Chronically overworked

[hallowmann]

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...Things will be worse as an intern, worse as a resident, and worse as an attending. Contrary to what people say, medicine doesn't get easier as you go along.

This is absolutely true. If anything things pile on higher, you just get better at shoveling.

I'm getting the impression that OP is simply depressed, burnt out, and unhappy. They're taking every comment that doesn't offer a "that sucks, I'm so sorry" and stop there as a slight against them.

OP, I genuinely mean this and not as a form of condescension, criticism or anything else, but please talk to someone. Reach out, build your support network, work on finding things that bring you happiness outside of school, etc. You'll need that for the interview trail, intern year, residency, and beyond. I hope that you can find less stress and pain on this road. Good luck.

 

[honey0102]

If you want to project condescension, you can. My yoga instructor is great and probably does more for more people than I ever could as a doctor. Her quality of life is amazing, too.

I am serious -- if 20 days of a difficult rotation is enough to break you, then consider a career pivot. Things will be worse as an intern, worse as a resident, and worse as an attending. Contrary to what people say, medicine doesn't get easier as you go along.

Define "break"-it stressed me but yet here I am still pursuing a career in medicine

 

[honey0102]

This is absolutely true. If anything things pile on higher, you just get better at shoveling.

I'm getting the impression that OP is simply depressed, burnt out, and unhappy. They're taking every comment that doesn't offer a "that sucks, I'm so sorry" and stop there as a slight against them.

OP, I genuinely mean this and not as a form of condescension, criticism or anything else, but please talk to someone. Reach out, build your support network, work on finding things that bring you happiness outside of school, etc. You'll need that for the interview trail, intern year, residency, and beyond. I hope that you can find less stress and pain on this road. Good luck.

I never expected it to get easier as I went on. I was just frustrated that in a situation where studying might have been possible, it wasn't.
It's also untrue that I took every comment against me. If you read through it, some people did offer contrarian views-but were polite as they did it, and I accepted that. It's like preceptors offering constructive criticism. I'd take it well and not even be offended (more taken as a "growth" mindset)-as long as they were professional as they did it.
But yes, am working on finding things to bring happiness outside of school. Thanks.

 

[Lawpy]

If you want to project condescension, you can. My yoga instructor is great and probably does more for more people than I ever could as a doctor. Her quality of life is amazing, too.

I am serious -- if 20 days of a difficult rotation is enough to break you, then consider a career pivot. Things will be worse as an intern, worse as a resident, and worse as an attending. Contrary to what people say, medicine doesn't get easier as you go along.

Honestly, i have no idea what SDN is saying if people keep giving contradictory advice on many important topics.

 

[Baron Samedi]

Define "break"-it stressed me but yet here I am still pursuing a career in medicine

You felt stressed to the point when you claimed to have physical symptoms. It only gets worse from here, mate. If you proceed with medicine, you will one day long to return to the days of medical school where you have very, very little in terms of responsibilities.

 

[Baron Samedi]

Honestly, i have no idea what SDN is saying if people keep giving contradictory advice on many important topics.

It doesn't get easier, it always gets more difficult. As a medical student, you have essentially zero true responsibilities and the focus is on your own development. That focus shifts starting as an intern, and by the time you are staff literally nobody cares about you except for yourself. The workload and responsibilities scale dramatically.

What changes is that some people find ways for managing the intense workload and stress. They find purpose outside of work(I would echo another poster's recommendation for reading Man's Search for Meaning).

 

[Angus Avagadro]

It doesn't get easier, it always gets more difficult. As a medical student, you have essentially zero true responsibilities and the focus is on your own development. That focus shifts starting as an intern, and by the time you are staff literally nobody cares about you except for yourself. The workload and responsibilities scale dramatically.

What changes is that some people find ways for managing the intense workload and stress. They find purpose outside of work(I would echo another poster's recommendation for reading Man's Search for Meaning).

I think @hallowmann said it best. Paraphrasing...as the piles get larger, you just get better at shoveling.

Things may not get so much worse, you just get so much better

 

[Candidate2017]

Things will be worse as an intern, worse as a resident, and worse as an attending. Contrary to what people say, medicine doesn't get easier as you go along.

There are times when things get tougher than med school but also times when things get easier. But let’s not pretend it’s consistently tougher. The attending side can be easier in non-surgical specialties and more so in places with residents, which recruiters love to advertise as a perk. My attendings throw a hissy if some otherservice's attending or RN figures out how to contact them after hours. Granted, private practice docs grinding for more money work harder but they have more autonomy and staff support.

There’s no reason for students on an outpatient rotation to write a full day’s worth of notes and then go into the evening to write notes for other attendings, especially when none of this happens to residents. Again, this is outpatient. In intern year the only time I stayed past 6 pm on an outpatient service was because the attending wanted to lecture on random stuff. Nowadays I can't envision that happening to me, inpatient or outpatient, as I wrap up notes well before then.

 

[Angus Avagadro]

There are times when things get tougher than med school but also times when things get easier. But let’s not pretend it’s consistently tougher. The attending side can be easier in non-surgical specialties and more so in places with residents, which recruiters love to advertise as a perk. My attendings throw a hissy if some otherservice's attending or RN figures out how to contact them after hours. Granted, private practice docs grinding for more money work harder but they have more autonomy and staff support.

There’s no reason for students on an outpatient rotation to write a full day’s worth of notes and then go into the evening to write notes for other attendings, especially when none of this happens to residents. Again, this is outpatient. In intern year the only time I stayed past 6 pm on an outpatient service was because the attending wanted to lecture on random stuff. Nowadays I can't envision that happening to me, inpatient or outpatient, as I wrap up notes well before then.

