MD & DO Away Rotator Pimping Residents

[Redpancreas]

So I’m on IM as a sub-I and this gen surg M4 rotator came to talk to our team. I was busy chugging away at my notes and this dude walks up to my senior and asks him what the consult was for and if we were aware of this and that, etc. then starts asking him a bunch of abrupt questions that are like mocking in nature. My senior basically starts to ignore him and he leaves to go do something so the student goes and asks the M3s doing UWorld on their laptops basic science questions and then proceeds to pimp an Intern as well. He was like, maybe if your team used some of that medical knowledge you wouldn’t be calling us for this cellulitis case. Has anyone ever seen anyone act like this before? Should we let that surgery know this happened?

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[libertyyne]

So I’m on IM as a sub-I and this gen surg M4 rotator came to talk to our team. I was busy chugging away at my notes and this dude walks up to my senior and asks him what the consult was for and if we were aware of this and that, etc. then starts asking him a bunch of abrupt questions that are like mocking in nature. My senior basically starts to ignore him and he leaves to go do something so the student goes and asks the M3s doing UWorld on their laptops basic science questions and then proceeds to pimp an Intern as well. He was like, maybe if your team used some of that medical knowledge you wouldn’t be calling us for this cellulitis case. Has anyone ever seen anyone act like this before? Should we let that surgery know this happened?

This has to be the funniest thing I have read today. Did someone tell him that audition rotations are not for the role of being a Dick. You should report him to the surgical pd or something.

 

[HomeSkool]

Has anyone ever seen anyone act like this before?

Yes, but I only had to see him once. He ended up doing residency in Who Cares Not My Program.

Should we let that surgery know this happened?

Meh, none of your business. If he's that big a douche, Surgery already knows.

 

[libertyyne]

Now I know how this happens.

 

[LebronManning]

Is it common for surgery to mock medicine in general? I thought this was just stereotype and much of the surgery superiority was checked with the procedural revolution of medicine (GI, interventional cards).

 

[ButterButter]

Is it common for surgery to mock medicine in general? I thought this was just stereotype and much of the surgery superiority was checked with the procedural revolution of medicine (GI, interventional cards).

A 4th year medical student on surgery service doesn't represent the surgery department. And I don't think it's common for any physicians to directly mock colleagues to their faces, unless you're talking about an episode of The Resident.

 

[ortnakas]

Not your circus. Not your monkey. Stay out of it.

Not a good look for him though; I’d be shocked if your senior didn’t say something to his senior.

 

[Redpancreas]

A 4th year medical student on surgery service doesn't represent the surgery department. And I don't think it's common for any physicians to directly mock colleagues to their faces, unless you're talking about an episode of The Resident.

Absolutely. Before we continue this discussion this has nothing to do with Gen Surg and the resident could have been another field and done the same thing.

 

[LebronManning]

Cool that's what I was thinking. In my clinical experience, I've honestly seen nothing but good vibes from each specialty to another contrary to stereotypes and tv shows. Though they might talk **** behind each other's back haha

 

[operaman]

Yeah your senior will pass that word along. But if you get a chance, no harm in mentioning that to anyone you know on surgery. My guess is they’ve got stories of their own and if not, would like to know now before they accidentally match that turd into their program.

 

[CherryRedDracul]

Cool that's what I was thinking. In my clinical experience, I've honestly seen nothing but good vibes from each specialty to another contrary to stereotypes and tv shows. Though they might talk **** behind each other's back haha

Most specialties get (or should get) along in a hospital. But they all talk **** behind each others' backs.

EM usually takes the brunt of it.

 

[SunsFun]

Don’t hate bro I just had to establish dominance

 

[SilverCat]

I’ve seen a couple of really strange M4 gen surg auditioning students at one hospital I rotated at during my M3 surgery rotation.

One was yelling at nurses and trying to take all of the cases away from myself and another M3 ( there was only enough room for one student to scrub in per case). The resident I was working with was overhead to say this person was not going to be ranked at the program.

