Got yelled at by the NP for over stepping

[AsianPersuasion]

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TLDR: I think I just killed my chance of matching vascular at this program.

So, to make the story short, part of our surgery rotation involves doing community hospital rotation and the way this hospital operates is the NP / PA would be the first to see surgical consults and then they call the attending if needed etc. So we had a patient S/P AVF c/o pain with no + effect from narc, pallor, muscle weakness, pain with motor skills etc. This patient was sent to fast track, was seen by the PA and then the PA paged the surgical vascular NP who I was with. We assessed the patient and then the NP called the patient....there was something obviously wrong. Looking at the H/P, I suspected that it's either DHIS or Ischimic Neuropathy.

I pleaded with the NP and suggested that we contacted the attending to look into it further and maybe do an arteriogram or ultrasound, but she brushed it off and said that the previous study they done after the placement of AVF showed positive flow...

Still not convinced, I spoke with the ED attending and plead my findings.

The ED attending agreed with me, went to look at the patient agreed to page the surgeon.

The surgeon called the NP and was asking about the situation and why ED attending got involved, the NP pleaded her case, and the surgeon came in anyway.

Before the surgeon got there she was tore me a new a**hole in front of everyone in the ER, told me that I have no privileges or say in terms of treatment plans, I am not board certified to make decisions, I am not a physician (yet), undermining superiors etc etc etc. I didn't say anything and just stood there letting her get it out of her system.

End result? STEAL Syndrome.


I'm worried as to how my grade and evaluation will take a hit because of this. Maybe I did overstep. But I honestly felt like something was wrong.

 

[chromuffin]

TLDR: I think I just killed my chance of matching vascular at this program.

So, to make the story short, part of our surgery rotation involves doing community hospital rotation and the way this hospital operates is the NP / PA would be the first to see surgical consults and then they call the attending if needed etc. So we had a patient S/P AVF c/o pain with no + effect from narc, pallor, muscle weakness, pain with motor skills etc. This patient was sent to fast track, was seen by the PA and then the PA paged the surgical vascular NP who I was with. We assessed the patient and then the NP called the patient....there was something obviously wrong. Looking at the H/P, I suspected that it's either DHIS or Ischimic Neuropathy.

I pleaded with the NP and suggested that we contacted the attending to look into it further and maybe do an arteriogram or ultrasound, but she brushed it off and said that the previous study they done after the placement of AVF showed positive flow...

Still not convinced, I spoke with the ED attending and plead my findings.

The ED attending agreed with me, went to look at the patient agreed to page the surgeon.

The surgeon called the NP and was asking about the situation and why ED attending got involved, the NP pleaded her case, and the surgeon came in anyway.

Before the surgeon got there she was tore me a new a**hole in front of everyone in the ER, told me that I have no privileges or say in terms of treatment plans, I am not board certified to make decisions, I am not a physician (yet), undermining superiors etc etc etc. I didn't say anything and just stood there letting her get it out of her system.

End result? STEAL Syndrome.


I'm worried as to how my grade and evaluation will take a hit because of this. Maybe I did overstep. But I honestly felt like something was wrong.

Personally, I wouldn’t worry. We are trained to care more about the patient than stepping on a superior’s toes. In the end, you were correct to involve the attending. As one of my attending once told me, being silent about an issue you might have seen is far worse than being incorrect. You’re here to learn. You’re here to make mistakes. If you receive a negative course evaluation, I would strongly urge you to involve the course director and, if needed, dean. You could always involve the ombudsperson in a situation if you want a more professional, unbiased answer prior to seeking out someone. Best of luck!

 

[deleted610572]

Not saying anything was the right choice. I doubt she will have a say in if you get an interview or not. If anything the surgeon will be impressed with you which will make you more memorable come application time.

TL;DR - who cares she wasn't even at your main site. She's just embarrassed because "just" a medical student picked something up that she didnt. Its an ego thing.

