I'm incompetent

[JustPlainBill]

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Where to start....

Ok - don't know that here at this program an OB postpartum visit REQUIRES a H&P (yeah, a full admission like H&P) rather than a targeted one-- you're incompetent

Use a standard template to write your note that doesn't have something the attending views as necessary and never told you -- you're incompetent.

Don't know - immediately off the top of your head -- the formulas for repleting sodium -- you're incompetent.

Have upper levels order studies and procedures w/o telling you on your patient and you don't know the results -- you're incompetent

Not be able to quote - in detail - which study is relevant to a particular single problem in a problem list that your patient has --- you're incompetent.

Decide to track I/O's instead of daily weights on an ascitic patient on diuretics -- you're incompetent.

Not know you have to do an entire ROS on daily inpatient progress notes because this is the only place you've been that does that -- you're incompetent.

Not be able to carry 7 train wrecks on your first week of intern year inpatient -- you're incompetent.

Not know how to replete K+/Mg your first week of intern year -- you're incompetent.

Not know the treatments for various clinical conditions in detail -- down to dosage and frequency -- your first month of intern year -- you're incompetent.

......Ok, I get it, I'm incompetent.....we're rapidly approach the low GAFF zone....

 

[ShyRem]

This too shall pass.....

 

[JustPlainBill]

Added today --

Use a template from a previous 'rock star' intern who aced the rotation which doesn't have the comment du jour in it --- you're incompetent.

 

[peppy]

Sorry to hear that you're having such a rough time. I don't know why some people don't realize that interns are there to learn. If everyone came out of med school knowing everything then we wouldn't need residencies in the first place.

 

[FutureInternist]

"I thought residency was for learning. If I showed up knowing everything then why the f*** am I doing a residency".....and walk away ! 🙂

 

[Top Gun]

Don't worry about it. Your knowledge base will continue to grow throughout your residency. I was just like you beginning of my intern year. I barely had a clue how to even titrate a heparin drip or supplement potassium. Now that I'm four months from the end of my third year, I'm much more confident in my skills. I can manage a variety of medical conditions now, including potentially trainwreck ICU patients.

 

[michaelrack]

You should have the standard textbook of your specialty memorized. Residency is to learn the practical application of the info as well as to learn procedural skills.

I am sort of joking.

 

[JustPlainBill]

You should have the standard textbook of your specialty memorized. Residency is to learn the practical application of the info as well as to learn procedural skills.

I am sort of joking.

I hear you....and recognize the tongue-in-cheek/semi serious tone....problem is FM is quite a big specialty and I'm in a university program with LOTS of specialty residencies and other primary care residencies that we rotate with.....

The program has never recommended one text for our specialty...but a whole lot of other specialty textbooks.....do you have one for FM that's the equivalent of Williams for OB?

 

[JustPlainBill]

"I thought residency was for learning. If I showed up knowing everything then why the f*** am I doing a residency".....and walk away ! 🙂

I did something like that ,"I'm just an intern" when getting pimped and grilled into paste. Wound up getting slammed on my review for using that as an excuse and not being proactive.....it's like,"Hey jerkweed, if I knew the answer to your question, I'd be a flippin' attending, que no?".....

 

[Yo GabbaPentin]

I did something like that ,"I'm just an intern" when getting pimped and grilled into paste. Wound up getting slammed on my review for using that as an excuse and not being proactive.....it's like,"Hey jerkweed, if I knew the answer to your question, I'd be a flippin' attending, que no?".....

Never ever EVER use that excuse. Seriously. Turn into a paste and say "thank you, may I have another."

If you are being viewed as incompetent then you are giving your program ammo to cut ties with you. Especially if it is showing up in documented evals. The paper trail is being formed and I advise you to be very careful and to get pimped into paste with a smile on your face.

 

[Doctor4Life1769]

Generally, if I didn't know, I told them, and then I looked it up and got back to them (attendings/residents)..
I know I'm only an MS-4, but I plan to use that line as an intern.

 

[smq123]

I did something like that ,"I'm just an intern" when getting pimped and grilled into paste. Wound up getting slammed on my review for using that as an excuse and not being proactive.....it's like,"Hey jerkweed, if I knew the answer to your question, I'd be a flippin' attending, que no?".....

Never ever EVER use that excuse. Seriously. Turn into a paste and say "thank you, may I have another."

Yeah, saying "I'm just an intern" is not a good excuse to use. What excuse will you use next year when you're getting pimped, and you're no longer an intern?

The answer that they're looking for is, "I'm going to look it up." That shows that you're taking personal responsibility to fill in the gaps of your knowledge, not just chalking it up to inexperience. Throwing up your hands and saying that you're "just an intern" looks like a cop-out.

 

[anonperson]

I did something like that ,"I'm just an intern" when getting pimped and grilled into paste. Wound up getting slammed on my review for using that as an excuse and not being proactive.....it's like,"Hey jerkweed, if I knew the answer to your question, I'd be a flippin' attending, que no?".....

Lol...Not the smartest thing to say to an attending but it's fine.

