How to deal with painful attendings

[Putmetosleep]

how do you residents deal with those extra special attendings who are so skilled at criticizing EVERY aspect of your anesthetic down to the type of tape you choose to secure the tube. i know that attendings have their own styles and we should accept this and try to incorporate as much as you can into your own style but there is a point where highly critical and anal attendings tend to negatively affect me. then there are those attendings who completely set your up for failure. there are times where I just completely shut down when working with particular attendings who need to have everything done their way. as I progress in my training I am getting increasingly more annoyed and frustrated. i know this must come up for many residents and I was wondering how you all deal with it.

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[johankriek]

you are a resident. welcome the criticism.. every criticism you hear is a learning point. If they dont point out the bad things you do, you will never be any good. Im serious. My attendings berated us to the point of it being personal. But i still remember every single point they were making. I was never given any freedom as a resident. they kept me on a tight leash. But i am a better attending for it.

 

[militarymd]

ignore them, what's the worst they can do to you?

Not give you a pee break?

 

[zippy2u]

Piss on em, they are where they are because they couldn't hack it in the private sector... Regards--- Zip

 

[dhb]

Piss on em, they are where they are because they couldn't hack it in the private sector... Regards--- Zip

 

[Gern Blansten]

I know the types of attendings you speak of. They exist in all programs. Just do your best to bite your tongue and be respectful. Do your best to do it their way as appropriate. Always be well prepared and well read. Don't give them reason to pick you apart. Always have some tough questions to ask them to take the focus off of the minutiae. Make sure they are pertinent and useful questions so you don't appear to be a buffoon. As you progress in your training, you can get more autonomy and expand to do it your way, or the way other attendings have taught you that you find useful.
Just think twice before blowing them off as if you don't care about their opinion. These types are also the most likely to complain about you if they feel that you treat them with disrespect. The residency will pass quickly and hopefully your share of time with that particular attending will not be too great. Good luck.

 

[Lonestar]

we have more than a fair share of those attendings at our program. the number of residents getting in trouble has increased. there really is no one way to deal with them. just do your best and hopefully you will emerge out that hellhole unscathed. In our program, the entire cardiac anesthesia group is just horrible (none of the seniors want to do even a single month with that shady group), same group does ICU, OB director is a complete biaatch (and bipolar), couple of the general anesthesia attendings are just not right to say the least. All in all, i must say i have never been so poorly treated in my life. We as anesthesia residents get better treatment from the surgical attendings than from our own (at least at our program).

 

[mille125]

I have felt your pain. Anesthesiology seems to attract an unequal share of the "fanatic fringe". I believe that you should always take the high road. Treat him/her with respect. When you think about it, you will have very limited exposure to an individual attending during your residency (maybe 4 or 5 times tops). This particular attending is probably used to most residents treating him/her with disdain. If you take the high road, you will likely win his/her respect which will reflect well in your evaluations. You are only a resident for a very limited time....

 

[Mman]

I guess I feel lucky that very few of our attendings are difficult to work with, maybe 10-15% tops and at least 30-40% are downright awesome to work with and I know it'll be a fun day as soon as I see their name on the schedule.

When I get stuck with one of the bottom 10%? Listen to teaching points, stupid criticisms go in one ear and out the other, and I grab a beer after work.

 

[loveumms]

SO lonestar - out of curiousity which program do you call home?

 

[UTSouthwestern]

This is a situation that you will encounter throughout your residency and the way to deal with it is to listen to the criticism, ask about the reasoning behind the choices these particular attendings use, learn their techniques, decide for yourself whether or not you will ever use them in the future, and move on.

Above all else, always, ALWAYS look them in the eye when they are criticizing you. Nothing intimidates an intimidator more than someone who will NOT be intimidated and can ask valid questions about why they choose a technique, tape, blade, etc., and can then back up their own opinions and techniques with hard data.

I always loved doing that. I loved having Johnston, Shearer, Hall, White, etc. trying to challenge my mind with their techniques and their practice philosophies. They were great teachers. Some others used to preach their ideas as if they were the gospel and I had no qualms about respectfully disagreeing and shooting them down.

