Is it normal to feel that you are slowing down your attendings?

[atethesun]

For my attendings, they can each do a case by themselves in 45-60 min.
I feel that if I have to see the patient first, it might double the time involved....
30min for me to interview the patient + 5 min to gather my thoughts + 10 presentation and discussion + 10min to see the patient together + 30 min to write the notes + 5min for the attending to read my note and sign it, etc. In total, it's about 75-90 min for each case.

Is it a bad sign if the attending chooses to see another pt while I'm seeing a pt just to save time? I feel like I'm slowing them down and I feel bad.
I feel better when I'm on call.

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[vistaril]

For my attendings, they can each do a case by themselves in 45-60 min.
I feel that if I have to see the patient first, it might double the time involved....
30min for me to interview the patient + 5 min to gather my thoughts + 10 presentation and discussion + 10min to see the patient together + 30 min to write the notes + 5min for the attending to read my note and sign it, etc. In total, it's about 75-90 min for each case.

Is it a bad sign if the attending chooses to see another pt while I'm seeing a pt just to save time? I feel like I'm slowing them down and I feel bad.
I feel better when I'm on call.

first off, what setting is this? outpt intakes? C-L assessments? ER?

but you're looking at it wrong....the reality is that(if you are decent at what you do) you're attending is slowing you down.

Since midway through my intern year I've never had an attending change a plan Ive had. Now part of that is because I can predict what certain attendings are going to do anyways so sometimes I'll just present that as the plan if it seems reasonable. If I feel really strongly that what I prefer is right and what they will likely prefer is wrong, I will proactively shoot down what I think will probably be their idea by saying explaining(before they can mention it) why I'm not going to do that.

 

[nitemagi]

Teach a man to fish...

 

[OldPsychDoc]

If you're a normal resident, yes--because you are.
That's what having residents on your service is all about.

 

[dl2dp2]

OP, your post made me smile. Around here, half of the time I feel like the attending is slowing ME down with the endless psychodynamic drivel.

 

[shan564]

Does your attending actually wait for you while you see a patient, collect your thoughts, etc? Maybe the hospitals in my area just have a different culture, but I always expect the attending to go and do something else while the resident or med student sees a patient... and then they might go in with us later.

 

[michaelrack]

For my attendings, they can each do a case by themselves in 45-60 min.
.

That would be pretty slow for an inpatient setting; what kind of setting are you in?

 

[Doctor Bagel]

For my attendings, they can each do a case by themselves in 45-60 min.
I feel that if I have to see the patient first, it might double the time involved....
30min for me to interview the patient + 5 min to gather my thoughts + 10 presentation and discussion + 10min to see the patient together + 30 min to write the notes + 5min for the attending to read my note and sign it, etc. In total, it's about 75-90 min for each case.

Is it a bad sign if the attending chooses to see another pt while I'm seeing a pt just to save time? I feel like I'm slowing them down and I feel bad.
I feel better when I'm on call.

This is a completely appropriate amount of time to take for a case either in the consult or inpatient setting. 20 of those minutes aren't even your fault, hence the whole attendings slowing down residents (not to say teaching isn't valuable, but it does make it take longer for you to do your work). While I know as a new resident, you want to be able to do everything, it's also not bad that your attending sees a pt while you're seeing one to save time. And no, you're not "slowing" them down because this is their job -- no one has to teach residents if they don't want to.

So, in sum, you're doing great. I hear you on feeling less stressed out when you don't have to worry about the attending being around, hence preferring to be on call, though.

 

[F0nzie]

For my attendings, they can each do a case by themselves in 45-60 min.
I feel that if I have to see the patient first, it might double the time involved....
30min for me to interview the patient + 5 min to gather my thoughts + 10 presentation and discussion + 10min to see the patient together + 30 min to write the notes + 5min for the attending to read my note and sign it, etc. In total, it's about 75-90 min for each case.

Is it a bad sign if the attending chooses to see another pt while I'm seeing a pt just to save time? I feel like I'm slowing them down and I feel bad.
I feel better when I'm on call.

You're just as fast as your attendings. Simple mathematics. You are at 60 minutes for interviewing the patient and writing the note. This is consistent with your proposed length of time an average attending takes to do an eval (45-60 min). With 60 minutes being your upper limit, this makes you a slow attending. You are performing at an attending's pace nonetheless.

Here's my hypothesis: Setting aside 30 minutes of face-to-face time for a standard eval seems very reasonable. Is there a way to quicken your writing? Well, it currently takes you 30 minutes to write the note, however, it really it only takes you 15 because the other 15 minutes was wasted by writing it eloquently to please the attending. Now you're at 45 minutes. Which really makes you a fast attending all along.

I would argue that attendings do not want to see attending-style chicken scratch notes from residents. Use that extra 15 minutes to develop your own style and get feedback. Over time you will gain mastery over writing evals through repetition and your appraisals of what you deem valuable and pertinent.

The true length of time of a psychiatric evaluation in clinical practice is highly variable and based upon any number of factors. In general, the evals that tend to be quicker are those in which patients are highly disorganized or impaired with no collateral. The longer ones tend to be longer for any number of reasons that you will come to understand with experience.

 

[michaelrack]

If your attending was as efficient as a priv prac attending, you would be slowing him down. It takes approx 5 minutes for a typical priv prac attending to dictate an eval.

It's hard to tell if you are slowing down an academic attending- though you probably are- but that's the nature of residency.

 

[michaelrack]

In the inpt priv prac setting, it takes 30-45 minutes (max) to do the initial admission. However, a lot of work is done in the next 24 hours by ward staff, esp SW, in gathering more info (talking to family, etc)- info the psychiatrist will typically review the following day.

A psychiatry resident performs many of the functions of a social worker, as well as serving as a physician.

In addition, in a priv prac inpt psych setting, medical problems (even minor/stable ones) are turfed off to a primary care doc

 

[whopper]

If you're a first year, it's normal to slow them down and they should be mindful of this. By the end of first year you should be up to speed.

Most residents I knew, where I did general psychiatry training, were actually faster and better vs most of the attendings by the time they reached 2nd to 4th year.

 

[atethesun]

Cool, good to know. I was worried about it for a while =P

 

[whopper]

If you have a good attending, they know and will remember the stress of being a PGY-1 and won't hold your newbie status against you. You can only learn so much so fast. Try not to beat yourself up too much. Everyone was green. Medicine is an ever-learning profession, and most doctors have several years ahead of you.