NY Shut 'Em Down!

Started by Consigliere
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SaltyDog said:
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Oh hell to the no!!!!
 
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chocomorsel said:
@FFP, I do remember on my CV rotation an attending telling me to give the patient a push of Esmolol at least 30 minutes before the case even started. I asked the attending why, because it didn't make sense. I got in trouble because I should not have done it in front of the patient and made him look bad. I was doing a bit of thinking out loud and questioning what the hell benefit esmolol in pre-op before a CV case is going to accomplish in a stable, non tachycardic, non symptomatic patient who either forgot their B Blocker that morning or we were doing the whole B blocker before surgery thing.

Whatever the case, my lack of situational awareness and making the attending look bad got me in the principals office and in trouble. Surprise surprise. I learned my lesson. It was at an abusive away rotation in Houston where the attending anesthesiologists were some of the biggest dinguses I had ever seen. Very unusual for anesthesiologists.

But in my program it was my directness that would get me in trouble. I am direct person who doesn't beat around the bush which from a black woman, is a little intimidating to a lot of people. Some found it disrespectful and my problem in residency was the whole "professionalism" BS. I needed to learn to keep my mouth shut. But besides that whole away rotation BS, and me talking back to this vascular surgeon who screamed at me repeatedly while I was waiting on my attending it was always the damn nurses and techs and secretaries who I would get into it with. I was a nurse in my past life and didn't experience that level of abuse and didn't see the need for it, so therefore was not gonna have it. But academics is a different beast. Some nurses thrive on being jerks to residents.

Anyway, I hate academics as the two academic places I have worked have both left a horrible taste in my mouth. I am sure they aren't all like that. At least I hope.
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Can I please implore you to work your way up at the ASA to leadership? The gloves are off, our leaders need to be take no s@@t type of individuals. I liked the last president a lot, he didn't mince words and seemed relatively unconcerned about being politically correct to avoid pissing off the nurses. Plus as a former nurse you have seen both sides of the coin. I think you'd be great.
 
Twiggidy said:
well in defense on residents, I'd say that's a problem right there. if you have resident, you're at a teaching program, so you have to actually teach. you may say who cares what's more comfortable, but that resident has to eventually go out into the world and actually practice anesthesia and if they never get comfortable doing things in a way the provides them success then they'll be sh*tty "real world attending". trust me, i see this everyday when some of our "weaker colleagues" dump patients on our service and I ended doing the case and saying "what the hell? this was easy". the "my way or the highway" attending does nothing for the resident who's there to learn and also hone their skills.

An example, I'm left handed, and when I first started learning cardiac to put in a RIJ with my right hand was super awkward, so I had do it from the side of the patient using my left hand. for some attendings this was an issue because i'm "supposed to be standing behind the head of the patient" and doing it like they do it. Or what about attendings who never use ultrasound because "that's how they learned". Well in the real world (and with many colleagues in their programs) residents are taught to use ultrasound. "Who cares if you're more comfortable with ultrasound? Do it my way."? You see how that can be problematic?
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You misunderstand me. I actually try to teach and to push them to do new things, especially as CA-3s. I just hate when they want to do their usual "protocolized" anesthesia, the way they have always done it for 3 years at their fancy-shmancy program. You know, every program has certain preferred idiosyncrasies, but residents need to learn as many different ways to do things as they can, especially the seniors. I am sorry, but if they like to only be "comfortable" with one way, maybe they should put 4 letters after their names. Even then, if it's a good plan, I usually let them choose between that and my alternative.

You brought up the ultrasound. The other day, one of them insists on having the ultrasound for an a-line with a BOUNDING pulse. I mean the kind of pulse you can probably even see, if you look carefully. I told the senior resident that there won't be ultrasounds lying around in emergencies, and this is not a fluid-overloaded difficult ICU patient. I get the usual answer that this is the way s/he's used to doing them. I said fine, got the U/S (better for the patient, too). I am not going to force them to learn, because that just makes me the bad guy (and that's where American education is going to hell, because the best teacher is the one who pushes your limits). The sooner we are done, the sooner we can all go home. It may seem like a win-win to them, but I am the only one winning here.

They just don't get it: being coached by an experienced person is a privilege; learn as much as possible even from the least likable people. Now is the time. Once you are an attending, you're on your own; there is nobody to catch you when you fall.

