Disaster

[ocean11]

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I HATE MY SUB-I..... man just when I thought things were getting better in my fourth year, my SUB-I hit. My last rotation was pretty laid back, cardiology, did well in it, not the most interesting, but not too high stress either.

ANYHOW, fast fwd to today! finished a week and a half of my sub I and I hate my senior resident. He dosn't really like me and tends to favor the other med students on the team. He's given me the worst patients: ones that I can't present b/c their admission is very simple (ie: a 90 y/o woman admitted for a simple fall about to be d/c). Anyhow, today I made the mistake of coming in late--> no tmie to preround--> patient crashed two hours later (she was 95)--> resident was super pissed that I didn't preround (yes I take the blame)--> yelled at me for a bunch of other things--> tells me I'm the worst Sub I ever--> I start to cry, couldn't even help the patient when I was needed to be there-->two hours later, resident tells me that he's done all the work for me. He's super dissapointed and well... yeah I am horrified with my own performance today. This has never happened to me before! but I've seen in happen to many other residents/students/interns..... all I can do is try harder tomorrow.... facing everyone is going to be hard.... I feel like such a screw up! I hope to pass this rotation.... perhaps I should go into psych and forget about IM.... I'm seriously considering Psych now!

Ocean1🙁

 

[Medstudentquest]

I HATE MY SUB-I..... man just when I thought things were getting better in my fourth year, my SUB-I hit. My last rotation was pretty laid back, cardiology, did well in it, not the most interesting, but not too high stress either.

ANYHOW, fast fwd to today! finished a week and a half of my sub I and I hate my senior resident. He dosn't really like me and tends to favor the other med students on the team. He's given me the worst patients: ones that I can't present b/c their admission is very simple (ie: a 90 y/o woman admitted for a simple fall about to be d/c). Anyhow, today I made the mistake of coming in late--> no tmie to preround--> patient crashed two hours later (she was 95)--> resident was super pissed that I didn't preround (yes I take the blame)--> yelled at me for a bunch of other things--> tells me I'm the worst Sub I ever--> I start to cry, couldn't even help the patient when I was needed to be there-->two hours later, resident tells me that he's done all the work for me. He's super dissapointed and well... yeah I am horrified with my own performance today. This has never happened to me before! but I've seen in happen to many other residents/students/interns..... all I can do is try harder tomorrow.... facing everyone is going to be hard.... I feel like such a screw up! I hope to pass this rotation.... perhaps I should go into psych and forget about IM.... I'm seriously considering Psych now!

Ocean1🙁

Sorry about your situation. While it is really unfortunate that the day that you came in late your patient happened to crash, I don't think it's the end of the world. Btw-is the patient ok? If you've apologized and normally do good work and continue to work hard and be responsible, I assume you can get past this. I doubt it that it would cause that much damage to you matching into IM. IM is not super competitive and if you have done well thus far, you should be ok. Why would you consider switching to psych? It's an awsome field, but I don't see why you would make the switch just because of this?

 

[Hard24Get]

Sorry about your situation. While it is really unfortunate that the day that you came in late your patient happened to crash, I don't think it's the end of the world. Btw-is the patient ok? If you've apologized and normally do good work and continue to work hard and be responsible, I assume you can get past this. I doubt it that it would cause that much damage to you matching into IM. IM is not super competitive and if you have done well thus far, you should be ok. Why would you consider switching to psych? It's an awsome field, but I don't see why you would make the switch just because of this?

I disagree with the tone of this post, Medstudentquest. As a sub-I, you are supposed to be responsible for the vast majority of the patient's care. Many times when patient's crash the team can look back can look back and see where SOMEBODY missed the warning signs they were about to crash and/or failed to react appropriately - that somebody is usually the intern or the sub-I (who should have backup until they have proven themselves, of course). So I wouldn't say the patient "happened" to crash.

And I wouldn't be so blithe as to say, "it's not the end of the world". It isn't, but it IS a big deal since people will be checking up on us even less 11 mos from now. And Ocean 11 is right to accept some blame - it is likely that by prerounding properly, he or she could have intervened on the impending crash. These are serious lessons we learn in medicine because we learn them many time to the detriment of our patients.

Ok, done with the sermon to Medstudentquest (sorry). ocean11, you need to sit down with your resident and go over (calmly) all the things he thinks you are doing wrong. It was inappropriate of you to be late and not preround and it was inappropriate of him to yell at you, especially the things he said. Hopefully he will also be ashamed and agree this is a good time to regroup. There is often constructive criticism to be found amidst the anger and perceived prejudice. You may even find you are getting the simpler patients because he doesn't trust you for some reason. Go over each problem, discuss how to address it, take notes, and make promises. Forget about hating him and concentrate on learning from him.

It is important to address these issues fast so you can get the most out of this rotation and salvage your grade (BTW, really streamline and add educational value to your presentations to impress your attending - you may need his/her support if this guy truly doesn't like you/won't work with you).

 

[Tired]

I disagree. Write off this bad-luck rotation and move on. If you can drop it now, do it. If not, suck it up and tough out the rest, but certainly don't sit down with someone you think has a personal animous towards you and ask about your deficiencies. So you f-ed up a day, and it was a day where someone tanked. That sucks, but life does go on (yours, anyway).