My friends in private practice dont have extra support and take night and weekend call. Some are in employed private, and some pure private practice. The employed one takes students with no compensation. The pure private practice takes students also without compensation. Students, often a joy, but dont make your life easier. Neither have scribes or midlevels. So all of the work falls on them. Notes, refills, consults, phone calls, night and weekend call. Some jobs are better than others.

 

[Goro]

Honestly, i have no idea what SDN is saying if people keep giving contradictory advice on many important topics.

Consider the sources, for starters .

 

[sharkbyte]

In those few weeks, I woke up stressed and nauseated. Lost a ton of weight due to the stress of not being able to study enough. Your second comment is very condescending and to be honest I'm shocked you as a doctor who *should* be empathetic can be so dismissive-I think you're just trying to show off...whatever. Life's too short to deal with comments like this.

Update: The rotation is over. Don't have my shelf score yet. Pulled many semi-all nighters the week of, fingers crossed it went well.
To those-with either opinion-who helped me, or even who were just polite while expressing opinions, thank you.
To those who decided to be condescending and rude, I sincerely hope this attitude doesn't carry over when you are with your patients.
Happy Holidays everyone!

Boom, Burnett's Law. There it is. Was just a matter of time.

 

[BigPikachu]

M3 in a primary care clerkship right now, outpatient based.
It's a busy practice. We see patients q15 minutes. My preceptor has me write notes for everyone I see-and will sometimes make me see the next patient before I'm done w/ notes for the previous one. She leaves after the last patient is seen and makes me stay late (1-2 hrs) and finish the notes. At this point she herself, writes very few notes-I do the bulk of it.
She has this policy (note, NOT a school policy) that anytime any doctor in that clinic is in-house (4 total), I must be too. Which means, if she opens shop at 8, I must be there at 8-but when she leaves at 4 or 5, if another doctor (who began at 11 AM) stays until 8 PM-then so must I, writing notes for the other doctor. She opens at 6 to leave at 2 sometimes-and I must help her from 6 AM-2 PM, then the other doctors until whenever clinic closes.
On top of it, as I'm writing notes, she will pimp me extensively on minute details from online, or very specific "zebra-like" clinical scenarios beyond med student scope. It is overwhelming. I barely have time to think. Assigns me tons of readings too. at least 1/d.
On top of this...got shelf to study for.

I'm burned out and beginning to feel depressed and apathetic about just about everything. Do students deserve such little respect that we're literally used as unpaid labor? I know it's good to see patients/learn but at this point the practice is using me as free labor with this policy that anytime any doctor is in house, I must be their scribe-aren't people paid to do that, in gap year jobs? I went into medicine as I like to help patients which I definitely still do, but now I'm worrying about the hierarchy in the field, lack of respect until being significantly established...etc

Options:

1) Speak to your preceptor directly. I would like to think that most of us have a open door policy to receiving direct feedback if it's reasonable and appropriate, regardless of heirachical chain-of-command. Your preceptor does sound a bit of a tightass but hopefully she doesn't have an arrogant ego that prevents her from empathising with your situation.

2) Speak to your clinical term coordinator or program director, and feedback your grievances in a reasonable and honest way. Most schools and hospitals recognise physician burnout as a real thing and respect the mental health of clinicians. The outcome of this usually results with arranging a new preceptor. However be aware that your new preceptor may not necessarily be any 'nicer'.

3) Put up with it if it's not too bad. If your rotation is only a few months, just get on with it. What doesn't kill you, makes you stronger. Many rotations as a student, and then later as a resident and registrar, are tiring where you're treated like a underpaid overworked slave monkey that has to multi-task between studying for exams and the overwhelming paperwork of clinical practice. That's not saying it's necessarily right; medicine is notorious with cultural rigidity and heirachical bullying. Provide feedback at the end of your rotation so that they can work on improving clerkship rotations for future students.

 

[Mass Effect]

M3 in a primary care clerkship right now, outpatient based.
It's a busy practice. We see patients q15 minutes. My preceptor has me write notes for everyone I see-and will sometimes make me see the next patient before I'm done w/ notes for the previous one. She leaves after the last patient is seen and makes me stay late (1-2 hrs) and finish the notes. At this point she herself, writes very few notes-I do the bulk of it.
She has this policy (note, NOT a school policy) that anytime any doctor in that clinic is in-house (4 total), I must be too. Which means, if she opens shop at 8, I must be there at 8-but when she leaves at 4 or 5, if another doctor (who began at 11 AM) stays until 8 PM-then so must I, writing notes for the other doctor. She opens at 6 to leave at 2 sometimes-and I must help her from 6 AM-2 PM, then the other doctors until whenever clinic closes.
On top of it, as I'm writing notes, she will pimp me extensively on minute details from online, or very specific "zebra-like" clinical scenarios beyond med student scope. It is overwhelming. I barely have time to think. Assigns me tons of readings too. at least 1/d.
On top of this...got shelf to study for.

I'm burned out and beginning to feel depressed and apathetic about just about everything. Do students deserve such little respect that we're literally used as unpaid labor? I know it's good to see patients/learn but at this point the practice is using me as free labor with this policy that anytime any doctor is in house, I must be their scribe-aren't people paid to do that, in gap year jobs? I went into medicine as I like to help patients which I definitely still do, but now I'm worrying about the hierarchy in the field, lack of respect until being significantly established...etc

This is NOT okay. As an attending, let me attempt to speak for all my reasonable colleagues and say I am sorry you are with such a terrible attending for this rotation. I would absolutely, positively put this in this person's evaluation. I wouldn't hold back. I would spell it out just as you did here and tell the school you don't think any other students should be assigned to her as you're actually not learning if you're doing that many notes and working that many hours. She's basically using students to be her own personal scribe AND pimping the students out to her colleagues in the practice. None of this is okay and students shouldn't be allowed within 50 feet of her in the future.