All I ask for is some damn respect.
 
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FFP said:
You misunderstand me. I actually try to teach and to push them to do new things, especially as CA-3s. I just hate when they want to do their usual "protocolized" anesthesia, the way they have always done it for 3 years at their fancy-shmancy program. You know, every program has certain preferred idiosyncrasies, but residents need to learn as many different ways to do things as they can, especially the seniors. I am sorry, but if they like to only be "comfortable" with one way, maybe they should put 4 letters after their names. Even then, if it's a good plan, I usually let them choose between that and my alternative.

You brought up the ultrasound. The other day, one of them insists on having the ultrasound for an a-line with a BOUNDING pulse. I mean the kind of pulse you can probably even see, if you look carefully. I told the resident that there won't be ultrasounds lying around in emergencies, and this is not a fluid-overloaded difficult ICU patient. I get the usual answer that this is the way s/he's used to doing them. I said fine, got the U/S (better for the patient, too). I am not going to force them to learn, because that just makes me the bad guy (and that's where American education is going to hell). The sooner we are done, the sooner we can all go home. Win-win? Not for them.

They just don't get it: being coached by an experienced person is a privilege; learn as much as possible even from the least likable people. Now is the time. Once you are an attending, you're on your own; there is nobody to catch you.
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I totally understand. It's a fine line and I'm years out from dealing with residents and have been hesitant of CRNA jobs for all these reasons. I think something this being dodged, especially with the idea of this generation being hard to teach, is how much of it is that Medical school is so expensive that only the more privileged are attending and kids who have been given everything their entire life are much harder to teach and deal with. Straw man argument.
 
Twiggidy said:
I totally understand. It's a fine line and I'm years out from dealing with residents and have been hesitant of CRNA jobs for all these reasons. I think something this being dodged, especially with the idea of this generation being hard to teach, is how much of it is that Medical school is so expensive that only the more privileged are attending and kids who have been given everything their entire life are much harder to teach and deal with. Straw man argument.
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I don’t think tuition increases are leading to only the privileged going to med school. The same kids are going - they’re just ending with more debt when they’re done.
 
FFP said:
That has been always like this, and humans haven't changed in thousands of years. I have read a lot of ancient wisdom myself. Still, this generation is something. The mouth on them...
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Is someone forcing you to work with residents? Gun to your head? I know you are at the top of the burnout tree and had some bad experiences I guess over the years but dude, come on you sound like you’re 100.

I’ll be working with them next year and I have this year. Looking forward to it as I enjoy teaching. Not everyone is cut out for it, for sure.

Also, EVERY generation says this. What do you think they were saying during the Woodstock/Vietnam War era?
 
Man o War said:
Can I please implore you to work your way up at the ASA to leadership? The gloves are off, our leaders need to be take no s@@t type of individuals. I liked the last president a lot, he didn't mince words and seemed relatively unconcerned about being politically correct to avoid pissing off the nurses. Plus as a former nurse you have seen both sides of the coin. I think you'd be great.
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Wow, Thanks. Appreciate that.

However, I think I would need to be in academics making all the proper connections in order to make all that s hit happen. And I hate academics.
 
FFP said:
You misunderstand me. I actually try to teach and to push them to do new things, especially as CA-3s. I just hate when they want to do their usual "protocolized" anesthesia, the way they have always done it for 3 years at their fancy-shmancy program. You know, every program has certain preferred idiosyncrasies, but residents need to learn as many different ways to do things as they can, especially the seniors. I am sorry, but if they like to only be "comfortable" with one way, maybe they should put 4 letters after their names. Even then, if it's a good plan, I usually let them choose between that and my alternative.

You brought up the ultrasound. The other day, one of them insists on having the ultrasound for an a-line with a BOUNDING pulse. I mean the kind of pulse you can probably even see, if you look carefully. I told the senior resident that there won't be ultrasounds lying around in emergencies, and this is not a fluid-overloaded difficult ICU patient. I get the usual answer that this is the way s/he's used to doing them. I said fine, got the U/S (better for the patient, too). I am not going to force them to learn, because that just makes me the bad guy (and that's where American education is going to hell, because the best teacher is the one who pushes your limits). The sooner we are done, the sooner we can all go home. It may seem like a win-win to them, but I am the only one winning here.

