Hi!
I registered just so I could reply to Neuronix, as I had very similar experience in clerkships. First off, I studied, and now wait for residency in a European country, but I am puzzled by the similarities.
I spent a few weeks on a general surgery ward once. I had been advised to greet
all nurses, and tiptoe my way around. Upon arriving, I pretty much made record of everyone I saw, kept a mental record of their names, but I didn't spot the
head nurse. When seated with the nurses in the lounge, I asked what they expected of me as a (then) medical student. The head nurse, whom I met for the first time, gave me a lecture of how I should greet everyone. I learned that she had seen me (even though I hadn't seen her - maybe because she was passing in a rush, and insisting on greeting busy people is a high-risk game). I had just read a book on assertiveness, so I put on a smile and asked the nurse why she hadn't stopped me, if she saw me, so that I could greet her? I can't remember her reply, but I do remember being pulled aside by the director before surgery the day after, and lectured on complaints by nurses already at day 1. I decided to act assertive as much as I could, and said that I was disappointed to hear that, what was the problem? But he yelled, I don't have time, I am heading into surgery, you straighten up your act, or you are outta here.
) (man, I hate abrasive and macho ppl)
Now, fast-forward a few days, and picture the morning staff meeting, they discussed a case of not being able to determine whether the entire tumor in a cancer patient had been resected or not, due to wrongful marking of the specimen. The surgeons yelled at each other, and the pathologist stuttered a concern, as he was simultaneously trying to point out a problem, whilst also trying to avoid impeaching himself for not being able to give a proper diagnosis... What a sight.
Then, a few minutes later, they started discussing a patient case when I decided to ask if I could voice an idea. The department director quickly brushed me off. Then I didn't back off and said in a friendly tone that he asked us to contribute if we had the possibility. I continued with a workup suggestion. Another surgeon gave me a friendly nod. The head nurses which were present, and the one who had ratted me out then came back to flirt...
Anywayzzz... I could allow myself this, as I had the freedom to take my clerkships wherever I wanted, whenever.
But now residency is coming up, and what bugs me is that being assertive seems to be a dangerous strategy.
Granted, there are many ways to appear less confrontational, and more problem oriented, when asking questions when you are confronted by superiors who are ticked off by something. For instance, instead of saying: what was the problem, you can make a suggested guess, like: "was the problem that I didn't call you before I ordered the CT or should I have made a spinal tap by ophtalmoscopic exclusion only?"
But even that might bee too much, and so I wonder:
Is there
any way of avoiding the boot by mere
chance? There will always be something you should have done differently. Even top USMLE scorers, and super-slimeball suck-ups are bound to step wrong ONCE. Now, say that you are called out for doing something you KNEW was the best thing to do, and if you just reply with "yessir, I understand sirr, I should have given the steroids before salbutamol sirrr," then you postpone a problem until next time you do it wrong again. And even worse, if the nurses smell blood, they can throw rocks in your path.
What
is the optimal algorithm to maximize chances of surviving, granted there are no real deficiencies in the medicine skills department? Even if you are invisible, you might raise suspicion, or be depicted as less amicable by colleagues. Even with a shy smile, a positive face, and shutting your trap, can you be safe??? Is that the best bet?
Also, even if you disagree with your resident, just tell them yes they are right, and either do what they say or indirectly pretend like you did what they said without harming the patient.
But in case #2, what do you do next time around.... They are gonna find out you aren't doing as you are told.
OK, so why don't they like you? Are there lessons you can learn to modify your behavior?
If the problems aren't purely attributable to unforeseen chance, then yes. And I would suspect unforeseen (as in statistically impossible to foresee, not just related to the bad judgment of the resident himself) causes aren't the ones occurring most often?
I completely don't buy the story of being banned from a hospital just for telling someone that fellows weren't allowing them to do lines.
Haha, while waiting for residency, I have gotten a license to practice, and began working in an ER. I gave a student the silent treatment for a) asking me where I had studied (she was in the most prestigious school) b) looking good. c) having confidence. I know I would have hated myself as a superior, I know I acted like an a-hole, but I needed to right there and then. And never would I have admitted that in front of my boss, I would have put the blame on her, by e.g saying how she shouldn't have asked me difficult qs in front of the one with a scalp laceration.
But I made it up to her later. I saved a patient case extra for her, and helped her put in her first stitches an hour later. I do have some self-insight, I just can't control the negatives all the time.
A lot of people style themselves as some sort of hero or iconoclast for speaking out against some perceived wrong. In many of these situations, there is a major lack of observation or common sense which could have replaced the speaking out.
Very true. That holds in general for all people. Either you are completely right, and you are completely innocent, or you have the sole blame. This seems to be a thought pattern among insecure people, and they tend to go a long way to be rectified. When they are shot down by their program director, they come online to complain.
BUT: that doesn't exclude the possibility that, despite their shortcomings, they have been treated in a disgusting way. I have such a potential ****er deep inside. Just treat me miserable, and never cuddle my vanity, and it
will come out. Next student.........