the patient, and called his service (it was the "blue" service - there had been a push to rename/recolor CR to "brown" and urology to "yellow", but that did not come to fruition). There was a PA for him that day (not covering the service, as I recall, but just HIM). She was dismissive, and was vague about seeing the patient and when she would get there.

A brief while later, the chair of surgery shows up. Now, he's my boss's boss's boss - the next step above him is the Chancellor. He sees the patient, and comes back to dictate his note. I asked him what he thought, and he told me what he did - "I stuck my finger in the colostomy, broke up all that stool, dug it out as much as I could, and the patient started freely having stool out". He's a very charismatic guy, and it was like the chief of police writing a traffic ticket. He leaves, and it's all good. A good half hour later, the PA shows up, and disinterestedly said "where's the patient?" I told her that Dr. Jacobs had already come and gone, and stuck his finger in the colostomy and gotten the stool out. I asked her, "Didn't he tell you?" Her eyes got wide like in a cartoon, and she turned as white as her coat - I thought she, honestly, was going to have syncope. Apparently, he had not told her.

Another example is the smartest guy who ever lived - Sir Isaac Newton - said "If I have seen farther than others, it is because I have stood on the shoulders of giants". Now, for a guy who could have had the biggest ego ever, and deserved it, that's pretty humble.

The point is, if the top of the pile isn't being an ass, if someone in the middle of the list is, then that person stands out - not notable, but notorious. If you're the one yelling, and the only one - even if you are "right", it is not "no harm, no foul". I yell at you, I get in trouble, I may lose my job - but I'm board certified. I find another one. If you lose your job, you are a residency reject, and, when the reasons come out why, well, good luck.

But you keep yelling at people. Let us all know how that works out for you.

 

[dynx]

I'm also amazed. Hell of a long response.

Wow...I am amazed. It seems to bounce off of you. First, yelling at someone - raising your voice in an angry manner, when you can be heard at a lower volume - is disrespectful. Being disrespectful is unprofessional. Professionalism is one of the six core competencies. If you are actively, affirmatively being unprofessional, that is, by definition, showing that you are incompetent in that area. That you don't get that is remarkable.

1. Yes it is disrespectful. Thats kind of the point. To return disrespect that is being shown to me.
2. The core competencies are crap. Be that as it may, if the ER/ped/IM doc was evaluating me on the "core competencies" maybe I would care, but he's not. My attendings are and I do quite well.
3. I don't randomly yell at people. I yell back at people. I don't yell at people below me on the totem pole. Thats cowardly. The people I yell at, as mentioned, are not normal healthy professional people. They don't understand normal healthy professional communication. I put things in terms and at a volume they can understand. It's effective communication.

Now, on the same tack, it's one of two things: either you've done this more than once, which shows a systemic problem, or it's just wishful thinking. However, you wrote that it was "...(w)orth every single writeup". Really? Do you intend to be a problem for your program? Because, I can tell you from my anecdote (and to which someone above alluded), if, when you show up, you are regarded as "the yelling guy", you have already poisoned the water. I mean, I thought "A little rudeness and disrespect can elevate a meaningless interaction to a battle of wills and add drama to an otherwise dull day." was just a saying - I didn't realize that you actually lived it.

I've done this many times. Its not much of a problem for my program. I sit down and talk to my PD or chair for 5 minutes and explain why the other person is ******ed. He says don't yell in the future, he checks off the little box that said he gave me feedback. I go back to work. Not much sweat off his ass.

And I think that we're on different pages as far as "crap on a resident". Can you "crap on" a non-general surgery attending, or just someone that doesn't fall under the "surgical" aegis? What about interventional rads, or a neurologist that coils aneurysms? Can you crap on them, too? See, I meant "assign an onerous task that someone will have to do"; you assumed it to be "treat someone badly".

I did. So we were meaning two different things at the start.