Another was pimping us in front of the resident and attendings. It’s fine if you offer to review topics with the M3s during down time, but this was an obvious ploy to show off their knowledge. Don’t know his fate.

The sad thing is both of these people were very competent and intelligent individuals.

 

[OrthoTraumaMD]

The sad thing is both of these people were very competent and intelligent individuals.

Clearly not that intelligent, if they behaved in such a way.


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[TypeADissection]

You can't hide being a douche canoe. If it's that apparent, then everybody already knows.

 

[AnatomyGrey12]

In what world would you ever think acting like this would get you a residency spot?

 

[Oso]

Here is a future pic of the M4 student at his graduation, still unhappy about his match result

 

[doyouhaveaflag]

When I was an away rotator earlier this year at a very fancy-name Plastics program, one of my four co-rotators was a total nightmare. Perhaps I will write the full story some day but it may be fairly identifying as everyone on the interview trail had heard about this guy. Not only did he pimp us fellow rotators, but he went out of his way to actually sabotage us.

We disliked him so strongly but could see that the residents and faculty didn't know what was going on, so we actually considered trying to warn them. However, we decided against it. We were all afraid of matching with him. I met another M4 from his home program and she was extremely concerned about the possibility of matching with him as well.

The end result was that of the five of us rotating that month, he was the only one offered an interview. He ended up matching there. I guess sometimes gunning works?

 

[BluegrassBuckeye]

Most specialties get (or should get) along in a hospital. But they all talk **** behind each others' backs.

EM usually takes the brunt of it.

Out of curiosity, why does EM take the brunt of it?

 

[Redpancreas]

Out of curiosity, why does EM take the brunt of it?

Because their job is to stabilize and allocate, other places are accountable for diagnosis and proper fixes. EM is paid well despite this and is full of competitive AMGs. No shortage of competence in EM, it’s just their vantage point.

 

[Treebeard]

In what world would you ever think acting like this would get you a residency spot?

Probably by observing attending surgeons

 

[libertyyne]

When I was an away rotator earlier this year at a very fancy-name Plastics program, one of my four co-rotators was a total nightmare. Perhaps I will write the full story some day but it may be fairly identifying as everyone on the interview trail had heard about this guy. Not only did he pimp us fellow rotators, but he went out of his way to actually sabotage us.

We disliked him so strongly but could see that the residents and faculty didn't know what was going on, so we actually considered trying to warn them. However, we decided against it. We were all afraid of matching with him. I met another M4 from his home program and she was extremely concerned about the possibility of matching with him as well.

The end result was that of the five of us rotating that month, he was the only one offered an interview. He ended up matching there. I guess sometimes gunning works?

Give us the full story.

 

[DrGainzzz]

When I was an away rotator earlier this year at a very fancy-name Plastics program, one of my four co-rotators was a total nightmare. Perhaps I will write the full story some day but it may be fairly identifying as everyone on the interview trail had heard about this guy. Not only did he pimp us fellow rotators, but he went out of his way to actually sabotage us.

We disliked him so strongly but could see that the residents and faculty didn't know what was going on, so we actually considered trying to warn them. However, we decided against it. We were all afraid of matching with him. I met another M4 from his home program and she was extremely concerned about the possibility of matching with him as well.

The end result was that of the five of us rotating that month, he was the only one offered an interview. He ended up matching there. I guess sometimes gunning works?

You better drop that story in a new thread, I’m counting on reading this drama with no details left out

 

[Oso]

You better drop that story in a new thread, I’m counting on reading this drama with no details left out

+ 1

Gotta spread the drama, baby

 

[CherryRedDracul]

Out of curiosity, why does EM take the brunt of it?

From a radiology perspective, the clinical history they often provide with their imaging orders is often sparse, and not too infrequently, incorrect.

