Bizarre Medical Student

[Redpancreas]

I am a resident who has noticed strange behavior from a particular medical student over the past few months and just wanted to share my experience and solicit advice on how to deal with this case. This medical student has been observed by me on two subsequent rotations we happen to coincidentally be on. I have noticed more what I would classify as bizarre and at times egotistical (not unsafe or overtly malignant) behaviors from him/her and I don't think this person should be doing this and think someone should be notified.

1.) There was a case where we were treating an HIV patient for CAP as a primary service. This was based off a measured fever in the ED/questionable infiltrate/new onset cough which the patient presented to the hospital for (his CD4 was not <200, he only required 2L on presentation, no COPD hx). Two days later, the student reported the patient was having diarrhea which he attributed to the antibiotics and he said this quite condescendingly. I felt dumb that I missed diarrhea so I went after rounds without telling anyone to get more history on the diarrhea and the patient and nurse denied the diarrhea. I later asked the student about it and he gets defensive and tells me he noted it on the flowsheets. I look on the flowsheets and noted there was one episode of semi-formed stool documented but neither the nurse or the patient had thought much of it and the rest of the stools were solid. This nurse and I had some rapport from a previous case and he shared with me that the student had spent 30 minutes with the patient talking to him about how antibiotics were overprescribed and this was not a pneumonia based off his experience. I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here.

2.) This is really what I felt was bizarre. We had a patient who came in for a unilateral cellulitis with intact skin with hx of DM, HF. The patient owned a dog but to his knowledge the dog had not bit or interacted (bit/licked, etc.) with the leg. We felt the etiology for related to venous stasis. This student tries to make the case that the dog bit the patient and caused this reaction. The next day when I go to see the patient he told me one of the doctors had told him that his dog would need to be euthanized to determine if it had caused the issue and if this was true. I had a suspicion what had led to this discussion, but I asked the student unassumingly if he had asked the patient about rabies and he told me he had a long discussion with the patient about it. I asked directly if he had told the patient his dog needed to be put down and he said he had never told the patient this. Of note, there were no consultant teams seeing the patients, my senior did not speak with the patient, and the attending does not typically do so outside of rounds and no one had mentioned rabies. I spoke to him about this and brought up the previous time with the HIV patient and the Pneumonia but I don't think the student really respected what I had to say.


Overall, I really don't know what to do here. On one end, I really don't like reporting things because I think every time you report something, admin looks into both sides of the story and I don't want to come off as a problem resident and have worked hard to cultivate the best impression I can. On the other hand I am really put off by the student's condescending behavior and think he needs to be spoken to or disciplined in some way for the way he talks with patients. I am really not sure who to discuss this with.

Thoughts?

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[M&L]

So i am a student.

You should DEFINITELY talk to their supervisor at their school. If this behavior is not corrected during medical school, they will kill someone later in residency.

Talk to the clerkship director for that specific rotation. This is serious. The student should know their place and scope of what they can and cannot do.

 

[LimpSpatula]

Don’t ask us, just do what you already know is the right thing to do. Steal some of their confidence....and crush them with it. Don’t let anyone play around with your patients.

 

[Osteosaur]

Can you tell your PD or someone who can go to bat if you don't feel secure enough in your position to speak up? It's a legit fear if their parent is an attending.

But someone has got to be told.

I am just a student, but this is beyond bizarre. They're lying and trying to stress patients out. My school typically doesn't even want us discussing findings with patients unsupervised because we could be wrong or cause confusion.

 

[deleted966164]

(…) the student's dad was an attending here.

Yikes. You know how dealers in casinos visibly swipe and clap their hands to show that they’re “clear” before they leave the table? This is what I’d do in this case, and walk away. Kid sounds obnoxious but if you do something about it chances are they’ll complain to their dad and then you may have a target on your back. The world is a stupidly made place…

 

[operaman]

This absolutely needs to be reported to the clerkship director and probably even to the dean’s office. This is something that requires strong formal written feedback and for the admin to investigate and see if this has been a pattern elsewhere too.

If he’s really innocent or simply misunderstanding then a formal report will wake him up to what he’s doing so he can fix it. Sounds like he’s cutting corners and possibly even lying about important patient care information. That’s the scariest thing. These people are often very smart and think they’re getting away with something.