Despite the overly serious tone of Hard24Get, this isn't your responsibility, it's your Chiefs. And a good Chief would have pointed out that the buck stops with him, not you.

 

[Medstudentquest]

I disagree. Write off this bad-luck rotation and move on. If you can drop it now, do it. If not, suck it up and tough out the rest, but certainly don't sit down with someone you think has a personal animous towards you and ask about your deficiencies. So you f-ed up a day, and it was a day where someone tanked. That sucks, but life does go on (yours, anyway).

Despite the overly serious tone of Hard24Get, this isn't your responsibility, it's your Chiefs. And a good Chief would have pointed out that the buck stops with him, not you.

I concur. I mean it is definitely not good that he/she was late and did not pre-round and that unfortunately that happened to be the day the patient crashed. But ultimately, it is the responsibility of the senior to round on all patients and make sure that all patients are taken care of. This is not to say that Ocean did not have a responsibility, he/she did. He/she screwed up yes, but it happens to the best of us. I have seen much worse (i.e.: chief resident continuing to operate after her arm got contaminated for example in a patient who had leukemia and disastrous consequences, etc) so it is certainly not the end of the world. I agree w/you that it wouldn't be wise to sit down w/the senior because the only thing that will do is tear him to shreds. Again, Sub-I definitely screwed up, not saying he didn't-he needs to apologize, keep working hard and move on. The senior however should still have cheked up on the patient.

 

[Medstudentquest]

I disagree with the tone of this post, Medstudentquest. As a sub-I, you are supposed to be responsible for the vast majority of the patient's care. Many times when patient's crash the team can look back can look back and see where SOMEBODY missed the warning signs they were about to crash and/or failed to react appropriately - that somebody is usually the intern or the sub-I (who should have backup until they have proven themselves, of course). So I wouldn't say the patient "happened" to crash.

And I wouldn't be so blithe as to say, "it's not the end of the world". It isn't, but it IS a big deal since people will be checking up on us even less 11 mos from now. And Ocean 11 is right to accept some blame - it is likely that by prerounding properly, he or she could have intervened on the impending crash. These are serious lessons we learn in medicine because we learn them many time to the detriment of our patients.

Ok, done with the sermon to Medstudentquest (sorry). ocean11, you need to sit down with your resident and go over (calmly) all the things he thinks you are doing wrong. It was inappropriate of you to be late and not preround and it was inappropriate of him to yell at you, especially the things he said. Hopefully he will also be ashamed and agree this is a good time to regroup. There is often constructive criticism to be found amidst the anger and perceived prejudice. You may even find you are getting the simpler patients because he doesn't trust you for some reason. Go over each problem, discuss how to address it, take notes, and make promises. Forget about hating him and concentrate on learning from him.

It is important to address these issues fast so you can get the most out of this rotation and salvage your grade (BTW, really streamline and add educational value to your presentations to impress your attending - you may need his/her support if this guy truly doesn't like you/won't work with you).

I never meant that Ocean11 had no responsibility for what happened. He/she made a mistake yes, but that doesn't mean that it will forever ruin his/her career. What is Ocean going to do-drop out of school because he/she screwed up? No, Ocean will have to improve, work harder possibly, and make sure he/she never forgets this lesion. He/she should definitely accept part of the blame for what happened yes, but so should the senior. The senior must check up on every single patient. Seniors are responsible for the patients of the sub-I, interns, and more senior residents on the team. Again, while Ocean's actions were inappropriate in that he/she did not show up on time, it is also inappropriate that the senior didn't check on the patient before. It's also not to say that even if Ocean would have checked on the patient the patient wouldn't have crashed. So while this is unfortunate, sitting down with the resident will only give him and opportunity for the resident to rip him/her apart and ultimately destroy the rotation. I wouldn't recommend that.

 

[Hard24Get]

I never meant that Ocean11 had no responsibility for what happened. He/she made a mistake yes, but that doesn't mean that it will forever ruin his/her career. What is Ocean going to do-drop out of school because he/she screwed up? No, Ocean will have to improve, work harder possibly, and make sure he/she never forgets this lesion. He/she should definitely accept part of the blame for what happened yes, but so should the senior. The senior must check up on every single patient. Seniors are responsible for the patients of the sub-I, interns, and more senior residents on the team. Again, while Ocean's actions were inappropriate in that he/she did not show up on time, it is also inappropriate that the senior didn't check on the patient before. It's also not to say that even if Ocean would have checked on the patient the patient wouldn't have crashed. So while this is unfortunate, sitting down with the resident will only give him and opportunity for the resident to rip him/her apart and ultimately destroy the rotation. I wouldn't recommend that.

I still disagree with all of you. What kind of doctor ducks his or her head in the sand when accused of a fault? They will still have daily contact with the guy, might as well get it over with.
And I think it's weird that people as close to graduating as I am are still happily bumping off responsibility to others (and since when do chief residents preround on everyone?).

Whatever.

 

[DoctorPhud]

.

 

[jennyboo]

Sorry your sub-I didn't get off to a good start! Here are some thoughts I have.