 

[cfdavid]

lol, This reminds me of when I was in high school working for my uncle (and dad, but my uncle was more uptight...). He'd literally stand over you, watching how you broke down boxes and loaded em into the dumpster so we would maximize the load capacity of the damn thing.

I was once critisized for using the "wrong" masking tape to tape up a package. It was f..ing ridiculous! Now we're buds though, but at the time, I wanted to ring his neck....

 

[Stimulate]

I try to learn their little quirks so that they leave me alone. Some times you can give them the figurative finger by saying something like, "I know you have a very specific way of taping the ETT tube..would you like to do it" as I pass them the tape. If they want things a certain way you can make them active participants.

Bottom line is that you need to stay out of trouble with them. When they treat you like **** keep that in mind as they try to recruit you for fellowship and attending slots. If they can't recruit faculty they will be forced to work more and more hours and you can take pleasure in that (passive-aggressive yet satisfying, hehe).

 

[foxtrot]

I sympathize with many of the residents on this post. It is very depressing and exhausting to deal with abusive negative attendings. And some times it is very hard to take the high road after you have worked for 12 hours straight. I have almost dropped out of anesthesia residency because of the horrible treatment I have endured from many of the attendings I have worked with. But I think that Zippy said it best.... Most of the people in academics are there because they could not make it in private practice. If you think about it, if you are in an MD only group, you have only yourself to blame if something goes wrong, you can't criticize anyone else (except maybe the surgeon). If you supervise CRNA's and you treat everyone like crap, people are going to complain and members of your group are going to see you as a "problem." Thus, I have decided that residency is a finite period that you have to go through in order to become an anesthesiologist. I am there to get a piece of paper and learn the basics of anesthesia. The real training and learning will come when I get into private practice. Keep your head up and just try to stay under the radar. And if someone does go after you, just say you are sorry and it won't happen again and it was a good learning experience. And then after you graduate, tell them to go $#&* themselves!!!

 

[pgy13]

As an academic attending, I'm going to have to object to the notion that "Most of the people in academics are there because they could not make it in private practice". Yes, there is a small subset for which that is probably true. But believe it or not, some of us actually like teaching and/or research in addition to clinical care.

 

[mille125]

pgy13 has a point. when i look at my former anesthesiology department, the attendings fit into one of three catagories

1) The "I love to teach type": residents love this type. this is the guy that wins numerous teaching awards and is a resident advocate. every department has a few...some are lucky to have many

2) The "I am a scientist type": academic departments are full of this type. spends 3-4 days doing clinical research and one day (if that)in the OR...some residents love this type... he will leave you alone because he has many experiments to look after and grants to write...you really have to drag him there for induction and wakeup....he will teach you nothing about the metabolism of sevoflurane but he would be more than happy to sign you up as cheap labor is his lab....some academic departments have many of this type.

3) The "I hate everything about you and the world type": everyone knows this type.....some departments are lucky to have a few...some seem like this guy ran out the other two types......this type will give you the business...this guy is most likely to harass you about taping the tube, putting in alines.....This guy feels like he has been screwed over and feels like someone owes him something....he is going to take it out on your hide.....he probably failed in private practice or was passed over in academics... in any event it is going to be a long day.............


I think that just about all of the academic attendings fall into one of these catagories....hopefully your department has many more 1's instead of 2's and 3's

 

[ronin8]

it's unfortunate that people can't just have common courtesy when treating others. i learn nothing from an attending who gets mad and yells because they don't like what i did or whatever. it serves no purpose, and you may learn a thing or two, but there are better ways to learn and nobody deserves this kind of disrepect. there oughtta be a law.

 

[mille125]

it's unfortunate that people can't just have common courtesy when treating others. i learn nothing from an attending who gets mad and yells because they don't like what i did or whatever. it serves no purpose, and you may learn a thing or two, but there are better ways to learn and nobody deserves this kind of disrepect. there oughtta be a law.

ronin..........you need to get over it...there are good teachers and bad ones....nice ones and mean ones....smart ones and not so smart ones....you have to deal with them all...just like you have to deal with all different types of patients....if you get through it and still keep your laughter, your sense of humor, and your integrity, believe it, nothing in this world will stop you from succeeding............

