Disastrous second visit

[res-2007]

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I had a second look at my #2 program and buried my foot and leg in my mouth.
The PD wasn't present, but the chief res was.
After I extracted my lower limb, the reception turned decidedly chilly.

My advice, if you go for a 2nd visit, ask questions.
Try to avoid answering any questions or offering any opinions.

 

[Adam_K]

I think that in psych that this must happen to all of us.

I offered my opinion on a patient's diagnosis, only to find out too late that my philosophy was not quite the same as the world view of the attending I was shadowing. Oh, well.

 

[Abby Normal]

Duly noted.

Perhaps it won't impact you as badly as you think. Even if it does, since it was your second choice, maybe it was an indicator of the program not being the best fit in the first place.

Sorry that happened to you.

 

[i61164]

My advice, if you go for a 2nd visit, ask questions. Try to avoid answering any questions or offering any opinions.

Can you apply this strategy to rotations too, or just interviews and 2nd looks? Sounds like a good way to play it safe.

 

[RustNeverSleeps]

I had a second look at my #2 program and buried my foot and leg in my mouth.
The PD wasn't present, but the chief res was.
After I extracted my lower limb, the reception turned decidedly chilly.

My advice, if you go for a 2nd visit, ask questions.
Try to avoid answering any questions or offering any opinions.

Res, do you mean avoid answering academic or personal questions? Hopefully it's one of those things that seems a lot worse to you than it did to everyone else.

 

[50960]

Philosophy??? I can see that academic psychiatry has many of the same problems ology has...stuck in the philosophy dept. Good Dx is good Dx, based upon good clinical and medical experience, not philosophy.

 

[Anasazi23]

I could be wrong in this case, but I doubt we're talking about philosophy as in the traditional liberal arts search for knowledge.

Usually, differences in philosophy in the psychiatric sense refers to theoretical orientation, either belief or rejection of purely biological model, or the opposite, an approach based on psychodynamic interpretation, to name a few

Virtually all PDs are clinicians as well. The purely academic psychiatrist is very rare, unlike in psychology.

These comments remind me of an attending I had in geri-psych, who was trained in an Eastern European model of psychiatry. Her belief was that schizophrenia permeated many more patients than we tend to think of schizophrenic here in the states. She wasn't as interested in DSM criteria per se, but a phenomenological fracturing of the essential self, which led to a variety of psychotic spectrum (albeit many were very "soft") symptoms.

In that example, what one resident may call schizoid or avoidant, she would call schizophrenic. That might be one example of what the OP was talking about, if it wasn't the more common biology vs. psychodynamic aproach to diagnosis and treatment.

 

[res-2007]

Res, do you mean avoid answering academic or personal questions? Hopefully it's one of those things that seems a lot worse to you than it did to everyone else.

The chief res contacted me and asked me to come on a specific day. When I arrived the chief res was not there and no one knew I was coming . I was assigned to attend one of the morning conferences (there are 3 different morning conf). The attending asked ques about meds, side effect and probable diagnoses of newly admitted patients.

Mid afternoon the entire department met to discuss acute or problematic patients. There was one patient who was physically attacking other patients. The same attending pointed to me and said "you seem pretty sharp, after pumping your patients full of all the drugs you suggested earlier, how are you going to handle this patient and his aggression?"

Stupid me, I said "the department had a responsibility to ensure the safety of all patients including the aggressor, and should provide close observation of the patient".
At which point he said "and where the hell are we supposed to get all the extra staff to provide close supervision to each and every aggressive MANIAC, which by the way is ALL of them? I half expected you to tell me which drug from your arsenal you would use!"
Totally inappropriate way to speak to resident, applicant, student or anyone else.

I counted to five and said "It might be a better idea to speak to the patient and ask him to explain the incidents, what does he feel is causing him to react the way he is doing before pumping him full of drugs."
The man just snorted!

Big disappointment. Not even sure if I will rank this program any more.

 

[Adam_K]

I could be wrong in this case, but I doubt we're talking about philosophy as in the traditional liberal arts search for knowledge.