You only need to PASS this rotation. That's right, the main purpose and the minimum amount you have to do is to get credit for this month so that you can graduate. Do not get too stressed out about your evaluations. This is not going to make or break your Residency Match. At worst, if you did not get great evaluations this month, you can negotiate with your dean's letter writer to (ahem) not mention the negative review in your dean's letter, which they most likely would not do anyway. You can also (at worst) do a second sub-I and get a good evaluation from that.

Some perspective on why your resident is assigning you boring patients. I'm guessing that he probably thinks it would make life easier for both you and him to give you simple patients. Residents will usually try to avoid assigning unstable or complicated patients to students, and try to assign those with only one problem who will hopefully be discharged pretty quickly. Unfortunately, this often backfires -- sometimes simple patients turn out to be complicated, or gomers who look like they should be gone in a day end up sitting around waiting for a rehab bed for a week. Unfortunately, you don't learn very much from that. And unfortunately, since you were assigned the patient as a sub-I and not as an MS-3, it's more of a hassle to re-assign the patient to one of the interns and you can't simply ask to be relieved of aforementioned gomer who sits around for a week. So you have to take this without complaint (as does everyone who is actually paid to work in the hospital) -- but if you have an honest feedback session, you can gently remind your resident that you would like to handle more than just the simple patients. You can ask for specific things, such as "Can I get a GI case next time?" -- IF you have demonstrated that you are succeeding in managing your current patients well.

You did not make the patient crash. Yeah, it was obviously very unprofessional of you to arrive late (maybe you had a good reason, maybe not -- at this point, doesn't matter). But like many of us, it often happens that we see the patient in the morning and they look fine and then they crump. You didn't do that. Your vigilance (or lack there-of) most likely didn't cause that. You aren't expected to have the experience to see and recognize situations that are going south, although if you can catch such things, good for you and you're doing well. If something was obviously declining in the hours before, the night float or the resident should have seen it -- and maybe there was nothing. It doesn't matter.

 

[Top Gun]

I still disagree with all of you. What kind of doctor ducks his or her head in the sand when accused of a fault? They will still have daily contact with the guy, might as well get it over with.
And I think it's weird that people as close to graduating as I am are still happily bumping off responsibility to others (and since when do chief residents preround on everyone?).

Whatever.

Sigh...

Yes, the OP screwed up. But no one is just bumping off responsibility to others. The OP has even taken her share of the blame for the mistake. The OP is still a student and the senior resident still has ultimate responsibility for the patients. Anyway, hopefully the OP has learned from her mistake and will not repeat it.

 

[Medstudentquest]

Sigh...

Yes, the OP screwed up. But no one is just bumping off responsibility to others. The OP has even taken her share of the blame for the mistake. The OP is still a student and the senior resident still has ultimate responsibility for the patients. Anyway, hopefully the OP has learned from her mistake and will not repeat it.

Ding ding ding!!

 

[Hard24Get]

Sigh...

Yes, the OP screwed up. But no one is just bumping off responsibility to others. The OP has even taken her share of the blame for the mistake. The OP is still a student and the senior resident still has ultimate responsibility for the patients. Anyway, hopefully the OP has learned from her mistake and will not repeat it.

Funny enough, I had no problem with anything the OP said. Not jumping on him or her, I took issue with what other posters said. Never attacked the OP and offered advice I thought was appropriate. I am done now. 🙄

 

[ocean11]

Thanks for the kind responses everyone, it is much appreciated.

Today I came in extra early, pre-rounded checked out the heart monitor, got vitals, talked to the nurses etc etc... my resident isn't that concerned anymore b/c she's DNR/DNI. He should have done that from the beginnign since she is 95 y/o with dementia and cachexia.... but I suppose 'he forgot' which is why he was pissed off at me yesterday. Anyhow.... yeah I totally take most of the blame.

Well today he is still an a$$ to me, ignoring me and talking to the two other sub-Is on the team.... and he nitpicks at small things. He actually asked me 'did you see your patient this morning, b/c you told me her NRB mask was on and it was off' when I told him I was DEFINETLY there and did everything, he said 'well make sure her restraints are tight next time so she can't take off the mask'.... then he felt somewhat bad and said 'its not your fault, but the nurses....' and then meakly said 'good job' as I left the residents lounge quickly! all the nurses and secretaries here hate him. One of them told me that he wrote her up last week, she was super upset!

Anyhow, hopefully this won't destroy my eval, nxt week I get new residents and have just over a week with them, so maybe they will do my evaluations. This guy just sucks!

thanks for the support.... 6 more days and counting until switch day!

Ocean11

PS: the patient is doing fine, still suffering from dementia and barely responsive, but otherwise VSS and is doing well 'relatively'.

 

[jennyboo]

Thanks for the kind responses everyone, it is much appreciated.

Today I came in extra early, pre-rounded checked out the heart monitor, got vitals, talked to the nurses etc etc... my resident isn't that concerned anymore b/c she's DNR/DNI. He should have done that from the beginnign since she is 95 y/o with dementia and cachexia.... but I suppose 'he forgot' which is why he was pissed off at me yesterday. Anyhow.... yeah I totally take most of the blame.