I had a similar with an intern when I was in training. I reported to the PD and another couple faculty members who were cool snd understanding. The mix of formal and informal feedback actually helped them turn things around fast and may have possibly saved their career. Dishonesty in particular can get someone canned immediately once they’re senior enough that it ends up hurting someone; addressing it early and putting them under the microscope gives them the best shot of finishing school/training.

If you report, I would also recommend telling the student personally after you do. I did this in my situation above because I wanted everything in the open and no doubts about who said what. It’s not a fun conversation to have but I felt it was the right thing to do. I wanted to make sure it didn’t come across as punitive but rather as a serious concern from a colleague. It’s what I’d want from my peers if/when the day comes I’m doing something that puts patients at risk.

 

[Babble Heap]

For better or for worse, I've worked with a few medical students who have displayed questionable ethics and decision-making. I'm pretty accommodating since I know a lot of it comes from inexperience and will ultimately improve as they improve their clinical skillset. That being said, our ultimate goal in all phases of training is to serve the patient. Nothing supersedes this, including a father who is an attending. I will 100% risk my comfort in residency (and I have) in order to address a patient safety problem regardless of the context. I also feel like it is the duty of each person in the chain of command, from med student to administrator, to help course correct trainees who are struggling. If we don't do that, then there's no point in training. We don't get to choose the good ones and the less good ones, so better to just endeavor to improve them all. Walking away from a trainee who is struggling is the easier choice, but it is also the incorrect one.

Your first experience seems concrete. The second, unfortunately, is not. Although it is clear that this medical student was likely the provider in question, you don't really have evidence for it. In those circumstances, I work my way from bottom to top. I start by having a direct, clear, unequivocal conversation with the trainee about unacceptable behaviors. I offer feedback on how to identify them and how to correct them. No point in being punitive at this stage, just provide some tools for self improvement. If that doesn't work, then I would move to senior resident, then to team attending, and finally to medical school staff. Starting high on that list will likely only cause this medical student to dig in. Personal, direct conversation with an uncomfortable amount of eye contact has always been my tool of choice, and remains the most effective in helping people understand what they need to change, and why it is so important.

 

[LunaOri]

Sounds as though the student is the one with diarrhea (of the mouth!). I would make sure that he is supervised when he has discussions with patients. He may be trying to be helpful, but his mouth is way ahead of his knowledge base.

 

[Chelsea FC]

I am a resident who has noticed strange behavior from a particular medical student over the past few months and just wanted to share my experience and solicit advice on how to deal with this case. This medical student has been observed by me on two subsequent rotations we happen to coincidentally be on. I have noticed more what I would classify as bizarre and at times egotistical (not unsafe or overtly malignant) behaviors from him/her and I don't think this person should be doing this and think someone should be notified.

1.) There was a case where we were treating an HIV patient for CAP as a primary service. This was based off a measured fever in the ED/questionable infiltrate/new onset cough which the patient presented to the hospital for (his CD4 was not <200, he only required 2L on presentation, no COPD hx). Two days later, the student reported the patient was having diarrhea which he attributed to the antibiotics and he said this quite condescendingly. I felt dumb that I missed diarrhea so I went after rounds without telling anyone to get more history on the diarrhea and the patient and nurse denied the diarrhea. I later asked the student about it and he gets defensive and tells me he noted it on the flowsheets. I look on the flowsheets and noted there was one episode of semi-formed stool documented but neither the nurse or the patient had thought much of it and the rest of the stools were solid. This nurse and I had some rapport from a previous case and he shared with me that the student had spent 30 minutes with the patient talking to him about how antibiotics were overprescribed and this was not a pneumonia based off his experience. I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here.

2.) This is really what I felt was bizarre. We had a patient who came in for a unilateral cellulitis with intact skin with hx of DM, HF. The patient owned a dog but to his knowledge the dog had not bit or interacted (bit/licked, etc.) with the leg. We felt the etiology for related to venous stasis. This student tries to make the case that the dog bit the patient and caused this reaction. The next day when I go to see the patient he told me one of the doctors had told him that his dog would need to be euthanized to determine if it had caused the issue and if this was true. I had a suspicion what had led to this discussion, but I asked the student unassumingly if he had asked the patient about rabies and he told me he had a long discussion with the patient about it. I asked directly if he had told the patient his dog needed to be put down and he said he had never told the patient this. Of note, there were no consultant teams seeing the patients, my senior did not speak with the patient, and the attending does not typically do so outside of rounds and no one had mentioned rabies. I spoke to him about this and brought up the previous time with the HIV patient and the Pneumonia but I don't think the student really respected what I had to say.


