augeremt

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There's a kid in my class who's pretty unbearable to work with on rotations. He shows up 1.5 hours early to take extra patients, interrupts patient presentations in front of the team, orders people around, and jumps in to answer pimp questions when they are clearly directed at another student.

All of this wouldn't bother me so much if it wasn't taking away from my learning experience (and thus, grade). The extra patients thing results in him having 3 patients while some people have 0. He interrupts a SOAP note to correct the presentation since he's already seen other students' patients on his own. And he answers all the pimp questions before the attending/resident even has a chance to finish asking them, especially if they are directed at another student.

I've been lucky to avoid him for the past few months, but it looks like we'll be on a small team for 4 weeks of internal medicine.

I'm not the type of person to let people get away with this kind of stuff, especially when it takes away from my education. Also, the reason he's like this well into his 20s is because no one's ever stood up to him. So part of me wants to start challenging him and correct his actions, but that usually makes things awkward for the team, which is not how I want to stand out during 3rd year.

How do I deal with this? Anyone have good coping mechanisms so I don't lose my mind? Or ways to approach this person without making things worse for myself?
 
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doyouhaveaflag

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I was on a team with another third year who did similar things but not quite to that degree. That sucks, I'm sorry you're dealing with that. The person I was on with frequently felt the need to add to my presentations even though they weren't her patients, and always answered the pimping questions even if directed to me. I finally just said to her that I would appreciate if she'd give me a shot at answering before jumping in if the questions were for me. This person is someone I consider to be a friend though, so I didn't feel weird approaching her about it. She's just socially not very aware.

It got better after I talked to her, but I ended up getting a truly subpar eval from the attending, while according to the other student, she was given comments about how she performed above the expected level for a third year. I was pissed off about that for a couple days.
 
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augeremt

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Thanks for the quick reply! The disparity in evals you mention is exactly my concern. He comes off as being awesome because he does all this "extra work", which is really throwing everyone else under the bus. Not exactly the team player you'd want in medicine. But attendings and residents are too busy to see his true colors and instead reward his awful actions by giving him good evals. All that validates him to continue being an a**h0le because the means justify the end in his mind.

I'll try taking him aside and asking him to give me a chance to answer questions, like you suggested. Hopefully he'll tone it down a little bit.
 

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I was on a team with another third year who did similar things but not quite to that degree. That sucks, I'm sorry you're dealing with that. The person I was on with frequently felt the need to add to my presentations even though they weren't her patients, and always answered the pimping questions even if directed to me. I finally just said to her that I would appreciate if she'd give me a shot at answering before jumping in if the questions were for me. This person is someone I consider to be a friend though, so I didn't feel weird approaching her about it. She's just socially not very aware.

It got better after I talked to her, but I ended up getting a truly subpar eval from the attending, while according to the other student, she was given comments about how she performed above the expected level for a third year. I was pissed off about that for a couple days.
That's life man. Some of the worst people do well and some great people get something they don't deserve. There's not much you can do about it. Just have to roll with the punches.
 
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Phloston

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There's a kid in my class who's pretty unbearable to work with on rotations. He shows up 1.5 hours early to take extra patients, interrupts patient presentations in front of the team, orders people around, and jumps in to answer pimp questions when they are clearly directed at another student.

All of this wouldn't bother me so much if it wasn't taking away from my learning experience (and thus, grade). The extra patients thing results in him having 3 patients while some people have 0. He interrupts a SOAP note to correct the presentation since he's already seen other students' patients on his own. And he answers all the pimp questions before the attending/resident even has a chance to finish asking them, especially if they are directed at another student.

I've been lucky to avoid him for the past few months, but it looks like we'll be on a small team for 4 weeks of internal medicine.

I'm not the type of person to let people get away with this kind of stuff, especially when it takes away from my education. Also, the reason he's like this well into his 20s is because no one's ever stood up to him. So part of me wants to start challenging him and correct his actions, but that usually makes things awkward for the team, which is not how I want to stand out during 3rd year.

