Overly critical doc :(

[NonTradMed]

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I don't vent often on SDN because while med school is hard, I understand part of the struggle makes us better doctors.

However, I am feeling upset right now after dealing with a very critical doctor who thought poorly of the physical examination I completed despite making changes at his bequest.

This doctor is known to be kind of nitpicky and tends to ramble at times. He is sometimes critical with others as well, and I, admittedly have a thin skin for this sort of thing.

This doctor gave me a detailed and long list of what I did wrong the last time he saw me do an exam. Some of it was useful, others not so much, and he delivered it over a long conversation with me. Suffice it to say, I didn't remember everything he told me to change, only the gist of it.

Months later, when he observed me again, he said he was not happy that I made the same mistakes, including two he thought very egregious.But I thought I did make improvements on a few places at his suggestion.

I think the problem is that he nitpicks so much that I don't know what are the 'big' stuff I should try to correct and the little things that I can shrug off. For example, the last time we spoke on my P/E, he spent so much time talking to me about my interview technique that I ended up focusing on improving that, which now became irrelevant since this time he spent the entire conversation talking about lacking in exam skills (and that I didn't heed any of his suggestions!).

But my doc gives suggestions in every step of the exam so I don't know which are necessary changes and which are just differing styles and can be ignored.

And it doesn't help this doctor just gives me a gigantic list of things I did wrong, taken in a long rambling message, some of which (after speaking with other students doing the same thing), are tiny nitpicks.

So despite spending time getting the exam down, he made me feel like I did a piss poor job of everything even though it would seem that I only did a few things wrong. He apologized for ending our tenure together on such a negative note but that didn't change anything. I felt that while I could have been more diligent, this doc could have been a better teacher.

 

[asmallchild]

[youtube]http://www.youtube.com/watch?v=dnzXzoPfr8Y[/youtube]

EDIT: I just realized my advice was ambiguous. Go for the kicking, pass on the sleeping.

👍

😛

 

[IHeartNerds]

As a medical student, your physical exam will always be lacking in something, your progress notes will always be too detailed or not detailed enough, and your suture ends will always be too short or too long in the OR.

This is the nature of things. It will not change regardless of how much you bust your ass to do so, and it does not really reflect on you.

👍

 

[WellWornLad]

Feedback is a two-way street. If your instructor is doing a poor job of instructing you, then you need to give them some feedback too.

Yeah, I know, easier said than done, but that's what they're always telling me in my neck of the woods.

 

[Kedan]

We all have people like this who need to deal with but the point is not to get riled up over it, just take the lesson and move on. You're not in medical school to impress Dr. XYZ and in truth you may never impress him but here's the important thing, he's not the God of Medicine. Obviously you're going to continue taking note of the important stuff (he complained about the examination so work on that) but the rest of the ramble isn't worth getting hot and bothered over.

Edit: Here's the thread - http://forums.studentdoctor.net/showthread.php?t=615281

 

[SouthernSurgeon]

As a medical student, your physical exam will always be lacking in something, your progress notes will always be too detailed or not detailed enough, and your suture ends will always be too short or too long in the OR.

This is the nature of things. It will not change regardless of how much you bust your ass to do so, and it does not really reflect on you.

👍

One attending actually complimented me one day on the fact that he felt my suture ends were the length he wanted (he always specifies down to the millimeter!). It was the nicest thing he said on the whole rotation...I may have to ask him for a LOR now...😉

 

[asmallchild]

As a medical student, your physical exam will always be lacking in something, your progress notes will always be too detailed or not detailed enough, and your suture ends will always be too short or too long in the OR.

This is the nature of things. It will not change regardless of how much you bust your ass to do so, and it does not really reflect on you.

👍

I vividly remember this from my 3rd year surgery rotation. I was scrubbing with the rotation director, I was cutting the suture ends for him, and he erupts, "Cmon! Does that look like a cm? Are you stupid?"

I nicely reply, "How long is a cm? Am I leaving too much on the ends?"

He requests a ruler from the scrub tech in order to show me up. "Here, measure it out. It's not that difficult"

Turns out my suture lengths? Exactly 1 cm.

The guy turned red through his mask.

 

[RxnMan]

I vividly remember this from my 3rd year surgery rotation. I was scrubbing with the rotation director, I was cutting the suture ends for him, and he erupts, "Cmon! Does that look like a cm? Are you stupid?"...

I always start by asking the surgeon if he wants his suture ends "too long" or "too short"

 

[bambi]

I would say if you are still doing the same things wrong when he sees you a second time months later then fair enough if he tells you! You might think some things are minor and can be ignored, but that might be because you don't know what you are doing, maybe you are missing really important things!