 

[PieOHmy]

. Contrary to what people say, medicine doesn't get easier as you go along.

It used to get easier. Now it is all a pile of excrement and every one of us should get out if we cam.

 

[Mass Effect]

Build resilience, work hard and keep a decent perspective.

OMG, stop. This is not resilience building. The guy (or gal) is paying a fortune to LEARN and he/she is being treated like a scribe. This is NOT okay and is NOT about building resilience. It's that kind of talk that leads to isolation and depression. We need to stop propping up our peers to put up with BS to build "resilience" instead of calling it what it is - abuse.

 

[Mass Effect]

As others have said the note writing experience will be helpful. I didn’t have to do very many clinic notes last year and I’m very clunky with them. The experience will also help with taking CS and efficiency in general.
When you feel run down just realize there is a benefit to you and your future preparedness. I wish my rotations were more practical and rigorous.

No it will not. Guys, nothing about this scenario is okay. You don't learn to write notes by writing notes for someone else. Why? Because (a) they may be using a different EMR, (b) they may have a completely different template, (c) any residency worth its salt is going to want your intern notes to be vastly different than the notes you're writing for an FM attending who's been in practice for who knows how many years, especially if she's in private practice. This is scribe work. Let's not try to spin it into something else. The OP should be seeing patients, discussing those patients, looking up interesting things that came up with those patients, and writing maybe 3 - 5 notes during an 8-hour day. He/she should not be seeing patients q15 minutes and writing a ton of notes not only for this attending but for others as well. Not okay. Not at all.

 

[ciestar]

OMG, stop. This is not resilience building. The guy (or gal) is paying a fortune to LEARN and he/she is being treated like a scribe. This is NOT okay and is NOT about building resilience. It's that kind of talk that leads to isolation and depression. We need to stop propping up our peers to put up with BS to build "resilience" instead of calling it what it is - abuse.

You see it all the time on here, or just hear it in general.. i hate the words “build a thicker skin” like that excuses awful behavior of certain people and it is somehow the student’s fault? Please.

You’re right, telling people to just suck it up or that others have it worse means squat..

 

[Mass Effect]

Honestly, i have no idea what SDN is saying if people keep giving contradictory advice on many important topics.

These are the moments when I get so unbelievably frustrated with SDN and doctors in general. This mentality of defending anything and everything someone is forced to do in order to continue on with the "you need to have grit to be a doctor because there's so much abuse involved" is nauseating to me and is what's killing our profession, frankly.

It doesn't get easier, it always gets more difficult. As a medical student, you have essentially zero true responsibilities and the focus is on your own development. That focus shifts starting as an intern, and by the time you are staff literally nobody cares about you except for yourself. The workload and responsibilities scale dramatically.

It's pretty clear, this med student DOES have true responsibilities and the focus is NOT on his/her own development. This med student is being treated as a scribe working an attending's schedule. At his/her level, this is completely inappropriate and IMO, anyone who says otherwise is drinking the Kool-Aid.

 

[Mass Effect]

My friends in private practice dont have extra support and take night and weekend call. Some are in employed private, and some pure private practice. The employed one takes students with no compensation. The pure private practice takes students also without compensation. Students, often a joy, but dont make your life easier. Neither have scribes or midlevels. So all of the work falls on them. Notes, refills, consults, phone calls, night and weekend call. Some jobs are better than others.

Except they're employed and it was THEIR choice to take that job. No one forced them to do it. Maybe they take students to help them get the work done.

Boom, Burnett's Law. There it is. Was just a matter of time.

It's warranted in this case.

 

[PieOHmy]

It is all a pile of excrement!!!!!!

 

[Lawpy]

OMG, stop. This is not resilience building. The guy (or gal) is paying a fortune to LEARN and he/she is being treated like a scribe. This is NOT okay and is NOT about building resilience. It's that kind of talk that leads to isolation and depression. We need to stop propping up our peers to put up with BS to build "resilience" instead of calling it what it is - abuse.

You see it all the time on here, or just hear it in general.. i hate the words “build a thicker skin” like that excuses awful behavior of certain people and it is somehow the student’s fault? Please.

You’re right, telling people to just suck it up or that others have it worse means squat..

SDN unfortunately doesn't seem to be helpful when things get worse, since people will always find a way to tear you apart with criticism. So much for having a supportive, empathetic support on here

 

[libertyyne]

OMG, stop. This is not resilience building. The guy (or gal) is paying a fortune to LEARN and he/she is being treated like a scribe. This is NOT okay and is NOT about building resilience. It's that kind of talk that leads to isolation and depression. We need to stop propping up our peers to put up with BS to build "resilience" instead of calling it what it is - abuse.

For everyone in this thread that characterizes OPs situation as abuse, It is a little hypocritical to say that OP should just deal with it or deal with it after the rotation ends.

Instead what you should be advocating is:
OP immediately remove themselves from the situation,
Report to the School administration
Stop going to the rotation
Report to LCME
Report to Hospital system
Report to hospital accrediting body

I would be interested to see what the actual complaint of abuse was.

Working within LCME hour guidelines? check
Writing notes?
Not having enough time to study ?
Working with another doctor at the same site ?

I am still in incredulous that any physician working for a major hospital system would allow a student to write non-templated free hand notes for billing purposes. Considering the physican would get coding/billing queries for every one of those notes.