Usually, differences in philosophy in the psychiatric sense refers to theoretical orientation, either belief or rejection of purely biological model, or the opposite, an approach based on psychodynamic interpretation, to name a few

I don't want to go into details, but you've hit the nail on the head.

 

[Doc Samson]

From the sound of it, it seems like the attending has his head up his @ss, rather than you having your foot in your mouth. Wouldn't necessarily write off the whole program based on one a-hole though.

 

[Anasazi23]

The chief res contacted me and asked me to come on a specific day. When I arrived the chief res was not there and no one knew I was coming . I was assigned to attend one of the morning conferences (there are 3 different morning conf). The attending asked ques about meds, side effect and probable diagnoses of newly admitted patients.

Mid afternoon the entire department met to discuss acute or problematic patients. There was one patient who was physically attacking other patients. The same attending pointed to me and said "you seem pretty sharp, after pumping your patients full of all the drugs you suggested earlier, how are you going to handle this patient and his aggression?"

Stupid me, I said "the department had a responsibility to ensure the safety of all patients including the aggressor, and should provide close observation of the patient".
At which point he said "and where the hell are we supposed to get all the extra staff to provide close supervision to each and every aggressive MANIAC, which by the way is ALL of them? I half expected you to tell me which drug from your arsenal you would use!"
Totally inappropriate way to speak to resident, applicant, student or anyone else.

I counted to five and said "It might be a better idea to speak to the patient and ask him to explain the incidents, what does he feel is causing him to react the way he is doing before pumping him full of drugs."
The man just snorted!

Big disappointment. Not even sure if I will rank this program any more.

I would have screamed at the top of my lungs.....



THORAZINE, BABY!!!!!!! BOO-YAH!

 

[50960]

Sazi, I knew what the OP meant, but just think it is silly and unprofessional.

 

[whopper]

It might not have been you that put your foot in your mouth but the Chief Resident.

"How in the Hell!?" is not exactly the type of language you want to give to a prospective candidate.

I actually did put my foot in the mouth a few days ago, I blew up because one of the other residents in my program has been slacking off bigtime and no one's doing anything about it. The guy shows up 1-2 hrs late to work a day, and has been doing this his entire time in the program, he's now a 4th year resident (transferred in his 2nd year). His lack of work is making the attendings tell the other residents to cover for him.

I blew up and said I was putting my foot down, told the attending that if the resident isn't going to do their work, I shouldn't be held responsible, then told the attending it was his responsibility to make sure that resident did the work. Then I said to him something to the effect that if he was going to punish me for not doing work he requested, I'd be fine with that, because that other resident has a 2 year history of not doing work, and this was my first time, and I'd be expecting this attending to punish me for my 1 "insurrection" when this other guy had dozens that still need to be accounted for, and would be expecting to see my punishment be equitable in comparison to the punishment I'd be expecting to see for this other guy.

I was ticked off.

I might have gotten away with the first because several in the program agreed with me, including other attendings. However just a few days later another incident (very similar) involving the same resident happened again and I blew up again! Never blew up in the program for 2.5 years and it happened twice in 2 weeks.

Anyways, even in hindsight I think I was right, but I also realize that politically, it might not have been a smart thing to do. Nothing has happened to me in terms of punitive action, but this could reflect badly on my evaluations.

I'm sure there's someone in the program now suggesting I'm manic, entitled, OCPD, etc right now.

 

[Solideliquid]

The chief res contacted me and asked me to come on a specific day. When I arrived the chief res was not there and no one knew I was coming . I was assigned to attend one of the morning conferences (there are 3 different morning conf). The attending asked ques about meds, side effect and probable diagnoses of newly admitted patients.

Mid afternoon the entire department met to discuss acute or problematic patients. There was one patient who was physically attacking other patients. The same attending pointed to me and said "you seem pretty sharp, after pumping your patients full of all the drugs you suggested earlier, how are you going to handle this patient and his aggression?"

