Jerk residents

[bobhagopian]

During third year, my residents were mostly nice, although there was the occasional undiagnosed psych disorder. I worked hard that year, but I learned a lot and it always felt pretty respectful between residents and students.

This year, I have this jackass of an intern on my ICU rotation. Every morning, he assigns himself one patient to see (the guy who has been in the ICU for months, who has the same issues every day that he did the prior day), but assigns me three, including all the brand new trauma patients that have 25 imaging studies and an evolving-by-the-minute story. When we are finally blessed with an attending who likes to teach students, this intern refuses to page him for rounds, insisting that the fellow run rounds so that he can get done sooner. Once, the attending asked him to e-mail the students a well-known review article; I started to give him my address so that I could forward it to the rest of the students, and as soon as I started talking, he said, "Does anyone have a normal name?" When the attending told the students that "since we have a lot of students this month, you guys don't have to strictly follow the 1 day off in 7 rule, as long as there are two students each weekend day. This was when the intern protested, saying, "Well, according to the clerkship guidelines, they're only supposed to get four days off, and [clerkship director] will get upset." Then, today, I overheard the residents talking to each other, saying "[Intern] is not happy that bobhagopian shows up after him in the mornings, so he has been assigned him the hardest patients every day."

Anyway, I'm not used to this sort of childishness from anyone, much less a resident, much less an intern that was a medical student (at my school) four months ago. But maybe I just had a comparatively good experience with residents during my third year. Has anyone else had experiences like this? Am I justified in thinking this guy is a tool? Is there anything I can do? (Not for me, as I am leaving the rotation, but for the sake of other students.)

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[Law2Doc]

Am I justified in thinking this guy is a tool? Is there anything I can do? (Not for me, as I am leaving the rotation, but for the sake of other students.)

The guy is a tool, but hardly unique, and there is nothing you can do, other than blast him harshly on evaluations (if you get to evaluate the resident staff). Every med student comes across at least one person like this during rotations. You deal with it and move on.

 

[78222]

Why is an intern assigning you patients? It's pretty much always an upper level resident who does that on all the rotations I've been on. What I'd do is just start going over his head to the next resident up the totem pole - there is no reason to take **** from a frickin intern.

 

[gerido]

that's kind of interesting.. at my university, if you're a 4th year, you're a sub-I and work under the attending, fellow, or senior resident, not intern. In any case, that sounds kind of ****ty. My advice is do whats best for your patients and your team.. as far as the intern is concern... f*ck him/her. You already submitted your application.. and they're not gonna fail you unless you really mess up... so learn something and have some fun.

 

[bobhagopian]

that's kind of interesting.. at my university, if you're a 4th year, you're a sub-I and work under the attending, fellow, or senior resident, not intern. In any case, that sounds kind of ****ty. My advice is do whats best for your patients and your team.. as far as the intern is concern... f*ck him/her. You already submitted your application.. and they're not gonna fail you unless you really mess up... so learn something and have some fun.

That's probably a good approach. I don't know why the intern is assigning patients, probably because the more senior residents show up an hour after he has already assigned everyone.

Except for my experience with the intern in question, this has been an awesome rotation, and I'm definitely learning a lot. But (and maybe this is just vanity), I'll admit that I like being liked. I work hard for my patients, do everything I can for my patients, help out my fellow students (not that I'm an expert, but I'll answer their questions as best I can), as well as the residents (who often need help pulling up radiology studies). I do everything with a smile, not because I always love the hospital, but because I'm trying to be easy to get along with. It has just been frustrating to do all that and yet have to deal with this intern.

I appreciate everyone's support, and if nothing else, it's good to be reassured that I'm not just being too sensitive, and that this guy might actually be a real jerk.

 

[group_theory]

Hopefully the fellow or residents will take notice of the patient load and the distribution and say something

as a student, you shouldn't have to manage the hardest patients in the ICU (or if you do, it should be your sole responsibilities). People do tend to notice if the intern is a slacker who always takes care of chronic stable ICU patients while the "student" gets the new admissions or the difficulty admission.

Also, once you pick up a patient, you should follow that patient until he/she leaves the ICU (unless the patient gets too complicated in which case the intern should pick up the case). Before you leave for the day, ask the senior resident which patients you can follow the following day. Any new admissions - the intern (if there is no senior around) can divide them up amongst the interns and students ... but if it is a persistent "easy case for the intern, hard case for the student" - it will definately get noticed.

