Normal for visiting sub-I to steal your patients and cases?

[voxveritatisetlucis]

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[Goro]

no I am a sub-i so I have first pick of patients and cases.”

Is this normal for your school/rotation site?

 

[voxveritatisetlucis]

I feel like even if it was he should’ve let me know the night before or even that morning so I didn’t look like an idiot

 

[RangerBob]

How does someone steal a patient?

If I were seeing a patient I would keep seeing them until my resident or attending told me to stop.

I've heard of students fighting over which patient to take (moreso what surgical case to take), but I've never heard of someone stealing someone else's patient.

 

[operaman]

I missed the original post but sounds like someone is a real tool. Have no doubt, the residents think they’re a tool too.

Hopefully the residents clarify expectations. If the issue persists, would just ask the seniors to clarify the expectations for students and how patients/cases are divided among them.

Hopefully you’re in a target rich environment with lots of interesting patients and cases. We had tons of visiting sub Is come through, but our case volume was nuts so they’d all have their own good cases to scrub each day. Nobody can be in two places at once!

 

[Redpancreas]

It’s not unreasonable for a Sub-I to aim for priority cases, but this should be approached collaboratively, with a diplomatic discussion on the first day to ensure a win-win outcome. Showing up on the first day and claiming all the patients he wants "because he's the Sub-I" demonstrates poor interpersonal skills.

 

[mrbreakfast]

No idea what the original post said, but you've made it to fourth year and some people (particularly on surgery, which I'm assuming this is about, and particularly for aways) approach the rotation with the mentality that they're "not here to make friends." At my med school, surgery clinical students would often fight for cases; I have a away rotator sub-I on service right now who (while very good) is obviously much more interested in trying to impress me than in actually learning from me. It can be a competitive energy, especially with away rotators, and it can be tough even as the attending that everyone is trying to suck up to.

I've said this before but will emphasize it: your evaluators are interested in your performance, but also in your demeanor, attitude, mentality, teamwork, etc. Obviously trying to hurdle your co-rotators does not go unnoticed and while some programs may like that, most probably won't. Just focus on the work in front of you and on providing good patient care, not on impressing your superiors; the attendings and senior residents are much more in tune with the "vibes" of the service than you might assume.

 

[voxveritatisetlucis]

I deleted the original because it was a bit too specific but basically he told me 5 minutes before rounds started that he saw four of the patients that I prerounded on. When I asked him if we could split them he said no because he was a subi on audition rotation. So basically I looked like an idiot on rounds. I mentioned it to the resident after not to rat on the guy but more because I don’t want it to affect my evals

 

[voxveritatisetlucis]

Basically he doesn’t tell us who he is going to see so we don’t have time to pick other patients and then we look like idiots he also gets to pick his cases so gets to work with the pd

 

[wysdoc]

I deleted the original because it was a bit too specific but basically he told me 5 minutes before rounds started that he saw four of the patients that I prerounded on. When I asked him if we could split them he said no because he was a subi on audition rotation. So basically I looked like an idiot on rounds. I mentioned it to the resident after not to rat on the guy but more because I don’t want it to affect my evals

It sounds like the resident could distribute the presentations more evenly, though you can’t really stop the sub-I from reading up on all the patients

 

[GoSpursGo]

I deleted the original because it was a bit too specific but basically he told me 5 minutes before rounds started that he saw four of the patients that I prerounded on. When I asked him if we could split them he said no because he was a subi on audition rotation. So basically I looked like an idiot on rounds. I mentioned it to the resident after not to rat on the guy but more because I don’t want it to affect my evals

This is a resident issue. While it does make sense for the sub-I to get patients that allow them to show their ability, the senior resident should divide the patients in a way that allows for a good educational experience for all trainees.

Talk to the senior resident and ask for help dividing patients at sign out. The answer should not be "the students can figure it out." Then speak up at sign out the next day if they don't divvy up the patients. If the senior resident isn't responsive, bring it up to the attending at feedback.

 

[voxveritatisetlucis]

Ya so tomorrow he is insisting on seeing 4 patients while I have 0 since all mine got discharged. He’s insisting it’s because he has been following them he has to keep following them meanwhile I’ll look like an idiot on rounds with nothing to present.

What a clown. Don’t even know why he’s rotating here since he’s a DO and the program doesn’t take DOs

 

[Dral]

If he is following them already, it makes sense to keep following them to be honest. You should be (should have been) able to pick up some overnight admits.

 

[GoSpursGo]

Agree with above, it doesn't make sense to hand off patients from one student to another.

But again, this shouldn't be up to the students to divide patients. What are your residents telling you guys to do?

 

[LucidSplash]

Agree with above, it doesn't make sense to hand off patients from one student to another.

But again, this shouldn't be up to the students to divide patients. What are your residents telling you guys to do?

Sounds like the residents are busy. Or just enjoying the soap opera.

Discharging all your patients used to be called “winning the game.” No more?

 

[Dral]

Sounds like the residents are busy. Or just enjoying the soap opera.

Discharging all your patients used to be called “winning the game.” No more?

I still have pics of the blank white board in our work room every time I d/c'd everyone. I was an intern at the time though, so I guess it's different on the other side for med students trying to hustle for a grade/eval.

 

[GoSpursGo]

Sounds like the residents are busy. Or just enjoying the soap opera.

Discharging all your patients used to be called “winning the game.” No more?

Yes, sounds like the OP won the game--which is fine. Additionally, @voxveritatisetlucis it's important to remember that a sub-I is supposed to be seeing as many patients as the interns, so it would not make sense for a sub-I to give up their patients to a 3rd year because that means that one of the other interns is going to need to take those patients too and potentially imbalance the service. If you're bored you should ask to start following some of the patients being followed by the other interns.

To the other point, though, clearly there is a disconnect where the students don't have clear expectations of how to divide the patients. While of course residents are "busy," this should be something that the senior resident can spend 2 minutes on and clear up. It is not the sub-I's responsibility to ensure that the MS3 is having a good educational experience.

 

[Redpancreas]

Ya so tomorrow he is insisting on seeing 4 patients while I have 0 since all mine got discharged. He’s insisting it’s because he has been following them he has to keep following them meanwhile I’ll look like an idiot on rounds with nothing to present.

Agree with above. The same learners should be following patients for continuity sake. Learning + Patient Care>Learning. That said, by your tone I'm imagining you've had a long month and no one's stepped in to arbitrate. Try below.

What a clown. Don’t even know why he’s rotating here since he’s a DO and the program doesn’t take DOs

Probably contributing to his anxiety. Don't feel bad. Flatter/talk to him through his anxiety. He'll likely ease up on you.

 

[voxveritatisetlucis]

Thanks for the replies everybody. I‘ve been doing a good job lately so less frustrated, I just really don’t understand the point of letting a visiting student take priority over home students. If the school doesn’t have enough patients on its services then maybe it shouldn’t take visiting students. highly doubt this happens at big academic medical center type places since they probably have enough volume

 

[GoSpursGo]

I just really don’t understand the point of letting a visiting student take priority over home students.

It doesn't sound to me like that's what's been happening. The role of a sub-I and an MS3 are entirely distinct. The sub-I should have a greater deal of responsibility, while the residents should also ensure you have patients to follow. Are there no patients that the actual interns are caring for that you could follow?