All I can say is intern year is a hell of a grind. Work hours can get to you, but I find it's more the psychological aspect of being told you're an idiot in not so subtle terms over and over again until you doubt your physical and mental skills.

Oh well, just keep eating their $hit with a smile and get through with it.

 

[JustPlainBill]

Never ever EVER use that excuse. Seriously. Turn into a paste and say "thank you, may I have another."

If you are being viewed as incompetent then you are giving your program ammo to cut ties with you. Especially if it is showing up in documented evals. The paper trail is being formed and I advise you to be very careful and to get pimped into paste with a smile on your face.

I hear you...this isn't my first rodeo and I know all about what it takes to fire employees in my state --- and I've been keeping my own documentation with names/dates/times/places/incidents involving various attendings.....Mom didn't raise a fool....

but sometimes it is very frustrating and it builds up after a while.....which is why they make frosty adult beverages so you can vent 100 miles from the flagpole....

 

[Nellyakgo]

I do emphatize with the OP.
Sorry, this is going to sound like a really dumb question, but it's genuine.
If someone has completed their Step 3 exam, would they be more prepared/knowledgeable for such situations?

 

[smq123]

I do emphatize with the OP.
Sorry, this is going to sound like a really dumb question, but it's genuine.
If someone has completed their Step 3 exam, would they be more prepared/knowledgeable for such situations?

Not really.

Step 3 is a very basic exam that doesn't focus on a lot of the clinical pearls/details that attendings like to pimp you on. It's a pretty easy exam - it doesn't ask you for the nitty gritty details of how to replete sodium correctly, or how to titrate an insulin drip or anything.

And it definitely doesn't include a lot of the weird program-dependent idiosyncrasies. 😛

 

[Mattchiavelli]

And it definitely doesn't include a lot of the weird program-dependent idiosyncrasies. 😛

I'm not an intern, only a 4th year, but in my clerkships it has been SO helpful to take a step back, look at the situation, and ask if the problem was you were truly deficient in medical knowledge or did you just not have enough knowledge of the institution's way of doing things (their mores and folkways). The problem is there are enough people that can't tell the difference that will make you miserable.

 

[JustPlainBill]

It's all good --- just got the word -- somehow my talents which had previously gone unrecognized have suddenly come to fore and I passed to PGY2 effective July 1.....

 

[Nellyakgo]

Congrads! 🙂

 

[digfast]

---------

 

[tkim]

I hear you...this isn't my first rodeo and I know all about what it takes to fire employees in my state --- and I've been keeping my own documentation with names/dates/times/places/incidents involving various attendings.....Mom didn't raise a fool....

Sounds like you aren't getting it. Congrats on a PGY2 contract, but documenting the sad, frustrating, but traditional method of resident teaching as some sort of defense if you get let go is a waste of your energy.

 

[JustPlainBill]

Sounds like you aren't getting it. Congrats on a PGY2 contract, but documenting the sad, frustrating, but traditional method of resident teaching as some sort of defense if you get let go is a waste of your energy.

Thank you for your opinion --- but the steps I'm taking have been given the nod by more than one attending who I've talked to that are in my corner.....appreciate the help though...

 

[tkim]

Thank you for your opinion --- but the steps I'm taking have been given the nod by more than one attending who I've talked to that are in my corner.....appreciate the help though...

Yup, have fun with the rest of residency.

 

[JustPlainBill]

Wow -- something happened July 1 and I don't know what it was....all of a sudden things just clicked...and then I got tossed into an EM month and they clicked even more....

I am by no means an expert in anything, but I now I get what the heck the problem was and how to fix it...and I've got a LOT of work to do....but it's self motivated, not external pressure motivated which means I'll get it done quickly and with a smile.....

Thanks everyone for listening to me whine.....

 

[Nellyakgo]

Great!

 

[Doctor4Life1769]

Was always told POD 1 patients who spike a fever was likely due to atelectasis (gen surg, vasc cases, etc) and didn't need a fever workup.

 

[Doctor4Life1769]

The Major Joint guys get a lot more nervous because they're putting implants in. Cultures POD 1 & 2 still very low yield, but the risks are pretty high if you miss an aggressive early post-op infection. Sepsis is bad enough, but sepsis plus a long-term nonfunctioning hip or knee is even worse.

Gotcha. Thanks for the explanation. This goes back to some other thread someone created about algorithms, there really isn't one. Everyone's different, their cases different... gotta manage accordingly, even though things can get dicey and confusing. I always see the patient first.

 

[Nellyakgo]

Routine operative patient has a mild reaction to anesthesia before the case starts. Attending surgeon tells you that, since Anes screwed up his case, they can admit the patient for observation. Anesthesia correctly points out that hospital policy does not allow them to admit their own patients. Surgeon says he doesn't care. You say screw it, write your own orders, and admit him to the surgical service. Surgeon finds out, throws a fit, and again reiterates that you are ... incompetent.

Sounds like an ego -trip but I don't know details of the context.

What would have been the "right" way to handle this situation?

 

[SitraAchra]

Was always told POD 1 patients who spike a fever was likely due to atelectasis (gen surg, vasc cases, etc) and didn't need a fever workup.