 

[smq123]

This year, I have this jackass of an intern on my ICU rotation. Every morning, he assigns himself one patient to see (the guy who has been in the ICU for months, who has the same issues every day that he did the prior day), but assigns me three, including all the brand new trauma patients that have 25 imaging studies and an evolving-by-the-minute story. When we are finally blessed with an attending who likes to teach students, this intern refuses to page him for rounds, insisting that the fellow run rounds so that he can get done sooner. Once, the attending asked him to e-mail the students a well-known review article; I started to give him my address so that I could forward it to the rest of the students, and as soon as I started talking, he said, "Does anyone have a normal name?" When the attending told the students that "since we have a lot of students this month, you guys don't have to strictly follow the 1 day off in 7 rule, as long as there are two students each weekend day. This was when the intern protested, saying, "Well, according to the clerkship guidelines, they're only supposed to get four days off, and [clerkship director] will get upset." Then, today, I overheard the residents talking to each other, saying "[Intern] is not happy that bobhagopian shows up after him in the mornings, so he has been assigned him the hardest patients every day."

Anyway, I'm not used to this sort of childishness from anyone, much less a resident, much less an intern that was a medical student (at my school) four months ago. But maybe I just had a comparatively good experience with residents during my third year. Has anyone else had experiences like this? Am I justified in thinking this guy is a tool? Is there anything I can do? (Not for me, as I am leaving the rotation, but for the sake of other students.)

I felt like, in some rotations, the new interns felt a little....threatened?....by the sub-Is. I think some of the interns were SO anxious to make a good impression that they'd do anything (including steam-rolling the MS4s) to get to that point.

As others have said, as a sub-I, you should not be supervised by an intern, and you should almost certainly not be evaluated by an intern. Just refuse to get into a situation where you are following the intern's "orders." Spend as much time as possible with the senior resident. Make it clear, through your body language and your actions, that you consider the senior resident to be the one that you answer to - and NOT the intern. I think that group_theory had a great suggestion: run all your actions by the SENIOR RESIDENT, not the intern. Ask the senior which patients he feels that you should follow. Ask the senior if it's okay if you pick up this admission. Ask the senior if it's okay if you discuss vent settings the next day with the rest of the team, and request that the senior discuss certain learning topics with you. It sends the subtle hint that the intern has no real role in your rotation, except as a fellow member of the treatment team.

 

[Anka]

Unfortunately, you might be stuck with the team dynamics; the culture of your team/rotation/department will largely determine your role and who it is who manages you. Any attempts to be clever and bypass the heirarchy are unlikely to be well-received. For example, the fact that the senior residents know about the situation (based on the conversation you overheard) and are not doing anything about it means it's unlikely they care enough to take on the role of managing you. At some places, part of the intern's role is to protect their seniors from having to deal with students, who are seen as demanding/annoying/bothersome.

As far as your sense of injustice at the fact that your superior was in your shoes just a month ago, welcome to the medical heirarchy. There's still a big difference between an intern and a subI, usually in knowledge but even if you know more than the intern, are technically superior to the intern, and are harder-working than the intern... there remains a difference in role. And when you're an intern and your resident is lazy and dumb, they're still your superior.

Finally, keep in mind that at some institutions, things have changed rapidly in the structure of the clerkships, such that the intern may thing that even though he went through the same program you did, that the version he experienced was more traditional, and that he thinks it's simply inappropriate and is going to take it out on you.

I certainly would have thought it inappropriate as a medical student to come in later than my intern, although due to changes in the structure of the clerkship it is now very common where I am. I try not to take it out on the students, but it's frustrating sometimes to have them show up right before rounds and start chattering away when I'm already an hour into my work day and trying to slog through... and I get a little frustrated when they start asking me how their patients did overnight, having not bothered to see them that morning. When I was a student, it was my job to preround and tell the intern about the patients!

Anyway, my advice is, since you're learning a lot, just hang in there and learn as much as you can. Following a lot of complex patients will pay off in terms of your knowledge base. And your superiors will likely notice how much you are doing.

Best,
Anka

 

[sunshinedoc]

I also would suggest just getting through the rotation and then writing a scathing review of him (mention by name) on your evals. I have also had a run in with a resident on my current rotation whose sole intention seemed to make my life a living hell. I saw one of my rotation partners try to take this resident on, and it just made things worse. So while it is really crappy, just put up with, do a great job and show him up and then move on.

 

[Substance]

I was on a rotation during clerkship at a community hospital. It was me and one family medicine intern - a newly minted doctor of all of two months duration.

I was doing just fine. The attending liked my style and I did very well. However, this resident was being totally unreasonable. The attending told me to come in at 0900, but the intern was going in at 0800. Thus, I was cornered by the intern one day, where she demanded that I come in at 0800 too. Of course I refused, because coming in that early would add nothing to my patient care since I got as much done in 3 hours as she got done in 4, and because the attending had already told me to come in at 0900. She didn't like that very much, and proceeded to smear my name around to the other family medicine residents. But I really didn't care since it was a community hospital full of FM residents who had no bearing on my future career. So, I got away with retorting her ridiculous suggestions.