They just don't get it: being coached by an experienced person is a privilege; learn as much as possible even from the least likable people. Now is the time. Once you are an attending, you're on your own; there is nobody to catch you when you fall.

All I ask for is some damn respect.
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I respect you if any of that matters. And if you are just a direct, no nonsense, but cordial person, then you are my cup of tea. What I hate is the ones who are just straight up evil, or smile in your face and talk s hit to other attendings behind your back. Some 40, 50 and 60 year old high schoolers.
 
chocomorsel said:
I respect you if any of that matters. And if you are just a direct, no nonsense, but cordial person, then you are my cup of tea. What I hate is the ones who are just straight up evil, or smile in your face and talk s hit to other attendings behind your back. Some 40, 50 and 60 year old high schoolers.
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I'm sad to know that this type of crap doesn't stop in just medical school.

I am 24 year old but always have seemed to gotten along with the nontrads in my programs a lot more than similar folks my age.

Idc about the kartrashians... who is dating who... or your butthurt attitude to an attending calling you out on an issue.

I respect those who keep it real and give it to you straight because I actually look at the INTENT behind the words rather than the words itself. They don't have time to waste talking about crap that doesn't really have to do with the job at hand.

If you are obviously trying to be a doucher and disrespectful... well.. we can cross that bridge if we get there.

Are you trying to tell me I am wrong and help me see the right way to do something or approach a problem? I am all for it.

I really hope once I make it to residency that I have a whole batch of residents that are less bratty and all get the job done.

🙁
 
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AdmiralChz said:
Is someone forcing you to work with residents? Gun to your head? I know you are at the top of the burnout tree and had some bad experiences I guess over the years but dude, come on you sound like you’re 100.

I’ll be working with them next year and I have this year. Looking forward to it as I enjoy teaching. Not everyone is cut out for it, for sure.

Also, EVERY generation says this. What do you think they were saying during the Woodstock/Vietnam War era?
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This discussion got sidetracked because some of us said that working with CRNAs is usually easier than working with residents (on average). You can pin it on me, on my lack of teaching skills, or some imaginary burnout, but fact is that the younger generations don't properly respect their educators anymore. Which makes it a much less rewarding job than you'd think. Much different experience than as a fellow. Of course, there are always the exceptions that make me happy to waste even hours on them.

I could just be their buddy-buddy and get through the day, and get good reviews etc. I just don't think people learn much like that. The best learning happens with a bit of pressure and stress, and that's why coaches create that environment. Looking back, most of the good educational stuff I remember from residency is linked with some criticism and/or unpleasant moment. That's human nature. Memories need a strong emotional context. One's coach shouldn't be one's friend.
 
chocomorsel said:
I respect you if any of that matters. And if you are just a direct, no nonsense, but cordial person, then you are my cup of tea. What I hate is the ones who are just straight up evil, or smile in your face and talk s hit to other attendings behind your back. Some 40, 50 and 60 year old high schoolers.
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I am not cordial, remember? But I am pretty direct, as in one can read me just by watching my facial expressions. 🙂

The passive-aggressive thing you mentioned is cultural, and is another byproduct of this generation (and the one before it, in this country). When people cannot have a minority opinion without being bullied/persecuted for it, they just learn to hide their thoughts and share them only with a chosen few. Political correctness and all the semi-authoritarian hell that comes from it can destroy a society, because people simply stop debating people they disagree with. Just look at the huge red-blue divide today. It's much easier than being called names, and labeled, and God forbid even lose one's job and livelihood.
 
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FFP said:
I am not cordial, remember? But I am pretty direct, as in one can read me just by watching my facial expressions. 🙂

The passive-aggressive thing you mentioned is cultural, and is another byproduct of this generation. When people cannot have a minority opinion without being bullied/persecuted for it, they just learn to hide their thoughts and share them only with a chosen few. Political correctness and all the semi-authoritarian hell that comes from it can destroy a society, because people simply stop debating people they disagree with. Just look at the huge red-blue divide today. It's much easier than being called names, and labeled, and God forbid even lose one's job and livelihood.
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I don't recall saying you were not cordial. In recent memory.
You certainly speak your mind, but if you tell me you are cordial/non malignant/non evil then who am I to dispute.
I am quite open about the kind of person I am and hope that others are the same with me, even though I know that's not the case at all times.
 
