OMG, got in trouble again

[bestcoast]

---

Members don't see this ad.

I got a "Does Not Meet Expectation" in two items on the Eval form: 1) "Recognition of own limitations, seeking advice when needed" and 2) "Interprofessional relationships with physicians".
All I did was saying "why not" to an attending for a couple of cases because we do things differently at where I trained for med school.
Now I have to meet my program director for that.
I feel iffy because every other attending during my other rotations says that I'm a pleasure to work with.

It will all come down to "he said she said" during the meeting.
How should I deal with that?

 

[Doctor Bagel]

In the meeting, don't get defensive because that will kill you. Be nice, humble and ask for other ways to handle this situation. You can share your side of the story and then ponder how that might have been perceived with your PD rather than implying that the person who perceived it poorly was wrong (which he very well might be, but you can't win on that).

 

[aa1984]

Yikes. That's how nitty gritty evaluations can be? Good luck! Hope it works out.

 

[TexasPhysician]

One of the first things I learned in interviewing patients is to avoid the word "why". It can too easily be perceived with a negative connotation and as applying judgement.

I always restructure the question to use "what" or "how", etc. Phrasing questions are better done in a tone that emphasizes that you are trying to understand better and not impart judgement.

I have no idea if this is the case with you, but everything may well have started with a simple misunderstanding based on how you asked the question.

Who knows? Maybe discussing the possibility of a misunderstanding with said faculty would improve things. Maybe it's something totally different.

 

[shopsteward]

You aren't at medical school any more, and "how things were done there" isn't going to impress anyone, particularly an attending in the middle of dealing with his cases. If you don't understand why an attending is taking a particular approach, you need to 1) research for yourself why this might be a better approach/more appropriate in the circumstances, and 2) if you still don't understand, ask the attending, preferably when he is not busy and is not going to think that you are challenging him in front of others.

At the meeting with your program director, you could say something like "I was puzzling over the difference between two different approaches to [the issue], and didn't stop to think how my question might come across to the attending. I'll take care not to do that again."

 

[NotAProgDirector]

I'm going to point out the somewhat ominous word in the thread's title, "again".

If you're showing a pattern of poor performance, that's a problem. It will shortly be time to decide about promotions to the next year of training.

 

[rokshana]

I got a "Does Not Meet Expectation" in two items on the Eval form: 1) "Recognition of own limitations, seeking advice when needed" and 2) "Interprofessional relationships with physicians".
All I did was saying "why not" to an attending for a couple of cases because we do things differently at where I trained for med school.
Now I have to meet my program director for that.
I feel iffy because every other attending during my other rotations says that I'm a pleasure to work with.

It will all come down to "he said she said" during the meeting.
How should I deal with that?

there is no he said, she said in this...the only one that is gonna count is the attending's eval...you need to essentially acknowledge that you were in the wrong and that you realize that how you handled things was not the right way and what you have learned to make sure it doesn't happen again.

as others have posted..."why" usually comes off as being a bit on the offensive... you need to find another way to voice your question so it sounds like you are looking to learn something new, not questioning what someone else is doing.

 

[sluggs]

I trained at a mid-sized university IM program. I worked very hard and stayed on top of stuff. Of course I made mistakes, like all trainees do, and I learned from them. I was respected by me peers and by most attendings. However, I was a smart ass and rubbed a few people the wrong way. No big deal. I went on, got the fellowship I wanted and a great job. There were 2 guys in my class, though, who were also smart and good and hardworking, but they were even bigger smart-asses; they both got screwed at the home institution for fellowship, and one got a bit blackballed more permanently. Now I am an attending in a mixed teaching/non-teaching situation. As long as my residents do their work and are respectful to patients and nurses, I don't care about the rest, but a lot of my co-workers are hard asses about it. Moral: watch out who you piss off!!