Overall, I really don't know what to do here. On one end, I really don't like reporting things because I think every time you report something, admin looks into both sides of the story and I don't want to come off as a problem resident and have worked hard to cultivate the best impression I can. On the other hand I am really put off by the student's condescending behavior and think he needs to be spoken to or disciplined in some way for the way he talks with patients. I am really not sure who to discuss this with.

Thoughts?

I would just keep your head down and not cause trouble.. They can hurt you more than u can hurt them.

 

[Med Ed]

On one end, I really don't like reporting things because I think every time you report something, admin looks into both sides of the story and I don't want to come off as a problem resident and have worked hard to cultivate the best impression I can.

You know what really pisses admin off? When a problem student flies under the radar until right before graduation because no one had the guts to say anything.

 

[LimpSpatula]

I would just keep your head down and not cause trouble.. They can hurt you more than u can hurt them.

Its medicine not the mob. This is a patient safety issue and it needs to be reported.

 

[deleted50541]

You should DEFINITELY talk to their supervisor at their school. If this behavior is not corrected during medical school, they will kill someone later in residency.

Talk to the clerkship director for that specific rotation. This is serious. The student should know their place and scope of what they can and cannot do.

I second this. It's one thing for students to see patients on their own after rounds and review their records for clarity, which I always encouraged as a way to foster patient ownership and generate discussions about management plans. But it's another to openly question the medical decision making of the team to patients and offer their own unsupported opinions.

 

[mrbreakfast]

So this is tough. I think correcting aberrant behavior early is important, before the students hurts their chances (or a patient). That being said, I'm not sure I personally would report this student. You essentially have nothing - the first issue can be countered with "well, the patient told me they had diarrhea, so..." while the second could easily be chalked up to patient confusion (which is common).

I think a lot depends on the culture at your program. I would do what you think is right, even if nothing may come of it.


The main thing I've seen med students get in serious trouble for has been hitting on inpatients. Like, why...

 

[LimpSpatula]

The main thing I've seen med students get in serious trouble for has been hitting on inpatients. Like, why...

Because they’re human beings. Sometimes the patients are hot. A lot med students are entitled, grew-up-in-a-bubble types that at times, can be socially inept. Mistakes get made.

 

[NotAProgDirector]

First, I think the language you use matters. You're not "reporting" this student -- it's not like you've seen some illegal activity. You have concerns about their performance. You should share those concerns with someone. Either those concerns will be corroborated by someone else -- at which point it's a real problem -- or not.

I encourage you to share them with someone. The question is whom. Options:

1. The student themselves. I would highly encourage this. It avoids the appearance of "reporting" them -- you share your thoughts with them first. It also allows you to hear their side of the story. Doing this is an art -- you don't want to be confrontational. With the diarrhea issue, you could say "Thanks for bringing up the issue of diarrhea in pt X. One of the benefts of having multpiple people caring for the sam epatient is we're less likely to miss things. I went back and reviewed the chart and talked to the patient and nurse, and there seems to be some confusion. Can you tell me how you discovered the patient has diaarhea?" This doesn't accuse them of lying, or even of making a mistake. How they respond to an inquiry like this is often very helpful in figuring out what the problem is.

2. If you're an intern and uncomfortable doing this, then review with the resident and do it together.

3. The faculty for the team. You can review with them, tell them of your concerns. They may be able to focus on this student more. This is very culture dependent, it may or may not be relevant in your program.

4. The clerkship director, and in this case because of the politics involved, your PD also. Unless either of them is this kid's father, that would be a real mess.

I think it's important to review this with the student before moving it up the food chain -- but if you're concerned I wouldn't stop with just reviewing it with them. Consider it from your perspective -- would you want someone to bring concerns about your performance to the PD without talking to you?

I think it's also a good idea to not jump to conclusions here. There are lots of potential explanations. Many, and perhaps all of them, are bad and need addressing. Getting a sense if this is a medical knowledge issue (i.e. student has lots of book knowledge that they inappropriately apply to patient scenarios), shortcutting (student takes shortcuts that lead to incorrect information), or falsehoods (student just makes stuff up) is important to know. From what you've written here, sounds like the first -- the student anchors early on some factoid they learned in M1-2 and gets off track. Then, added to that, is the problem of sharing inappropriate information with patients.

Best of luck.