 

[Scottish Chap]

I don't vent often on SDN because while med school is hard, I understand part of the struggle makes us better doctors.

However, I am feeling upset right now after dealing with a very critical doctor who thought poorly of the physical examination I completed despite making changes at his bequest.

This doctor is known to be kind of nitpicky and tends to ramble at times. He is sometimes critical with others as well, and I, admittedly have a thin skin for this sort of thing.

This doctor gave me a detailed and long list of what I did wrong the last time he saw me do an exam. Some of it was useful, others not so much, and he delivered it over a long conversation with me. Suffice it to say, I didn't remember everything he told me to change, only the gist of it.

Months later, when he observed me again, he said he was not happy that I made the same mistakes, including two he thought very egregious.But I thought I did make improvements on a few places at his suggestion.

I think the problem is that he nitpicks so much that I don't know what are the 'big' stuff I should try to correct and the little things that I can shrug off. For example, the last time we spoke on my P/E, he spent so much time talking to me about my interview technique that I ended up focusing on improving that, which now became irrelevant since this time he spent the entire conversation talking about lacking in exam skills (and that I didn't heed any of his suggestions!).

But my doc gives suggestions in every step of the exam so I don't know which are necessary changes and which are just differing styles and can be ignored.

And it doesn't help this doctor just gives me a gigantic list of things I did wrong, taken in a long rambling message, some of which (after speaking with other students doing the same thing), are tiny nitpicks.

So despite spending time getting the exam down, he made me feel like I did a piss poor job of everything even though it would seem that I only did a few things wrong. He apologized for ending our tenure together on such a negative note but that didn't change anything. I felt that while I could have been more diligent, this doc could have been a better teacher.

Some of your worst critics will be your best teachers. It won't help how you feel, but it is important to have a thick skin in medicine - especially in this country where people tend to be pretty blunt.

You'll find that the attendings that don't play fair and are nit-picky tend to do this with everyone. I think every rotation has one such memorable attending. Even when you're more proficient as a 4th year medical student, you'll still deal with the odd difficult attending who majors in trivialities and micromanages. I worked with the harshest family medicine attending as a 4th year (worse than some hot dog-and-a-half surgeons I worked with); this person was rude to patients and students, and picked on everything I did. By this stage, I didn't take it personally. Oddly, the attending turned in a stellar evaluation and narrative and I got honors. This is just the way that some attendings role. If it really is a personality trait of the attending and not genuine issues that need improvement, the biggest difference between now and then is that you won't care what they say to you.....

 

[Non-TradTulsa]

I would say if you are still doing the same things wrong when he sees you a second time months later then fair enough if he tells you! You might think some things are minor and can be ignored, but that might be because you don't know what you are doing, maybe you are missing really important things!

I wonder if I am the only one rolling on the floor over this post (with all due respect, of course). Either Bambi is relatively new to medical education, or medical education in the British Isles is quite different from this country.

I think it's been proven, over and over again, that the old-style methods of medical education where you were physically and emotionally beaten to a pulp - and, if you survived, you might just be a good doctor - is not an effective style of education - of course you don't remember his entire "list" of what you did wrong - nobody can be 100% open to learning when you've just been thoroughly insulted.

SDN is not a bad place to vent your frustration. I would, however, try to develop a thicker hide over your thin skin. I still allow myself to become extremely angry over any comments that are personal - but very few criticisms are personal. You will encounter this same jerk with a different name and face over and over again in your education - there's lots of 'em out there.

 

[maceo]

I understand part of the struggle makes us better doctors.

thats the pile of manure that they try to sell you. Im here to tell you that the stuggle doesnt make you better. It makes you bitter. and bitter as (H word)

 

[bambi]

I wonder if I am the only one rolling on the floor over this post (with all due respect, of course). Either Bambi is relatively new to medical education, or medical education in the British Isles is quite different from this country.

I think it's been proven, over and over again, that the old-style methods of medical education where you were physically and emotionally beaten to a pulp - and, if you survived, you might just be a good doctor - is not an effective style of education - of course you don't remember his entire "list" of what you did wrong - nobody can be 100% open to learning when you've just been thoroughly insulted.

SDN is not a bad place to vent your frustration. I would, however, try to develop a thicker hide over your thin skin. I still allow myself to become extremely angry over any comments that are personal - but very few criticisms are personal. You will encounter this same jerk with a different name and face over and over again in your education - there's lots of 'em out there.

I am by no means new to medical education. I just don't think that you can automatically assume that the OP is great at what they were doing and that the attending was picking on minor things especially as the OP apparently made 2 of the same serious errors months later! Anyway, the OP didn't specify what was said, maybe if they did it would be easier to tell if the guy was just being annoying or if the OP was actually making serious errors. As for medical education- yes it's different here, and we are known to be far better clinically.