FFP said:
There's your definition of cordial, lol.
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That's completely lost in translation.
Just because you give a no nonsense death stare, as in you don't take no s hit, don't mean that you can't be cordial. As in, you can be nice but also mean business when people want to act stupid/ignorant/try to run over you. Cue... death stare. As in, don't mess with me cuz I am nice.

I am a black woman. I give death stares all the time.
 
chocomorsel said:
That's completely lost in translation.
Just because you give a no nonsense death stare, as in you don't take no s hit, don't mean that you can't be cordial. As in, you can be nice but also mean business when people want to act stupid/ignorant/try to run over you. Cue... death stare. As in, don't mess with me cuz I am nice.

I am a black woman. I give death stares all the time.
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I was just teasing you. 🙂
 
Dr.whom said:
The surgeon may bring the patient to the OR, but once you are involved, that is your patient too. As long as patient care is your priority, you never have to let the surgeon tell you what to do. They can’t do surgery without anesthesia and we’re not as replaceable as some people here lead you to believe. The key is to be with a group who will have each other’s backs.

Regardless, most surgeons out in private practice are quite cordial and will understand if you have issues with a case. Most surgeons I work with wants what’s best for their patients.
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FFP said:
This discussion got sidetracked because some of us said that working with CRNAs is usually easier than working with residents (on average). You can pin it on me, on my lack of teaching skills, or some imaginary burnout, but fact is that the younger generations don't properly respect their educators anymore. Which makes it a much less rewarding job than you'd think. Much different experience than as a fellow. Of course, there are always the exceptions that make me happy to waste even hours on them.

I could just be their buddy-buddy and get through the day, and get good reviews etc. I just don't think people learn much like that. The best learning happens with a bit of pressure and stress, and that's why coaches create that environment. Looking back, most of the good educational stuff I remember from residency is linked with some criticism and/or unpleasant moment. That's human nature. Memories need a strong emotional context. One's coach shouldn't be one's friend.
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Sounds like you are working with some bad residents. I'm definitely not a fan of the overconfident resident as I think that is dangerous. But overall, as a resident I am also not a fan of being micromanaged and that seems to be the general consensus among residents I know. I dont complain and still do whatever the attending wants since they are the boss and it's their license, but it doesn't mean i like it. If it is the correct thing for the patient, of course it should be done. However as I go thru more and more years of residency, I start realizing that many attendings have their own way of doing things, and they all think they are the best. As a resident it's good to learn many ways to do things, but by a certain point it gets real old. A lot of the micromanaging Ive experienced are also not very educational. If you have a way of doing XYZ and you have evidence based reasoning, I'd love to hear it, but if it's just personal habit, and there are 100+ attendings at the institution, as a resident I do not want to have to memorize your habits just so i can please you. Imagine you are a CA3 again, do you really want to be told what inch tape to use to tie the tube? 2 inch vs 1 inch vs 0.5 inch? Eye tape vs tegaderm over eyes vs ointment+tape.. Give 30 of fentanyl instead of 25 in an adult patient.. 1 stop cock on IV line vs 2.. taping your IV with tegaderm vs tape.. how many strips of tape to use on IV ... Labeling syringes circumferentially vs horizontally... and then you have attendings who just sit there and tell you 'change the prop to 50' then 5 min later change it to 40...

FFP said:
The ACT model is ridiculous, both with CRNAs and residents. We don't let residents operate unsupervised; why do we allow them to perform anesthesia without an attending in the room? Greed. The average Millennial anesthesiology resident is not much different than the average CRNA; both of them don't know what they don't know, are cocky and impossible to micromanage (as attendings should, but don't/can't). Just because we have found a way to rationalize the ACT on a daily basis, to be able to live with ourselves as doctors, doesn't make it less disgusting.
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I dont think surg and anes residents differ that much. Yes anes residents get left alone earlier on but anes attendings by policy here are supposed to be at all intubations, and aware of or present at all extubations, and be available for all critical parts. It's the same for the surgeon. It is very common at my institution to have the surgical resident do up to a certain point alone without attending present, then call the attending who will either be present for the critical portions or do it with resident assistance.
 
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