Hierarchy in medicine - a free pass to humiliate?

[onserfsaav]

Today I had to call a the Assistant clinical professor at his medical Center to ask about a patient. He was so pissed that I had introduced myself as, “I’m calling from IM” at the front desk even though to him I introduced myself as a medical student. He kept screaming about how it was dishonest and that no one teaches us about it and then won’t have it when I apologised and repeated what he had asked me to say. He was sO loud and used a very condescending tone. It was so humiliating. I had no intentions of deceiving anyone or being dishonest and I’m the politest and most respectful person. I’m trying to not let this experience ruin my rotation but honestly, I feel like ****. I was so angry that I ended up crying in front of the residents and I literally don’t ever cry - unless I’m angry, which I absolutely hate about myself. So to anyone reading this, please don’t be a jerk to your juniors. And if you really must spend your precious time with someone, please use it to maybe teach something useful to the students instead of humiliating them. Also, I’m an IMG and I’ve always heard that we need to be extra polite and nice to everyone, but the truth is that Americans are just as butter as the rest of us.

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[SpoiledMilk]

Sorry this happened, but in hindsight it is a good opportunity to grow a thick skin because as you continue on your career you will continue to interact with malignant superiors and patients. Best advice is to learn to control your emotions as you don't want to break down again in front of a superior or patient who is being a jerk.

The absolute worst attending I experienced during 3rd year clerkship was a general surgery attending who belittled everyone, fellow attendings included, OR staff, residents, MS etc. This pimple had a 'god-like' complex and I dreaded having to assist them in OR alone or with other residents or attendings. Every time something came out of their mouth, even when it was wrong, it was right. So I clenched my teeth under the mask and waited patiently for the day the clerkship ended. I know our paths will never cross again, but if so, best case scenario would be me as an expert witness for the plaintiff in a malpractice suit.

 

[annoyedpsychiatrist]

Today I had to call a the Assistant clinical professor at his medical Center to ask about a patient. He was so pissed that I had introduced myself as, “I’m calling from IM” at the front desk even though to him I introduced myself as a medical student. He kept screaming about how it was dishonest and that no one teaches us about it and then won’t have it when I apologised and repeated what he had asked me to say. He was sO loud and used a very condescending tone. It was so humiliating. I had no intentions of deceiving anyone or being dishonest and I’m the politest and most respectful person. I’m trying to not let this experience ruin my rotation but honestly, I feel like ****. I was so angry that I ended up crying in front of the residents and I literally don’t ever cry - unless I’m angry, which I absolutely hate about myself. So to anyone reading this, please don’t be a jerk to your juniors. And if you really must spend your precious time with someone, please use it to maybe teach something useful to the students instead of humiliating them. Also, I’m an IMG and I’ve always heard that we need to be extra polite and nice to everyone, but the truth is that Americans are just as butter as the rest of us.

This can happen with any job though, no matter what you do in life you have the risk of a boss who displaces their anger onto you. Before I was a physician i had many customer service jobs where I got yelled at. When you react to emotion with emotion, the end result ends up being emotion. Taking a second to compose yourself, apologize (whether you mean it or not) and shifting focus on the long term goal rather than the immediate unpleasant circumstance.

 

[DO2015CA]

Sorry this happened, but in hindsight it is a good opportunity to grow a thick skin because as you continue on your career you will continue to interact with malignant superiors and patients. Best advice is to learn to control your emotions as you don't want to break down again in front of a superior or patient who is being a jerk.

The absolute worst attending I experienced during 3rd year clerkship was a general surgery attending who belittled everyone, fellow attendings included, OR staff, residents, MS etc. This pimple had a 'god-like' complex and I dreaded having to assist them in OR alone or with other residents or attendings. Every time something came out of their mouth, even when it was wrong, it was right. So I clenched my teeth under the mask and waited patiently for the day the clerkship ended. I know our paths will never cross again, but if so, best case scenario would be me as an expert witness for the plaintiff in a malpractice suit.

Lol at last sentence

 

[scharnhorst]

Today I had to call a the Assistant clinical professor at his medical Center to ask about a patient. He was so pissed that I had introduced myself as, “I’m calling from IM” at the front desk even though to him I introduced myself as a medical student. He kept screaming about how it was dishonest and that no one teaches us about it and then won’t have it when I apologised and repeated what he had asked me to say. He was sO loud and used a very condescending tone. It was so humiliating. I had no intentions of deceiving anyone or being dishonest and I’m the politest and most respectful person. I’m trying to not let this experience ruin my rotation but honestly, I feel like ****. I was so angry that I ended up crying in front of the residents and I literally don’t ever cry - unless I’m angry, which I absolutely hate about myself. So to anyone reading this, please don’t be a jerk to your juniors. And if you really must spend your precious time with someone, please use it to maybe teach something useful to the students instead of humiliating them. Also, I’m an IMG and I’ve always heard that we need to be extra polite and nice to everyone, but the truth is that Americans are just as butter as the rest of us.