How do I deal with this? Anyone have good coping mechanisms so I don't lose my mind? Or ways to approach this person without making things worse for myself?
Best and most professional thing to do is quietly and politely speak to the person one-on-one. Try and express your concerns in the most validating and reaffirming way possible. If you inadvertently strike an oppositional or disapproving tone, the conversation will backfire.

You might feel really annoyed by this person at times, but one thing I would not resort to is reporting him to your SoM, unless he is actually unsafe or exhibiting conduct that you truly feel is a detriment to patients (and that means truly, not just stuff that rubs you the wrong way). And even if you did report him (through whatever mechanism your SoM has), they'll definitely want to know if you spoke to him first one-on-one.

I felt this way a few times on rotations and just ignored it, i.e., didn't even pull the individuals aside. I didn't like their character, but at the end of the day, I didn't feel patients were affected negatively in any way. The only time I had this type of convo was with a close colleague whom I had ultra-mild concerns about my last rotation of fourth year.
 
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EmergDoc2B

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During my presentation if another student interrupted me I would immediately say, Id appreciate any comments from fellow students after I'm finished presenting. Period. I would say this looking directly into that persons eyes so there was no confusion about who I was speaking to. If the attendings defend the students actions I would arrive 2 hours early, pick up extra patients and play the game the attendings reward.
 

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During my presentation if another student interrupted me I would immediately say, Id appreciate any comments from fellow students after I'm finished presenting. Period. I would say this looking directly into that persons eyes so there was no confusion about who I was speaking to. If the attendings defend the students actions I would arrive 2 hours early, pick up extra patients and play the game the attendings reward.
You could also point blank ask something like, "Are you presenting this one or am I?"
I personally would find that hilarious.

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But attendings and residents are too busy to see his true colors and instead reward his awful actions by giving him good evals. All that validates him to continue being an a**h0le because the means justify the end in his mind.

I'll try taking him aside and asking him to give me a chance to answer questions, like you suggested. Hopefully he'll tone it down a little bit.
Attendings/residents who aren't Ahols themselves will see right through it. He is probably smart, crafty and talented and knows how to play the system.

1) Simple 1 on 1, non-confrontational just asking/stating. Be decent and appeal for decency, don't be a jerk in response to jerkiness.
2) Differentiate yourself if you find that doesn't work. Keep your head down, be yourself and try to not let it bother you.
 

lymphocyte

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There's a kid in my class who's pretty unbearable to work with on rotations. He shows up 1.5 hours early to take extra patients, interrupts patient presentations in front of the team, orders people around, and jumps in to answer pimp questions when they are clearly directed at another student.

All of this wouldn't bother me so much if it wasn't taking away from my learning experience (and thus, grade). The extra patients thing results in him having 3 patients while some people have 0. He interrupts a SOAP note to correct the presentation since he's already seen other students' patients on his own. And he answers all the pimp questions before the attending/resident even has a chance to finish asking them, especially if they are directed at another student.

I've been lucky to avoid him for the past few months, but it looks like we'll be on a small team for 4 weeks of internal medicine.

I'm not the type of person to let people get away with this kind of stuff, especially when it takes away from my education. Also, the reason he's like this well into his 20s is because no one's ever stood up to him. So part of me wants to start challenging him and correct his actions, but that usually makes things awkward for the team, which is not how I want to stand out during 3rd year.

How do I deal with this? Anyone have good coping mechanisms so I don't lose my mind? Or ways to approach this person without making things worse for myself?
This sucks. It really does. Part of medicine is learning how to play nice with others. Another part is learning how to fix things on your own without seniors getting involved.

Edit: See below.
 
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Phloston

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During my presentation if another student interrupted me I would immediately say, Id appreciate any comments from fellow students after I'm finished presenting. Period. I would say this looking directly into that persons eyes so there was no confusion about who I was speaking to. If the attendings defend the students actions I would arrive 2 hours early, pick up extra patients and play the game the attendings reward.
Interestingly that type of response might come off a little defensive and aggressive, like you're playing a status game. Especially the part about the eyes - what's that about. If someone is contemptuously impertinent that's one thing, but I hope you're not over-generalizing as far as any colleague asking a question is concerned. Just my two cents.
 