I would not be surprised if all of those organizations did nothing.

 

[Mass Effect]

For everyone in this thread that characterizes OPs situation as abuse, It is a little hypocritical to say that OP should just deal with it or deal with it after the rotation ends.

Instead what you should be advocating is:
OP immediately remove themselves from the situation,
Report to the School administration
Stop going to the rotation
Report to LCME
Report to Hospital system
Report to hospital accrediting body

I would be interested to see what the actual complaint of abuse was.

Working within LCME hour guidelines? check
Writing notes?
Not having enough time to study ?
Working with another doctor at the same site ?

I would not be surprised if all of those organizations did nothing.

I'm pretty knowledgeable about what I should or should not be advocating. But if I ever need help figuring it out, I'll hit you up.

 

[libertyyne]

I'm pretty knowledgeable about what I should or should not be advocating. But if I ever need help figuring it out, I'll hit you up.

Great post.

 

[Neopolymath]

OP's continued reactions in this thread are far more telling of the long term problem than the suboptimal and very, very temporary situation they were in.

 

[Dr. Rafiki]

There is so much terrible advice in this thread. Really makes me sad at the future of the profession. I would have hoped we would eventually move past the "I had to go through it, so should you!" toxic mentality of medicine at some point but it doesn't seem like we will.

Your mental health is more important than any job you'll ever have. Med school is job training. If your mental health is at stake, seek help immediately. People put medicine on this pedestal where you should literally be killing yourself because, well, I had to too. That's stupid.

We lose doctors to suicides way too much in this country. About one one per day to be exact. If a colleague reaches out for help, maybe we should hear them out and help them get the help they need, not chastise them for being "weak".

OP, SDN is a horrible place with horrible people who know not what they speak. If your preceptor is abusing you then you need to reach out to a dean immediately.

 

[Lawpy]

There is so much terrible advice in this thread. Really makes me sad at the future of the profession. I would have hoped we would eventually move past the "I had to go through it, so should you!" toxic mentality of medicine at some point but it doesn't seem like we will.

Your mental health is more important than any job you'll ever have. Med school is job training. If your mental health is at stake, seek help immediately. People put medicine on this pedestal where you should literally be killing yourself because, well, I had to too. That's stupid.

We lose doctors to suicides way too much in this country. About one one per day to be exact. If a colleague reaches out for help, maybe we should hear them out and help them get the help they need, not chastise them for being "weak".

OP, SDN is a horrible place with horrible people who know not what they speak. If your preceptor is abusing you then you need to reach out to a dean immediately.

The problem with this thread is people are somehow bitterly divided here. Some people are willing to criticize OP through harsh feedback that's often delivered condescendingly. Others are trying to empathize with OP by giving reasonable solutions to help improve the situation. What this thread unfortunately signals is SDN is not a good place to get support or help in difficult situations.

Yes i get that hearing opposing advice is good but when i'm at the worst point of my life and need to vent, i'd rather not get publically torn apart with harsh advice. That only worsens the situation and makes the place rather toxic and unforgiving.

 

[Matthew9Thirtyfive]

So this thread has good info in it, and I’d rather not see it closed because of unprofessional bickering and mud slinging. It is okay to disagree with someone on whether something constitutes abuse. It is okay to discuss what someone should do, and differing advice is good.

Let’s keep the insults out of it. Just because someone disagrees with you doesn’t necessarily mean they are being condescending or toxic, so if you disagree with a post, let’s try professionally posting our opinions.

On the other hand, for the people who think this is either perfectly normal or within the bounds of a rotation, that’s fine. That’s your opinion that you are free to have and share. But like I said above, let’s express those opinions without insinuating that OP is somehow a lesser person for having a rough time and wanting to vent about it.

Now let’s stick to the topic. If you have something to contribute to the thread, have at it. If all you want to do is put someone down to make yourself feel better, then think about whether that will actually contribute to the thread. Calling other people toxic and insulting them while simultaneously talking about how this place is too toxic doesn’t contribute anything and just adds to the negativity. Thanks.

 

[kb1900]

For everyone in this thread that characterizes OPs situation as abuse, It is a little hypocritical to say that OP should just deal with it or deal with it after the rotation ends.

Instead what you should be advocating is:
OP immediately remove themselves from the situation,
Report to the School administration
Stop going to the rotation
Report to LCME
Report to Hospital system
Report to hospital accrediting body

I would be interested to see what the actual complaint of abuse was.

Working within LCME hour guidelines? check
Writing notes?
Not having enough time to study ?
Working with another doctor at the same site ?

I am still in incredulous that any physician working for a major hospital system would allow a student to write non-templated free hand notes for billing purposes. Considering the physican would get coding/billing queries for every one of those notes.

I would not be surprised if all of those organizations did nothing.

It doesn’t have to be abuse to be actionable - feedback is feedback. I had an outpatient rotation similar to op’s. 6 days/wk 12-14hrs/day with q20 appts and no learning and most note writing for health maintenance. Thankfully it was only 3 weeks long and my preceptor was actually reasonable when I talked to her about it, albeit on the third week.


anyway i had the discussion with the preceptor about it. Then with the clerkship director. Never use the word abuse but did use the word “expectations” a lot because, really, that’s what this is all about. is this the expectation for m3s? - if so fine. If not, let’s adjust things so that future students aren’t just used to keep your practice costs down to an almost unsafe level (my preceptor didn’t even see half the patients I saw which gave me serious anxiety that I missed something)

 

[ciestar]

There is so much terrible advice in this thread. Really makes me sad at the future of the profession. I would have hoped we would eventually move past the "I had to go through it, so should you!" toxic mentality of medicine at some point but it doesn't seem like we will.