However, since you are on a much larger team, I suggest you don't take this course of action. Instead, I suggest you pair up with another resident on the service if there are any. This intern seems like he matched pretty low and has a chip on his shoulder because of it, so he's making everyone else suffer. What a jerk!

Oh, and at the end of the rotation, mutilate him on evaluations.

 

[Samoa]

Hopefully the fellow or residents will take notice of the patient load and the distribution and say something

It sounds like they already have, since they were talking about how the intern assigns him the hardest patients every day.

Which, having been an intern myself, is very douchy of him. The intern should always be there first, and should never carry fewer patients than a student. Seriously, if the student got there first, it reflected poorly on me.

He sounds to me like a weak and lazy intern, and it also sounds like the residents are on to him.

 

[VFTW]

I had a bad intern once. She was basically just really mean and lazy and made me do all of her work while she rolled her eyes at me and acted angry.

On the last day of the clerkship, the Chief asked me how I thought it had gone, and told me I had done well. I cautiously mentioned that things with the intern had not gone swimmingly. He asked for more information, and I told him a little bit of what had been going on before he got there every morning and when he was in the OR every evening. He immediately told me that I should have come to him the first time that the intern ever did anything nasty to me because "she's an intern, where does she get off? You should have come to me! I would have told her to knock it off."

On my eval, I pretty mercilessly reported everything - I wrote a long, coldly professional bulleted list of all the ways in which she mistreated me and the other students on the team.

Moral of the story: if it gets to the point of ridiculous, talk to your Chief. And rip the nasty intern six new ones on your end of rotation eval.

 

[Ashers]

I had a horrible intern on inpatient peds. The peds department had a rule that no one was supposed to show up before 6AM, basically to protect the kids and their sleep time, it was nice for we students who had just finished our surgery rotations too. My intern wanted me to come in and start rounding before she got there at 6, so when she got there, I could tell her my whole presentation that I'd give to the team. These were on very stable patients that the entire team knew. If I didn't say the unchanging intro just right, I had to restart. She'd interrupt me, so it'd take about 20 min just to practice. At that point, I basically knew how to do a basic presentation (March of M3 year), especially after the attendings told us what they wanted in the presentation. If I didn't have a chance to practice my presentation, I wasn't allowed to present to the team. One of the attendings noticed that I wrote notes on a patient every day, but I never presented that patient, and she commented about that to me.

One of the days that I wasn't allowed to present, after I had gotten to the hospital, written the note, gone to present to my intern, and I was only able to get through 1 because she kept interrupting me, I had to go to teaching rounds, and I started crying because it was so unnerving. The teaching attending then went to the clerkship director and had me talk to the chief. The chief had the intern back off, so I only had to present the assessment and plan. I also got to work with the attendings by myself.

The intern was just crappy to begin with. She attempted to teach stuff, and what she tried to teach was just wrong information. She wasn't the one who found that a baby had ripped out her g-tube; I did, and she got mad that I hadn't been able to finish seeing all of my patients because I was dealing with the that baby and the only person who I could find to help me was the attending. I am usually very efficient and can get my notes done before rounds, or I manage to put them back in the charts during rounds. I was on a team that rounded all over the hospital. This intern would just put all her notes on my stuff and expect me to put them back in all the charts for her (normally I wouldn't mind -- my school teaches you how to do scut and do it fast, but after all the other problems, that was just over the top).

She didn't find other things on patients. I'd check up on patients during the day. I found one of patients was starting to get really sick, so the attending started asking me what I wanted to do.

There were lots of other little things -- I wasn't allowed to see new patients by myself, and some stuff I'm forgetting now, probably by repression. She also told me that she wasn't going to read a transfer summary I wrote for a really complicated patient from the ICU that took me 2 hours of going through the chart because she's "just going to have to do it again anyway." On my last day of peds, my intern didn't show up, and I worked with one of the other interns, who sent me to do an H&P and told me how much it helped. I was stunned that students were able to be helpful on the rotation since that sure wasn't what I was told many times before.

Fortunately, since I talked to my chief, it worked out, and the chief let the attendings know too, so they could watch out for me and let me have a little more independence. I still hated coming to the hospital every day because of that intern. In her eval I basically said she should never work with another student again. Her residency program was also pretty sketchy (I did family practice there), and it's being dissolved at the end of this June.

Edit: Oh yeah, and one night when I was on call and sick, the day after I was sent home sick, I finished all the work I had to do, and went to ask if there's any thing else. She gave me her 3 pagers and said "Enter all the orders the nurses want." I asked if she had seen any of the patients because they were cross-cover patients, and she said, "No, it doesn't matter, just do it." She also gave me some of the other interns' work that was signed out to her. The chief was not impressed.

I guess I can stop the rant now.