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I was speaking to the exact situation the OP described not over generalizing about anything. Nothing more nothing less. If that behavior goes unchecked it will continue. You cant go and complain to your attendings so I would nip it the bud, and have. The looking the person in the eyes is about having the person attention and projecting confidence when speaking to the person. You can be confident without being hostile. As for coming off defensive and aggressive I respectfully disagree. I feel a calm but direct response comes off as confident and cool headed. Allowing another student to essentially run all over you shows passivity and a lack of confidence.
 
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Take the high road and ignore it. This person will eventually get what they deserve. I had a senior resident that was identical to this in residency. There was actually a meeting between all the attendings to determine whether or not she be allowed to graduate from residency because of her actions. They all decided to graduate her anyway, because they were tired of dealing with her and wanted her gone. A few years later, she was being fired from another job and I was the medical director for our practice. I took great joy in refusing to even interview her. The good guys will win out in the end.
 
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augeremt

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Thanks for all the responses! It's going to be a test of patience for those 4 weeks. Based on what you guys have suggested, I'll speak to him in private the first time he does something obnoxious. If he doesn't change, then I'll say something during rounds, tactfully of course.

Unfortunately, other students don't want the trouble of engaging him so they let him get away with the things I've mentioned. As a result, he's only gotten more brazen and smug as the months go on. I'm not one to reward bad behavior by inaction, so I stood up to him a couple of times in group settings during the pre-clinical years. He seemed to be less disruptive around me for the duration of those particular group sessions so hopefully that trend continues more long-term this time. Classmates aren't as keen on rocking the boat even though they say they "have my back" so we'll see if that changes once I start putting my foot down and there are results.

I have no doubt that his actions will come around to bite him in residency if not sooner. Until then, I'll take the high road and try to minimize his disruption to my learning.

I'll keep you guys updated. There's a good chance I'll have him on other rotations as well, so maybe we'll see a progression toward a somewhat decent human being. Or not. I should probably keep my expectations low for now.
 
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augeremt

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5. Here's the horrible truth that nobody's point out yet: if he knows more about your patient then you do--not good. If he's carrying 3 patients, and others are carrying 0 without confronting him about it--not good. Attendings and residents see all of that too. Outwork him, on your patients. Your mission is to just be better than him. Use his asinine ways to make you a better doctor. (In the ends, this attitude has helped me cope the best.).
Agreed. I'll try to keep that in mind when steam is coming from my ears.

It'd be one thing if he chimed in with things pertinent to the patient's disease, but it's always something irrelevant like a history of DM in the aunt's husband's cousin's dog, etc. Or something the presenter hasn't gotten to yet but will say shortly or knows but didn't mention in the presentation.

I agree we should know our patients inside and out. But our fellow classmates should not be throwing us under the bus when we mess up. We get enough of that from everyone else in the hospital by virtue of being at the rock bottom of the totem pole. It'd be nice if he got that memo. But that may be too much to ask of him right now. Baby steps.
 
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lymphocyte

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It'd be one thing if he chimed in with things pertinent to the patient's disease, but it's always something irrelevant like a history of DM in the aunt's husband's cousin's dog, etc. Or something the presenter hasn't gotten to yet but will say shortly or knows but didn't mention in the presentation.

I agree we should know our patients inside and out. But our fellow classmates should not be throwing us under the bus when we mess up. We get enough of that from everyone else in the hospital by virtue of being at the rock bottom of the totem pole. It'd be nice if he got that memo. But that may be too much to ask of him right now. Baby steps.
If it's irrelevant, it's annoying for everybody and doesn't reflect well on him.

I hear what you're saying about baby steps, and I really admire you caring about the rest of the team. I think he needs the memo yesterday, and I would personally talk to him about it. What's the risk/benefit here? What's he realistically going to do other than mope or stew after you talk to him? Meanwhile, he's hurting everybody around him and probably himself too. People like that just don't get it. But it's not up to you to fix him or make him see the error of his ways. The only thing that matters is to minimise your unnecessary misery at his hands.

Anyways. Good luck. I'm wishing you all the best.
 