Your mental health is more important than any job you'll ever have. Med school is job training. If your mental health is at stake, seek help immediately. People put medicine on this pedestal where you should literally be killing yourself because, well, I had to too. That's stupid.

We lose doctors to suicides way too much in this country. About one one per day to be exact. If a colleague reaches out for help, maybe we should hear them out and help them get the help they need, not chastise them for being "weak".

OP, SDN is a horrible place with horrible people who know not what they speak. If your preceptor is abusing you then you need to reach out to a dean immediately.

My mental health almost led me to dropping out a couple of times. Then i considered a LOA as an M4(!) because crap hit the fan hard. I reached out to my dean and started counseling.

We’re led to believe for forever it is a rite of passage and we suck if we can’t handle it. Going it alone is legit the worst friggin idea ever.

 

[LoGo]

So how ‘bout them Lakers? LeBron going to win his 4th championship or what?

 

[Lawpy]

So this thread has good info in it, and I’d rather not see it closed because of unprofessional bickering and mud slinging. It is okay to disagree with someone on whether something constitutes abuse. It is okay to discuss what someone should do, and differing advice is good.

Let’s keep the insults out of it. Just because someone disagrees with you doesn’t necessarily mean they are being condescending or toxic, so if you disagree with a post, let’s try professionally posting our opinions.

On the other hand, for the people who think this is either perfectly normal or within the bounds of a rotation, that’s fine. That’s your opinion that you are free to have and share. But like I said above, let’s express those opinions without insinuating that OP is somehow a lesser person for having a rough time and wanting to vent about it.

Now let’s stick to the topic. If you have something to contribute to the thread, have at it. If all you want to do is put someone down to make yourself feel better, then think about whether that will actually contribute to the thread. Calling other people toxic and insulting them while simultaneously talking about how this place is too toxic doesn’t contribute anything and just adds to the negativity. Thanks.

OP seems to be done with their rotation anyways and said what they have to say. There are ways to deliver contrarian advice without being rude, which is really the point here. At this point, the arguments are getting repetitive but some constructive (and polite) posts can help OP manage potentially difficult rotations in the future.

 

[Matthew9Thirtyfive]

OP seems to be done with their rotation anyways and said what they have to say. There are ways to deliver contrarian advice without being rude, which is really the point here. At this point, the arguments are getting repetitive but some constructive (and polite) posts can help OP manage potentially difficult rotations in the future.

Agreed. I want to keep it open because other people might go through something similar and more constructive advice is better.

 

[Baron Samedi]

Let me share a story that I think might relate:

Towards the end of college, I decided to take things a bit easy. I had worked really hard to that point and was rewarded with an admission letter to my top choice of medical school. Now was the time, I thought, to take a breather before getting back in the grind. With that in mind, I filled my schedule with classes I thought would be interesting but easier than the hard science courses I tool before. Human sexuality, indoor plants, freshwater ecology, ornithology, and birdwatching. It seemed like a cakewalk.

Birdwatching. To this day, it is the hardest course(including medical school clerkships) I have ever taken. I had to wake up at 5am most days and meticulously fill out my birding journal. I had to keep notes on the birds I saw, describe their calls, identify them, and enter them into memory. I drew sketches in my notebook to help with recall. Every evening, I listened to bird calls on tape and tried my best to remember. Each test would have two portions -- a written and a practical. In the written, we identified taxidermied birds and birds using audio recordings for our test. For the practical, we were taken out into the woods for several hours with our binoculars. There, the TA or professor would point out a bird by sight or sound and we had to ID it. The course was incredibly hard, and despite my best effort I couldn't muster better than a B.

I couldn't understand how birdwatching, of all things, could be so hard. Why did the professor make it that way? What was the point? Isn't this supposed to be a fluff class?

It took a long time, but when I thought about it later I realized that the reason I thought it was so difficult was because of my preconceived notions of what it would be. I believed it was a fluff course, so was caught entirely off guard when it wasn't. I resented the professor for making it so difficult, when in reality the course was the professor's to design and not mine. She was the expert with decades of experience, not me. She knew what skills were important to develop in birdwatching, not me.

In the same way, you think you are being treated unfairly on this rotation because you came in with your own expectations. You believed that an outpatient rotation would be an easy respite -- not because that was ever told to you by your preceptor but because of your own personal beliefs of what the rotation should be. Your preceptor knows what skills and experiences are important for you, the student, to learn and is giving you that exposure. I imagine if you had this same experience on, say, a General Surgery rotation you wouldn't feel the same way because you would have expected it to be difficult.

 

[Lawpy]

Let me share a story that I think might relate:

Towards the end of college, I decided to take things a bit easy. I had worked really hard to that point and was rewarded with an admission letter to my top choice of medical school. Now was the time, I thought, to take a breather before getting back in the grind. With that in mind, I filled my schedule with classes I thought would be interesting but easier than the hard science courses I tool before. Human sexuality, indoor plants, freshwater ecology, ornithology, and birdwatching. It seemed like a cakewalk.

Birdwatching. To this day, it is the hardest course(including medical school clerkships) I have ever taken. I had to wake up at 5am mosr days and meticulously fill out my birding journal. I had to keep notes on the birds I saw, describe their calls, identify them, and enter them into memory. I drew sketches in my notebook to help with recall. Every evening, I listened to bird calls on tape and tried my best to remember. Each test would have two portions -- a written and a practical. In the written, we identified taxidermied birds and birds using audio recordings for our test. For the practical, we were taken out into the woods for several hours with our binoculars. There, the TA or professor would point out a bird by sight or sound and we had to ID it. The course was incredibly hard, and despite my best effort I couldn't muster better than a B.