Well today he is still an a$$ to me, ignoring me and talking to the two other sub-Is on the team.... and he nitpicks at small things. He actually asked me 'did you see your patient this morning, b/c you told me her NRB mask was on and it was off' when I told him I was DEFINETLY there and did everything, he said 'well make sure her restraints are tight next time so she can't take off the mask'.... then he felt somewhat bad and said 'its not your fault, but the nurses....' and then meakly said 'good job' as I left the residents lounge quickly! all the nurses and secretaries here hate him. One of them told me that he wrote her up last week, she was super upset!

Anyhow, hopefully this won't destroy my eval, nxt week I get new residents and have just over a week with them, so maybe they will do my evaluations. This guy just sucks!

thanks for the support.... 6 more days and counting until switch day!

Ocean11

PS: the patient is doing fine, still suffering from dementia and barely responsive, but otherwise VSS and is doing well 'relatively'.

Good for you for going back the next day and doing your best.

Sounds like your resident is well known to be a "bad resident," i.e. one who is not good to work with, micromanages on nitpicky details, gives poor feedback, has a negative attitude, and is unpleasant. If you are a person who gets along with the vast majority of people pretty well, then it sounds like you may have just gotten the luck of the draw in getting assigned to this person. Don't waste your effort trying to people-please a resident with a negative attitude -- as it turns out, those are also the people whose evaluations of their teams is looked upon skeptically. His program director and chief residents probably already know that he's not a good resident, and as such, take his opinions with a grain of salt.

It is not your job to make sure the patient's restraints are "tight" (it's the nurses'). As long as you've made sure the order is written for her to have them and the ordered is appropriately renewed when it expires, you have done your job. Oxygen masks go on and off the patient all day, so it was silly of him to make that snide comment. Do your best according to what you know of patient care and medical management, and beyond that don't worry about people-pleasing your resident.

And now is a GREAT time to start practicing your "Are you full code or DNR?" talk while you're admitting patients. This is not an easy topic to cover, especially since they don't teach you how to do it in medical interviewing. It is actually YOUR job to obtain code status for every patient you admit, and it's a good opportunity to practice. Take advantage of it and include it in your H&P!

 

[Hard24Get]

Thanks for the kind responses everyone, it is much appreciated.

Today I came in extra early, pre-rounded checked out the heart monitor, got vitals, talked to the nurses etc etc... my resident isn't that concerned anymore b/c she's DNR/DNI. He should have done that from the beginnign since she is 95 y/o with dementia and cachexia.... but I suppose 'he forgot' which is why he was pissed off at me yesterday. Anyhow.... yeah I totally take most of the blame.

Well today he is still an a$$ to me, ignoring me and talking to the two other sub-Is on the team.... and he nitpicks at small things. He actually asked me 'did you see your patient this morning, b/c you told me her NRB mask was on and it was off' when I told him I was DEFINETLY there and did everything, he said 'well make sure her restraints are tight next time so she can't take off the mask'.... then he felt somewhat bad and said 'its not your fault, but the nurses....' and then meakly said 'good job' as I left the residents lounge quickly! all the nurses and secretaries here hate him. One of them told me that he wrote her up last week, she was super upset!

Anyhow, hopefully this won't destroy my eval, nxt week I get new residents and have just over a week with them, so maybe they will do my evaluations. This guy just sucks!

thanks for the support.... 6 more days and counting until switch day!

Ocean11

PS: the patient is doing fine, still suffering from dementia and barely responsive, but otherwise VSS and is doing well 'relatively'.

He sucks, but he does seem to realize he was over the top yesterday. Thank goodness he is leaving, I thought he was doing your whole eval which is why I said you should sit down with him. Keep up the good work and he will get over it by the time he leaves and definitely by the time he writes your eval.

Why are there so many sub-Is on this team, anyway? 😕

 

[ocean11]

Hey guys,

I might even get away with him NOT writing my eval at all, b/c we give the names of the residents we want to evaluate us, and I definetly will NOT put his name down, since luckily we get other senior residents next week! I just hope he dosn't bad mouth me, or go to the director, since he has written up nurses in the past... I'm just going to do my best and try to forget about this...

and yeah its sucks that there are five of us on this sub-i team b/c we are compared to one another and I'm not looking so good right now! I didn't know it was going to be structured like this, otherwise I would have picked a different location.... oh well.... gotta make the best out of this.... this entire experience this has soured me completely on internal medicine! I'm seriously considering family now or maybe even psych.... I hate the drama of hospitals..... I just want to work in clinics!

 

[Final]

I HATE MY SUB-I..... man just when I thought things were getting better in my fourth year, my SUB-I hit. My last rotation was pretty laid back, cardiology, did well in it, not the most interesting, but not too high stress either.

ANYHOW, fast fwd to today! finished a week and a half of my sub I and I hate my senior resident. He dosn't really like me and tends to favor the other med students on the team. He's given me the worst patients: ones that I can't present b/c their admission is very simple (ie: a 90 y/o woman admitted for a simple fall about to be d/c). Anyhow, today I made the mistake of coming in late--> no tmie to preround--> patient crashed two hours later (she was 95)--> resident was super pissed that I didn't preround (yes I take the blame)--> yelled at me for a bunch of other things--> tells me I'm the worst Sub I ever--> I start to cry, couldn't even help the patient when I was needed to be there-->two hours later, resident tells me that he's done all the work for me. He's super dissapointed and well... yeah I am horrified with my own performance today. This has never happened to me before! but I've seen in happen to many other residents/students/interns..... all I can do is try harder tomorrow.... facing everyone is going to be hard.... I feel like such a screw up! I hope to pass this rotation.... perhaps I should go into psych and forget about IM.... I'm seriously considering Psych now!