 

[Gurby]

TLDR: I think I just killed my chance of matching vascular at this program.

So, to make the story short, part of our surgery rotation involves doing community hospital rotation and the way this hospital operates is the NP / PA would be the first to see surgical consults and then they call the attending if needed etc. So we had a patient S/P AVF c/o pain with no + effect from narc, pallor, muscle weakness, pain with motor skills etc. This patient was sent to fast track, was seen by the PA and then the PA paged the surgical vascular NP who I was with. We assessed the patient and then the NP called the patient....there was something obviously wrong. Looking at the H/P, I suspected that it's either DHIS or Ischimic Neuropathy.

I pleaded with the NP and suggested that we contacted the attending to look into it further and maybe do an arteriogram or ultrasound, but she brushed it off and said that the previous study they done after the placement of AVF showed positive flow...

Still not convinced, I spoke with the ED attending and plead my findings.

The ED attending agreed with me, went to look at the patient agreed to page the surgeon.

The surgeon called the NP and was asking about the situation and why ED attending got involved, the NP pleaded her case, and the surgeon came in anyway.

Before the surgeon got there she was tore me a new a**hole in front of everyone in the ER, told me that I have no privileges or say in terms of treatment plans, I am not board certified to make decisions, I am not a physician (yet), undermining superiors etc etc etc. I didn't say anything and just stood there letting her get it out of her system.

End result? STEAL Syndrome.


I'm worried as to how my grade and evaluation will take a hit because of this. Maybe I did overstep. But I honestly felt like something was wrong.

I'm an M1 here so no experience with this...

What did the surgeon do when s/he got there?

So you were working with the NP... does she have a say in your evaluation?

I wonder if OP should talk to the surgeon about this situation? Seems like the NP made a mistake and is rightfully embarrassed, and taking it out on OP. But in the end OP was right to stick to their guns, and it was the best thing for the patient that they did. Yet, the NP will likely bash them on the eval for it. Seems unfair and stupid.

 

[evilbooyaa]

First things first - you shouldn't be following a NP around. They can be involved in the care but you are not a NP student and should not be rotating with a NP. You should be rotating with an attending vascular surgeon if not with residents.

NP shouldn't have a role in evaluating you as a MS3, and if she does, that's a knock on your medical school.

NP got shown up by a medical student. Brush it off and keep doing you, OP.

 

[AsianPersuasion]

I'm an M1 here so no experience with this...

What did the surgeon do when s/he got there?

So you were working with the NP... does she have a say in your evaluation?

I wonder if OP should talk to the surgeon about this situation? Seems like the NP made a mistake and is rightfully embarrassed, and taking it out on OP. But in the end OP was right to stick to their guns, and it was the best thing for the patient that they did. Yet, the NP will likely bash them on the eval for it. Seems unfair and stupid.

We took the patient to the OR and I got to first assist with the revision of the AVF, which I NEVER get to do if I was at our flagship hospital cause the residents and fellows get first dibs. That was one great thing about the community rotation, I got to do soooooooo much, which opened my eyes to surgeons in Community hospital.

I don’t know how the whole situation is gonna go down. Apparently anybody who had their hands on our education and teaching moments gets input on our eval. So we shall see next week.

First things first - you shouldn't be following a NP around. They can be involved in the care but you are not a NP student and should not be rotating with a NP. You should be rotating with an attending vascular surgeon if not with residents.

NP shouldn't have a role in evaluating you as a MS3, and if she does, that's a knock on your medical school.

NP got shown up by a medical student. Brush it off and keep doing you, OP.

It was part of our “night float” duty. They don’t have residents at that hospital during the night which I found to be weird, and the services are staffed by NP and PA. The only attending I saw that night was the ED and hospitalist which there was like 1 for a 200 bed facility. I found that insane.

 

[AsianPersuasion]

I’m just worried cause I want to take a stab at I-5 Vascular residencies.