I couldn't understand how birdwatching, of all things, could be so hars. Why did the professor make it that way? What was the point? Isn't this supposed to be a fluff class?

It took a long time, but when I thought about it later I realized that the reason I thought it was so difficult was because of my preconceived notions of what it would be. I believed it was a fluff course, so was caught entirely off guard when it wasn't. I resented the professor for making it so difficult, when in reality the course was the professor's to design and not mine. She was the expert with decades of experience, not me. She knew what skills were important to develop in birdwatching, not me.

In the same way, you think you are being treated unfairly on this rotation because you came in with your own expectations. You believed that an outpatient rotation would be an easy respite -- not because that was ever told to you by your preceptor but because of your own personal beliefs of what the rotation should be. Your preceptor knows what skills and experiences are important for you, the student, to learn and is giving you that exposure. I imagine if you had this same experience on, say, a General Surgery rotation you wouldn't feel the same way because you would have expected it to be difficult.

This is good advice, and it seems to fit well with the suggestion on knowing the right attendings in advance and taking every rotation seriously.

 

[Mass Effect]

In the same way, you think you are being treated unfairly on this rotation because you came in with your own expectations. You believed that an outpatient rotation would be an easy respite -- not because that was ever told to you by your preceptor but because of your own personal beliefs of what the rotation should be. Your preceptor knows what skills and experiences are important for you, the student, to learn and is giving you that exposure. I imagine if you had this same experience on, say, a General Surgery rotation you wouldn't feel the same way because you would have expected it to be difficult.

This has very little to do with expectations and more to do with inappropriateness. It is inappropriate for an attending to expect an MS-3 to see patients q15 min all day long for 12+ hours. It is inappropriate for an attending to expect the MS-3 to scribe by doing most/all of the notes on those q15 min patients. It is inappropriate for an attending to pimp out the med student to scribe for the other attendings. It doesn't matter if it's surgery, FM, peds, psych, OB, or anything else. It's just plain inappropriate. A student's job is to learn. That's it. You don't learn by seeing patients so quickly that you don't get to ask history and actually learn what's going on. You don't learn by cranking out pointless notes because you don't have time to actually digest and research the information you're writing. This is a terrible rotation and I wouldn't hesitate to call the attending out on your eval.

 

[ciestar]

So how ‘bout them Lakers? LeBron going to win his 4th championship or what?

Trust the process

 

[hallowmann]

This has very little to do with expectations and more to do with inappropriateness. It is inappropriate for an attending to expect an MS-3 to see patients q15 min all day long for 12+ hours. It is inappropriate for an attending to expect the MS-3 to scribe by doing most/all of the notes on those q15 min patients. It is inappropriate for an attending to pimp out the med student to scribe for the other attendings. It doesn't matter if it's surgery, FM, peds, psych, OB, or anything else. It's just plain inappropriate. A student's job is to learn. That's it. You don't learn by seeing patients so quickly that you don't get to ask history and actually learn what's going on. You don't learn by cranking out pointless notes because you don't have time to actually digest and research the information you're writing. This is a terrible rotation and I wouldn't hesitate to call the attending out on your eval.

You actually learn quite a bit by seeing patients in primary care. Repetition is very valuable. On top of that, I don't think you are completely characterizing what OP has described to us.

This attending was on a regular basis providing the OP with articles, readings, discussing topics and even working with them to get a research experience (case study) out of it. Were they doing lots of hours and writing a lot of notes, yes, but when OP actually talked to them about not having time for things, the attending was actually receptive to that.

The inherent problem is an issue of expectation mismatch and bad timing. The OP had already gone through 2 blocks of long hour inpatient IM rotations, and this was meant to be a break so they could spend more time studying for the shelf. Instead it was a much busier rotation, that didn't give OP the time needed to study.

One of my best and earliest rotations in med school was a primary care rotation that was busy, involved seeing a lot of patients, reading a lot of articles, exposure to different clinical staff, and writing a bunch of notes. While in it, it was rough, and I was also anxious about the shelf. I ended up opting to postpone my shelf, and it actually took a lot of the pressure off and I learned a ton in the rotation. Later rotations were easier, I was clearly ahead of peers when it came to my comfort level seeing patients and writing notes. Studying for and taking the PE (CS equivalent) was a cake walk. The main preceptor also ended up writing one of my stronger LORs for residency. Overall it was actually a great experience despite the work and not knowing it at the time. Perhaps that shapes my judgement a bit, but I'm sure abusive experiences have colored some of the other responses on this thread as well.

I generally agree that there are abusive situations in med school (and residency for that matter) where you do end up doing a lot of busy work with limited learning. I also hate when people say, well I was abused so you should be too. It's pointless. That said, I would take a rotation working 65 hrs a week with weekends off actually seeing patients, being taught, and writing notes over shadowing for 50 hrs a week and getting almost nothing out of it.

Ideally OP would have had this rotation after their shelf, they would have been able to freely absorb the material without the stress of the shelf hanging over them, learn from the cases, write up the case reports, etc. Unfortunately, we can't always choose when we have what rotation. In this scenario, the best thing would have been to communicate with the attending and explain the situation with the shelf. I've also had to do this before in a similar situation (adjusting schedule for the sake of shelf studying), and usually it's received well enough by attendings.

I hope that the variety of responses and experiences expressed in this thread help OP and other med students in the future.