Ocean1🙁

hey wheres my orchestra? oh founded it:

 

[MeowMix]

Ocean, I am sorry to point this out, but you are a total drama queen (at least on SDN). Every rotation turns into a deep emotional gut-wrenching experience complete with the Worst Resident Ever. At this rate, you will be wrung out by the time you reach the second month of intern year, and so will we. It's like reading about Britney or Paris or Brangelina. So I think I better just stop reading your posts, for my own peace of mind.

 

[ocean11]

Ocean, I am sorry to point this out, but you are a total drama queen (at least on SDN). Every rotation turns into a deep emotional gut-wrenching experience complete with the Worst Resident Ever. At this rate, you will be wrung out by the time you reach the second month of intern year, and so will we. It's like reading about Britney or Paris or Brangelina. So I think I better just stop reading your posts, for my own peace of mind.

It's funny, if you knew me, I am really NOT a drama queen, nice of you to make assumptions based one what? 3 posts over the past couple of months?!?! if you look closely, I've posted on completely different topics too over the past couple of years, given advice and helped people out, but no lets focus on the negative..... nice to know that there are people like you out there....

Anyhow, I'm trying to focus on the positive now, so I think I'll ignore any more posts by you 🙂 ....

6 more days until a new resident comes in 🙂 YEY!

 

[Medstudentquest]

Ocean, I am sorry to point this out, but you are a total drama queen (at least on SDN). Every rotation turns into a deep emotional gut-wrenching experience complete with the Worst Resident Ever. At this rate, you will be wrung out by the time you reach the second month of intern year, and so will we. It's like reading about Britney or Paris or Brangelina. So I think I better just stop reading your posts, for my own peace of mind.

Oh come on now. Can't we all just get along?

 

[DebDynamite]

I HATE MY SUB-I...... I feel like such a screw up! I hope to pass this rotation.... perhaps I should go into psych and forget about IM.... I'm seriously considering Psych now!

Ocean1🙁

Wow.

I'm really glad your confidence is on the rebound. I would hate it for you to have to go into Psych.

 

[Medstudentquest]

Wow.

I'm really glad your confidence is on the rebound. I would hate it for you to have to go into Psych.

Hey! Why is everyone putting down psych? I love psych and am thinking of going into it. What's so wrong with psych?

 

[DebDynamite]

Hey! Why is everyone putting down psych? I love psych and am thinking of going into it. What's so wrong with psych?

Hey!

I'm going into Psych. I love, love, love Psych.

I have three Internal Medicine docs in my family. One is super connected to a group of internists who are all in the top 5% nationwide when it comes to both salary and work hours.

I have no doubt that: #1. I can ahhem, "cut it" in medicine, and #2. Land a job in medicine that many would find super appealing. I am choosing psych, and will actively pursue a program where my colleagues are not those who feel that can't cut it in medicine.

Peace Out.

 

[ocean11]

well... this morning I saw my patient who was resting and not very active as usual. I did examine her.... 2 hours later, my residents starts yelling about how she has no bowel sounds and why I didn't tell him... I did hear bowel sounds... anyhow, turns out she dosn't have a SBO, but possibly ileus as per x-ray. Man.... I can't believe I missed this! I'm super mad at myself.... the resident dosn't even believe I pre-roudned on her! anyhow, I don't think there is any way I can salvage what he thinks of me, but I am stopping to care, because really, honestly, is this really going to affect my life? is it going to destroy me in the long term? NO! ultimately, I'm going to learn from all these mistakes and take something positive out of it. I'm going to be SO thorough with my patients from now on and am going to try hard not to miss anything.

Its funny though, I hear MANY stories about doctors (in all specialties) who miss something here and there.... perhaps I'm not the only one. But I will get better, i will learn from this and just move on. I hope that in a few weeks I can look back and laugh, right now its kinda hard, but I'm sure I'm not the only one going through this!

5 more days and then a new resident! and a new chance...

good luck all (and thanks for the kind comments)😍

 

[RockShox]

well... this morning I saw my patient who was resting and not very active as usual. I did examine her.... 2 hours later, my residents starts yelling about how she has no bowel sounds and why I didn't tell him... I did hear bowel sounds... anyhow, turns out she dosn't have a SBO, but possibly ileus as per x-ray. Man.... I can't believe I missed this! I'm super mad at myself.... the resident dosn't even believe I pre-roudned on her! anyhow, I don't think there is any way I can salvage what he thinks of me, but I am stopping to care, because really, honestly, is this really going to affect my life? is it going to destroy me in the long term? NO! ultimately, I'm going to learn from all these mistakes and take something positive out of it. I'm going to be SO thorough with my patients from now on and am going to try hard not to miss anything.

Its funny though, I hear MANY stories about doctors (in all specialties) who miss something here and there.... perhaps I'm not the only one. But I will get better, i will learn from this and just move on. I hope that in a few weeks I can look back and laugh, right now its kinda hard, but I'm sure I'm not the only one going through this!