The last I'll give you is a story that is my residency location specific. I have to preface this, because there is a lurker that e-stalks me, who I fully expect to pop in and say something if I mention where that was. In any case, I was at Duke. What do you think of Duke Surgery? Generally considered to be pretty high level, right? And the chair of surgery at Duke - the tip of the spear? In the line of Sabiston, and Sabiston Jr., and all that? The current chair is a CR guy, and he's still active in patient care. Back in 2004 or 2005, one of his patients with a colostomy came into the ED. I saw the patient, and called his service (it was the "blue" service - there had been a push to rename/recolor CR to "brown" and urology to "yellow", but that did not come to fruition). There was a PA for him that day (not covering the service, as I recall, but just HIM). She was dismissive, and was vague about seeing the patient and when she would get there.

A brief while later, the chair of surgery shows up. Now, he's my boss's boss's boss - the next step above him is the Chancellor. He sees the patient, and comes back to dictate his note. I asked him what he thought, and he told me what he did - "I stuck my finger in the colostomy, broke up all that stool, dug it out as much as I could, and the patient started freely having stool out". He's a very charismatic guy, and it was like the chief of police writing a traffic ticket. He leaves, and it's all good. A good half hour later, the PA shows up, and disinterestedly said "where's the patient?" I told her that Dr. Jacobs had already come and gone, and stuck his finger in the colostomy and gotten the stool out. I asked her, "Didn't he tell you?" Her eyes got wide like in a cartoon, and she turned as white as her coat - I thought she, honestly, was going to have syncope. Apparently, he had not told her.

Another example is the smartest guy who ever lived - Sir Isaac Newton - said "If I have seen farther than others, it is because I have stood on the shoulders of giants". Now, for a guy who could have had the biggest ego ever, and deserved it, that's pretty humble.

The point is, if the top of the pile isn't being an ass, if someone in the middle of the list is, then that person stands out - not notable, but notorious. If you're the one yelling, and the only one - even if you are "right", it is not "no harm, no foul".

Some people are amazingly patient and good willed. I work with a couple of those people. I'm not like that. They have strengths I don't have and I have other strengths that they don't have. Standing out, notorious or otherwise, doesnt matter to me. Being right matters to me. If others don't share that value judgement, so what? They can apply for program director at my program and then they can fire me.

I yell at you, I get in trouble, I may lose my job - but I'm board certified. I find another one. If you lose your job, you are a residency reject, and, when the reasons come out why, well, good luck.

Yeah...so its okay as long as you can get another job? what?
Anyway, I'm matched in my first choice fellowship and going to graduate well liked at my program by my fellow residents and attendings. What else matters? I can tell you what doesnt matter, the core competencies. If they did they'd find a way to enforce them better.

But you keep yelling at people. Let us all know how that works out for you.

Will do.
Current update...works fine.

 

[SLUser11]

Some people are amazingly patient and good willed. I work with a couple of those people. I'm not like that. They have strengths I don't have and I have other strengths that they don't have. Standing out, notorious or otherwise, doesnt matter to me. Being right matters to me. If others don't share that value judgement, so what? They can apply for program director at my program and then they can fire me.

Will do.
Current update...works fine.

Dynx, I love your posts in general, but I hope this is a caricature of your true approach to inter-disciplinary conflict.

Depending on where you train, yelling and screaming can become an effective way to navigate through a dysfunctional, antagonistic environment....but it's still sort of sad to see that we are breeding such bad behavior. Med students and junior residents see us yell/scream/condescend, and it's like a small child hearing a curse word: they just repeat it over and over again. My guess is that a lot of what you do is learned behavior that you first experienced by watching a mentor do it.

That's fine if you're in an environment where your actions don't have consequences, and you can still match at your top choice fellowship, etc, but it's still a miserable way to practice medicine. I've always been amazed at how people treat eachother in academic medicine, because it would absolutely not be tolerated in any other areas of society.

 

[blue2000]

The one time I got disrespectful with an ER attending I was 39 weeks pregnant. It was 2 am, and the attending had been abusing my junior resident all night (I was a chief) and when I witnessed a really outrageous, abusive interaction, I stepped in an clarified my position, in terms that were not respectful and totally justified. The ER attending called my vascular staff, who smoothed everything over, probably pointing out that I was perhaps mildly irrational due to the fact I was about to drop a baby on the floor.