 

[Mass Effect]

You actually learn quite a bit by seeing patients in primary care. Repetition is very valuable

Repetition is valuable only when you understand what's going on. Seeing that many patients at that frequency does not allow you a chance to read through the chart and actually understand what's happening with the patient. All it allows is symptom assessment over and over and over again with no context and the same diagnosis that's already in the chart. That has very little value.

There should be a notable difference between a med student and a scribe. When I have an MS3, I see patients with him/her for the first few days, then ask the med student to see the patient and come back and talk to me about the patient. Meanwhile, I see any other patients waiting and allow the med student as much time as he/she needs. If he/she takes too long, that's what we talk about later in terms of feedback. Depending on how many patients the med student saw that day, I ask that he/she write a few notes and allow them ample time to do so because I write my own notes for the chart so even if the med student doesn't complete the notes until the next day, that's okay and will just be part of efficiency feedback. I then read the notes and go over them with the student at some point (admittedly, it sometimes has to wait until a day or so later due to time). I assign readings as well, but the readings are always relevant to shelf exams and/or common things every physician needs to know. The only time I ever ask my med student to see a patient for a different attending is if that attending has a zebra or if the attending has something the med student should see that my panel doesn't offer (for example, one of my colleagues had a catatonic patient recently discharged from the hospital; my med student saw that patient because I wanted him to be familiar with catatonia, the scales/diagnosis, and the treatment), but other than for educational purposes, my student works with me and does only the work that's educational.

 

[BigPikachu]

Meh. Am I overworked? I see about 40 to 50 paitents in the outpatient clinic each day, then have to do a round on the 10 to 20 on the inpatient ward. I work 10+ hours a day, 6 days a week, and about 300 days a year. And, I do all my own typing and paperwork.

 

[hallowmann]

Repetition is valuable only when you understand what's going on. Seeing that many patients at that frequency does not allow you a chance to read through the chart and actually understand what's happening with the patient. All it allows is symptom assessment over and over and over again with no context and the same diagnosis that's already in the chart. That has very little value.

There should be a notable difference between a med student and a scribe. When I have an MS3, I see patients with him/her for the first few days, then ask the med student to see the patient and come back and talk to me about the patient. Meanwhile, I see any other patients waiting and allow the med student as much time as he/she needs. If he/she takes too long, that's what we talk about later in terms of feedback. Depending on how many patients the med student saw that day, I ask that he/she write a few notes and allow them ample time to do so because I write my own notes for the chart so even if the med student doesn't complete the notes until the next day, that's okay and will just be part of efficiency feedback. I then read the notes and go over them with the student at some point (admittedly, it sometimes has to wait until a day or so later due to time). I assign readings as well, but the readings are always relevant to shelf exams and/or common things every physician needs to know. The only time I ever ask my med student to see a patient for a different attending is if that attending has a zebra or if the attending has something the med student should see that my panel doesn't offer (for example, one of my colleagues had a catatonic patient recently discharged from the hospital; my med student saw that patient because I wanted him to be familiar with catatonia, the scales/diagnosis, and the treatment), but other than for educational purposes, my student works with me and does only the work that's educational.

Your students are on Psychiatry rotations. That's the definition of a good psychiatry rotation.

You're assuming all primary care is is chronic condition management (digging in the chart, knowing what's going on before you go in, etc.). Its not. There's a lot of acute care and preventative care involved. You hear that murmur that you've only read about or heard digitally cleaned up. You hear it next to 10 other normal heart sounds. You see those 10 moles and are able to differentiate concerning features from not. You see lipomas, arcus senilis, glaucoma, jaundice, spider angiomata, etc. You actually hear crackles and rhonchi for the first time. You practice reassuring patients that all they have is a viral illness. You encourage people to invest in their healthcare with vaccinations and other preventative medicine. You actually feel a stiff fibrotic liver. You feel splenomegaly. You hear people's stories of addiction as they are initiating suboxone. You actually meet someone with uncontrolled ADHD in the primary care setting and see how disruptive it is in their life. These are literally the things I experienced in 4 wks on my busy primary care rotation. The only way you get this is by seeing a lot of patients. Seeing what's normal and what's not. There's a reason why the FM RRC requires a minimum number of outpatient continuity encounters (>1650) in training, and of those minimums for geriatric and pediatric patients.

A scribe is someone who sits quietly and listens to the doctor talk to a patient, documenting it. OP was actually interviewing and examining those patients, then the attending talks to them, and then OP writes the notes. That's not being a scribe, that's how medical student encounters work.

You and I will simply have to agree to disagree on this. Like I said, I get where OP is coming from, and it sucks being in that situation. It sucks that they have to worry about things like the shelf when they could just focus on those patients and absorbing those experiences. That's where communication has to come in.

 

[Angus Avagadro]

Meh. Am I overworked? I see about 40 to 50 paitents in the outpatient clinic each day, then have to do a round on the 10 to 20 on the inpatient ward. I work 10+ hours a day, 6 days a week, and about 300 days a year. And, I do all my own typing and paperwork.

Some here would think your are. This would be closer to the private practice norm when I talk to my friends. Some suggest the income makes it all better or you could just look for another job. Has not been my experience. My W-2 didnt take out the sting of having slept only 4 hrs over a call weekend Changing jobs takes many many factors into consideration. Spouses job, kids in school, etc., Not every less than ideal situation is abusive. Sometimes things are just hard.
I agree SDN should be a place to vent without harsh advice and be a place for collegial disagreement. Venting to non medical people wont provide much support.

 

[sunshinefl]

Meh. Am I overworked? I see about 40 to 50 paitents in the outpatient clinic each day, then have to do a round on the 10 to 20 on the inpatient ward. I work 10+ hours a day, 6 days a week, and about 300 days a year. And, I do all my own typing and paperwork.