5 more days and then a new resident! and a new chance...

good luck all (and thanks for the kind comments)😍

What a tool. Its his ******* own fault. He/She should be do their own exam and not simply using you to be a note/exam jocky. This crap does not stop after residency either. These are the types of docs that get a call and instead of seeing the patient themselves get some nurse to do this or that. It catchs up to them eventually when someone gets hurt. It is not your fault if you did or did not hear the bowel sounds. You are still very young in your training. You did the exam you were supposed to. The resident is paid to be responsible and do is own work.

 

[ocean11]

What a tool. Its his ******* own fault. He/She should be do their own exam and not simply using you to be a note/exam jocky. This crap does not stop after residency either. These are the types of docs that get a call and instead of seeing the patient themselves get some nurse to do this or that. It catchs up to them eventually when someone gets hurt. It is not your fault if you did or did not hear the bowel sounds. You are still very young in your training. You did the exam you were supposed to. The resident is paid to be responsible and do is own work.

thanks for the kind words....I suppose he made it feel like my responsibility b/c we don't have interns on our team and he told us 'you HAVE to function like an intern' and 'you're a fourth year now'. So I felt totally incompetent and stupid. I didn't get the best training during my medicine clerkship, the residents there barely examined patient's in the morning and would just walk into the room and 'eyeball' them. If the patient was there for a cardiac issue, they would NOT listen to the abdomen or examine anything other than the heart or lungs. I started out examining the entire patient every morning, until the residents told me not to bother, just a 'focused exam' which is why I missed it on this current patient. Not to mention she suffers from dementia, and she can't talk or verbalize ANY complaints. She's in restraints so she can't even point to anything. She's been unhappy since day 1 and after a few abd xrays and chest xrays we found nothing.... anyhow, as a 'just starting' fourth year med student, a very VERY challenging case. The one good thing is that I've learned alot from it. I've learned that with these very elderly patients, anything can happen ANYTHING.... so examine the ENTIRE patient EVERY morning, not just the heart and lungs and extremities, but to look closely at EVERYTHING! Its a VERY good learning experience for me. The funny thing is the resident OR attending NEVER watched for this either!

I think it would be nice if my resident treated me better, explained things in a non-confrontational way and didn't expect me to be an intern, b/c I'm not one yet! but I am trying and will improve and won't take his shait personally! anyhow, today I'm on overnight call with this tool! lets hope its not too bad, if it is I will complain, I don't care too much for my evaluation anymore, I've gotten straight A's in almost everything this year, so my sub-I won't hurt my applications (too much hopefully). Anyhow, Pray for me tonight.... much love

Ocean11

 

[Final]

thanks for the kind words....I suppose he made it feel like my responsibility b/c we don't have interns on our team and he told us 'you HAVE to function like an intern' and 'you're a fourth year now'. So I felt totally incompetent and stupid. I didn't get the best training during my medicine clerkship, the residents there barely examined patient's in the morning and would just walk into the room and 'eyeball' them. If the patient was there for a cardiac issue, they would NOT listen to the abdomen or examine anything other than the heart or lungs. I started out examining the entire patient every morning, until the residents told me not to bother, just a 'focused exam' which is why I missed it on this current patient. Not to mention she suffers from dementia, and she can't talk or verbalize ANY complaints. She's in restraints so she can't even point to anything. She's been unhappy since day 1 and after a few abd xrays and chest xrays we found nothing.... anyhow, as a 'just starting' fourth year med student, a very VERY challenging case. The one good thing is that I've learned alot from it. I've learned that with these very elderly patients, anything can happen ANYTHING.... so examine the ENTIRE patient EVERY morning, not just the heart and lungs and extremities, but to look closely at EVERYTHING! Its a VERY good learning experience for me. The funny thing is the resident OR attending NEVER watched for this either!

I think it would be nice if my resident treated me better, explained things in a non-confrontational way and didn't expect me to be an intern, b/c I'm not one yet! but I am trying and will improve and won't take his shait personally! anyhow, today I'm on overnight call with this tool! lets hope its not too bad, if it is I will complain, I don't care too much for my evaluation anymore, I've gotten straight A's in almost everything this year, so my sub-I won't hurt my applications (too much hopefully). Anyhow, Pray for me tonight.... much love

Ocean11

you are starting to get very annoying. please just deal with it like the rest of us do. i am so sad that you are my future colleague. yech.

 

[ocean11]

you are starting to get very annoying. please just deal with it like the rest of us do. i am so sad that you are my future colleague. yech.

If u have nothing nice to say, don't say anything at all

have a great day🙂

Ocean11

 

[misery]

I love student like you, they just make the rest of us that aren't completely whacked out look good. I mean c'mon are you seriously in your 4th year complaining on SDN about how the "big mean resident was snide to you" Get your panties out of a wad, quit bitchin', and start working.

 

[SkylineMD]

i think at some point you have to realize that its all on on you. Earlier in the thread you talked about taking responsibility and admitting that you messed up which made it seem as if you were being very mature about the matter.