That's one of those bs answers you get pimped on. A post-op fever is almost NEVER atelectasis. Just keep that answer in your pocket for rounds like a scorpion sting causing pancreatitis.

Also why are there MS-4s in here giving interns advice?

 

[Doctor4Life1769]

That's one of those bs answers you get pimped on. A post-op fever is almost NEVER atelectasis. Just keep that answer in your pocket for rounds like a scorpion sting causing pancreatitis.

Also why are there MS-4s in here giving interns advice?

I'm no longer an M4. I'm an intern currently. However, I dont think that initial tip I gave about looking something up and getting back to them was a bad one.

Thanks for your tip above.

 

[dragonfly99]

Never ever EVER use that excuse. Seriously. Turn into a paste and say "thank you, may I have another."

Agree...as a fellow, would not want to hear the excuse of, "I'm just an intern". Pimping may be a bit malignant, but for things like repleting potassium, etc., I would expect people to know that (even early in intern year). However, if someone does not know, then asking an R2 resident or looking it up would be the thing to do. My other least favorite intern answer is, "That's not one of the patients I admitted...it was admitted by night float" as an excuse for not knowing the patient's labs, reason for being in the hospital, plan for care, etc. However, I agree that the OP was being treated malignantly. As long as someone has a good attitude and caring about the patients and not ridiculously knowledge deficient, the rest can be learned by most people...reaming someone out for what he/she doesn't know is generally pretty low yield. I don't like to repetitively have to tell someone the same things, but if he/she hasn't bene instructed before, that is another thing. However, I shouldn't have to remind you every day how to replete the potassium.

 

[Doctor4Life1769]

Agree...as a fellow, would not want to hear the excuse of, "I'm just an intern". Pimping may be a bit malignant, but for things like repleting potassium, etc., I would expect people to know that (even early in intern year). However, if someone does not know, then asking an R2 resident or looking it up would be the thing to do. My other least favorite intern answer is, "That's not one of the patients I admitted...it was admitted by night float" as an excuse for not knowing the patient's labs, reason for being in the hospital, plan for care, etc. However, I agree that the OP was being treated malignantly. As long as someone has a good attitude and caring about the patients and not ridiculously knowledge deficient, the rest can be learned by most people...reaming someone out for what he/she doesn't know is generally pretty low yield. I don't like to repetitively have to tell someone the same things, but if he/she hasn't bene instructed before, that is another thing. However, I shouldn't have to remind you every day how to replete the potassium.

It is the NF's fault if they don't know the plan for care, etc. if the patient was admitted at night and we ask for it during sign out and they have no clue. Trust me, it's happened. Then, it affects us during AM rounds. Labs, meds, reason for hospitalization we can get from documentation and orders, but sometimes the plan may not be as obvious if it's not been stated or circulated around.

 

[Doctor4Life1769]

Then you shouldn't have complained when I gave the entire ward rectal bananas.

 

[Nellyakgo]

I have no idea. But I stood by what I did because it felt like the right thing to do.

In the "best interest of the patient" I agree it seems the right thing to do. But we all know medicine/doctors/hospitals don't always operate that way.

In this case I guess it was an "adminstrative" thing - though I don't know what.

 

[Nellyakgo]

Comfortable with an ass-chewing, because really, it was like the 5th one that morning.

Love it! 🙂

 

[JustPlainBill]

Sooo---Now that I am an attending and out of that place --- yeah, it was freakin' malignant, they tried their best to fire me/get me to quit but I didn't -- I'm out and realize now how piss weak the program was and they were covering for their incompetence -- just glad I'm out....Funny but I did well on most off cycle rotations but when I was with them -- it was back in the freakin' barrel.....I realized about year 2 that they couldn't teach a bunch of horny Boy Scouts what to do inside a Vegas cathouse.....

 

[CATrtb]

Nice

 

[cabinbuilder]

Poor Bill, so sorry

 

[dozitgetchahi]

Here's how it breaks down:

Surgeon - Pissed off at anesthesia because their drugs caused a reaction that cancelled his case, wasting a 3hr OR slot. Doesn't want to manage a medical inpatient, because he doesn't run a medical service.

Anesthesiologist - Doesn't care what the surgeon thinks, and knows the hospital will back his refusal to manage an inpatient.

Surgical Residents - Glad they don't have to deal with this b*llsh*it, since the intern manages the ward and ICU patients.

Anesthesia Residents - Like the yeti, they are often discussed but rarely seen.

Patient - Disturbed he had a weird anesthesia reaction, wishes he could have had surgery, and now sitting in the PACU wondering when he's going to be moved a room.

Intern (me) - Realizes it is just a lot easier to admit a patient and manage a resolving allergic reaction, rather than serve as a mediator between warring parties. Comfortable with an ass-chewing, because really, it was like the 5th one that morning.

Hell, brother, this sounds like an 'admit to medicine' case! Everyone knows the medicine service is the wastebasket into which issues like these are dropped...

(And as a medicine resident I'm saying this jokingly/sarcastically, mind you)