Yes.

 

[aldol16]

I don't mind the long hours by themselves. What stresses me is not being able to study for shelf, not being able to master material needed to be a good doctor.

You have to realize that in a lot of cases, being present and engaged in what you're doing is studying for the shelf. Writing the assessment and plan - which is what most people care most about anyway - helps you reason out why you're doing what you're doing. You need to know and understand all that reasoning for the shelf. Did the attending say to do X Y or Z? If you don't understand, ask why. If they seem too busy to answer, look it up on UptoDate. That's studying right there.

As a future medical professional, you have to learn how to 1) carve out study time for yourself, i.e. on weekends or evenings and 2) learning on the fly and using each patient as a case to learn from. You're no longer a pre-clinical medical student where your only responsibility is learning from books. Now you're learning by doing, which I believe is a much more rewarding way to learn anyway.

***Also I apologize for quoting something from so long ago - I didn't realize I was only on the first page at the time.

 

[aldol16]

But if anybody feels like they are being mistreated, then they should make their case and reach out to the clerkship director, who should be taking these complaints seriously. If the student is afraid that it will negatively impact their evaluation, then there is the option to wait until after the clerkship and taking the issue up with the clerkship director, dean, or even the university ombudsman whose job is to investigate such claims. In most medical schools, there is a process by which to do all this that helps to protect and minimize the impact on the student, although one should realize that due to these protections, the individual being investigated may not actually see any consequences until months after the fact.

 

[acstylin]

Wow 6am to 8pm (on some weekdays) schedule. Sounds better than residency.

Wow an attending who pimps you and gives you relevant medical literature assignments to read. Sounds better than residency.

Wow an attending who lets you write notes so you can actually learn how to write a billable note and work on your documentation efficiency. Sounds like something that we don't let med students do because it takes more time to correct their notes than just do the notes ourselves.

Wow an attending who has asked their partners if you could be in their clinic (likely slowing them down). Sounds like an attending who cares about your education.

Wow the commute sucks. Sounds like not your attending's fault.


You might have found yourself in the unfortunate situation of having an attending who actually cares about your education. You should definitely write them up in your post-course review so they lose the will to teach future medical students. Or you could embrace the "challenge" of a 60 hour work week. Diligently study pimp topics that are "above your level" so they are no longer above your level. You may actually find that all the hard work you are doing studying topics while in clinic, and the higher volume of patients you are seeing then your fellow medical students pay off with an excellent shelf grade.

 

[BigPikachu]

I’m about to start med school this fall and as I was reading the op I couldn’t help but think the same thing as you. This would be a dream rotation for me, but I’m an older non-trad who is used to working 70+ hrs/week. I treat my apprentices (in my field of work) the same way the op is being treated and I feel like I’m giving them a tremendous opportunity to grow- one they might not find anywhere else.

I don't mind working 60 to 80 hours a week. Have been doing it for the last decade. Works well for me. You get used to it.

 

[Dr. Rafiki]

Meh. Am I overworked? I see about 40 to 50 paitents in the outpatient clinic each day, then have to do a round on the 10 to 20 on the inpatient ward. I work 10+ hours a day, 6 days a week, and about 300 days a year. And, I do all my own typing and paperwork.

Yes, you are. But by the looks of it you have chosen this schedule and you like it. Stop trying to downplay the adverse mental health effects of the OP's very specific situation. The toxic culture of medicine where we continually beat each other down is on full display here and you are doing well to highlight it.

 

[BigPikachu]

Yes, you are. But by the looks of it you have chosen this schedule and you like it. Stop trying to downplay the adverse mental health effects of the OP's very specific situation. The toxic culture of medicine where we continually beat each other down is on full display here and you are doing well to highlight it.

I'm not trying to 'beat anyone down' or encourage a 'toxic culture', I am simply highlighting the realites of medical practice that the stressors felt by medical students and junior doctors doesn't get any easier as a senior doctor.

The reality being that a career in medicine is hard work, and people should go in to it with a certain expectation and resilience concerning the demands of the job. Difficult supervisors and an overhwleming workload are inevitable in this career path (and in any other career for that matter). I'm simply illustrating a point of view of "choosing your battles"; the options for the OP are clear: either put up with it and leave the situation stronger and over and done with, or to seek help by speaking to her program supervisors or directors to feedback her situation.

Having said that I'm not using that as an excuse to dismiss the real issue of physician burnout and mental health, nor am I condoning the actions of this demanding preceptor. A good clinician should have enough insight and personal reflection to realise when they're overworked at the deteriment of his mental health and ability to provide good patient take, at which point they should step back and take time off or seek help. Talking in a safe place on this forum is one avenue of support to discuss a complicated situation and see how other people would approach the situation.

 

[Chemist0157]

I think experiences like this can be helpful. No doubt that was a busy month for an outpatient primary care med student block. Hopefully, you got something out of it. Doctors are very busy. I thought I was busy in medical school, and boy was I wrong. Intern year was certainly worse than the rest of residency, but I can think back to very busy weeks in fellowship and now as attending. The work does not generally slow down.

The points of being handed over to some other doctor who is not the preceptor are a bit unsavory, unless the other doctor was teaching you.

I am a little alarmed about the number of patients you saw, and the feeling you did not have much oversight sometimes. I would like to think the preceptor did whatever was appropriate as she is ultimately responsible. I was not there so I cannot know either way.

It sounds like the month would have been more manageable if you felt you had ample time to study for the shelf. That alone would have alleviated a lot of stress.