Dealing with difficult attendings as an intern

[Shya]

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I'm looking for advice on handling difficult attendings. I'm almost halfway done with my internship, and I'm finding that I'm butting heads a lot with some attendings. I'm from the South and I'm interning in New England, so I know that some of these feelings are just cultural differences, but I often feel like I'm being 'singled out' or brushed off. On Christmas day the attending on kept giving me any case that walked in the ER even though there were 3 other interns on with me. It was to the point that the case I signed up to see at noon didn't get seen until 3 or 4pm because I kept getting handed cases to start - as if they thought I was slacking and not actively working on something.

There are also times when I ask a question from an attending and am completely brushed off or get my head bit off because they didn't understand what exactly I was asking. For example, I had a mildly azotemic patient and I was trying to gauge if it should be hospitalized and the attending just looked at me and goes "... Possibly." Which is not a helpful answer. Am I being too sensitive? Do I just need to suck it up and get through the next 6 months? They've offered me a job at this ER . . .

 

[VIN-Foundation]

Sorry you are running into this. This is usually the toughest time of year for interns. The excitement has worn off and the grind is starting to wear you down ... but you're not close enough to the end that it's just around the corner.

Nothing you wrote sounds egregious. In fact, giving you more cases than the other interns may be because they trust you're the one that will take care of business. The fact that they've offered you a job is consistent with that.

If it was one specific attending you're having trouble with it might be worth having a chat to try and see what's up. But if it's several attendings I would be tempted to just keep my head down and power through.

 

[that redhead]

For example, I had a mildly azotemic patient and I was trying to gauge if it should be hospitalized and the attending just looked at me and goes "... Possibly." Which is not a helpful answer. Am I being too sensitive?

If I were the attending and an intern or even student came to me and said hey I have a mildly azotemic patient does it need to be hospitalized? I’d probably say the same thing Instead, act like the doctor. “Hey Dr. Attending, can I run this case by you? [insert brief synposis] I’m not thinking/I am thinking it needs to be hospitalized because of xyz factors I’ve considered, would you agree?/Does that seem reasonable?”

Next time they’re bombarding you with cases, you could say, “This would be a really great learning case, but I know Internmate doesn’t have anything right now and I’ve got seventeen hospitalized patients. Would you mind me sending this case to him?” That’s assuming you know exactly what else your fellow interns have on their plates

These are going to be your colleagues in the field, even if you don’t work at the site after internship; you can stand up for yourself and earn their respect. You can be polite and still set your boundaries.

 

[WhtsThFrequency]

I'm looking for advice on handling difficult attendings. I'm almost halfway done with my internship, and I'm finding that I'm butting heads a lot with some attendings. I'm from the South and I'm interning in New England, so I know that some of these feelings are just cultural differences, but I often feel like I'm being 'singled out' or brushed off. On Christmas day the attending on kept giving me any case that walked in the ER even though there were 3 other interns on with me. It was to the point that the case I signed up to see at noon didn't get seen until 3 or 4pm because I kept getting handed cases to start - as if they thought I was slacking and not actively working on something.

There are also times when I ask a question from an attending and am completely brushed off or get my head bit off because they didn't understand what exactly I was asking. For example, I had a mildly azotemic patient and I was trying to gauge if it should be hospitalized and the attending just looked at me and goes "... Possibly." Which is not a helpful answer. Am I being too sensitive? Do I just need to suck it up and get through the next 6 months? They've offered me a job at this ER . . .

Yes, you're being too sensitive. And I mean that very gently and without malice.

Unless your internmates were sitting on their hands with absolutely no cases while you kept being assigned cases, there may have been a million reasons why that happened. Perhaps your internmates had fewer cases, but they were more complex and/or emergent and required more attention. You never know what your colleagues may be dealing with in terms of their own workload. Perhaps as mentioned before, the attendings consider you someone who is very on top of your game and more able to handle multiple cases (this is the curse underneath the blessing of being good at what you do).

And yes, if I had an intern come up to me and say they had a mildly azotemic patient (of course I'm assuming here this was all the information you gave them, or did you do a proper thorough patient presentation and give your own opinion before asking theirs?) and ask if they needed to be hospitalized, I would give the same answer. Because that's all you can say with that much information. We aren't just here to answer question/give you the answer (even when the answer is simple, and it sounds like in this case it is not anyway), we are here to help you think diagnostically. When my students ask me a question such as "Should we test for XYZ" I will tell them "Possibly. why do you want to run it? What specific information will it give you? What are you looking for?" as a way for them to become more thorough and ultimately independent in their thinking process.

Rather than assuming that your attendings are being short with you because they "don't understand exactly what you are asking", try re-framing the situation - are you asking the question in a clear manner? Is there a more straightforward or detailed way you could have asked it to make your point more clear? Are you coming across as having thought through scenarios and done your own mental legwork to form your own opinion/plan, or do you come across as just wanting the easy answer?