 

[ronin8]

ronin..........you need to get over it...there are good teachers and bad ones....nice ones and mean ones....smart ones and not so smart ones....you have to deal with them all...just like you have to deal with all different types of patients....if you get through it and still keep your laughter, your sense of humor, and your integrity, believe it, nothing in this world will stop you from succeeding............

so much for trying to make change for the better with that kind of attitude. positive improvements can only happen when you believe there is a better way and work towards it, not accepting mediocrity and the status quo. sure we have to deal with things in life, but we see injustice and we change them. read "if disney ran your hospital"

 

[Gern Blansten]

so much for trying to make change for the better with that kind of attitude. positive improvements can only happen when you believe there is a better way and work towards it, not accepting mediocrity and the status quo. sure we have to deal with things in life, but we see injustice and we change them. read "if disney ran your hospital"

Little known fact:
A couple of years ago, the job voted worst in the US was ride operator on "It's a Small World." Apparently listening to that song over and over will drive you insane. That job beat out Crack ***** and Assistant Crack *****. So, if Disney ran your hospital, the patients might be happier, but the employees (residents) might not necessarily be happier. Disney is not real life and I think mille125 called it exactly as it is. Just like high school and college. You will have some teachers that are better than others. You should just look for the programs that seem to have an abundance of the good teachers and a paucity of the bad ones. If you get stuck with a bad one on a given day, it will just build character and help you learn to deal with abrasive personalities because dealing with those people IS real life. You need to possess those skills.

 

[ronin8]

Little known fact:
A couple of years ago, the job voted worst in the US was ride operator on "It's a Small World." Apparently listening to that song over and over will drive you insane. That job beat out Crack ***** and Assistant Crack *****. So, if Disney ran your hospital, the patients might be happier, but the employees (residents) might not necessarily be happier. Disney is not real life and I think mille125 called it exactly as it is. Just like high school and college. You will have some teachers that are better than others. You should just look for the programs that seem to have an abundance of the good teachers and a paucity of the bad ones. If you get stuck with a bad one on a given day, it will just build character and help you learn to deal with abrasive personalities because dealing with those people IS real life. You need to possess those skills.

why does everyone assume that just because i don't like mean attendings equals i don't have skills to deal with them? if i don't like it i'll post about it. most likely people like you are going to be those attendings with attitude problems

i don't think it's unreasonable that most people prefer working with nice people. and institutions that have good reputations hire good teachers that people like to work with, that's a selling point. and i'd rather be in that kind of environment, there's no detriment to my education in wanting that

 

[Gern Blansten]

Ronin,
I am sorry you took offense to the fact that someone's opinion is different than yours. It is clear now that you do possess the ability to deal well with others. Good luck to you. I sincerely wish you the best.

 

[urgewrx]

Be respectful. Try to remerber their quirks. Sile at the fact that once you get done you will disregard their BS and do whatever the hell you want.

 

[foxtrot]

As an academic attending, I'm going to have to object to the notion that "Most of the people in academics are there because they could not make it in private practice". Yes, there is a small subset for which that is probably true. But believe it or not, some of us actually like teaching and/or research in addition to clinical care.

I am glad that there are people like you in academics but I have to say that the overwhelming majority of the the academic attendings I have worked with could not make it in private practice either because they have such bad attitudes and like to cause drama or because they are extremely lazy. Now, I am not at a top tier program so maybe it is different at higher caliber residencies but I know where I am, most of the attendings really seem to enjoy making residents lives unpleasant. I wish it were not the case but this just seems to be the way it is.