The surgeon didn’t say anything he just dabbed me and was like good call, bud. Lol

 

[evilbooyaa]

Oh. Hmm gray zone with NPs at night I guess.

Regardless, you made the right call. The NPs eval shouldn't be on your radar. Surgeon probably remembers you (in a good light) for sticking to your guns.

 

[AsianPersuasion]

Oh. Hmm gray zone with NPs at night I guess.

Regardless, you made the right call. The NPs eval shouldn't be on your radar. Surgeon probably remembers you (in a good light) for sticking to your guns.

Thank you. It means a lot to hear that. I usually don’t let things like getting chewed out like that get to me but a lot of time, in this process, being told you don’t know what you’re doing multiple times by multiple different people can get you to question your own base knowledge.

 

[deleted610572]

I’m just worried cause I want to take a stab at I-5 Vascular residencies.

The surgeon didn’t say anything he just dabbed me and was like good call, bud. Lol

Got a dab, you're in like sin.

 

[DubbiDoctor]

Maybe you should have politely told the NP in advance that you would consult the surgeon to hear his view, so as not to appear as if you were going behind her back to undermine her. I doubt it will affect your grade, but in medicine you need put extra effort into getting along with people, even when they're unreasonable.

 

[AsianPersuasion]

Got a dab, you're in like sin.

Praying to God!!!

I’ve literally been just “getting by” in med school without a worry, thinking that I’m destined for that FM life and could care less about grades, ranking etc. But then surgery hit me like a bomb and now I’m finding myself making a 180 toward surgery, lol but with less than Stella score and no research, ugh.

 

[AsianPersuasion]

Maybe you should have politely told the NP in advance that you would consult the surgeon to hear his view, so as not to appear as if you were going behind her back to undermine her. I doubt it will affect your grade, but in medicine you need put extra effort into getting along with people, even when they're unreasonable.

I did. I literally said to her that I think we should rule out ischemia and call the surgeon. She was like no, I’m sending the patient home with a different kind of narc and I’m like the one we have on here doesn’t even work. I don’t think a different narc is going to help. She meets all the criteria for possible ischemia. That’s when she walked away from me and then I went to the ED attending.

 

[NYCdude]

No doubt this case will go under the data for "positive NP led outcomes" in whatever BS studies get thrown around.

 

[Gurby]

I did. I literally said to her that I think we should rule out ischemia and call the surgeon. She was like no, I’m sending the patient home with a different kind of narc and I’m like the one we have on here doesn’t even work. I don’t think a different narc is going to help. She meets all the criteria for possible ischemia. That’s when she walked away from me and then I went to the ED attending.

What post-op day is patient, and when was the previous study showing good flow? Again I'm just an M1 but this seems real bad. Maybe I am misinterpreting the situation.

 

[deleted610572]

Praying to God!!!

I’ve literally been just “getting by” in med school without a worry, thinking that I’m destined for that FM life and could care less about grades, ranking etc. But then surgery hit me like a bomb and now I’m finding myself making a 180 toward surgery, lol but with less than Stella score and no research, ugh.

Still stick with the FM life. 🙂

Nights, weekends, family time > wickedly awesome, adrenaline inducing, surgery

 

[ndafife]

If you're going to go outside the hierarchy, you better make sure you are right. You were right.

I really wouldn't worry about a single NP messing up your chances. Im sure you impressed the person who you need to impress - the Attending

 

[TypeADissection]

I think you'll be fine. Hard work. Attention to detail. These will carry you through. Cheers. Good luck in the match.

 

[deleted480308]

I did. I literally said to her that I think we should rule out ischemia and call the surgeon. She was like no, I’m sending the patient home with a different kind of narc and I’m like the one we have on here doesn’t even work. I don’t think a different narc is going to help. She meets all the criteria for possible ischemia. That’s when she walked away from me and then I went to the ED attending.