 

[Mr hawkings]

I am by no means new to medical education. I just don't think that you can automatically assume that the OP is great at what they were doing and that the attending was picking on minor things. The OP didn't specify what was said, maybe if they did it would be easier to tell if the guy was just being annoying or if the OP was actually making serious errors. As for medical education- yes it's different here, and we are known to be far better clinically.

here we go again

 

[4Doc4]

here we go again

+1..... Who's got the popcorn?

 

[NonTradMed]

I am by no means new to medical education. I just don't think that you can automatically assume that the OP is great at what they were doing and that the attending was picking on minor things especially as the OP apparently made 2 of the same serious errors months later! Anyway, the OP didn't specify what was said, maybe if they did it would be easier to tell if the guy was just being annoying or if the OP was actually making serious errors. As for medical education- yes it's different here, and we are known to be far better clinically.

My problem was that one of the 'serious' errors I made I did not realize was a big error. He gave me a long list of what he thought I should correct and I didn't realize that some of that were major "must change" items and others were minor things.

It wasn't until the second time he observed me that he really hit me hard on one of those 'must change' items that I realized he really, really thought it was important (over everything else he talked about).

I wish he had been more succinct with his criticism, tell me the major things that was wrong, and then put the minor stuff later on. Instead, the doctor made every criticism equal in comparison. I am not saying the criticisms weren't valid or the guy was being a jerk about it, only that he did a poor job of expressing what he thought were the truly egregious things in what I did.

I know my exam skills need improvement and I could have done more to improve it, but I wish I had better directions on the changes I should make.

I guess this will type of situation will continue to happen. I do not consider myself a quick learner. I learn by watching others first and then practicing many times. I guess I will have to make the most of what I'm given. Thanks for everyone's comments!

At least now I will never make the same mistakes again! 🙂

 

[Non-TradTulsa]

As for medical education- yes it's different here, and we are known to be far better clinically.

By whom? The RCP? I actually felt guilty about poking fun until I saw this bit of arrogance. I'll concede, however, that an NHS doc is probably a bit better than I am at physical exam - because he has limited access to CT and other advanced imaging technology. With extraordinary physical exam skills, you can identify many abdominal conditions with a sensitivity as high as 70% or a bit better - with lots and lots of practice. But, CT probably has a sensitivity of better than 90% for the same condition. Which is why we have lots of physicians in this country with only fairly good physical exam skills - and many, many CTs. I hear many arguments about how we need to learn to practice medicine with fewer toys and less electricity, but I'll still throw 'em in the scanner every time if there's the slightest doubt. We also have something in this country called "lawsuits."

 

[RxnMan]

...At least now I will never make the same mistakes again! 🙂

Something to think about is that they have 10, 15, 20 years of experience on you. They will know by the look of the patient and the c/c where to go. They know the top 5 in the differential, including 2 rare conditions you never heard of but are big and bad (lawsuit material). They know the questions that differentiate these. They know how to explain things to patients in half the time you do.

Their physical exam will be different. They will tell you that the anterior drawer test you did is worthless, and you should do the Lachman's and pivot-twist instead. And add in a hip roll, because in kids, knee problems = hip problems, until proven otherwise, and the hip roll is the most sensitive test for hip fracture. I experienced all of this last week.

My point? The game is rigged, you will not be as good as they are, they will always know more, and they will always correct/add/critique you. Some do so more harshly than others. Adjust your perceptions to novice and live with it.

 

[scrambizle]

On my last day of surgery, the attending took 5 minutes to explain to me how I was holding the scissors wrong when I cut his sutures. All I could think was "thank god I will never, ever have to scrub in again. Ever"

 

[crystalgreen]

i think that u shouldnt take it so personal b/c maybe he's like that with alot of people. also, at least he tells you what's wrong so you can actually improve whereas some docs dont say anything and you end up learning nothing...which benefits you more?

 

[psychforme]

It's a physical exam not brain surgery.

 

[degoo_]

As a medical student, your physical exam will always be lacking in something, your progress notes will always be too detailed or not detailed enough, and your suture ends will always be too short or too long in the OR.

This is the nature of things. It will not change regardless of how much you bust your ass to do so, and it does not really reflect on you.

👍

This person gets medical school.

 

[OncoCaP]

My problem was that one of the 'serious' errors I made I did not realize was a big error. He gave me a long list of what he thought I should correct and I didn't realize that some of that were major "must change" items and others were minor things.

It wasn't until the second time he observed me that he really hit me hard on one of those 'must change' items that I realized he really, really thought it was important (over everything else he talked about).