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I was speaking to the exact situation the OP described not over generalizing about anything. Nothing more nothing less. If that behavior goes unchecked it will continue. You cant go and complain to your attendings so I would nip it the bud, and have. The looking the person in the eyes is about having the person attention and projecting confidence when speaking to the person. You can be confident without being hostile. As for coming off defensive and aggressive I respectfully disagree. I feel a calm but direct response comes off as confident and cool headed. Allowing another student to essentially run all over you shows passivity and a lack of confidence.
I don't really see what this has to do with confidence either, as you've mentioned three times here. But it probably wouldn't be in anyone's best interest for us to derail the thread with this interplay.

Scpod has made a great point that ignoring it is best, if at all possible. I think the OP has his answers.
 

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I don't really see what this has to do with confidence either, as you've mentioned three times here. But it probably wouldn't be in anyone's best interest for us to derail the thread with this interplay.

Scpod has made a great point that ignoring it is best, if at all possible. I think the OP has his answers.
I dont see it as derailing a thread as much as two people with differing points of view on the same subject; which was the point of the thread.
 
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EmergDoc2B

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Thanks for all the responses! It's going to be a test of patience for those 4 weeks. Based on what you guys have suggested, I'll speak to him in private the first time he does something obnoxious. If he doesn't change, then I'll say something during rounds, tactfully of course.

Unfortunately, other students don't want the trouble of engaging him so they let him get away with the things I've mentioned. As a result, he's only gotten more brazen and smug as the months go on. I'm not one to reward bad behavior by inaction, so I stood up to him a couple of times in group settings during the pre-clinical years. He seemed to be less disruptive around me for the duration of those particular group sessions so hopefully that trend continues more long-term this time. Classmates aren't as keen on rocking the boat even though they say they "have my back" so we'll see if that changes once I start putting my foot down and there are results.

I have no doubt that his actions will come around to bite him in residency if not sooner. Until then, I'll take the high road and try to minimize his disruption to my learning.

I'll keep you guys updated. There's a good chance I'll have him on other rotations as well, so maybe we'll see a progression toward a somewhat decent human being. Or not. I should probably keep my expectations low for now.
Good luck to you. I hope the rotation gets better for you and your classmates.
 
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If it makes you feel better, know that residents and attendings aren't idiots. They were in your shoes not that long ago, and have seen a lot more med students than you. There's a reason part of evaluations is interpersonal skills and professionalism.
Eh, some of them are. One of our attendings/clerkship directors luuuuuves in-your-face people who wouldn't shut up. I had someone exactly like OP describes on my team with that attending, and this person answered about 90% of student questions on the rounds regardless of who they were addressed to (and there were 4 students on that team which is ridiculous in itself but oh well) and prerounded on my patients and made comments about them on rounds (the comments didn't add anything but seemed to serve the purpose of letting everyone know he saw those patients - I don't even know why anyone should care about such a waste of time). One of the residents actually talked to him about that in private but it didn't change anything. The attending, on the other hand, loved the guy. The same person would also jump in and answer most questions in our didactics lead by the same attending, and the attending loved that, too (instead of trying to interfere and let other people answer as well). I'm sure the attending gave this guy a raving awesome eval. So yeah, while most people will dislike this kind of behavior, some will love it (I wonder if these people behaved like that when they were students themselves), and some of these people may be influential.
 
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Eh, some of them are. One of our attendings/clerkship directors luuuuuves in-your-face people who wouldn't shut up. I had someone exactly like OP describes on my team with that attending, and this person answered about 90% of student questions on the rounds regardless of who they were addressed to (and there were 4 students on that team which is ridiculous in itself but oh well) and prerounded on my patients and made comments about them on rounds (the comments didn't add anything but seemed to serve the purpose of letting everyone know he saw those patients - I don't even know why anyone should care about such a waste of time). One of the residents actually talked to him about that in private but it didn't change anything. The attending, on the other hand, loved the guy. The same person would also jump in and answer most questions in our didactics lead by the same attending, and the attending loved that, too (instead of trying to interfere and let other people answer as well). I'm sure the attending gave this guy a raving awesome eval. So yeah, while most people will dislike this kind of behavior, some will love it (I wonder if these people behaved like that when they were students themselves), and some of these people may be influential.
It's like we're describing the same person...complete with the didactics scenario. It's so infuriating but also comical when he invariably gets something wrong. His face twists like Sheldon's on "Big Bang Theory" when things don't go his way.

