How do I redeem myself with my attending???

[MD'05]

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I really need some advice here!!! I can't talk to anyone on my rotation or in my school for that matter since I do not want to make a big deal of this.

Apologies if I am vague, but it is intentional!! This week we have a new attending on my rotation and I made the mistake of being post call and having to present a patient I thought I had a good history on and was well prepared -- it turned out that I was not. It could also be the attending has a personal problem with me, but I can't worry about that part of it. In short, the attending layed into me when I made a statement that the attending felt was part of the diagnosis and not the chief complaint (it was the chief complaint) and I choked and now when I try to present progress on a patient the attending absolutely ignores me. The senior resident is also not allowing me to admit new patients -- not that this person has come out directly and said this, but I can tell what is going on.

What can I do to fix this situation? I want to approach the attending, but it may piss this person off. Again I don't want to say anything to the senior or my intern since I don't want to make a big deal of this -- I only want to correct my mistake!

Any advice would be most appreciated.

 

[chicamedica]

Hmmm, about your senior resident not assigning you any new admits lately, well maybe it was that the attending got mad at him for choosing a not-so-good patient for an MS-III (the case that you had to present), and maybe the resident is now trying to be more picky about patients he gives you. just another possibility to think about. . .

About the attending ignoring you when you present. . .are you sure he/she is really ignoring you? sometimes they might seem like they're not paying attention, but they really are. . .It just seems really strange to me that anyone would have a grudge against a new MS-III for accidentally unknowingly saying a dx in the cc. . .

 

[Renovar]

Originally posted by MD'05
I really need some advice here!!! I can't talk to anyone on my rotation or in my school for that matter since I do not want to make a big deal of this.

Apologies if I am vague, but it is intentional!! This week we have a new attending on my rotation and I made the mistake of being post call and having to present a patient I thought I had a good history on and was well prepared -- it turned out that I was not. It could also be the attending has a personal problem with me, but I can't worry about that part of it. In short, the attending layed into me when I made a statement that the attending felt was part of the diagnosis and not the chief complaint (it was the chief complaint) and I choked and now when I try to present progress on a patient the attending absolutely ignores me. The senior resident is also not allowing me to admit new patients -- not that this person has come out directly and said this, but I can tell what is going on.

What can I do to fix this situation? I want to approach the attending, but it may piss this person off. Again I don't want to say anything to the senior or my intern since I don't want to make a big deal of this -- I only want to correct my mistake!

Any advice would be most appreciated.

I would observe for a week or so. And try the best you can to perform at the top of your game to the style of your resident and attending. If, at the end of the week, they wont stop chewing you up, then you need to do something.

If that's the case, I would first go to the clerkship director/coordinator who does your final evaluation for the clerkship and ask him what's the expectations of you, and complain to him you were not being treated well. Do it immediately and dont wait for it to end before it's too late. Some reasonable clerkship directors will look at your other evals, and offer you to tone down the bad eval if the attending lay down the hammer if all your other evals are good. I know in my institution, some attendings (residents) have really bad reputation of chewing out medical students, that the clerkship director sort of take their evals with a grain of salt. It is understandable for a beginning MS3's to make mistakes, and as long as they take it in stride and learn from them, it usually is not a big deal. Most evaluators know that. And I think it is important to touch base with him early. Another thing you can do is talk to the chief resident of the service, who usually looks after medical students. They can usually pursuade the senior resident a little bit in terms of getting you new patients if you tell the chief that you need more patients.

 

[Whisker Barrel Cortex]

I'd recommending giving it a little more time (few more days to a week) to see if anything changes. As an above poster mentioned, he may not be ignoring you and if he is it may not be your fault. Any attending that acts as an antagonist instead of teacher has those tendencies.

If things do not change, I'd talk to your resident and attending and discuss how to improve your work. Don't confront him and ask why he's ignoring you etc. Instead, start by reminding him your stage in training ("I'm in my second rotation of third year and am continuing to work on my skills, do you have any comments on how I'm doing and what I can improve on.") Then, if their comments are vague and not helpful, ask more specific questions: How are my presentations? Any suggestions on improving my notes? Then, after their suggestions, implement them.

Do not go above them to the course director or the odds are you will regret your decision. If the course director talks to them about it and you don't, they will not be happy. If at the end of the month you feel like you weren't given a fair shake, then consider talking to the course director.

 

[fourthyear]

I'd ask your residents what you can do to improve. Let them know you're really interested in doing a good job, you realize you didn't present yourself well that day, and that you'd like their advice on how to do better. At least then they know you want to do better and maybe they'll give you some useful hints.

You may be totally misinterpreting them ignoring you. Now that i'm a resident I realize how I get so busy someitmes I forget to tell our students what they can be doing and how to help the team. Luckily, they ask me often what they can do to help out, and that reminds me to pay attention to them and give them something to do that helps the team out. Plus I tend to teach more to the students who help me more, just because they tend to be around more asking questions and letting me know they are interested. If you stay quiet and don't ask your residents how you can help, they either will just get busy with their own work and forget you are there, or, worst case scenario - they will get the idea you don't care to help out, which I'm sure is not true at all in your case.

 

[Samir Desai]

It sounds like you are in a tough situation and I certainly hope everything turns out well. I would like to offer you some advice from the attending perspective but I would need to know more details about your situation. If you wish, you can send me a private message and we can communicate further, either by email or even by phone.

Good luck,

Samir Desai, MD
Assistant Professor of Medicine
Baylor College of Medicine

 

[MD'05]

Thank you all for the input. I will try to open up a dialog with my attending directly. It could be a matter of the attending's style since this person has also chewed on the interns as well.