I wish he had been more succinct with his criticism, tell me the major things that was wrong, and then put the minor stuff later on. Instead, the doctor made every criticism equal in comparison. I am not saying the criticisms weren't valid or the guy was being a jerk about it, only that he did a poor job of expressing what he thought were the truly egregious things in what I did.

I know my exam skills need improvement and I could have done more to improve it, but I wish I had better directions on the changes I should make.

I guess this will type of situation will continue to happen. I do not consider myself a quick learner. I learn by watching others first and then practicing many times. I guess I will have to make the most of what I'm given. Thanks for everyone's comments!

At least now I will never make the same mistakes again! 🙂

Yes, it would be nice if every attending was able to adapt the feedback to the student or perhaps was respectful to the student at the time of giving feedback or advice. Seems like this thread has given you a chance to vent your frustations about the way the feedback was provided, specifically with respect to the lack of prioritization.

I'm not sure what options you have available to you for improvement. Clearly you could just follow his recommendations outright. This might be difficult if he gave you a long list. Perhaps there is an intern/resident on your service that is willing to take some extra time to teach you physical exam skills (obviously would need to be someone who seems to indicate a willingness to do some extra teaching and isn't going to create more problems for you)? Perhaps you can engage in additional practice with fellow med students? Worst case, you could practice more on your own. Another possibility is to ask residents or this attending for more frequent feedback. Some clerkship directors are very helpful as well in terms of lining up additional resources for people who need to practice a particular skill, etc.

Good luck to you. Seems like you are working hard to come up with a path toward improvement. I also suspect that given a little time and reflection, such negative feedback won't sting quite as much in the future because you will have traveled this unpleasant road before. Like you said, it's quite possible that this experience could help prepare you for a challenging situation in your future career and enable you to become a better physician even if it might not be a lot of fun right now. 🙂

 

[JPmamd09]

Yes, it would be nice if every attending was able to adapt the feedback to the student or perhaps was respectful to the student at the time of giving feedback or advice. Seems like this thread has given you a chance to vent your frustations about the way the feedback was provided, specifically with respect to the lack of prioritization.

I'm not sure what options you have available to you for improvement. Clearly you could just follow his recommendations outright. This might be difficult if he gave you a long list. Perhaps there is an intern/resident on your service that is willing to take some extra time to teach you physical exam skills (obviously would need to be someone who seems to indicate a willingness to do some extra teaching and isn't going to create more problems for you)? Perhaps you can engage in additional practice with fellow med students? Worst case, you could practice more on your own. Another possibility is to ask residents or this attending for more frequent feedback. Some clerkship directors are very helpful as well in terms of lining up additional resources for people who need to practice a particular skill, etc.

Good luck to you. Seems like you are working hard to come up with a path toward improvement. I also suspect that given a little time and reflection, such negative feedback won't sting quite as much in the future because you will have traveled this unpleasant road before. Like you said, it's quite possible that this experience could help prepare you for a challenging situation in your future career and enable you to become a better physician even if it might not be a lot of fun right now. 🙂

I think that's a really great idea. I think it'd be good to go to someone whose teaching style you prefer and whose exam skills are very good, and ask them for feedback as well. In my own experience, while there is a "right way" to do physical exam maneuvers and components, everyone seems to have their own little quirks and methods of doing things. And unfortunately some people just aren't as good of teachers as others. I'd say try to get something out of your experience with this doc and try to let the rest roll off. This is coming from one thin-skinned person to another - I really have a difficult time with criticism myself (and also with feeling like/looking like an idiot).

My own personal horror stories from rotations involve an OB literally slapping my hand during a delivery (then later telling me I was one of the best students he'd worked with - WTF? I guess he felt bad) and getting absolutely reamed and called stupid by another OB for not cutting the suture short enough during a perineal repair (on my birthday, while on call, on a weekend). Unfortunately, as someone mentioned before, we've got to learn to take it for a while, and then hopefully use our experiences to make us better teachers later on. Hope things are going better, try not to get down on yourself and learn as much as you can (and try to have fun too 🙂).

 

[Pembleton]

However, I am feeling upset right now after dealing with a very critical doctor who thought poorly of the physical examination I completed despite making changes at his bequest.

My preceptor is the opposite. He makes very little commentary on what I do. Sometimes I feel like I'm fumbling around like an idiot while he stands there bored. It's very frustrating because I want to be a good clinician. I get very little critical feedback and it's not because I'm doing everything right. He is a very poor teacher. If it weren't for Bates and physical diagnosis videos, I'd be completely uneducated.

 

[sprinkibrio]

I see some of you want to turn this venting thread into an advice thread. You do realize that the OP is complaining about advice, right?