We also have big teams on some rotations and the way to make time go faster is by having patients to work up. Sitting around twiddling my thumbs because I have 0 patients and he has 3 is another layer of torture on top of already having to spend time with him.

How did you and your classmates deal with this? Any tips? Did you feel his jumping in on questions and pre-rounding on your patients hurt you academically? And emotionally? I already know it's going to drive me nuts.

These types of people don't change their behavior when they see it's working with attendings (because an attending's opinion trumps the residents' opinions any day in their mind). Instead, it's validating and makes them even worse as the year goes on.
 
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I think that speaking to your classmate 1-on-1 is the right idea, but if this person is truly taking ownership of multiple patients on your service while other students have no patients at all, you really need to talk to your senior resident as well.

At the end of the day, it is the senior resident's responsibility to distribute patients so that everyone is cared for AND everyone on the medical team has a chance to learn. The only way I can see this misdistribution being reasonable is if everyone else on the team has discharged their patients while your classmate has several long-term patients who are medical rocks. If that isn't the case, talk to your resident. It may be as simple as saying. "Hey - can we figure out some system for alternating admissions/assigning medical student patients on our team? It looks like several of us don't have patients right now and I want to make sure we all have the chance to learn". It's a reasonable request and I think almost all residents would help you out on that one.
 
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lymphocyte

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It's like we're describing the same person...complete with the didactics scenario. It's so infuriating but also comical when he invariably gets something wrong. His face twists like Sheldon's on "Big Bang Theory" when things don't go his way.

We also have big teams on some rotations and the way to make time go faster is by having patients to work up. Sitting around twiddling my thumbs because I have 0 patients and he has 3 is another layer of torture on top of already having to spend time with him.

How did you and your classmates deal with this? Any tips? Did you feel his jumping in on questions and pre-rounding on your patients hurt you academically? And emotionally? I already know it's going to drive me nuts.

These types of people don't change their behavior when they see it's working with attendings (because an attending's opinion trumps the residents' opinions any day in their mind). Instead, it's validating and makes them even worse as the year goes on.
Maybe it's because I did consulting before medicine, but if any of my colleagues ever did this to me (especially in front of a client or managing director), they would get a talking to. Privately, factually, no blame--but knock it off. Seniors aren't always going to be there to fix problems for you, and not everybody sees the problem in the same way. Where you see an obnoxious loudmouth, they might see an enthusiastic hard-worker that's at least venturing answers, even if they are "invariably wrong"--as everybody's answers invariably are. Who knows what your seniors actually think? You can hope they see it your way, but it's only a hope.

I just don't get the passivity in this thread. There's a lot of silent brooding, but what's the risk/benefit of tactfully confronting? And that's not meant to judge. But dealing with an obnoxious person is an important interpersonal skill to develop. You will definitely come across people like this again, not just in medicine but in life. I mean, you've been dealing with this for months with another rotation coming up. What will it take? And like everything in medicine, early interventions matter. This needed to have been nipped in the bud yesterday. Today is the next best time.

And no, these people don't always get what's coming to them--at least, not in a way that would be helpful to you. Sure there might be schadenfreude. They'll probably struggle with meaningful professional and personal relationships until they get it; or they never get it, and they'll be stuck wondering why they're so lonely and chronically underperforming in life. But how does any of that actually help you? Own your learning. Own the problem. Talk to him or round up a posse of people that he's selfishlessly embarrassed to talk to him. Stay factual, focus on your feelings ("I feel X when you do this" instead of "You are ruining this me") and put the onus on him to find the solution. Buy him a beer afterwards (because you'll still have to work with him), and call him out if he does it again.

If you really need to a senior to step in, one suggestion I got from a wise surgery resident: there are no problems in life, only solutions. To the greatest extent possible, only present your bosses with solutions. "I want to do X," where X is the next admit, or consult, or whatever. Easy. Done. Move on with it.
 