 

[Lawpy]

the student's dad was an attending here

Ugh i hate legacy kids especially when they get a free pass for something bad

 

[Goro]

As someone with a lot of experience with troublesome students, I'll wager that this kid has had issues in the past. Students just don't become bizarre overnight.

Wise advice has already been given, but the student's clinical Dean(s) need to know about this behavior.

 

[Chelsea FC]

Its medicine not the mob. This is a patient safety issue and it needs to be reported.

Funny if the tables were turned and it’s a attending doing that you would tell the med student to shut up and hold his head down. When the attending actually has medical implications to the patient when the student does not. If it’s a big enough issue someone else would raise the issue why would the resident put his neck on the line knowing that they can be wrecked by an attending that has a axe to grind.

 

[Goro]

Funny if the tables were turned and it’s a attending doing that you would tell the med student to shut up and hold his head down. When the attending actually has medical implications to the patient when the student does not. If it’s a big enough issue someone else would raise the issue why would the resident put his neck on the line knowing that they can be wrecked by an attending that has a axe to grind.

Lovely example of a straw man argument there.

 

[LimpSpatula]

Funny if the tables were turned and it’s a attending doing that you would tell the med student to shut up and hold his head down. When the attending actually has medical implications to the patient when the student does not. If it’s a big enough issue someone else would raise the issue why would the resident put his neck on the line knowing that they can be wrecked by an attending that has a axe to grind.

If I had concerns an attending was giving my patient an incorrect dx or telling my patient they need to put down their dog, I would try to have them explain their reasoning to me. If it wasn’t the community standard I would tell them what is. And then I would tell medical students what the standard is. And then I would let my PD know. Our heirarchy is archaic and has a lot of trickle down abuse, but it’s not that bad.

This is somewhat of a moot point though because if they’re an attending and doing these kinds of things, everyone knows it already. Past behavior is predictive of future behavior, which is exactly why you try to nip things like this in the bud.

 

[Chelsea FC]

Lovely example of a straw man argument there.

Its to show inconsistency in this forum. In which yall come down hard on medical students but make it an attending do something off and you all piling on saying the emd student should mind their business and hold their head down

 

[Goro]

Its to show inconsistency in this forum. In which yall come down hard on medical students but make it an attending do something off and you all piling on saying the emd student should mind their business and hold their head down

Whataboutisms are not a defense, and you are hijacking a valuable conversation.

 

[LimpSpatula]

Its to show inconsistency in this forum. In which yall come down hard on medical students but make it an attending do something off and you all piling on saying the emd student should mind their business and hold their head down

Who’s you all? Did you read my reply? Unless you’re giving specific examples of attendings with similar behavior, then yes, it’s a strawman.

 

[deleted1100659]

To me this isnt really bizarre, this is more just someone with an ego who is trying to catch that one thing that the rest of team misses and be the hero/obtain recognition.

I'm going to take the middle ground here and offer that maybe the patient misinterpreted what the student said, and maybe he didn't actually say it the way it was reported. Was he wrong to initiate a conversation about rabies to that extent to the patient and overly worry the patient? Definitely. Is he misguided? Probably. Does he have an ego? Likely. Does he deserve punishment? Hm, not so sure about that. I was arrogant and foolhardy in my medical school days.

Punishment often tends to follow people, and I think a better approach would be to have a team meeting with the student, and discuss in a non accusatory manner how he may be coming across and better ways for him to present his findings, as well as checking in with the rest of the team before giving speeches about rabies.

People tend to grow with time and experience, maybe with the right feedback he would be receptive. I think he would be more receptive if the entire team sat down and it was more of a group feedback thing, and they were able to back you up, because often if its just one person scolding another repeatedly you may get made out to be the bully even though that isnt the case.

 

[LimpSpatula]

To me this isnt really bizarre, this is more just someone with an ego who is trying to catch that one thing that the rest of team misses and be the hero/obtain recognition.

I'm going to take the middle ground here and offer that maybe the patient misinterpreted what the student said, and maybe he didn't actually say it the way it was reported. Was he wrong to initiate a conversation about rabies to that extent to the patient and overly worry the patient? Definitely. Is he misguided? Probably. Does he have an ego? Likely. Does he deserve punishment? Hm, not so sure about that. I was arrogant and foolhardy in my medical school days.

Punishment often tends to follow people, and I think a better approach would be to have a team meeting with the student, and discuss in a non accusatory manner how he may be coming across and better ways for him to present his findings, as well as checking in with the rest of the team before giving speeches about rabies.