Just to clarify, the attending did not ignore me (I wasn't clear), the attending interrupted my presentation by addressing the senior regarding the patient's issues. The attending also told me that I could place my SOAP notes in the patient's chart if I wanted to and that he could look at them if I wanted him to. This is just kind of strange since the hospital's course director specifically laid out expectations for student daily activities.

So far my attendings have been great. The first two weeks of my rotation were great! I was busy, I was given patient responsibility, and I really felt like I was part of the team. Now I feel like I might as well stay home each day. This person may be an outlier, but I need to fix this situation rapidly.

Dr. Desai, thank you for the offer -- I have read your book, but I am still sitting on mistake #83. Let me see how the day goes.

Thanks again everyone. I will let you know how it goes.

 

[8744]

I'm going to suggest a different approach which might anger some and offend you:

I say screw the dialog. If your attending is such a dickhead that he will penalize you for making a mistake then, with respect to your sensibilities, **** him.

By groveling at his feet in some misguided atempt to ingratiate yourself you will probably only garner more of his contempt.

What do you care what he thinks? His evaluation of you is only one of many hundreds that you will get in third and fourth year. In the end it will have a negligible effect on your standing, your grades, and the residency that you get. (I mean assuming that you are generally a good student and not a constant screw-up.)

I would not humiliate myself for the sake of my GPA, whatever the case.

I repeat, you have nothing to apologize for. I understand that in medical school you sometimes have to keep your mouth shut and "suck it up." While I have been fortunate to have had fairly decent treatment from my residents and attendings, there have been a couple of times when it has taken a great deal of effort to keep my mouth shut and my speech civil. Some of the attitudes of a few residents over here would result in a quick ass-kicking anywhere else but medical school.

I do not advocate beating residents or speaking to them disrespectfully. Practically, it is best to endure their criticism in silence. But you don't have to dignify thier poor leadership skills and rotten personalities by apologizing.

You're going to be on this rotation for what, one month? Two weeks? Just tough it out. Man. I step on my dick every single day here in third year. It is just a part of medical education. We are expected to be a little incompetant. That's why my resident checks the patients, reviews my progress notes. and only let's me bovie when there is no chance of nicking the ureter.

 

[MD'05]

Hey PandaBear,

No offense taken ... outside of medical school I would have used this attending as a punching bag ...

An update:

I have come to the conclusion that this attending has psychotic tendencies which even the attending recognizes as having and is thus behaving in a much more civilized manner towards everyone save a few choice patients. Very interesting situations that I would love to share with everyone, but not until I obtain my MD! However, if this attending treats the wrong patient in this manner, you may be hearing about it on CNN.

Again, thank you everyone for the input since it helped me realize that it is ok to be the fumbling, inept (but striving for improvement) medical student that I am!!!

 

[Tazmaniac]

I used to beat myself over the head over every mistake ever made during 3rd year. Then I realized: Wait a minute, I'm just a third year! I can make mistakes as long as I keep trying!

The light-bulb-over-the-head realization that you CAN make mistakes is what ultimately relaxed me for future rotations. Now I don't mind being pimp-questioned because I know I don't have to get them all right. So far, I'm doing pretty well in rotations; I'm learning as fast and as much as I can, and no attending can stop me.

Oh, and don't overanalyze. Saves you a lot of trouble. No attending thinks that your fumbling your H & P was a direct attempt to humiliate you, him or her, right?

-Todd MSIV USC.

 

[secretwave101]

Among the students in my class, there are people who take criticism well and others who REALLY struggle with it.

The mistake you made was minimal. Sometimes being a perfectionist is a hinderance, and perhaps there's some of that going on with you in this situation. So you screwed up the presentation (again, minimally, I'd think), chances are you won't do it again. This means you learned. Good job. Go on with life.

The advice I've consistently gotten about the wards is that residents and attendings want to teach people who want to learn. Being perfect isn't learning. If you roll with the criticism and show that you learned from it - and are still eager to help and present - I'd think you'll get another shot.

 

[chef]

WTF.. dude, why are u even puttin up with this $Hit? you are a tuition paying med STUDENT, not an employee. he may bitchslap around nurses or residents but he should know better than that, and u r there to learn by making mistakes.

i'd go talk to M3 curriculum director immediately and tell him what's going on. my medschool admin. and faculty bend over backwards to make sure their students get the education they deserve and that they are completely satisfied with teh learning expereince, and should an issue or concern rise the admin will do everything to correct it.

u r there to learn about medicien and how to tx pts, and u shouldnt be spending all that time worryin yer ass about ass kissing & medicine politics at thsi stage (that comes up very soon tho hahaha)

 

[rrreagan]

Just do the best you an. Ask some questions and try to get the most of your learning experience.

Students are invariably treated shabbily everywhere, so don't be overly concerned.

Medical education is designed with residents in mind and students are just there to fight over the scraps.

 

[AznTrojan]

ward rule number 1.. don't take pimping personally.. once u do.. you're toast..

 

[Jingojango]

Bad days can often lead to displaced frustration.

Alternatively, some people are just rude jerks

What I love most about being a student in a clerkship is, even if you mess up, you'll be somewhere else next month!

Good Luck.

 

[lowbudget]

Relax. Just do your best, figure out how he wants you to present, and do it. The attending and sr residents have their jobs to do too, and sometimes hate bringing a med student along. Don't take it personally. Do your best.

My surgery attending laid into me constantly for stupid ****. It was my first rotation so how was I supposed to know? Anyways, I read my evals after the rotation and he gave me really high marks and said some decently nice things... his evals were way better than what I had expected. Sometimes/A lot of times, when it SEEMS like they're laying into you, they're simply trying to teach you. It sucks being corrected, I know, but just learn from it and move on.

(And then go to the gym and punch the hell out of the punching bag, stupid bastard).