I agree with Smurfette. You build a reputation in residency (this is also a VERY good lesson for private practice). You have a choice. After you build that reputation, you get more slack when things don't go ideally.

I also echo the general advice -- if an outside attending is giving you ****; don't cave, clarify, invoke your attending, and suggest that you give them a call to sort the matter out. When I was a junior resident, I had the idea that a truly strong resident solved all problems. As an attending, I'm happy to deal with that kind of BS -- I have sway that a junior doesn't have.

 

[ESU_MD]

Its certainly a strange dynamic between any type of resident and a different service attending.

Most of the time, EC consults should be staff to staff, then the accepting staff should give the "have your residents call mine" - or something like that- eliminates the vast majority of nonsense.

In my view all the staff (all specialties) are in one club, and the residents are in another club. At the end of the day, I think minimising fraternization is probably better for all.

 

[45408]

I guess it's good that we're not in the same circles, then, because I wouldn't give you something for which you would yell at me (as I don't yell in any regard, so that is #1 strike against you), and, if you did indeed rise up against me, I would do the professional thing (which isn't publicly berating someone, in case you weren't clear on the concept), let you dig your hole, and then tell your boss. Even if you think/know you are right, if you were such the expert, you wouldn't be a resident - but you're still in the hierarchical structure. And, as the saying goes, "**** rolls downhill".

A PGY-6 neurosurgery resident is more trained than most attendings in other specialties, and they're probably much more of an expert than the rest of us. It's an extreme example, but my chiefs get calls from the new hospitalists who are basically PGY-4s (in another specialty no less) getting belligerent toward a PGY-5 about a dumb consult they want us to see.

 

[Apollyon]

A PGY-6 neurosurgery resident is more trained than most attendings in other specialties, and they're probably much more of an expert than the rest of us. It's an extreme example, but my chiefs get calls from the new hospitalists who are basically PGY-4s (in another specialty no less) getting belligerent toward a PGY-5 about a dumb consult they want us to see.

Indeed, but in a much narrower field - akin to a PhD. It's like the adage about ortho: "Taking the smartest students, and making them into the dumbest doctors." The NSx guys (and women) know their stuff, but it is SO specific.

But your point is indeed valid.

 

[SLUser11]

A PGY-6 neurosurgery resident is more trained than most attendings in other specialties, and they're probably much more of an expert than the rest of us. It's an extreme example, but my chiefs get calls from the new hospitalists who are basically PGY-4s (in another specialty no less) getting belligerent toward a PGY-5 about a dumb consult they want us to see.

Years of training does not always equal level of expertise. Autonomy and experience occur at an accelerated pace once you're on your own. A newly-minted ER doc or hospitalist likely knows more about topics within their scope of practice than a PGY-6 surgery resident.

I understand not wanting to take crap from an attending that you had as a medical student, but I don't think that an inherent rank/hierarchy exists based on number of years outside of medical school.

 

[igap]

When I was a resident, I fielded my fair share of inappropriate consults from EDs all over the city.

Some general rules that I learned as an intern from one of my chiefs were:

1. Usually it's easier to just take care of the consult even if it's borderline inappropriate. For plastics, it means sewing a lot of lacs up, that could easily be done by a medical student.

2. Always be calm, and take the high road when dealing with difficult personalities. If you are always the calm one, you will stand out for your equanimity, and serenity.

3. Do PR rounds through the ED on the way home every day. Run through the ED, ask if there are any consults related to your specialty that are brewing that you can take care of before you leave. This makes you appear very helpful, and saves you a call 1 hour after you get home. It also probably saves you some late night consults because ED attendings know you and you're not some faceless consultant to abuse at 3 am. Doing this daily also allows you to get to know a lot of the ED staff/residents/attendings so that when you have to go to the ED, the folks there like you and want to help you, and you get done with your work faster.