 

[Coastie]

how do you residents deal with those extra special attendings who are so skilled at criticizing EVERY aspect of your anesthetic down to the type of tape you choose to secure the tube. i know that attendings have their own styles and we should accept this and try to incorporate as much as you can into your own style but there is a point where highly critical and anal attendings tend to negatively affect me. then there are those attendings who completely set your up for failure. there are times where I just completely shut down when working with particular attendings who need to have everything done their way. as I progress in my training I am getting increasingly more annoyed and frustrated. i know this must come up for many residents and I was wondering how you all deal with it.

Sedate them

 

[swpm]

Sedate them

I think succinylcholine sans sedation would be more satisfying. It'd be worth it for the fasciculations alone.

 

[militarymd]

I think succinylcholine sans sedation would be more satisfying. It'd be worth it for the fasciculations alone.

Challenge them to a sux race.

20 mg IM sux in quad, then see who can run further down the hallway before collapsing.....

Be gracious...and allow your elder to go first to set the bar that you will try to beat.

 

[VolatileAgent]

... I have worked with could not make it in private practice either because they have such bad attitudes and like to cause drama or because they are extremely lazy.

good thread to vent. i agree with most of what's been said here.

i don't know if it's laziness, though. usually, i don't think it is. i think it's more about inefficiency and lack of pressure in getting cases turned around because of the "academic" nature of the practice. safety is always the number one pursuit in our profession, but my frustration usually arises with what i feel are inefficient anesthetic plans.

for example, i recently got into a "discussion" with an attending concerning a young, otherwise healthy patient who was going to have a mass excised from his leg in our outpatient surgery center. the guy was very nervous, and had already taken his daily xanax in the morning. i started the i.v., planned on just doing a propofol "stun" when they injected the local, and then light sedation (as i've done literally dozens of times before) during the case. he didn't want to remember the procedure. fine. propofol would take care of that. MAC with standby. standard asa monitors. my plan was to get the guy to the PACU and out the door as rapidly as possible.

well, my attending insisted that we give the guy midazolam on top of his home alprazolam. apparently, midazolam (in many people's minds) is a perfectly acceptable substitute for actually having to talk with a patient and use positive patient interaction as your anxiolysis. it get's better. he then further insisted that i use alfentanil prior to the injection of the local so he wouldn't "feel the injection" of the local anesthetic. i said, "well, he certainly won't remember it with the propofol. do you have particular concern about a healthy, active albeit anxious 36-year-old's cardiovascular status?"

so, what was the end result? an extended PACU stay with significant post-op nausea and dry heaves. what's worse? this particular attending, normally a reasonable guy who's expertise is doing more complex cases in the main hospital, repeatedly defended his decision. i explained that i'd always had good experience with propofol only, especially with such a procedure. i reminded him that propofol, in and of itself, has anti-emetic properties. i told him that many of our other attendings would also have done the case with propofol only. i asked him why he thought his plan was better. he told me that it was his "experience" in talking with his patients afterwards that they preferred his method. at that point i just smiled and didn't say anything else. hey, his name was on the anesthetic record as the responsible party.

only 4 months 'til i'm on my own...

 

[Stimulate]

I get annoyed with having to intubate everybody who would be perfect LMA candidates. Many attendings want ETT because when they are covering lots of rooms they prefer having a secure airway. Perhaps maybe I would feel the same way if I were in their shoes but it certainly does add some time to the turn-over.
I agree the countdown is ON...

 

[ronin8]

Ronin,
I am sorry you took offense to the fact that someone's opinion is different than yours. It is clear now that you do possess the ability to deal well with others. Good luck to you. I sincerely wish you the best.

same to you my friend. think about it

 

[VolatileAgent]

I get annoyed with having to intubate everybody who would be perfect LMA candidates.

... and you can still "relax" them, if/when needed, by using a sux drip. i've used sux drips on several patients, even some with LMAs, and i'm still amazed at the number of attendings who are terrified of and/or have never done this technique.

 

[Lonestar]

"Life is like a box of chocolates. you never know what you are gonna get."
Residency sucks period. you are the slave. Just suck it up and don't let them intimidate you. If people on the outside found out about the treatment of young doctors, many of these hospitals would be sued. But that will never happen, b/c people on the outside (patients) don't care as long as it doesn't affect their free care.