Listening in on Attendings' convos: Is it wrong?

[chicamedica]

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I'm an MS-3 doing my EM rotation right now and whenever I hear attendings discussing my patients, either with other attendings or with my resident, I'm interested in hearing that convo as well, so I just waltz up and listen in. Sometimes I feel like some of the attendings don't welcome me there and look at me as if I'm weird and butting in to things that aren't my business.

Is it impolite/improper for me to listen in on those discussions? How about letting the attending know some info that the pt told me, during the discussion that originally did not include me?

 

[chicamedica]

Hi again fellow peoples--
so does anyone have any opinions on this? I'd really like to know whether I'm making a fool of myself or being rude. . .


Any comments would be much appreciated

 

[Entei]

You're probably not looking for my opinion, since I'm a stupid MS1 who shouldn't be posting in this forum, but I'll say something anyway. I don't think there's anything wrong with listening in on the attendings' discussions of your patients because: 1.) They're discussing YOUR patients, about whom you are supposed to know everything, 2.) You're the student, so you're supposed to be learning everything you can, and 3.) If the attendings see you listening in, and they don't move away or ask you if you have something better to do than stand around and eavesdrop, then they probably don't mind and you shouldn't worry.

This is my natural reaction to the situation, but I would be interested in hearing the opinions of those more "in the know" about hospital etiquette and politics than I am.

 

[DOtobe]

I agree with Entei. Since you are part of the team, you have a right to know what they are discussing about your patients, and since you are part of the team, they should include you in the conversation. But sometimes we "lowly medical students" (as my current attending calls me jokingly) get pushed aside. I think you should feel free to tell the attending what your patient told you, because I have found that some patients have been more open to me than they have been with the attending. Medical students can give attendings some information about their patients that they wouldn't have known otherwise. I have found that my attendings so far have welcomed me giving them extra information.

Just my two cents.

 

[BPKurtz]

You should be listening to discussions about your patients. But I would also try to be attuned to the body language of residents and attendings. Occasionally I stroll into a conversation that I think is about patients but it turns out to be about department politics, a doctor-nurse battle, a rant about how some other service completely mishandled everything, or something else to that effect. If you stumble upon something like that, you should walk away and let them to continue to talk, especially if they are speaking in hushed tones with eyes darting around or giving you a fishy look.

bpkurtz

 

[ERMudPhud]

If the attendings and residents are discussing your patients you definately should be included and should feel free to listen in. On the other hand there is a time and a place to interject your own information and a discussion of the case between residents and attendings may not be the time or place. Part of learning to practice medicine is learning when what the patient says means something and when it doesn't. Some patients have what we call a positive review of systems meaning if you ask them if their hair hurts (pretty much impossible) they would say yes. A med student jumping in with everything the patient said during a discussion between the resident and attending could start to seem annoying, especially to the resident.

 

[Samir Desai]

If your attending happens to be talking to another attending or consultant about your patient, you should feel comfortable listening in on the discussion. Of course, you should be sure that it is your patient they are discussing rather than some sensitive issue that doesn't involve you. If you are not sure, it's best to just wait until the conversation is over.

Because medical students perform thorough and detailed evaluations of patients, it's not unusual for students to pick up things that residents or attendings miss. I recall many instances when my students have discovered some crucial information that changes the diagnosis and management of a patient's problem. You should realize that you are valuable members of the team and despite the fact that circumstances or situations may make you feel otherwise, your contributions are important.

If you happen to join in on a discussion that has been in progress, before you interject and share some information, consider the possibility that your attending may have already conveyed that information to the other attending before you joined the discussion. As for other attendings not making you feel welcome, you should really be concerned only with what your attending or resident thinks. After all, these are the people you are working with.

If you are unsure of whether to join in on discussions, it is perfectly reasonable to ask your attending or resident about their preferences. I can't imagine too many attendings telling you not to be a part of a conversation that involves your patient.

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