4. If you find yourself in a situation with a bad actor in any situation whether it is an attending, a resident in another field, nursing staff, etc... Do not lose your cool. Refer the matter to your attending and take yourself out of the equation. I have seen a lot of bad behavior by residents in the ED and it just never goes well. The resident generally "loses" even if he/she "wins" or is "right".

In general, would you rather be respected for being a calm, rational, helpful individual, or be hated/mocked/laughed at for being a caustic, obnoxious, tool who justifies rude behavior because he/she is "right"?

You will get a lot further in life by being respected.

 

[SocialistMD]

Years of training does not always equal level of expertise. Autonomy and experience occur at an accelerated pace once you're on your own. A newly-minted ER doc or hospitalist likely knows more about topics within their scope of practice than a PGY-6 surgery resident.

I understand not wanting to take crap from an attending that you had as a medical student, but I don't think that an inherent rank/hierarchy exists based on number of years outside of medical school.

Correct, but their scope of practice isn't general surgery, it is IM, EM, etc...
The whole reason they are calling the consult is because the patient problem is beyond their scope of practice, otherwise they could take care of it themselves, right? Since that is a fact, then the treatment needed is better defined by the consultant, not them.

And while I agree that the rank/hierarchy isn't based on the number of years outside of medical school, who the "expert" on the question at hand often can be, especially when concerning specialized (and, yes, general surgery falls in this category) care. For example, I will concede that you likely know more about colorectal disease than I do, even though (a) you've never been in practice on your own and (b) I graduated a year before you did. That said, I would say I know more about colorectal disease than an EM attending who graduated med school in 2004.

 

[SLUser11]

Correct, but their scope of practice isn't general surgery, it is IM, EM, etc...
The whole reason they are calling the consult is because the patient problem is beyond their scope of practice, otherwise they could take care of it themselves, right? Since that is a fact, then the treatment needed is better defined by the consultant, not them.

And while I agree that the rank/hierarchy isn't based on the number of years outside of medical school, who the "expert" on the question at hand often can be, especially when concerning specialized (and, yes, general surgery falls in this category) care. For example, I will concede that you likely know more about colorectal disease than I do, even though (a) you've never been in practice on your own and (b) I graduated a year before you did. That said, I would say I know more about colorectal disease than an EM attending who graduated med school in 2004.

I agree with you 100%. That's why I bolded the "scope of practice" part of my statement. I do think that surgery residents, myself included, get a little upset though when we feel like we've been "passed" in the hierarchy, and a previous underling now holds more power than us, and we get a little defensive when we're told to do something by such a person.

Of course, most of those former students of ours have more tact than to try a power move.

 

[45408]

Years of training does not always equal level of expertise. Autonomy and experience occur at an accelerated pace once you're on your own. A newly-minted ER doc or hospitalist likely knows more about topics within their scope of practice than a PGY-6 surgery resident.

I understand not wanting to take crap from an attending that you had as a medical student, but I don't think that an inherent rank/hierarchy exists based on number of years outside of medical school.

I also don't think there's much of a hierarchy among different specialties, but my hospital frequently hires new medicine grads as hospitalists (e.g., half of the last class is still working here). For someone that was a resident like us, at the same hospital no less, to "pull rank" is kind of weak. It did just happen recently, which is why I reference it.

 

[Buzz Me]

I've also run into this problem...someone that used to be my med student or junior (off-service) resident who is now a fellow/attending asking for a ridiculous consult. I've been here so long that there are med students I started off with (as an intern) who have since finished med school, residency and fellowship, and are now attendings.

 

[45408]

I've also run into this problem...someone that used to be my med student or junior (off-service) resident who is now a fellow/attending asking for a ridiculous consult. I've been here so long that there are med students I started off with (as an intern) who have since finished med school, residency and fellowship, and are now attendings.

There was a peds cardiac surgeon at my med school who started med school a few years after I was born, and she finished her last fellowship (including a PhD in the middle) when I was nearing the end of college.

 

[Gastrapathy]

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