People tend to grow with time and experience, maybe with the right feedback he would be receptive. I think he would be more receptive if the entire team sat down and it was more of a group feedback thing, and they were able to back you up, because often if its just one person scolding another repeatedly you may get made out to be the bully even though that isnt the case.

This is solid. Thank you for your input. Username checks out.

 

[Fatalis]

I am a resident who has noticed strange behavior from a particular medical student over the past few months and just wanted to share my experience and solicit advice on how to deal with this case. This medical student has been observed by me on two subsequent rotations we happen to coincidentally be on. I have noticed more what I would classify as bizarre and at times egotistical (not unsafe or overtly malignant) behaviors from him/her and I don't think this person should be doing this and think someone should be notified.

1.) There was a case where we were treating an HIV patient for CAP as a primary service. This was based off a measured fever in the ED/questionable infiltrate/new onset cough which the patient presented to the hospital for (his CD4 was not <200, he only required 2L on presentation, no COPD hx). Two days later, the student reported the patient was having diarrhea which he attributed to the antibiotics and he said this quite condescendingly. I felt dumb that I missed diarrhea so I went after rounds without telling anyone to get more history on the diarrhea and the patient and nurse denied the diarrhea. I later asked the student about it and he gets defensive and tells me he noted it on the flowsheets. I look on the flowsheets and noted there was one episode of semi-formed stool documented but neither the nurse or the patient had thought much of it and the rest of the stools were solid. This nurse and I had some rapport from a previous case and he shared with me that the student had spent 30 minutes with the patient talking to him about how antibiotics were overprescribed and this was not a pneumonia based off his experience. I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here.

2.) This is really what I felt was bizarre. We had a patient who came in for a unilateral cellulitis with intact skin with hx of DM, HF. The patient owned a dog but to his knowledge the dog had not bit or interacted (bit/licked, etc.) with the leg. We felt the etiology for related to venous stasis. This student tries to make the case that the dog bit the patient and caused this reaction. The next day when I go to see the patient he told me one of the doctors had told him that his dog would need to be euthanized to determine if it had caused the issue and if this was true. I had a suspicion what had led to this discussion, but I asked the student unassumingly if he had asked the patient about rabies and he told me he had a long discussion with the patient about it. I asked directly if he had told the patient his dog needed to be put down and he said he had never told the patient this. Of note, there were no consultant teams seeing the patients, my senior did not speak with the patient, and the attending does not typically do so outside of rounds and no one had mentioned rabies. I spoke to him about this and brought up the previous time with the HIV patient and the Pneumonia but I don't think the student really respected what I had to say.


Overall, I really don't know what to do here. On one end, I really don't like reporting things because I think every time you report something, admin looks into both sides of the story and I don't want to come off as a problem resident and have worked hard to cultivate the best impression I can. On the other hand I am really put off by the student's condescending behavior and think he needs to be spoken to or disciplined in some way for the way he talks with patients. I am really not sure who to discuss this with.

Thoughts?

Doesn't seem bizarre at all, just a run of the mill over confident/ uworld=medicine type of med student who over steps and thinks the hospital was specifically built for them.
What should you do? Nothing, you won't change his/her behavior for they are a med student and holier than thou

 

[Chelsea FC]

All im saying is reporting more likely hurt you than help them. Talk to the person and see if you can connect with them and point out how they are being difficult. What u dont do is report him/her and get yourself in trouble. Med students hear and see attending so inappropriate stuff all the time and keep our mouth shut because we know at the end of the day its not worth the trouble. People egging you on to make a big deal about this has no skin in the game.

 

[Lawpy]

All im saying is reporting more likely hurt you than help them. Talk to the person and see if you can connect with them and point out how they are being difficult. What u dont do is report him/her and get yourself in trouble. Med students hear and see attending so inappropriate stuff all the time and keep our mouth shut because we know at the end of the day its not worth the trouble. People egging you on to make a big deal about this has no skin in the game.

How would reporting the student get OP in trouble? Because you think OP's dad will step in and blindly condemn OP for slamming his kid?

OP has i'm guessing full evaluation power so that's his job. I agree talking to the student is the first step but the idea of allowing nepotism and legacy to endanger patient care looks ridiculous and a complete failure of US healthcare

 

[Chelsea FC]

How would reporting the student get OP in trouble? Because you think OP's dad will step in and blindly condemn OP for slamming his kid?

