Ever have an attending you thought was an idiot?

[sliceofbread136]

how do you deal with this? I often had to raise my concerns about what I thought was incorrect patient care and really felt like I was starting to come off as “difficult” after awhile...

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[HomeSkool]

how do you deal with this? I often had to raise my concerns about what I thought was incorrect patient care and really felt like I was starting to come off as “difficult” after awhile...

Yes, I had attendings like that. It's a delicate situation, but you need to remember that they - not you - are responsible for the patient's care. If you see anything that rises to the level of negligence or malpractice, you should submit an anonymous complaint. Barring that, however, it's best to avoid being "difficult". As a trainee, you will not win a pissing match with an attending.

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[sliceofbread136]

Ya I think it will just be easier to go back to the old medical student smile and nod route, right up until I end up calling the rrt

 

[Rendar5]

Agree With the above. You are treating the patient under their guidance, but it is their license and their decision ultimately , not yours. Your job is to learn whether or not you want to do things the same way as that attending when you are on your own. There are many different ways to deal with things medicine, and the majority of them are perfectly correct. Some attendings who I thought were idiots, just had their own way of doing things, and were not very good about communicating their underlying thought process. Other attendings who I thought were idiots, were in fact idiots (though this was quite rare).

What I would suggest is to inquire what their thought process was or why they want to do things their way as opposed to what your thoughts would be. I would just not directly challeng them or repeatedly question them further if you don’t like the answer.

 

[Raryn]

None of my attendings are idiots. I might have called a few of them idiots while ranting over dinner with my coresidents/cofellows, but all of them are all board certified in my field and got through training, then were hired by my program.

Some may have different practice habits than the most recent sets of guidelines. Or based on their clinical experience. Occasionally, this is because they are not aware of the most recent evidence. Other times, it is because they have reviewed the underlying papers behind those recommendations and disagree with the interpretation. And other times, it's because they simply have their own way they like to do things, evidence be damned.

When I run into this situation, I try to discuss the plans with them to learn which situation we're in. Lets say I still disagree with the plan but it is something that is minimally harmful to the patient (obtain more labs, or whatever), I'll drop it and move on. If I think it's something harmful to the patient, I'll typically push. If we have time, I might pull the guidelines, ask the attending to discuss, and often I can get them to change their minds (or convince me they're right). If they insist on their way, then I make a note of it, do what they say (given it's their license on the line since their name is at the bottom of the note), look up the evidence for myself later on, and just understand I won't manage it that way when I'm in independent practice.

You have to understand, most of the stuff we do doesn't really matter that much. There's a lot of ways to skin a cat, and even treating a patient in a less than ideal way usually won't lead to long-term negatives. I've never had it where the attending is insisting on something definitely acutely harmful to the patient, but if I did I'd probably push harder.

 

[MediCane2006]

I had an attending in fellowship I thought was an absolute idiot...overly pedantic, constantly hung up on trivialities, and did things in surgery that I would roll my eyes over.

Then I became an attending, and realized that that guy basically made me reflexively detail-oriented (because I knew he'd ask about minutiae), compulsive about planning a surgery ahead (because I would try and anticipate where he would get hung up), and overall just a much better surgeon than I would have been otherwise. I actually emailed him the other day thanking him.

You learn something from every attending, even the bad ones....

 

[FutureInternist]

You learn something from every attending, even the bad ones....

You can’t change an attending so far into their career, or even a new attending for that matter, specially when you are a resident or fellow.

Best you can do is what Medicane said.
Whether its a positive (detail oriented etc) or negative (how not to talk to a pt about DNR), theres always something to learn.

 

[JustPlainBill]

Attending an idiot? You mean like the one who couldn't figure out how to use a Saf-T-Centesis kit and wound up using the 18 ga draw needle to puncture the abdomen during a therapeutic tap and inserted the end that was supposed to be inserted into the abdomen through the previously made scalpel incision into the vacuum bottle? essentially reversing the entire kit? or the same one who ordered me to do a rectal on a patient looking for bleeding when there was frank blood in the bedside commode right on top of a pile of brown soft stool because if we didn't do one "we'll look like idiots to GI"...when GI, per the note, said to just get admitted if the patient had rectal bleeding and consult them? Or the twit who made me write down transducer noise as a fetal heart tone due to a very poor understanding of electronics while trying to find something to write me up for (I'm a former EE and verified the transducer noise with a different Ob attending)? Or the one who accused me of not knowing how to handle a COPD exacerbation because I used 60 of prednisone vs 40?

First and best lesson to learn -- attendings are human, some are better than others, in some cases the rule of "those that can, do; those that can't teach" applies; in other cases, just because you're good at it, doesn't mean you can teach it....mixed bag --- just grit your teeth, put your head down and graduate while learning as much as you can and avoid getting dinged....