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Maybe it's because I did consulting before medicine, but if any of my colleagues ever did this to me (especially in front of a client or managing director), they would get a talking to. Privately, factually, no blame--but knock it off. Seniors aren't always going to be there to fix problems for you, and not everybody sees the problem in the same way. Where you see an obnoxious loudmouth, they might see an enthusiastic hard-worker that's at least venturing answers, even if they are "invariably wrong"--as everybody's answers invariably are. Who knows what your seniors actually think? You can hope they see it your way, but it's only a hope.

I just don't get the passivity in this thread. There's a lot of silent brooding, but what's the risk/benefit of tactfully confronting? And that's not meant to judge. But dealing with an obnoxious person is an important interpersonal skill to develop. You will definitely come across people like this again, not just in medicine but in life. I mean, OP has been dealing with this for months with another rotation coming up. What will it take? It's already driving you nuts. And like everything in medicine, early interventions matter. This needed to have been nipped in the bud yesterday. Today is the next best time.
Agreed with all this. I worked a corporate job before med school so I'm with you about correcting his behavior privately and factually. Medicine has its own rules and hierarchy so I was curious what other methods there were for dealing with people like him. Looks like there's no secret formula, just common sense.

I haven't had rotations with him yet, just random group stuff in the pre-clinical years. Everything I've mentioned here has been from others who have had rotations with him or shared lectures. Even though everyone hates his behavior, they've told me they don't want to do anything about it because it's easier to let it slide. Their inaction and seeming approval from superiors (enthusiastic hard-worker instead of obnoxious loudmouth like you mentioned) have made him more brazen to the point where he bosses fellow students around with comments such as "Why aren't you doing your notes?"

I'm not blaming his personality on my classmates by any means. He was like this when he started school but he has clearly gotten worse. Like you said, it needs to be corrected sooner rather than later for everyone's sake.

I mentioned finding it funny when he gets something wrong because he cannot stand being imperfect and it shows all over his face. The rest of us have come to terms with being wrong and take it as a learning experience. He gets offended and it's hilarious to watch his internal struggle, only because he's such an unpleasant person to be around.

Thank you for writing this out. It's given me the kick in butt to take ownership of the next 4 weeks.
 
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Maybe it's because I did consulting before medicine, but if any of my colleagues ever did this to me (especially in front of a client or managing director), they would get a talking to. Privately, factually, no blame--but knock it off. Seniors aren't always going to be there to fix problems for you, and not everybody sees the problem in the same way. Where you see an obnoxious loudmouth, they might see an enthusiastic hard-worker that's at least venturing answers, even if they are "invariably wrong"--as everybody's answers invariably are. Who knows what your seniors actually think? You can hope they see it your way, but it's only a hope.

I just don't get the passivity in this thread. There's a lot of silent brooding, but what's the risk/benefit of tactfully confronting? And that's not meant to judge. But dealing with an obnoxious person is an important interpersonal skill to develop. You will definitely come across people like this again, not just in medicine but in life. I mean, you've been dealing with this for months with another rotation coming up. What will it take? And like everything in medicine, early interventions matter. This needed to have been nipped in the bud yesterday. Today is the next best time.

And no, these people don't always get what's coming to them--at least, not in a way that would be helpful to you. Sure there might be schadenfreude. They'll probably struggle with meaningful professional and personal relationships until they get it; or they never get it, and they'll be stuck wondering why they're so lonely and chronically underperforming in life. But how does any of that actually help you? Own your learning. Own the problem. Talk to him or round up a posse of people that he's selfishlessly embarrassed to talk to him. Stay factual, focus on your feelings ("I feel X when you do this" instead of "You are ruining this me") and put the onus on him to find the solution. Buy him a beer afterwards (because you'll still have to work with him), and call him out if he does it again.

If you really need to a senior to step in, one suggestion I got from a wise surgery resident: there are no problems in life, only solutions. To the greatest extent possible, only present your bosses with solutions. "I want to do X," where X is the next admit, or consult, or whatever. Easy. Done. Move on with it.
OMG yes, this! There is nothing rude or unprofessional about handling a conflict politely and professionally.