OP has i'm guessing full evaluation power so that's his job. I agree talking to the student is the first step but the idea of allowing nepotism and legacy to endanger patient care looks ridiculous and a complete failure of US healthcare

"I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here". I trust the Senior understands the culture where he is working at more and he advised against it. Plus how is this kid affecting care??

 

[RespectTheChemistry]

"I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here". I trust the Senior understands the culture where he is working at more and he advised against it. Plus how is this kid affecting care??

From the original post, the student is without a doubt affecting care. There are these two patients OP is aware of, but there could be more that have flown under the radar.

 

[Redpancreas]

Today there was another incident. The troublemaking student told a patient a diagnostic endoscopic procedure would be done today (as a separate consultant not on the procedural consulting team) and called the procedural consulting team (apparently another medical student) to tell them to make sure the procedure was done that day. I came to know of this later from the other medical student on the procedural consultant team who told me later what he was told by the trouble making medical student on our team - we have the texts/receipts). The fellow on that consulting team called me to clarify (because his attending was pissed and thought our attending had made this request) since I am the resident listed as caring for this patient. I did not respond coherently at the time because I did not know why he was so upset but when I found out what happened via texting the medical student on their service, I called the fellow back and let him know what the medical student on his own team had told me and he told me to report this to my program director so I did via email and copied the fellow on the email with his permission. I will also discuss it with the student tomorrow and frankly I am just going to say it was kind of out of my hands because frankly it was and numerous people were upset by this. Afterwards, I shouldn't be working with this medical student again. As interns, we don't eval medical students. I had a senior on the last rotation and he did but I don't know what he said.

 

[Chelsea FC]

Today there was another incident. The student in question told a patient an endoscopic procedure would be done today and called the consulting team (apparently another medical student) to tell them to make sure the procedure was done that day (I came to know of this from the other medical student who told me later what he was told by this medical student). The fellow on that consulting team called me to clarify since I am the resident listed caring for this patient. I did not respond coherently at the time because I did not know why he was so upset but when I found out what happened via texting the medical student on their service, I called the fellow back and let him know what the medical student on his team had told me to report this to my program director so I did via email and copied the fellow on the email with his permission. I will also discuss it with the student tomorrow. Afterwards, I shouldn't be working with this medical student again. As interns, we don't eval medical students. I had a senior on the last rotation and he did but I don't know what he said.

Dammmmm haha this student is frecking wild. HAHA playing stupid games.

 

[operaman]

I’d just like to add that as someone who had his own behavior reported to the dean as a 4th year student: if it’s really nothing then it’s not a big deal. It’s only a problem if it’s a pattern.

I had an off service surgery intern report me for presenting myself to patients as an attending. If this had been true it would have been a serious issue and should definitely have been reported. The dean let my service attending know and she thought it was hilarious because we had some ongoing jokes about my being old so this was just icing on the cake! And of course the first thing the patient in question asked on rounds was if I’d gotten any more residency interview invites.

If this kid’s behavior is just a fluke if misunderstanding then the report will did a quick death as it should. If it’s a pattern, then he is in dire need of corrective action before he gets himself in unsalvageable trouble.

 

[Lawpy]

I’d just like to add that as someone who had his own behavior reported to the dean as a 4th year student: if it’s really nothing then it’s not a big deal. It’s only a problem if it’s a pattern.

I had an off service surgery intern report me for presenting myself to patients as an attending. If this had been true it would have been a serious issue and should definitely have been reported. The dean let my service attending know and she thought it was hilarious because we had some ongoing jokes about my being old so this was just icing on the cake! And of course the first thing the patient in question asked on rounds was if I’d gotten any more residency interview invites.

If this kid’s behavior is just a fluke if misunderstanding then the report will did a quick death as it should. If it’s a pattern, then he is in dire need of corrective action before he gets himself in unsalvageable trouble.

What do you make of this?

Today there was another incident. The troublemaking student told a patient a diagnostic endoscopic procedure would be done today (as a separate consultant not on the procedural consulting team) and called the procedural consulting team (apparently another medical student) to tell them to make sure the procedure was done that day. I came to know of this later from the other medical student on the procedural consultant team who told me later what he was told by the trouble making medical student on our team - we have the texts/receipts). The fellow on that consulting team called me to clarify (because his attending was pissed and thought our attending had made this request) since I am the resident listed as caring for this patient. I did not respond coherently at the time because I did not know why he was so upset but when I found out what happened via texting the medical student on their service, I called the fellow back and let him know what the medical student on his own team had told me and he told me to report this to my program director so I did via email and copied the fellow on the email with his permission. I will also discuss it with the student tomorrow and frankly I am just going to say it was kind of out of my hands because frankly it was and numerous people were upset by this. Afterwards, I shouldn't be working with this medical student again. As interns, we don't eval medical students. I had a senior on the last rotation and he did but I don't know what he said.