I think dubbi was saying it was appropriate to tell the NP, “I’m sorry but I feel strongly about this and am going to talk to the EM doc”

You can go over someone’s head without going behind their back

 

[deleted245139]

You did the right thing here. Beyond that I'd hope the ED attending would have disagreed with the initial assessment as well.

 

[DexterMorganSK]

OP, you did the right thing by not saying anything back to the NP. That takes courage and maturity. Good for you.

 

[mimelim]

If you feel comfortable, PM me which hospital. This was a major topic at the SVS meeting last week. Can't have this kind of bs getting in the way of MS3s rotating on vascular. Wouldn't bring up anything direct and wouldn't address it myself (certainly not my place). But, maybe down the line... Might be helpful to know about... Regardless, it is hard to see this negatively affecting you going forward.

As an aside, ischemic steal syndrome is not as dramatic as this thread makes it sound. I routinely send patients home from the ER with steal. Granted not with a new narcotic script, but a date for surgery, but I don't routinely admit people simply because they have steal. Also, there is quite a range of symptoms of steal. 80%+ of fistulas steal, but we only intervene on ~5%. Ischaemic monomelic neuropathy is a different story...

 

[ACSurgeon]

OP- be careful out there and pace yourself. You may gave gotten lucky this time but do not think this behavior will serve you well in residency. This scenario could have just as well ended with you being wrong and seeming to overstep boundaries. There’s a fine line between speaking up to stop a medical error and walking around as a student or junior resident thinking it’s your job to show people up. My advice isn’t a criticism of this incident and it’s without knowing you at all as a person, but didn’t want you building on this moving forward, least you get burned bad in the near future.

 

[ACSurgeon]

If you feel comfortable, PM me which hospital. This was a major topic at the SVS meeting last week. Can't have this kind of bs getting in the way of MS3s rotating on vascular. Wouldn't bring up anything direct and wouldn't address it myself (certainly not my place). But, maybe down the line... Might be helpful to know about... Regardless, it is hard to see this negatively affecting you going forward.

As an aside, ischemic steal syndrome is not as dramatic as this thread makes it sound. I routinely send patients home from the ER with steal. Granted not with a new narcotic script, but a date for surgery, but I don't routinely admit people simply because they have steal. Also, there is quite a range of symptoms of steal. 80%+ of fistulas steal, but we only intervene on ~5%. Ischaemic monomelic neuropathy is a different story...

I was going to address the spectrum that is steal but you addressed it better than I would. All the more reason to caution the OP that going outside of his or her chain of command to save the day may have not been received that way depending on the details and the surgeon on that day etc...

 

[Wordead]

Might affect your grade (would contact med school dean if it does), pretty much 0% chance this affects chances at integrated vascular.

 

[GadRads]

If I were the NP, I would have told you, "good call". Too much egos in medicine.

 

[DarkHorizon]

That’s pretty ballsy as an M3. You have to be absolutely sure that patient care is being compromised before stepping in like this. Granted they are an NP and not a physician, I assume they have been in that role for a while and know a tons more than an M3. I wouldn’t even trust an M3 with their physical exam.

I remember being an intern in the SICU early in the intern year. Worked with many mid levels, and they saved my ass all the time. In fact, I routinely asked them various patient management questions as they had been doing it for years and I was just starting.

 

[rg2o3]

Something that I learned in the military that may apply here. If you’re going to throw someone under the bus (in this case rightfully so and for a good reason), just give them the professionals courtesy of a heads up. Nothing worse than being blindsided, even if you deserve it.

 

[AsianPersuasion]

OP- be careful out there and pace yourself. You may gave gotten lucky this time but do not think this behavior will serve you well in residency. This scenario could have just as well ended with you being wrong and seeming to overstep boundaries. There’s a fine line between speaking up to stop a medical error and walking around as a student or junior resident thinking it’s your job to show people up. My advice isn’t a criticism of this incident and it’s without knowing you at all as a person, but didn’t want you building on this moving forward, least you get burned bad in the near future.