Stupid me, I said "the department had a responsibility to ensure the safety of all patients including the aggressor, and should provide close observation of the patient".
At which point he said "and where the hell are we supposed to get all the extra staff to provide close supervision to each and every aggressive MANIAC, which by the way is ALL of them? I half expected you to tell me which drug from your arsenal you would use!"
Totally inappropriate way to speak to resident, applicant, student or anyone else.

I counted to five and said "It might be a better idea to speak to the patient and ask him to explain the incidents, what does he feel is causing him to react the way he is doing before pumping him full of drugs."
The man just snorted!

Big disappointment. Not even sure if I will rank this program any more.

Yeah, doesn't sound like you did anything wrong at all. Besides, are you sure the attending knew you were an interviewing candidate? Mayhaps he had you pegged as a med student?

 

[res-2007]

Yeah, doesn't sound like you did anything wrong at all. Besides, are you sure the attending knew you were an interviewing candidate? Mayhaps he had you pegged as a med student?

He knew.
He asked why I was there and I told him it was my second visit.
I felt like he was baiting me deliberately.

My first reaction was to tell him, he (the attending) needed to be sedated but what use would that be.

 

[whopper]

some programs intentionally bait candidates during an interview to see how they handle the pressure.

Such a type of interview really does give the interviewer a more honest picture than the nice-nice interview where the interviewer BS's about how great the program is, and how interviewee BS's about how much they want to get into that program. However it ticks off too many candidates to be considered a good method of interview IMHO.

 

[Anasazi23]

It might not have been you that put your foot in your mouth but the Chief Resident.

"How in the Hell!?" is not exactly the type of language you want to give to a prospective candidate.

I actually did put my foot in the mouth a few days ago, I blew up because one of the other residents in my program has been slacking off bigtime and no one's doing anything about it. The guy shows up 1-2 hrs late to work a day, and has been doing this his entire time in the program, he's now a 4th year resident (transferred in his 2nd year). His lack of work is making the attendings tell the other residents to cover for him.

I blew up and said I was putting my foot down, told the attending that if the resident isn't going to do their work, I shouldn't be held responsible, then told the attending it was his responsibility to make sure that resident did the work. Then I said to him something to the effect that if he was going to punish me for not doing work he requested, I'd be fine with that, because that other resident has a 2 year history of not doing work, and this was my first time, and I'd be expecting this attending to punish me for my 1 "insurrection" when this other guy had dozens that still need to be accounted for, and would be expecting to see my punishment be equitable in comparison to the punishment I'd be expecting to see for this other guy.

I was ticked off.

I might have gotten away with the first because several in the program agreed with me, including other attendings. However just a few days later another incident (very similar) involving the same resident happened again and I blew up again! Never blew up in the program for 2.5 years and it happened twice in 2 weeks.

Anyways, even in hindsight I think I was right, but I also realize that politically, it might not have been a smart thing to do. Nothing has happened to me in terms of punitive action, but this could reflect badly on my evaluations.

I'm sure there's someone in the program now suggesting I'm manic, entitled, OCPD, etc right now.

I blow up about once a week if that makes you feel any better.

 

[Doc Samson]

I blow up about once a week if that makes you feel any better.

I'm basing an entire career on it... it's a valued trait in consultation psychiatry.

 

[OldPsychDoc]

I'm basing an entire career on it... it's a valued trait in consultation psychiatry.

👍 If you can't launch a well-timed tirade now and then, it might be an indication that you've just stopped caring enough. 🙁

(Still, I wouldn't think it constructive to direct it at the random med student in the audience!)

 

[PsychMD2100]

Reminds me of the classic med school interview question where they would set up applicants. They would have applicants climb a couple flights of stairs in their interview suits to reach the office. They would then turn up the heat in the office to make it toasty warm. The interviewer would comment on how warm it was in the office and then ask the applicant "would you mind opening the window?" Finally, the applicant would get to window and find that it was nailed shut. The interviewer would then observe them to see how they kept their composure under stressful conditions.