 

[Matthew9Thirtyfive]

Dammmmm haha this student is frecking wild. HAHA playing stupid games.

Is he still not affecting care and shouldn’t be reported?

 

[deleted50541]

As was said, it's more the pattern of behavior of that disturbs me than isolated incidents. We only have what information we're given, but I wouldn't be surprised to hear about similar episodes on other rotations.

Does this guy seem like he's receptive to constructive comments/criticism? Sounds likes no based on your initial post. That said, the next best thing you can do is document what happened like you've done. It's unfortunate that this is the climate we work and live in these days, but documentation is important to have in these situations.

 

[Mass Effect]

If it’s a big enough issue someone else would raise the issue

This is exactly the type of thinking that gets us people like Christopher Duntsch aka Dr. Death. Everyone just moves on and makes it someone else's problem.

I'm amazed by the number of people willing to just ignore this type of behavior that very definitely affects patient care. I'm guessing those of you who are following this line of thinking aren't aware that when the student really screws up and causes damage, it'll be all the other students/residents/fellows along the way who will be questioned because they passed him and didn't say anything. Wouldn't want to be on the receiving end of that hell when it happens.

 

[Matthew9Thirtyfive]

This is exactly the type of thinking that gets us people like Christopher Duntsch aka Dr. Death. Everyone just moves on and makes it someone else's problem.

I'm amazed by the number of people willing to just ignore this type of behavior that very definitely affects patient care. I'm guessing those of you who are following this line of thinking aren't aware that when the student really screws up and causes damage, it'll be all the other students/residents/fellows along the way who will be questioned because they passed him and didn't say anything. Wouldn't want to be on the receiving end of that hell when it happens.

These are the same people who say to just ignore it when questions about reporting cheating in undergrad or preclinical come up. And then they think we’re crazy when we say it just escalated.

 

[Lawpy]

These are the same people who say to just ignore it when questions about reporting cheating in undergrad or preclinical come up. And then they think we’re crazy when we say it just escalated.

Many SDNers strongly believe in "minding your own business" or "snitches get stitches" or some other nonsense to justify themselves in not doing anything when seeing academic dishonesty or even outright danger to patient safety. This mindset is repetitive and longlasting which is frustrating

 

[catnip12]

OP like you know I am sure, you should forward your concerns over to whoever is concerned with Medical student education. Also, you should beware of inadvertently doxxing yourself given the specifics surrounding these situations, and how recent they are.

 

[Mass Effect]

Many SDNers strongly believe in "minding your own business" or "snitches get stitches" or some other nonsense to justify themselves in not doing anything when seeing academic dishonesty or even outright danger to patient safety. This mindset is repetitive and longlasting which is frustrating

And it makes me wonder if they're "that guy", the one cheating, the one doing these things and they want everyone else off their back.

There's a very clear ethical code here and that is that patient care comes before any "allegiance" to shady doctors/med students doing something wrong.

 

[operaman]

What do you make of this?

Yeah reporting was absolutely the right thing. I would also add the other incidents into your report if you haven’t already done so. You’ve done a nice job presenting it here too - very objective, just facts as you see them, with minimal editorializing. I sincerely hope the fallout from this is that he takes a step back and plays better in the sandbox.

I don’t think of this as “snitching” in the least because that’s not the nature of your relationship to this or any other student. You are a member of the profession and part of your duty is deciding who is and isn’t worthy of joining. This kind of behavior is clearly unprofessional so he needs to either correct it or consider another profession.

Uncorrected, I think we all know what this kid will be like as an intern. Think he’s gonna run plans by his chief or attending? Maybe in July but by October when he’s a the summit of Mt Stupid, he’s gonna do some boneheaded stuff and people will get hurt. Maybe a little reckoning now will save him from himself.

 

[Chelsea FC]

Is he still not affecting care and shouldn’t be reported?

He def is and should be.

 

[deleted966164]

Can you ask fellow residents or nurses if they have observed a pattern of that behavior as well?

 

[operaman]

Can you ask fellow residents or nurses if they have observed a pattern of that behavior as well?