E.g., for a chest X-ray I read a while back

History: Motor Vehicle Collision
Clinical Indication: Chest pain
Comments: no chest pain

I'm like wtf is this. I look in the chart and the patient had actually lost control of his bike and fell off it. No motor vehicle hit him. Our X-ray techs did confirm he did have chest pain.

A little piece of my soul dies every time I'm on call.

 

[Psai]

When I was an away rotator earlier this year at a very fancy-name Plastics program, one of my four co-rotators was a total nightmare. Perhaps I will write the full story some day but it may be fairly identifying as everyone on the interview trail had heard about this guy. Not only did he pimp us fellow rotators, but he went out of his way to actually sabotage us.

We disliked him so strongly but could see that the residents and faculty didn't know what was going on, so we actually considered trying to warn them. However, we decided against it. We were all afraid of matching with him. I met another M4 from his home program and she was extremely concerned about the possibility of matching with him as well.

The end result was that of the five of us rotating that month, he was the only one offered an interview. He ended up matching there. I guess sometimes gunning works?

I've found that bad people prosper. If you have good intentions and work hard, you will get **** on.

 

[Wordead]

Id probably mock your ******* team for consulting a surgical team for cellulitis too

 

[Goro]

So I’m on IM as a sub-I and this gen surg M4 rotator came to talk to our team. I was busy chugging away at my notes and this dude walks up to my senior and asks him what the consult was for and if we were aware of this and that, etc. then starts asking him a bunch of abrupt questions that are like mocking in nature. My senior basically starts to ignore him and he leaves to go do something so the student goes and asks the M3s doing UWorld on their laptops basic science questions and then proceeds to pimp an Intern as well. He was like, maybe if your team used some of that medical knowledge you wouldn’t be calling us for this cellulitis case. Has anyone ever seen anyone act like this before? Should we let that surgery know this happened?

Synchro, I guarantee you that this guy will be making a thread in the General Residency forum soon about being kicked out of residency.

 

[Anti-PD1]

So I’m on IM as a sub-I and this gen surg M4 rotator came to talk to our team. I was busy chugging away at my notes and this dude walks up to my senior and asks him what the consult was for and if we were aware of this and that, etc. then starts asking him a bunch of abrupt questions that are like mocking in nature. My senior basically starts to ignore him and he leaves to go do something so the student goes and asks the M3s doing UWorld on their laptops basic science questions and then proceeds to pimp an Intern as well. He was like, maybe if your team used some of that medical knowledge you wouldn’t be calling us for this cellulitis case. Has anyone ever seen anyone act like this before? Should we let that surgery know this happened?

I swear, there should be a med school TV show with this kind of stuff.

Gunners gonna gun.

He'll trip over himself eventually.

 

[Anti-PD1]

When I was an away rotator earlier this year at a very fancy-name Plastics program, one of my four co-rotators was a total nightmare. Perhaps I will write the full story some day but it may be fairly identifying as everyone on the interview trail had heard about this guy. Not only did he pimp us fellow rotators, but he went out of his way to actually sabotage us.

We disliked him so strongly but could see that the residents and faculty didn't know what was going on, so we actually considered trying to warn them. However, we decided against it. We were all afraid of matching with him. I met another M4 from his home program and she was extremely concerned about the possibility of matching with him as well.

The end result was that of the five of us rotating that month, he was the only one offered an interview. He ended up matching there. I guess sometimes gunning works?

That's crazy. Similar experiences in neurosurgery, and yep, some programs value that kind of tude, ahem NYC.

With small residents class sizes, it's nuts how important who you match with is.

 

[AsianPersuasion]

So why did you guys consult surgery for a cellulitis?

 

[You shall know the Truth]

Here is a future pic of the M4 student at his graduation, still unhappy about his match result

View attachment 232673

It looks like a multilayered doughnut with a doughnut hole on top.