Now all you can talk about all the horrible training you received, how the resident is unfair, how the patient can't verbalize anything, how its a difficult case etc (insert more "the world is against me" story). You've totally regressed to being a 2 year old child wanting someone to hold your hand, not say anything mean to you, yell at you, etc. Look around at the rest of the sub-i's and if they aren't complaining as much as you, then you've found your problem. It would just be best to suck it up and stop whining.

Your previous post about "if you have nothing nice to say ..." is a silly immature statement to make because you're once again falling back to "don't be mean to me" mentality. Just grow up because at least you're getting slack as a 4th year - all sub-i's are expected to act as INTERNS as the name implies. If you did this as an actual intern, you might end up knowing the members of the morbidity and mortality committee very well.

 

[ocean11]

😍

I love student like you, they just make the rest of us that aren't completely whacked out look good. I mean c'mon are you seriously in your 4th year complaining on SDN about how the "big mean resident was snide to you" Get your panties out of a wad, quit bitchin', and start working.

😍

 

[kat82]

wow, why is everyone getting so mean all of a sudden? im going to stick up for ocean11 here. it sounds like her resident was definitely rude and unfair towards her and singled her out. if this has ever happened to you, then you might have a little more sympathy. fine, you could argue that it was her fault (i still dont think the sub-i should be where the buck stops) but the resident could have taken a much less abusive approach to the whole thing. everyone has a bad day now and then and i thought this forum was a place where people could vent and feel supported by fellow sdn-ers.

as a sub-i, i guess its a good learning experience because things like that may happen as an intern. but i dont think its fair to keep saying that shes supposed to BE the intern. sub-i is NOT your internship. its where you learn how to be an intern and try your hardest to act like an intern. the resident should be taking ultimate responsibility, especially when theres a sub-i involved and NOT the intern. i think they should be watching a little more closely. the resident was probably just angry and taking it out on her

everyone makes mistakes. for those of you who are medical students and all high on yourselves because you didnt make any mistakes on your sub-i, i would just wait and see what happens next year as an intern because thats when the real world starts

so please people, cant we all just get along?

 

[Tired]

as a sub-i, i guess its a good learning experience because things like that may happen as an intern. but i dont think its fair to keep saying that shes supposed to BE the intern. sub-i is NOT your internship. its where you learn how to be an intern and try your hardest to act like an intern. the resident should be taking ultimate responsibility, especially when theres a sub-i involved and NOT the intern. i think they should be watching a little more closely. the resident was probably just angry and taking it out on her

Let's make a point of distinction here:

If she wants to get into this program, or is looking for a good letter, then yes, she does need to be the intern. That's how you impress a program and get them to select you.

If she was just doing it as an elective, or to get a little experience, then she can do whatever the hell she wants.

MSIV year is about you. You set the expectations on each of your rotations, and there is very little (other than yelling) that people can do to you.

 

[kat82]

my thoughts are that if you are a sub-i you do not yet have your MD, do you? being a sub-i is part of your medical school education. yes, you should definitely strive to function as an intern if you want to get top grades and impress people. and you should strive to function as an intern so that it will help prepare you for your intern year. but you are NOT the actual intern. when i am a resident, i will definitely be watching the sub-i's closely because i dont think you can trust them entirely, no matter how smart/responsible they are.

i think its fair to get reprimanded for being late/missing something important, but it was an honest mistake and the resident responded unprofessionally. it sounds like others have had issues with him as well, which makes it even more likely that he was unprofessional

i think the OP was just frustrated because the resident acted that way, and i dont know anyone that enjoys unprofessional abusive treatment from their colleagues

 

[ocean11]

my thoughts are that if you are a sub-i you do not yet have your MD, do you? being a sub-i is part of your medical school education. yes, you should definitely strive to function as an intern if you want to get top grades and impress people. and you should strive to function as an intern so that it will help prepare you for your intern year. but you are NOT the actual intern. when i am a resident, i will definitely be watching the sub-i's closely because i dont think you can trust them entirely, no matter how smart/responsible they are.

i think its fair to get reprimanded for being late/missing something important, but it was an honest mistake and the resident responded unprofessionally. it sounds like others have had issues with him as well, which makes it even more likely that he was unprofessional

i think the OP was just frustrated because the resident acted that way, and i dont know anyone that enjoys unprofessional abusive treatment from their colleagues

Thanks Kat,

You're right, I was very frustrated, and my resident was an a$$, the nurses hate this guy b/c he treats them so poorly, he screams at them frequently and they reciprocate by making his life hard. He subsequently takes it out on his students. ANYHOW, the GREAT news is that he is GONE after tomorrow... my last day with him WHEW! and then new seniors 🙂 . IN AN UPDATE: things have gotten better over the last 2 days, I've worked SO hard and discharged two of his patients he's actually been much nicer to me and even bought me an ice cream cone in the cafeteria. He's still a jerk, but is actually 'attempting' to be somewhat decent. I'm still NOT going to ask him to write my eval though....

Anyhow, I'm NOT looking for a LOR from this rotation, every fourth year HAS to do a sub-I at my school and I'm, required to do it too... I'm not sure if I want to go into IM at all.... not after this experience anyhow. IN 24 hours I'll be rid of this guy... CAN"T WAIT 🙂

thanks for the support all 🙂

Ocean11

PS: they can't 'only' yell at you, they can do alot worse (go to the program director) etc..... how naive r u?!?