I was going to address the spectrum that is steal but you addressed it better than I would. All the more reason to caution the OP that going outside of his or her chain of command to save the day may have not been received that way depending on the details and the surgeon on that day etc...

Thank you for the look out. I don't pride myself in this behavior at all. More than anything I was ready to **** my pants when I went to the ED attending cause there wasn't any other superiors around. I only recalled these info because just the other week, another VS was going over complications of AVF during a case so it was fresh in my head. Otherwise, I don't think I would've caught it. Like @mimelim said, I can pick out the abnormalities but I don't have enough knowledge on treatment plans yet and deciding whether to operate or not.

It's going to be a long week here at this hospital. I can already feel the cold shoulders from the other NPs and PAs. I think I'm just going to lay low and trek along to ride out this rotation.

 

[astromfs]

Why medical students are following NPs?

 

[Crabbygas]

You could always turn the tables and bring her up on charges for yelling at you and creating a hostile work environment. I don't recommend it but the thought is very satisfying.

 

[MSTPlease]

Not in a surgical specialty so might be wrong about this but the only thing I might have done differently is not involve the ED attending but instead bring it to the vascular consult resident, maybe the attending in the form of a question as to why we aren’t concerned about XYZ in this case.

 

[AsianPersuasion]

Not in a surgical specialty so might be wrong about this but the only thing I might have done differently is not involve the ED attending but instead bring it to the vascular consult resident, maybe the attending in the form of a question as to why we aren’t concerned about XYZ in this case.

There was no residents around. All the services are staffed by NP / PA.

 

[Wordead]

You guys are such *******. Rather let harm come to a patient than step on the toes of a midlevel

 

[FlyerScribe]

I cant say much on the hospital hierarchy but I think you're going to be a great doc. The patient is way more important and you put them first. Id want you as my doc.... So I wouldnt sweat it too much esp if they were a young NP (they might just be throwing you shade). You got surgeon dabs. You did the right thing.

Sent from my SM-G930P using SDN mobile

 

[HighwayVagabond]

This was a major topic at the SVS meeting last week. Can't have this kind of bs getting in the way of MS3s rotating on vascular.

Out of curiosity, what topic are you referring to exactly? The role of midlevels? I'm only asking because I sadly missed the SVS meeting and am interested to know. Thanks!

 

[Tenk]

Demand an apology and call them out on their bull****. Do it in front of the attending too, nothing to lose at this point but you can at least prove you aren’t a push over to the attending. Also, go to upper management and explain the situation and how you acted in the patient’s best interest. Use terms like “wanted what’s best for the patient” and “bullying.” They will crack down on that like lightning.

Bad on the ED attending though. Nobody yells at students in my ED. I don’t give a **** who they are. I would ask them to stop or just heckle the crap out of them until they get flustered and leave.

 

[mimelim]

Out of curiosity, what topic are you referring to exactly? The role of midlevels? I'm only asking because I sadly missed the SVS meeting and am interested to know. Thanks!

No, so far as I can tell the complaining about NPs is an SDN/medical student phenomenon.

The issue that has been brought up repeatedly, most recently at SVS is how to meet the increasing vascular surgery demands of the country. We have ~3300 vascular surgeons in the US right now. Virtually every study on physician shortages shows that vascular surgery is the specialty with the most increasing need and one of the largest bottlenecks in terms of training new surgeons. Combine that with the fact that 30% of board certified vascular surgeons are over the age of 60 and you have a recipe for disaster in terms of meeting the needs. The advent of the 0+5 training programs has helped a little, but the reality is that we need to be training ~220 vascular surgeons per year, starting now to be in reasonable shape in 2030. Currently, we train ~170. Most of this is a how do we convince CMS to increase the residency cap, but that is only part of it. By and large the IVS applicants are extremely strong academically, but it is a very self selecting group and the reality is that there is a severely limited pool of students interested in vascular surgery. A couple people have looked at this closely and the main issue is exposure. If you survey vascular residents across the country, the majority had some really good clinical exposure in medical school that sparked their interests. Most students do not rotate through vascular surgery or know anything about it. Most of the national meeting discussion is about how to better expose students by influencing things on a department/division level. My main thing is that this is a student interested in vascular surgery that is having a ****ty experience on a vascular rotation. In a field already short on people, losing someone early for stupid reasons is exasperating.