 

[Redpancreas]

Id probably mock your ******* team for consulting a surgical team for cellulitis too

It wasn’t my patient but T2DM with Hb of >10 and POOP, seemed kind of crackly according to an intern. When I saw it the next day it looked like a bad case cellulitis, but I think the concern was necrotizing and once surgery got up, they were concerned too and had us order a stat imaging to keep them updated. Regardless, the threshold for acting at this type of hospital is low and code blues get called for SOB with tachycardia. Regardless, no need for that attitude.

 

[Oso]

It looks like a multilayered doughnut with a doughnut hole on top.

.............. you been eating the wrong kinda donuts, bruh

 

[doyouhaveaflag]

You better drop that story in a new thread, I’m counting on reading this drama with no details left out

Perhaps under a different account. I'm readily identifiable by what I've posted on SDN, and Plastics is such a small world I worry about that kind of thing coming back to bite me in the a$$.

 

[DrGainzzz]

Perhaps under a different account. I'm readily identifiable by what I've posted on SDN, and Plastics is such a small world I worry about that kind of thing coming back to bite me in the a$$.

Completely understandable ! juicy unidentifiable drama is still good drama either way but I would hate to see u get burned for it

 

[Wordead]

It wasn’t my patient but T2DM with Hb of >10 and POOP, seemed kind of crackly according to an intern. When I saw it the next day it looked like a bad case cellulitis, but I think the concern was necrotizing and once surgery got up, they were concerned too and had us order a stat imaging to keep them updated. Regardless, the threshold for acting at this type of hospital is low and code blues get called for SOB with tachycardia. Regardless, no need for that attitude.

This is basically calling a cardiology consult for chest pain possible MI but you didnt get an ekg or trops or any workup. Be a ****ing doctor. A MEDICINE team that cannot start a nec fasc or an acute abdomen assessment is pathetic. Period.

And yes I know it wasnt your patient and no this isn't directed towards you. Just garbage care that seems to be rampant and people that can't seem to start workups that a M2 could.

 

[Redpancreas]

This is basically calling a cardiology consult for chest pain possible MI but you didnt get an ekg or trops or any workup. Be a ****ing doctor. A MEDICINE team that cannot start a nec fasc or an acute abdomen workup is pathetic. Period.

And yes I know it wasnt your patient and no this isn't directed towards you. Just garbage care that seems to be rampant and people that can't seem to start workups that a M2 could.

I mean they started abx., got him on insulin, cleaned the wound, and did supportive measures. They were probably going to do the imaging soon, but wanted to get surgery on board. What else can we do? I mean it wasn’t a venous insufficiency or else I would have done the unna boot.

 

[Oh_Gee]

It wasn’t my patient but T2DM with Hb of >10 and POOP, seemed kind of crackly according to an intern. When I saw it the next day it looked like a bad case cellulitis, but I think the concern was necrotizing and once surgery got up, they were concerned too and had us order a stat imaging to keep them updated. Regardless, the threshold for acting at this type of hospital is low and code blues get called for SOB with tachycardia. Regardless, no need for that attitude.

POOP?

 

[py335]

POOP?

It's an acronym:

 

[Tenk]

Sounds like he’s fitting right in to be a typical surgery resident. I wouldn’t report him for trying to bully the medicine team or they may just hire him on the spot.

 

[LucidSplash]

I mean they started abx., got him on insulin, cleaned the wound, and did supportive measures. They were probably going to do the imaging soon, but wanted to get surgery on board. What else can we do? I mean it wasn’t a venous insufficiency or else I would have done the unna boot.

If you are actually concerned, with a high degree of suspicion, about nec fasc, the order is simultaneous abx, imaging, surgery consult. If you are futzing around cleaning the wound and worry about his glucose level, you’re not that worried it is nec Fasc (or not worried enough).

What else can you do? Figure out the LRINEC score, have someone besides an intern examine the patient...

 

[jw3600]

It's an acronym:

I’m so mad at myself for not getting this posted sooner than you.

 

[evilbooyaa]

What is POOP in a medical context here?

Maybe the intern shouldn't be able to call a consult on his own without having somebody else from his team evaluate the patient. Agree that Nec Fasc isn't something you sit around playing with insulin doses for.