 

[dragonfly99]

I would do nothing about this. Just do your job, do your best to learn, etc. and try to stay clear of this person as much as possible. I don't think you have to worry about trashing this person on his/her evaluation either...he/she WILL get reamed if only presenting 1 patient/day. I'd be super surprised if he doesn't.
If the problem is you aren't getting there as early as the intern, you could fix that by beating him there every day...I'd do it just to prove I could, but that's just me.

As others have said on this thread, nothing that happens from here on out in your 4th year is likely to affect how you match, unless you get in a big fight with someone. In general, tangling with someone above your level (even by a year) will not turn out well in the hierarchy of medicine, but as a student you do have some protection...more so than you will as house staff. I guess you could complain about this person, but likely others already have noticed his behavior and complaining about it makes you look like...well...a complainer.

It is kind of weird for the intern to be assigning you patients...I'm wondering if this is the SICU rather than the MICU or something. In our MICU, the postcall intern presents all new patients, and presents pretty much all patients (except the 1 or 2 that a 4th year student might be following).

But I do agree that giving 3 sick ICU patients to a subI to handle is probably too much...3 new ones = definitely too much. A total of 3 (some that you have been following, etc.) wouldn't be that unreasonably in a busy ICU, but that would be about the top number I'd give a 4th year student. And you the student shouldn't have any real responsibility to speak of in the ICU...even during residency it's generally more the resident's show, with the intern writing the notes and orders, but the resident, fellow and attending making most of the decisions, just due to the level of illness of the patients and their complexity.

 

[bobhagopian]

Now that I'm off the rotation, I can give a little more information without worrying about loss of anonymity.

This intern was a prelim surgery intern going into anesthesia at a different hospital. He basically didn't give a crap. It was also a SICU rotation, and the intern volunteered for the job of assigning patients (the only job he ever seemed to do).

Me and my fellow classmates were carrying way more patients than we should have. On weekends, I had up to 6, one time including two liver transplants on POD 1 (one of whom was rejecting), one open AAA repair POD 1, one subdural hematoma guy POD 3, a POD 5 renal transplant, and one POD 15 intramedullary nail guy who was stable. (I kept these records so that I could include them in my eval of this intern.) That same day, the intern saw *one* guy who was POD 80-something -- he was sick, but certainly out of the woods.

I appreciated everyone's replies above. They gave me the determination and resolve to actually stick it to this guy in my eval. I said that the rotation was awesome and probably would have been the best one of my entire medical school career if it hadn't been for ____, for the following reasons..." With that, I think I've done my part. I only hope that something gets done about it. However, this guy is a prelim, and I'm not sure how much the program can do to him.

Annoyingly, I have bumped into the other residents on a few occasions since the end of my rotation, and they have independently made comments like, "I hope you had a good time and learned something on the rotation despite the way ____ treated you guys." Thanks for sticking up for your students, residents!

If anything good has come of this, it is a reminder of how not to behave as a resident. I think most of us don't have to be told what constitutes acceptable behavior on the wards towards one's juniors, but this experience has reminded me just how much one person can poison the environment for everyone. When I'm a senior, I'll protect my students from pointless abuse from anyone and everyone I can.

 

[Samoa]

Prelims can still get fired. Even if they're designated prelims. It probably takes actual incompetence rather than just the laziness your intern displayed, but it still can happen.

 

[jdh71]

This intern was a prelim surgery intern going into anesthesia at a different hospital.

Gas prelims are pretty useless everywhere

 

[themudphud]

Do we go to the same med school? 'Cause I know someone who is just like that! Right down to the "does anyone have a regular name around here"! Ha ha ha ha!!! What a tool!
It's amazing how some people think that 4-5 months of extra training over you entitles them to be a complete a**hole towards you. I got lots of love for interns and residents and the fact that those 4-5 months of hellish hours translates to more knowledge, but unless you were disrespecting this guy (and I doubt you were) there is no excuse for this intern to be such a tool.

 

[Lynda]

i'd say that anyone in this situation should talk to an attending or the course director for your rotation. we had a really lazy, rude resident who wanted to make our lives miserable on surgery and i mentioned his miserableness to another resident i was friends with and she was incredibly pissed and told me that interns have no right to treat med students like crap, they are supposed to teach us not make our lives miserable and said we should always tell our course director - once the powers-that-be knew what was going on the resident straightened out.

 

[C Daschbach MD]

(I am an Academic Director--- READERS BEWARNED)
Agree 100% with Lynda ...you are PAYING TUITION for this experience ?
It will NOT affect your grade...one of the 6 ACGME Core Competencies is "PROFESSIONALISM...and if the Intern is a Jerk, the Chief Resident, Program Director and DIO need to hear this...they will coroborate with others (residents, nurses, and maybe patients)...while there is no Human Empathy School fo Doctors, this Intern needs a formal development plan... he is failing the rotation himself...