 

[HighwayVagabond]

No, so far as I can tell the complaining about NPs is an SDN/medical student phenomenon.

The issue that has been brought up repeatedly, most recently at SVS is how to meet the increasing vascular surgery demands of the country. We have ~3300 vascular surgeons in the US right now. Virtually every study on physician shortages shows that vascular surgery is the specialty with the most increasing need and one of the largest bottlenecks in terms of training new surgeons. Combine that with the fact that 30% of board certified vascular surgeons are over the age of 60 and you have a recipe for disaster in terms of meeting the needs. The advent of the 0+5 training programs has helped a little, but the reality is that we need to be training ~220 vascular surgeons per year, starting now to be in reasonable shape in 2030. Currently, we train ~170. Most of this is a how do we convince CMS to increase the residency cap, but that is only part of it. By and large the IVS applicants are extremely strong academically, but it is a very self selecting group and the reality is that there is a severely limited pool of students interested in vascular surgery. A couple people have looked at this closely and the main issue is exposure. If you survey vascular residents across the country, the majority had some really good clinical exposure in medical school that sparked their interests. Most students do not rotate through vascular surgery or know anything about it. Most of the national meeting discussion is about how to better expose students by influencing things on a department/division level. My main thing is that this is a student interested in vascular surgery that is having a ****ty experience on a vascular rotation. In a field already short on people, losing someone early for stupid reasons is exasperating.

Thanks for the clarification.

Sorry to the OP for hijacking the thread. If you're anything like me, you'll be anxious until match day no matter what any of us say, but I don't think you should worry about this incident impacting your ability to match to integrated vascular. Best of luck!

 

[Psai]

Man so many problems here as everyone said. A midlevel seeing initial consults, a midlevel mentoring a medical student, a midlevel yelling at a medical student, people thinking that a midlevel is the medical student's superior,.

Every one of these issues is a major problem.

 

[QueenJames]

TLDR: I think I just killed my chance of matching vascular at this program.

So, to make the story short, part of our surgery rotation involves doing community hospital rotation and the way this hospital operates is the NP / PA would be the first to see surgical consults and then they call the attending if needed etc. So we had a patient S/P AVF c/o pain with no + effect from narc, pallor, muscle weakness, pain with motor skills etc. This patient was sent to fast track, was seen by the PA and then the PA paged the surgical vascular NP who I was with. We assessed the patient and then the NP called the patient....there was something obviously wrong. Looking at the H/P, I suspected that it's either DHIS or Ischimic Neuropathy.

I pleaded with the NP and suggested that we contacted the attending to look into it further and maybe do an arteriogram or ultrasound, but she brushed it off and said that the previous study they done after the placement of AVF showed positive flow...

Still not convinced, I spoke with the ED attending and plead my findings.

The ED attending agreed with me, went to look at the patient agreed to page the surgeon.

The surgeon called the NP and was asking about the situation and why ED attending got involved, the NP pleaded her case, and the surgeon came in anyway.

Before the surgeon got there she was tore me a new a**hole in front of everyone in the ER, told me that I have no privileges or say in terms of treatment plans, I am not board certified to make decisions, I am not a physician (yet), undermining superiors etc etc etc. I didn't say anything and just stood there letting her get it out of her system.

End result? STEAL Syndrome.


I'm worried as to how my grade and evaluation will take a hit because of this. Maybe I did overstep. But I honestly felt like something was wrong.