 

[AmoryBlaine]

An interesting thread. Ocean11 seems to have had a heck of a time. I do think it raises a good point about being an M4. I have a few more weeks on my sub-i and I've had a strange experience. About a week into it my senior sat me down and told me I was doing a great job and that he was very impressed with my work.

Naturally I felt good, and then I realized that the senior and the interns were backing off my patients. Flattering? Yes. Scary? Absolutely. No one trusts an M3 really, no matter how good they are. But if you show some worth as an M4 people are going to start to trust you.

Ocean11, this led me to a similar situation where I didn't discuss a change in a patient with the senior quite when I should have. No one blamed me at all because the dude was totally labile but he did end up the in unit. I felt pretty bad, but at the end of the day you do have to remind yourself that you didn't MAKE the person sick and just try to be all the more vigilant. My rule now is that if I think about going to check in on a pt, I just go do it.

 

[ocean11]

I agree with the above post completely,

This morning I checked in on my patient and she was saturating initially at 94%, I kept monitoring her and sure enough her O2 sat kept dropping, I suppose I walked in at 'just the right time'. Anyhow, I told the nurse to get her a NRB mask and put on the O2 to the max. We checked her vitals, but since she's DNR/DNI no one is too concerned. Anyhow, my resident was pleased that I picked it up and that I told him, I stayed with my patient for the next hour or so until her O2 stabilized, whew, I mean she's in her mid-90's demented... I don't see her getting any better, but you never know right? I was really shocked that my resident didn't bother checking up on her too much, he didn't even seem to care about her..... I suppose he had other things to do like eat breakfast while his patient was desaturating, anyhow, all is well now! still though, great way to start a morning!

Today IS a celebration, its the LAST day I have to work with him, I'm on call too! wish me luck 🙂 ALMOST THERE! although I must admit this week hasn't been too bad b/c I'm working so hard, he can't find anything to bit$h at me for!

thanks for the support guys 🙂

ocean11

 

[RockfordWF]

I HATE MY SUB-I..... man just when I thought things were getting better in my fourth year, my SUB-I hit. My last rotation was pretty laid back, cardiology, did well in it, not the most interesting, but not too high stress either.

ANYHOW, fast fwd to today! finished a week and a half of my sub I and I hate my senior resident. He dosn't really like me and tends to favor the other med students on the team. He's given me the worst patients: ones that I can't present b/c their admission is very simple (ie: a 90 y/o woman admitted for a simple fall about to be d/c). Anyhow, today I made the mistake of coming in late--> no tmie to preround--> patient crashed two hours later (she was 95)--> resident was super pissed that I didn't preround (yes I take the blame)--> yelled at me for a bunch of other things--> tells me I'm the worst Sub I ever--> I start to cry, couldn't even help the patient when I was needed to be there-->two hours later, resident tells me that he's done all the work for me. He's super dissapointed and well... yeah I am horrified with my own performance today. This has never happened to me before! but I've seen in happen to many other residents/students/interns..... all I can do is try harder tomorrow.... facing everyone is going to be hard.... I feel like such a screw up! I hope to pass this rotation.... perhaps I should go into psych and forget about IM.... I'm seriously considering Psych now!

Ocean1🙁

Just ignore the bullies....don't let them think it bothers you...

It's just like high school, you know.

 

[AF_PedsBoy]

As a mental note:

When a med student doesn't know a lab, consult result, or medicine the patient is on, I get annoyed at them (the third or fourth time 😀) because that's the med student role, to be a reporter.

When something bad happens to a patient I get annoyed at ME because I should be following everything too and theoretically should also know better as far as clinical judgement and plan.

So don't forget you may be over-interpreting the resident's annoyance, which may be purely because you were late and didn't know what was going on with the patient at the time. The patient coding - well, you'll have to talk that over with the patient However it's not your fault unless you accidentally unplugged their ventilator walking around the bed to examine them

 

[ocean11]

As a mental note:

When a med student doesn't know a lab, consult result, or medicine the patient is on, I get annoyed at them (the third or fourth time 😀) because that's the med student role, to be a reporter.

When something bad happens to a patient I get annoyed at ME because I should be following everything too and theoretically should also know better as far as clinical judgement and plan.

So don't forget you may be over-interpreting the resident's annoyance, which may be purely because you were late and didn't know what was going on with the patient at the time. The patient coding - well, you'll have to talk that over with the patient However it's not your fault unless you accidentally unplugged their ventilator walking around the bed to examine them

Yes thats true, as for the resident's annoyance, he specifically told me I was doing a bad job. It dosn't matter though, b/c my new residents love me, they are great! the old senior was hated be EVERYONE! He was lazy, would barely see the patients, when a lab wasn't drawn RIGHT on time, he would yell at the nurse then the secratary and then the medical student. He even yelled at his co-resident when he felt that he was getting too many patients on his side. He never talks in a calm, even voice, just yells and takes his frustration out on others infront of everyone. Once I learned that it wasn't 'just me' I stopped caring as much. Still though I'm going to write nasty things on his eval.....

3.5 more days of Sub-I and then its over 🙂 YEY! although I have nothing to really complain about anymore, my current residents are really nice!