That being said I feel more comfortable being assertive as an intern than as a med student. I feel like there was a lot of focus on objective evals as a med student... and as one of those stereotypical directly-from-college kids this was my first "real" job so I had to figure out what was and was not "professional". And as an intern, I'm now the one responsible for the patient and my priority is just to get my job done. I'm polite and professional, but I have a real need/motivation to resolve conflicts so I can do my job effectively and efficiency.

In the moment these would be my suggestions:

If they interrupt you on rounds - say "excuse me, I'm talking"/"excuse me, please let me finish my presentation"/the above comment about asking people to hold comments until you are finished

If they interrupt you while you are answering a pimp question - again say "excuse me, I'm talking" or "please don't interrupt me" etc

If they intercept before you can answer a pimp question but you were about to answer - you can try to prevent this by saying right away something like, "I've got this one, just give me a few seconds to think" that way the attending or resident knows you want to answer it. OR if an attending asks you directly to answer a question, like by name, and that person answers, you can say right away, "excuse me, but Dr. X asked me"

If they ask you why aren't you doing your notes - various approaches you can take. One would be just simply stating "okay". (There is a great recent Captain Awkward post about the power of "okay" in response to people being rude. Basically, her argument is that it doesn't say you agree with them or are taking them seriously but it acknowledges that they made/asked a comment/question.) Another would be to say something non-committal but tangentially related like, "Wow, we both have a lot of work to get done, don't we?" or, "sorry I'm busy and I need to concentrate, can we talk later?" Another would be to be more direct and say something like, "Can we focus on our own work right now? I'll let you know if I would like help/input. Thanks!" (maybe in combo with the "we both have a lot to do" comment)

If they are taking on too many patients - yes, the absolute BEST way to deal with this is to be super proactive and enthusiastic yourself. Tell your resident that you want the next patient/procedure when it comes up or honestly you can even tell them in advance, like "hey I really want to do an admission, can I have the next patient?" etc. and then you can remind them if appropriate.

My next step would be to confront them in person - especially if/when it becomes a pattern. About them coming in to see your patients early - you can even play it off as important to your learning like you want to improve your pre-rounding skills by pre-rounding independently, even though they are "helpful" you really want to work on this for yourself thanks. Another way you might resolve the issue with them answering every pimp question is to get all of the students on rotation to agree to alternate who answers what question and that if you don't know the answer you will ask the other students. Of course they have to play by these rules but that might encourage others rotating with you to also speak up.

And I agree with the idea of speaking with your senior resident if they are taking so many patients that others have none. As someone else said it's the resident's job to make sure patients are distributed evenly.

And honestly, I would highly recommend going through the Captain Awkward and/or Ask a Manager archives for professional-sounding replies you can use.

edit: sorry about the gazillion typos. Most importantly, I meant "subjective" evals for 3rd year not "objective" haha. Also the key to responding in the moment is a smile or neutral expression, and polite but firm tone (basically don't act like you are upset).
 
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OP
augeremt

augeremt

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Aug 6, 2010
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OMG yes, this! There is nothing rude or unprofessional about handling a conflict politely and professionally.
Awesome reply! You've pretty much addressed all the possible scenarios.

One other thing...
Our residents have been very hands-off in assigning patients in that the med students decide amongst themselves who gets which patients, etc. Thus far, I've been on very collaborative teams where we try to keep the numbers and work-load even. We all show up at the same time in the morning and divvy up the new admits based on whose patients have been discharged.

Medicine will be different because we only take patients when we're on call and we have the same call schedule as the residents. So I can always go above the student's head and tell the resident I want the next admission if he keeps hogging all the patients.

But we will still have rotations after medicine where the students divvy up patients amongst themselves, which became a problem with our abrasive classmate last block. He would show up 1.5 hours before everyone else and take all 3 new patients, leaving none for anyone else (too many students, small census). I'm all for working hard and showing up early but I'm not about to get in a war of who can get to the hospital earlier. It's not a game I can win with him and it's also incredibly passive aggressive.