LOL

WTF?

Neither is she lolol

 

[Mad Jack]

If anything this would help your application. Standing up for the health of a patient should never hurt a medical student, and if it does this isn't the sort of place you'd want to go anyway

 

[AsianPersuasion]

So...the plot thickens.

I spoke with one of the SICU nurse who I'm buddy with and she said that the NP talked about me in their break lounge about how I broke protocol, how these new young doctors have no respect for authority, the attending didn't address the "disrespect", this is "our" house, they're just visitor and they think they can come in and wreck havoc...

Mind you, I did not apologize to her for the second time because honestly, I'm not apologetic about it. I told her beforehand that I don't think we should send the patient home with new narc and that we need to call the VS for eval. She walked away from me and left me, which led me to ask the ED attending. Could my approach be different? Absolutely. I will learn from this experience on forth. But I am not apologetic for the fact that I contacted the surgeon for a consult. I used the criteria to assess risk of complications and my gut / literature showed me that this could be emergent. If I was wrong I would gladly take responsibility for it. But I acted based on the previous knowledge that was taught to me by other surgeons.

 

[sunshinefl]

So...the plot thickens.

I spoke with one of the SICU nurse who I'm buddy with and she said that the NP talked about me in their break lounge about how I broke protocol, how these new young doctors have no respect for authority, the attending didn't address the "disrespect", this is "our" house, they're just visitor and they think they can come in and wreck havoc...

Mind you, I did not apologize to her for the second time because honestly, I'm not apologetic about it. I told her beforehand that I don't think we should send the patient home with new narc and that we need to call the VS for eval. She walked away from me and left me, which led me to ask the ED attending. Could my approach be different? Absolutely. I will learn from this experience on forth. But I am not apologetic for the fact that I contacted the surgeon for a consult. I used the criteria to assess risk of complications and my gut / literature showed me that this could be emergent. If I was wrong I would gladly take responsibility for it. But I acted based on the previous knowledge that was taught to me by other surgeons.

Honestly, this sounds like how certain nurses are. These new break room quotes could have easily been from a floor nurse. Sorry not “hating”, I’m an RN. I just know the type. This doesn’t really change anything.

 

[Scrubs101]

So...the plot thickens.

I spoke with one of the SICU nurse who I'm buddy with and she said that the NP talked about me in their break lounge about how I broke protocol, how these new young doctors have no respect for authority, the attending didn't address the "disrespect", this is "our" house, they're just visitor and they think they can come in and wreck havoc...

Mind you, I did not apologize to her for the second time because honestly, I'm not apologetic about it. I told her beforehand that I don't think we should send the patient home with new narc and that we need to call the VS for eval. She walked away from me and left me, which led me to ask the ED attending. Could my approach be different? Absolutely. I will learn from this experience on forth. But I am not apologetic for the fact that I contacted the surgeon for a consult. I used the criteria to assess risk of complications and my gut / literature showed me that this could be emergent. If I was wrong I would gladly take responsibility for it. But I acted based on the previous knowledge that was taught to me by other surgeons.

So she was wrong and is still trying to find a way to be “right” wowwwwwwww, some people just need to know when to cut their loses and admit they were wrong. Really hope someone that is in a positon to tell her off eventually does.

You did good OP, sorry you have to deal with that BS. I can’t predict what your eval will turn out to be like, but if i were the doc writing it i can promise you it would be glowing.

 

[AsianPersuasion]

You know what, it is what it is at this point. I'm not loosing sleep anymore over this. It just isn't worth it. If I get a bad eval, and if it comes up during interview or my dean letter, I'll explain the situation. There's nothing I can do to change it now.

But you better bet I'm not going down without a fight. I didn't work this hard to have my career and goals ruined because you can't accept the fact that you made the wrong judgement call.

 

[IMreshopeful]

So...the plot thickens.