This is always a part I struggle with. I’ve settled on thinking that such investigation is more the domain of the PD or clerkship director/dean than reporting clinician.

The best I could relay in a report would be “other residents and nurses say XYZ.” If someone else goes to those people asking for concrete examples of issues then they will get first hand accounts that are very useful. I’d probably mention that such behavior has been commented on by others but let the powers that be do their own legwork if they care enough.

That’s how my own PD handled these things. I was blessed with arguably the very best PD you could have and he was incredibly reasonable and fair. Whenever people brought him concerns he always did his due diligence. Whenever he was investigating he would often ask me if I had an personal issues with a particular resident or faculty member and was very specific that I not relay any rumors I’d heard, just whatever I had personally witnessed. Once he had talked to everyone he would close the loop and let all involved know what he found and what he did about it. Hopefully that’s what happens for this young man and I hope he learns from it and finds his footing.

 

[deleted966164]

Makes me also wonder how these things have slipped under in his MS3…?

 

[sloop]

Personally, I would talk to the student about this directly. I would be respectful but honest about my concerns. Anybody who thinks less of you because you had the spine to try to address a legitimate educational and clinical concern is an idiot.

I guess you could timidly float through the hospital for however many training years you have ahead but, realistically, you’re going to have to find some confidence at some point. It might as well be now.

Then again, I was never great at playing the obsequious hierarchical game of medicine and tend to speak my mind. Maybe that’s part of why I wound up in forensics.

 

[Aheadbyacentury]

I am a resident who has noticed strange behavior from a particular medical student over the past few months and just wanted to share my experience and solicit advice on how to deal with this case. This medical student has been observed by me on two subsequent rotations we happen to coincidentally be on. I have noticed more what I would classify as bizarre and at times egotistical (not unsafe or overtly malignant) behaviors from him/her and I don't think this person should be doing this and think someone should be notified.

1.) There was a case where we were treating an HIV patient for CAP as a primary service. This was based off a measured fever in the ED/questionable infiltrate/new onset cough which the patient presented to the hospital for (his CD4 was not <200, he only required 2L on presentation, no COPD hx). Two days later, the student reported the patient was having diarrhea which he attributed to the antibiotics and he said this quite condescendingly. I felt dumb that I missed diarrhea so I went after rounds without telling anyone to get more history on the diarrhea and the patient and nurse denied the diarrhea. I later asked the student about it and he gets defensive and tells me he noted it on the flowsheets. I look on the flowsheets and noted there was one episode of semi-formed stool documented but neither the nurse or the patient had thought much of it and the rest of the stools were solid. This nurse and I had some rapport from a previous case and he shared with me that the student had spent 30 minutes with the patient talking to him about how antibiotics were overprescribed and this was not a pneumonia based off his experience. I was really miffed and told my senior, but he told me to just ignore it and that the student's dad was an attending here.

2.) This is really what I felt was bizarre. We had a patient who came in for a unilateral cellulitis with intact skin with hx of DM, HF. The patient owned a dog but to his knowledge the dog had not bit or interacted (bit/licked, etc.) with the leg. We felt the etiology for related to venous stasis. This student tries to make the case that the dog bit the patient and caused this reaction. The next day when I go to see the patient he told me one of the doctors had told him that his dog would need to be euthanized to determine if it had caused the issue and if this was true. I had a suspicion what had led to this discussion, but I asked the student unassumingly if he had asked the patient about rabies and he told me he had a long discussion with the patient about it. I asked directly if he had told the patient his dog needed to be put down and he said he had never told the patient this. Of note, there were no consultant teams seeing the patients, my senior did not speak with the patient, and the attending does not typically do so outside of rounds and no one had mentioned rabies. I spoke to him about this and brought up the previous time with the HIV patient and the Pneumonia but I don't think the student really respected what I had to say.


Overall, I really don't know what to do here. On one end, I really don't like reporting things because I think every time you report something, admin looks into both sides of the story and I don't want to come off as a problem resident and have worked hard to cultivate the best impression I can. On the other hand I am really put off by the student's condescending behavior and think he needs to be spoken to or disciplined in some way for the way he talks with patients. I am really not sure who to discuss this with.

Thoughts?

I dont find the medical student bizaarre..

 

[aldol16]

You know what really pisses admin off? When a problem student flies under the radar until right before graduation because no one had the guts to say anything.

Dr. Death?

 

[Aheadbyacentury]

Dr. Death?

is that what you think happened with Dr Death?