 

[nancysinatra]

as others have posted..."why" usually comes off as being a bit on the offensive... you need to find another way to voice your question so it sounds like you are looking to learn something new, not questioning what someone else is doing.

Do you think it would make any difference if the OP were in the field of psychiatry, and were asking "why" in that setting? I ask because that's my field, and while I try not to go around challenging attendings, after 4 years, I'm not entirely impressed with some of the "reasons" I've seen for "why" certain things are done in this field. We have zero to go on in terms of imaging, labs, etc. Anyway I'm just curious if that would make a difference. Not in terms of getting in "trouble" but in terms of people's views of the legitimacy of asking,

 

[Dejavu]

there is no he said, she said in this...the only one that is gonna count is the attending's eval...you need to essentially acknowledge that you were in the wrong and that you realize that how you handled things was not the right way and what you have learned to make sure it doesn't happen again.

as others have posted..."why" usually comes off as being a bit on the offensive... you need to find another way to voice your question so it sounds like you are looking to learn something new, not questioning what someone else is doing.

This.

 

[thesauce]

In the meeting, don't get defensive because that will kill you. Be nice, humble and ask for other ways to handle this situation. You can share your side of the story and then ponder how that might have been perceived with your PD rather than implying that the person who perceived it poorly was wrong (which he very well might be, but you can't win on that).

Great advice.

 

[mamitch4]

As a resident, I tried to understand why my attendings made the decisions that they did- based on guidelines (specialty society or hospital), specifics studies, because that was how they learned when they trained, etc.
As a junior resident I tried to be a compliant sponge, basically showing my attendings that I could learn what they wanted me to learn and be relied upon to carry out their preferred treatment plans as expected. By the time I was a senior resident, I had formed a lot of my own preferences for care that mirrored and/or conflicted with some of my attendings, AND I had earned the respect and autonomy to manage some of their patients the way I wanted to.
I also observed that some of my colleagues struggled with this- the more confrontational junior residents were definitely less well received.

 

[Buzz Me]

I'm going to point out the somewhat ominous word in the thread's title, "again".

It's a reference to the "gap in knowledge" thread posted a couple weeks ago.

 

[bestcoast]

It's a reference to the "gap in knowledge" thread posted a couple weeks ago.

Ya that one.

Personally, I've never had any issues with my interprofessional relationships before. Every attending wrote "pleasure to work with"
Though one attending from last month who gave me a good eval said to me that I needed to tone down the way I behave. (This was from the rotation right after the neuro rotation). He said it's a love-or-hate situation. He liked it but it might rub someone else the wrong way. I've been toning it down ever since and no issues.
Should I tell my PD that? I mean I've been addressing it.

 

[gutonc]

Ya that one.

Personally, I've never had any issues with my interprofessional relationships before. Every attending wrote "pleasure to work with"
Though one attending from last month who gave me a good eval said to me that I needed to tone down the way I behave. (This was from the rotation right after the neuro rotation). He said it's a love-or-hate situation. He liked it but it might rub someone else the wrong way. I've been toning it down ever since and no issues.
Should I tell my PD that? I mean I've been addressing it.

This was the most common "bad" eval I got on my rotations. If you haven't noticed, I'm kind of a sarcastic d**k sometimes and my "filter" could use some work. I definitely dialed it back during residency but it still sometimes bit me in the butt.

I don't know if you should bring it up but address it if the PD does.

 

[matchb0x]

One of the first things I learned in interviewing patients is to avoid the word "why". It can too easily be perceived with a negative connotation and as applying judgement.

I always restructure the question to use "what" or "how", etc. Phrasing questions are better done in a tone that emphasizes that you are trying to understand better and not impart judgement.

I have no idea if this is the case with you, but everything may well have started with a simple misunderstanding based on how you asked the question.

Who knows? Maybe discussing the possibility of a misunderstanding with said faculty would improve things. Maybe it's something totally different.

Excellent advice with the avoiding "why?" word. This is a basic when using/learning therapeutic communication.