I’m an IMG , u don’t have to be extra polite but learn the local culture and respect the norms.
Sounds like this doc gave you the private Pyle treatment, unfortunate and unwarranted but happens a lot
So try to be like private joker instead!

 

[ChiDO]

Always introduce yourself as "Hi, im first name last name, a medical student/intern/3rd year resiswnt/fellow with specialty." This allows everyone to know your level of expertise in the subject you are talking about and the interaction that is going to follow.

Once in residency, as a PGY5 I returned a page, with the intro above and then Dr. X (on the phone, introduced themselves as Dr. X) started talking about a mutual patient. After like a min or two, I politely interrupted and ask who I was speaking to again as they were making no clinical sense with their presentation. They once again said I'm Dr x with medicine. About 15 seconds later found out that Dr X was 4 months into their intern year. So instead of listening to what they wanted me to do, I told them my expert opinion on the matter and if they had any questions on my recommendations their attending or senior resident should call me back.

I also sternly told them they they should not introduce themselves to colleagues as Dr X.

 

[guytakingboards]

I agree with the comments in this thread.

1) yes it sucks that guy was a jerk, but there are plenty of those types in medicine. work on developing a thick skin
2) learn cultural norms for trainee-attending interaction

Having been on the other side (the attending dealing with medical students), what ChiDO said it absolutely correct. I worked in an academic hospital where my service (neuroradiology) had no trainees. I.e. I answered all the phone calls whether it be techs, med students, or residents.

Two things you have to establish pretty quickly on a phone call are 'who you are' and 'what you want'.

It was one of my bigger annoyances to field calls from med students and interns. One because they don't know how to communicate effectively yet. Two because they often can't field questions about the patient. Three because they're not empowered to make any decisions about the patient. So it's a big deal if you think you're dealing with an attending but it's really a med student.

It's not a big knock on early trainees, they have to learn some how. But from the otherside, I'd hope their seniors/attendings would have trained them for those interactions. I've literally stopped med students/interns on phone calls and explained to them how to call a consult.

My rec to the OP is take this as a learning experience. While it wasn't the most pleasant learning experience, it should definitely hit home that you need to learn how to conduct yourself in a hospital.

 

[onserfsaav]

Thank you everyone for your comments and insight. You’re all correct, it’s important to have good trainee-attending interaction skills to ensure an efficient consult. After this experience, I actually became very particular about how I introduce myself and was always prepared with patient information and questions before making the call. I felt that this made the interaction much easier and some attendings were actually very happy to teach me more about their plan and thought process behind it. Also, I actually somehow have a lot respect for the referred attending since they provide excellent patient care. I still feel that speaking to a student or anyone in a loud and condescending tone shouldn’t be acceptable ever, but it’s good to not take things personally. It was bitter, but did turn out to be a learning experience after all!

 

[dgdg]

No workplace has a perfect environment, but having done many engineering summer internships prior to changing to medicine, I'd say residency is a high charged, stressed out, sleep deprived environment filled with a significant number of people (not all but some) who are placed in managerial/supervisory roles that have no management training nor natural ability. They make a difficult training program all the harder. I was shocked by the change in culture and worked hard to navigate the environment. I recall many stories from my days (mine and friends'). All through residency and beyond it made me extremely vigilant to provide a good environment for the people I managed.

 

[CrazyHorseLady]

As everyone said above, this experience will help you when you have tough patients/family as well. I am glad I spent so many years in customer service getting yelled at/spit at/sweared at by customers in retail and as a pharmacy tech. Because of this, I learned how to diffuse situations. I know many people do not have this kind of experience, let alone in America where there are many self-entitled people who will try to put you down. Some of my experiences still got to me too, like one OB/Gyn attending who would not even acknowledge my existence because I was too "low on the hierarchy". But for the most part, it has helped me with difficult patient encounters and dealing with unprofessional people.

 

[Redpancreas]

Today I had to call a the Assistant clinical professor at his medical Center to ask about a patient. He was so pissed that I had introduced myself as, “I’m calling from IM” at the front desk even though to him I introduced myself as a medical student. He kept screaming about how it was dishonest and that no one teaches us about it and then won’t have it when I apologised and repeated what he had asked me to say. He was sO loud and used a very condescending tone. It was so humiliating. I had no intentions of deceiving anyone or being dishonest and I’m the politest and most respectful person. I’m trying to not let this experience ruin my rotation but honestly, I feel like ****. I was so angry that I ended up crying in front of the residents and I literally don’t ever cry - unless I’m angry, which I absolutely hate about myself. So to anyone reading this, please don’t be a jerk to your juniors. And if you really must spend your precious time with someone, please use it to maybe teach something useful to the students instead of humiliating them. Also, I’m an IMG and I’ve always heard that we need to be extra polite and nice to everyone, but the truth is that Americans are just as butter as the rest of us.