 

[LucidSplash]

What is POOP in a medical context here?

Maybe the intern shouldn't be able to call a consult on his own without having somebody else from his team evaluate the patient. Agree that Nec Fasc isn't something you sit around playing with insulin doses for.

Guessing “pain out of proportion”...

 

[CherryRedDracul]

Basic rule for any surgical consult: in most cases, get the appropriate imaging prior to the consultation.

If it's a complicated case, then it's understandable to consult the surgical subspecialty and/or radiologist regarding what imaging should be ordered.

Concern for nec fasc? X-ray should have been ordered ASAP.

 

[OrthoTraumaMD]

Okay so I get the criticism on here, and I’m the first one to be a bit annoyed when I get consulted without xrays... But.... the whole point of consults is to help someone. The internists don’t know their ass from their elbow in ortho, literally. They don’t know if it’s nec fasc, arthritis, or gout. That’s why we are the specialists. The amount of time people bitch and argue about consults and what should or shouldn’t have been done beforehand is more than the time it takes to just go and see the patient, and help your fellow doctor who doesn’t know what to do for the patient but knows that something is wrong. I’m a fellowship trained traumatologist, able to fix an acetabulum or Masquelet an open fracture with bone loss, and do a flap to boot. And yet most of my daily life on call consists of shoulder and knee pain consults, usually not even acute. And I just get my ass up and go, though I’m salaried and not RVU-based. It’s not a waste of my time. Because when I want help with BP meds, I don’t want the internist going, “well why can’t you begin the workup yourself?” If I thought I was the best person for the job, I wouldn’t be calling.


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[Redpancreas]

If you are actually concerned, with a high degree of suspicion, about nec fasc, the order is simultaneous abx, imaging, surgery consult. If you are futzing around cleaning the wound and worry about his glucose level, you’re not that worried it is nec Fasc (or not worried enough).

What else can you do? Figure out the LRINEC score, have someone besides an intern examine the patient...

Points take. Thanks, @Wordead and @LucidSplash for the information.

 

[Redpancreas]

Basic rule for any surgical consult: in most cases, get the appropriate imaging prior to the consultation.

If it's a complicated case, then it's understandable to consult the surgical subspecialty and/or radiologist regarding what imaging should be ordered.

Concern for nec fasc? X-ray should have been ordered ASAP.

So I think it was. It was the CT we got after calling surgery.

 

[Raryn]

This is basically calling a cardiology consult for chest pain possible MI but you didnt get an ekg or trops or any workup. Be a ****ing doctor. A MEDICINE team that cannot start a nec fasc or an acute abdomen assessment is pathetic. Period.

And yes I know it wasnt your patient and no this isn't directed towards you. Just garbage care that seems to be rampant and people that can't seem to start workups that a M2 could.

I'm a board-certified medicine attending.

My acute management of suspected nec fasc is such:

1) Assess the patient
2) Put the patient on antibiotics (typically triple therapy with a beta lactam, vanc, and clinda. Everyone always forgets the clinda)
3) Order the labs to calculate a LRINEC score (if not done. The chem panel and CBC usually are, the CRP usually isn't) with the understanding that the followup trials haven't shown it to be as reliable for ruling out nec fasc as the pivotal trial was
4) If very high suspicion (rapid progression or crepitus on exam) and/or an elevated LRINEC score, get a surgical consultation.

Notice what isn't in that sequence? Imaging. To quote uptodate: "Surgical exploration is the only way to establish the diagnosis of necrotizing infection." The bold is theirs. They go on to say "Radiographic imaging can be useful to help determine whether necrotizing infection is present but should not delay surgical intervention when there is crepitus on examination or rapid progression of clinical manifestations"

If my suspicion is moderate but I'm not convinced of my assessment? I might order imaging at the same time (or before) surgical consultation. But unlike what apparently you would have done as an M2, the assessment of an experienced surgeon is the definitive test for nec fasc.