As a semi-southerner with a northern-born partner (romantic, not business), I definitely understand what you mean about culture. It took me a bit to adapt to his natural bluntness, whereas I'm a "bless your heart-er" (in all the senses of the phrase, lol) who tiptoes around feelings quite a bit. The best thing I can tell you on that front it "People in the south are nice but not always kind, people in the north are kind but not always nice". I have found this to be very true. You'll adapt to it. Honestly, being around someone with a more blunt and no-nonsense personal style slowly helped me become more confident myself. Take the positive parts of that energy and use it.

 

[Minnerbelle]

"People in the south are nice but not always kind, people in the north are kind but not always nice". I have found this to be very true.

this is so deep

 

[DVMDream]

Yes, you're being too sensitive. And I mean that very gently and without malice.

Unless your internmates were sitting on their hands with absolutely no cases while you kept being assigned cases, there may have been a million reasons why that happened. Perhaps your internmates had fewer cases, but they were more complex and/or emergent and required more attention. You never know what your colleagues may be dealing with in terms of their own workload. Perhaps as mentioned before, the attendings consider you someone who is very on top of your game and more able to handle multiple cases (this is the curse underneath the blessing of being good at what you do).

And yes, if I had an intern come up to me and say they had a mildly azotemic patient (of course I'm assuming here this was all the information you gave them, or did you do a proper thorough patient presentation and give your own opinion before asking theirs?) and ask if they needed to be hospitalized, I would give the same answer. Because that's all you can say with that much information. We aren't just here to answer question/give you the answer (even when the answer is simple, and it sounds like in this case it is not anyway), we are here to help you think diagnostically. When my students ask me a question such as "Should we test for XYZ" I will tell them "Possibly. why do you want to run it? What specific information will it give you? What are you looking for?" as a way for them to become more thorough and ultimately independent in their thinking process.

Rather than assuming that your attendings are being short with you because they "don't understand exactly what you are asking", try re-framing the situation - are you asking the question in a clear manner? Is there a more straightforward or detailed way you could have asked it to make your point more clear? Are you coming across as having thought through scenarios and done your own mental legwork to form your own opinion/plan, or do you come across as just wanting the easy answer?

As a semi-southerner with a northern-born partner (romantic, not business), I definitely understand what you mean about culture. It took me a bit to adapt to his natural bluntness, whereas I'm a "bless your heart-er" (in all the senses of the phrase, lol) who tiptoes around feelings quite a bit. The best thing I can tell you on that front it "People in the south are nice but not always kind, people in the north are kind but not always nice". I have found this to be very true. You'll adapt to it. Honestly, being around someone with a more blunt and no-nonsense personal style slowly helped me become more confident myself. Take the positive parts of that energy and use it.

A wild and rare WTF sighting. Hope you're doing well.

(I agree with WTF by the way. Need more information about the mild azotemia and the patient, the history, the rest of the bloodwork, etc to answer the question. It may need hospitalization it may not. Please give more details and include a USG, I've lost count of the number of times I have to say we need a USG to further qualify azotemia, especially mild azotemia.)

 

[WhtsThFrequency]

this is so deep

There was some comedian once who did a bit talking about how if you blow a tire in the south, people will sadly cluck their tongues and say "Oh poor dear, what a terrible thing to happen, I do hope they get help and get home all right, thoughts and prayers, etc" but just keep driving by you. Whereas if you blow a tire in the north someone will stop, ask you pointedly why the f*** you didn't notice that you had a deep scrape on your sidewall, call you an idiot because you don't have a jack.....and then proceed to use theirs and change your tire for you." or something along those lines hahaha. A bit of an exaggeration, but you get what I mean.

A wild and rare WTF sighting. Hope you're doing well.

(I agree with WTF by the way. Need more information about the mild azotemia and the patient, the history, the rest of the bloodwork, etc to answer the question. It may need hospitalization it may not. Please give more details and include a USG, I've lost count of the number of times I have to say we need a USG to further qualify azotemia, especially mild azotemia.)

Yeah I still putter around here rarely. Doing all the professor things. Hope things are well with you and Na'vi (and her blurpy tongue haha) as well.

 

[Minnerbelle]

There was some comedian once who did a bit talking about how if you blow a tire in the south, people will sadly cluck their tongues and say "Oh poor dear, what a terrible thing to happen, I do hope they get help and get home all right, thoughts and prayers, etc" but just keep driving by you. Whereas if you blow a tire in the north someone will stop, ask you pointedly why the f*** you didn't notice that you had a deep scrape on your sidewall, call you an idiot because you don't have a jack.....and then proceed to use theirs and change your tire for you." or something along those lines hahaha. A bit of an exaggeration, but you get what I mean.

This is so good. Thanks for the laugh.

I’m no help in this conversation as I most definitely identify with the kind but not nice northerner. I’m really matter of fact with my responses and I’m sure that comes off rude to someone who isn’t used to that. But it’s not to make anyone feel bad or coming from a place of judgment.