The quoted scenario if accurately described sounds like someone with an personality or mood disorder running unchecked in academia. Regardless, I am sorry you were upset. Having someone who you would presume as an authority figure talk to you in such a condescending manner would leave anyone shocked and questioning themselves on what they wrong. Crying is a reasonable emotion in this case.

That said, I think the title is a bit meh... don't let this experience deter you from the FACT that hierarchy and roles (go hand in hand) are very useful in medicine. Medicine is a team and teams function best when everyone does their job. The intern's job is to learn to collect the valuable data/complete tasks, the senior's job is to supervise them, advise, and coordinate tasks, and serve as a mini-consultant. If there's a fellow, they supersede the senior because of their specialized knowledge. The attending's job should ideally be to make sure everything makes sense and be a figure head to the patient but have the most experience and should supersede everyone and carries the liability if things go wrong. Without these roles, teams would be ineffective. Yes, a M2 doing an observership may have something valuable to point out on rounds so an attending should not belittle them, but in general the team should be steered with the ones with the most experience. You realize how important this can be as you progress in medicine and realize the learning curve between an M2 vs. an attending.

Also, completely agree with GuyTakingHisBoards above. Interns/Medical students don't know what's relevant, can't field information, and just generally are slower on the uptake for good reason. If you were the attending, you want to know whether you're talking to a learner or captain of the ship. It's the equivalent of hearing a patient case without giving the patient's demographics, hx, and reason for hospitalization (i.e. patient with chest pain, what should we do?).

 

[Redpancreas]

Always introduce yourself as "Hi, im first name last name, a medical student/intern/3rd year resiswnt/fellow with specialty." This allows everyone to know your level of expertise in the subject you are talking about and the interaction that is going to follow.

Once in residency, as a PGY5 I returned a page, with the intro above and then Dr. X (on the phone, introduced themselves as Dr. X) started talking about a mutual patient. After like a min or two, I politely interrupted and ask who I was speaking to again as they were making no clinical sense with their presentation. They once again said I'm Dr x with medicine. About 15 seconds later found out that Dr X was 4 months into their intern year. So instead of listening to what they wanted me to do, I told them my expert opinion on the matter and if they had any questions on my recommendations their attending or senior resident should call me back.

I also sternly told them they they should not introduce themselves to colleagues as Dr X.

But interns are DOCTORS! Don't let anyone tell them they're not and there's no place for hierarchy in medicine 😉. Seriously though, you're right, amongst colleagues I've noticed that sometimes the people that get the most triggered about hierarchy are the ones who are trying to do/say more than they know which is why again, it helps to understand the situation.

 

[Top Gun]

Interns are doctors IN TRAINING. An intern fresh out of med school is in no way, shape, or form equal to an attending who has graduated residency and is board certified. An attending has much more skill, knowledge, and experience. It’s not even comparable. There is a valid reason for hierarchy in medicine. Hierarchy is according to level of training and experience. The ones with the most experience and training should be the ones making the decisions. Because the ones who make the decisions take the responsibility. With great power comes great responsibility. It’s the same way the airline captain has more flight hours than the first officer and therefore is the one who makes the decisions and has final responsibility for the plane. No, attendings should not belittle med students and interns. But the hierarchy is there for a reason.

 

[operaman]

Interns are doctors IN TRAINING. An intern fresh out of med school is in no way, shape, or form equal to an attending who has graduated residency and is board certified. An attending has much more skill, knowledge, and experience. It’s not even comparable. There is a valid reason for hierarchy in medicine. Hierarchy is according to level of training and experience. The ones with the most experience and training should be the ones making the decisions. Because the ones who make the decisions take the responsibility. With great power comes great responsibility. It’s the same way the airline captain has more flight hours than the first officer and therefore is the one who makes the decisions and has final responsibility for the plane. No, attendings should not belittle med students and interns. But the hierarchy is there for a reason.

My epiphany about how little interns know came day 1 of my pgy2 year. I wasn’t self aware enough as a new intern to know how little I knew, but seeing these new interns only one year behind me I suddenly realized how far we had all come in a year!

And then pgy2 proceed to kick my tail pretty hard too!

Hierarchy is definitely a good thing. Continues after training too - new attendings need to listen carefully to the senior folks who’ve been in the game a long time. I’ve now seen a few young highly productive surgeons shown the exit door at my institution for going a bit cowboy and getting a rep for poor outcomes when they should have listened to their seniors and been a bit more cautious.