Any suggestions for how to talk to him about this? His argument has been that since he got there before us, he's entitled to his patients. I want to tell him that he's taking away from our learning process. Also, he's being selfish and it makes him look bad in the teamwork environment that is medicine (play to his desire to get good evals). I'm not sure either of those will appeal to his ego and sense of entitlement, though.

ETA:
I'm not sure how the dynamics worked on the previous team so maybe the other students didn't feel comfortable/didn't care enough to say anything to the residents about not having patients. Things could've been different if they'd spoken up but I'd rather try to resolve this with the student first than bother the residents with our personality conflicts.

One more question, as an intern/resident, do you notice these kinds of behaviors in the students? I'm always curious if you guys pick up on our idiosyncrasies since you're so busy doing real doctory things and are often overwhelmed.
 
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Pity him; he didn't read enough fiction as a child. He's become a caricature of himself. It's not an enviable fate.
Yeah the more I read this thread the more I feel sorry for this guy in a way. He is probably miserable taking on all that extra work and studying till who knows when.

Joke is on him.
 

Druggernaut

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Feb 14, 2008
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All of this wouldn't bother me so much if it wasn't taking away from my learning experience (and thus, grade). The extra patients thing results in him having 3 patients while some people have 0. He interrupts a SOAP note to correct the presentation since he's already seen other students' patients on his own. And he answers all the pimp questions before the attending/resident even has a chance to finish asking them, especially if they are directed at another student.
Your residents and attending are dropping the ball. This is behavior that they should stop. They shouldn't allow one student to have multiple patients while others have none, and a pattern of stepping on others' presentations and questions should be addressed. Some students aren't aggressive enough in securing their own educational opportunities and I'd be comfortable letting that ride within reason, but they shouldn't let one student get in the way of the education of others.

If I was in your position, I'd address it with the other student away from the group first. If they didn't improve, I'd at least talk to the upper level resident or whoever's assigning patients to have them distributed equally.
 

leviathan2

2+ Year Member
Jul 6, 2016
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I can't WAIT to be an attending so I can shut down this behavior. Those individuals would truly get a subpar evaluation from me because no matter how smart they may be, nobody wants them around. Seriously cannot stand it lol.
 

JustPlainBill

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Jan 5, 2007
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Wow -- you guys are all really professional -- I was going to suggest a trial of Ex-Lax brownies for this clown -- but I'd probably go passive-aggressive on him and just shut down over it. Childish behavior, I know --

OP -- Really can't offer any suggestions -- never had this personality type during my MS years -- although one of our classmates who wanted desperately to be a surgeon and made no bones about it -- to the point of knowing about a review course that was in the local area and keeping it to himself and his surgery posse -- really upgefucht one time on the FM rotation ---

This bozo was exactly like what you describe -- got in early, rounded on everyone's patients, dropped notes during the hospital week on the FM rotation --- and then he really screwed the pooch -- I wasn't there but to my understanding from the rumor mill, this person actually had the guts to comment (read: subtly challenge) when an attending was going over the plan with the patient, in the patient's room with the entire team there. He cited EBM, etc. and the attending thanked him for his commentary, asked the resident to move the team out to the nurses station as he (the attending) had a few things to discuss with the patient. Entire team moves to the nurses station --- about 5 minutes later the attending comes out and in very blunt, non-profane language proceeds to tell that student in front of the entire team that if they pull that again, the attending would end their medical career right there, period, end of story.

Must have worked since this person graduated and went on to a surgical residency. He was known to be a bozo who thought he was better than everyone else but he hid it with a nice-guy, I'm here to help personality --- very subtle douchebaggery....

Good luck to you --- let him crash and burn -- if he violates the rules of civil behavior, don't hesitate to call him out on it -- as in,"Excuse me, I'm presenting this patient. If you have something to offer, could you please wait until I'm finished" or "I believe the question was directed at me and I'm considering my answer. If you have something to add to my answer that will help with the learning of the team, please wait until I'm finished". It's not aggressive, but a recognition of common courtesy rules that this person is violating.