I spoke with one of the SICU nurse who I'm buddy with and she said that the NP talked about me in their break lounge about how I broke protocol, how these new young doctors have no respect for authority, the attending didn't address the "disrespect", this is "our" house, they're just visitor and they think they can come in and wreck havoc...

Mind you, I did not apologize to her for the second time because honestly, I'm not apologetic about it. I told her beforehand that I don't think we should send the patient home with new narc and that we need to call the VS for eval. She walked away from me and left me, which led me to ask the ED attending. Could my approach be different? Absolutely. I will learn from this experience on forth. But I am not apologetic for the fact that I contacted the surgeon for a consult. I used the criteria to assess risk of complications and my gut / literature showed me that this could be emergent. If I was wrong I would gladly take responsibility for it. But I acted based on the previous knowledge that was taught to me by other surgeons.

Yeah sorry man, honestly this is just the way some people are. I once got reported by a mid level on another service for similarly stupid reasons. Without getting into it, it involved me pointing out (by way of recommendations) mismanagement of a patient on a surgical service, and it ended up with an angry letter to my attending, who basically laughed it off.

I recognize that surgery is pretty hierarchical, certainly more so than medicine, so I can see her caring a lot about “looking bad” in front of the attending surgeon - especially because this is her job and livelihood and you are of course “just a visitor”. She might be afraid of getting yelled at by the attending or other attendings. It sounds like you were right here and as such probably no harm no foul.

On the other hand I would caution you - you will run into people who are abrasive, have their own style of doing things which may buck the way you were taught, and have huge egos. You will have to bite your tongue and work with those people in residency no matter how much you disagree. Even in IM, which stereotypically tends to be more open with regards to discussion or debate, I would often have to keep quiet if something (non life threatening) was performed in a way I disagree with to avoid conflict. It’s a delicate balancing act that you will need to continue.

 

[AsianPersuasion]

Yeah sorry man, honestly this is just the way some people are. I once got reported by a mid level on another service for similarly stupid reasons. Without getting into it, it involved me pointing out (by way of recommendations) mismanagement of a patient on a surgical service, and it ended up with an angry letter to my attending, who basically laughed it off.

I recognize that surgery is pretty hierarchical, certainly more so than medicine, so I can see her caring a lot about “looking bad” in front of the attending surgeon - especially because this is her job and livelihood and you are of course “just a visitor”. She might be afraid of getting yelled at by the attending or other attendings. It sounds like you were right here and as such probably no harm no foul.

On the other hand I would caution you - you will run into people who are abrasive, have their own style of doing things which may buck the way you were taught, and have huge egos. You will have to bite your tongue and work with those people in residency no matter how much you disagree. Even in IM, which stereotypically tends to be more open with regards to discussion or debate, I would often have to keep quiet if something (non life threatening) was performed in a way I disagree with to avoid conflict. It’s a delicate balancing act that you will need to continue.

That's the toughest part. @mimelim mentioned the fact that sometimes he sends people home with STEAL but with a surgical date etc. She wanted to send them home with a new narc, but keep the two months F/U that was already booked. It just doesn't make sense.

 

[RNthenDoc]

You stepped on toes for the good of the patient. That’s supposed to be forgivable.

Don’t worry about nurses gossiping in a breakroom. That’s gonna’ happen regardless.

If the surgeon didn’t get upset, you’re probably fine. It wouldn’t be a bad idea to make amends with the NP, or ask around what you could have done differently. One thing that NP should understand is trusting a gut feeling, though. That gets drilled into your head

 

[Candidate2017]

Praying to God!!!

I’ve literally been just “getting by” in med school without a worry, thinking that I’m destined for that FM life and could care less about grades, ranking etc. But then surgery hit me like a bomb and now I’m finding myself making a 180 toward surgery, lol but with less than Stella score and no research, ugh.

The real question is, "Are you willing to take this nonsense for 7 years?"