 

[Drjc1977]

Today I had to call a the Assistant clinical professor at his medical Center to ask about a patient. He was so pissed that I had introduced myself as, “I’m calling from IM” at the front desk even though to him I introduced myself as a medical student. He kept screaming about how it was dishonest and that no one teaches us about it and then won’t have it when I apologised and repeated what he had asked me to say. He was sO loud and used a very condescending tone. It was so humiliating. I had no intentions of deceiving anyone or being dishonest and I’m the politest and most respectful person. I’m trying to not let this experience ruin my rotation but honestly, I feel like ****. I was so angry that I ended up crying in front of the residents and I literally don’t ever cry - unless I’m angry, which I absolutely hate about myself. So to anyone reading this, please don’t be a jerk to your juniors. And if you really must spend your precious time with someone, please use it to maybe teach something useful to the students instead of humiliating them. Also, I’m an IMG and I’ve always heard that we need to be extra polite and nice to everyone, but the truth is that Americans are just as butter as the rest of us.

Abuse under the guise of teaching, is still abuse. Not appropriate!

 

[Top Gun]

My epiphany about how little interns know came day 1 of my pgy2 year. I wasn’t self aware enough as a new intern to know how little I knew, but seeing these new interns only one year behind me I suddenly realized how far we had all come in a year!

And then pgy2 proceed to kick my tail pretty hard too!

Hierarchy is definitely a good thing. Continues after training too - new attendings need to listen carefully to the senior folks who’ve been in the game a long time. I’ve now seen a few young highly productive surgeons shown the exit door at my institution for going a bit cowboy and getting a rep for poor outcomes when they should have listened to their seniors and been a bit more cautious.

Oh, believe me, I realise as an intern I didn’t know jack$hit. You ever look back on mistakes you made intern year and realise, in hindsight, how boneheaded they really were?

 

[operaman]

Oh, believe me, I realise as an intern I didn’t know jack$hit. You ever look back on mistakes you made intern year and realise, in hindsight, how boneheaded they really were?

Intern??! Shoot I look back on things I did as an attending LAST year and realize how boneheaded they were!

Medicine is a pretty merciless teacher sometimes.

 

[yandorio]

There's no reason why it has to be so abusive. I had a Proctor Attending in Oakland (IM Rotation) who
acted like a policeman trying to "break" me in his conversations/interrogations of me. I finally went to the top IM doc
who told the guy to quit being so nasty. In my Psych rotation the two proctors were criticizing my knowledge base
but when I look on PubMed I saw I had more publications in the field than both of them put together.
But the message boards are full of third year medical students talking about how horribly they were treated. In the end most of us end up as doctors who, I hope, know better than to treat people like cr@p.

 

[dgdg]

I worked briefly in another career before starting medicine which gave me a small but positive perspective. A successful work environment needs leadership with managerial training and experience who are also focused on team success instead of self glorification or malcontent.

Medical training is a high intensity workplace environment. Combine that with the realization that many of ones' supervisors are essentially promotions for passing the prior year's clinical goals until one graduates and leaves, or is promoted to the highest rank of a full attending. However, these clinical supervisors (at all levels) are also managers in a corporate workplace in addition to providing direct clinical care. Yet, many probably have no managerial experience or training. Hazard to say some in a managerial role do not want to manage. If the manager also has any degree of a mental health issue, it only makes things worse.

Yes, it takes time and patience to teach interns year after year. Not sure I could do that.
Teach and be an effective team manager as best you can.

"It is amazing what you can accomplish if you do not care who gets the credit."
- Harry S Truman

 

[Stellar Mudd]

Jerks exist everywhere but in my experience intelligent people are able to be more articulate and accurate in their attacks which makes it worse. Physicians in my experience can be some of the worst for this. Couple with pressures…

 

[Stellar Mudd]

We’ve all been there. During my third year OB/Gyn rotation, my chief resident (or maybe it was the clerkship director) wrote on my evaluation that I “had clear concern for my patients but lacked sufficient medical knowledge.” Gee, thanks for the encouragement! Anyway, I went on to complete IM residency and a nephrology fellowship and am medical director of two dialysis units with great quality initiative scores, so I’m clearly not the unintelligent, incompetent, waste of skin loser they thought I was. I totally agree there is way too much abuse that goes on in medical education. That being said, I still stand by my earlier comment that there is a reason that the medical hierarchy should be respected, provided they are actually teaching their trainees and not abusing them.

Not following how saying you lacked sufficient knowledge is inappropriate?

 

[Stellar Mudd]

Uh, the fact that I’m doing well now is maybe evidence that my abilities, intelligence, and potential were underestimated.

Fair. I just wasn’t following a comment about oh/gyn knowledge critique for a very early green trainee and how that was saying you were a loser. The didactic years M1-2 can leave a lot to be desired in that knowledge base and it’s not a crime for a student to lack that knowledge and for that to be noted on rotation.

I believe you they were rude to you, that has been said so much about ob/gyn and sadly is often true based on what I’ve heard from students. I’d be interested in what else they said or did to you.