And, you know what? I read that post and I couldn't agree more, Jet. I'm at the point where I can see the behaviors of some of our attendings... and why they could never hack it in private practice.
Just the other day, I got pulled aside and lambasted by an attending. Suffice it to say that he was criticizing my attitude, something about how I try to take charge too much for a resident, and that I don't know my place (i.e. I don't know as much as I think I do..., etc, etc). He was really trying to knock me down a peg or two. Why? I didn't realize initially. I had to think about it a little.
I was deeply bruised by this encounter. I thought long and hard about it afterwards. Then, it finally struck me. I realized the most important thing about this negative interaction we'd had.
I realized, from this interaction, that this dude could never hack it in private practice. Here's how I came to this conclusion...
I've noticed over the past few months that, when I'm in a non-urgent room, the surgeon usually looks over at me and asks how things are going, what's the next step (extubation vs. going to the unit), etc. It's natural. You develop a reputation after a while. People learn that they can start to trust your judgment.
Well, this happened about two weeks ago with this particular attending in the room towards the end of an ORIF. I noticed that, instead of the attending who was standing right there, they addressed me, and asked me what we were going to do for this patient who was going to CT scanner immediately after the case was over.
Well, my attending answered anyway. Then, I made the mistake. I said, right after he was done answering, what I thought should be done. It was different from his plan. It was a judgment call. He wanted to go tubed. I said, "Or, we could extubate and we can keep him sedated, if necessary, with a little midazolam." There was no need to keep this particular patient tubed. What happened? We ended-up going tubed.
This guy apparently was really stewing about this for a couple of weeks, and saved it until the other day when we were working together again. Now, you have to understand, many of the surgeons can't stand working with this particular anesthesia attending. One has even flat-out refused to do cases with him. He's a bona fide egomaniac and bully. He's strong clinically, don't get me wrong, and is an expert anesthesiologist in every sense of the word, but his personality often gets in the way. I think this is why they usually put him with CA-1's because he knows a lot, and is less likely to be challenged by them. As someone finishing CA-2 year, I made the stupid mistake of challenging him in front of a room of people.
This was a bruised ego at work, no doubt.
In my mind, extubating made more sense. This would've saved time recovering the patient. We could've gone to the CT scanner, I could've "recovered" him while there, and then he would've gone back to the floor. The attending wanted to keep him tubed, I guess, for convenience and the assurance that he absolutely wasn't going to move in the scanner. That's reasonable too, I suppose. But, then he was going to have to go back to the PACU to be recovered. This would tie-up resources up there, and it would've just taken more time, as well as potentially added additional risk (transporting an intubated patient, setting up an infusion to keep him sedated, etc.). Remember now, this was a relatively healthy 20-something trauma patient who needed a follow-up belly scan. We were finishing an ortho procedure. He wasn't ventilated before the case. This was an issue of getting scanner time. The trauma service wanted him scanned that day, and our slot just happened to be after the ortho case was over. No plans to take him back to the OR for an ex-lap or anything. I thought my plan was reasonable too, and certainly less resource intensive. I challenged his plan. After all, I'm growing my fledgling wings and starting to crawl towards the edge of the nest. I should start to develop and use my cerebral cortex a little more during this point in my training, shouldn't I?
So, apparently over the past couple of weeks, this gas attending had been brooding over this episode. He'd apparently been "saving it up" for the next time we worked together, which was a few days ago. What really bothered me most was that, when he finally confronted me the other day, it was after a heavy pimping session in the OR. I haven't been pimped that hard since the beginning of my CA-1 year. Mostly now with other attendings we have "discussions" about what the best course of action in a particular case is. That's what I've gotten used to over the past six months. But, instead, this guy launches into me with a full-bore pimp session during our first case. At the end, tells me basically that I don't know ****. That I'm never going to pass the boards. Then, he brings up the issue related to wanting to extubate before going to the CT scanner. He recounts about ten reasons why it was stupid of me to even think that - his reasons. Then, even worse, he starts going into **** that occurred over a year ago. The coup de grace was when he starts delving into what he perceives to be my personality flaws.
I just sit there and take it.
Now, this particular attending has a notoriously checkered history, as alluded to above. You know the type. Inevitably, he always feels compelled to "chime in" at Grand Rounds and challenge whomever is presenting. He routinely embrasses our department, in my opinion, especially when we've invited a prestigious speaker from somewhere... and he has to point out what he perceives to be flaws in their presentation.
After what was tantamount to a verbal abuse session, I was fuming. I wanted to go to my PD and tell him that it was unacceptable to use that as a forum to blast me.
Then, I stopped. It hit me. I have no power. I am a peon. And, I realized that I'm going to be outta here in a year.
I've just got to bide my time, learn as much as I can, take the good pointers and teaching when they come, and not worry about these a**holes who have such abrasive personalities that they could never hack it in the "real" world. These are the ones I allude to above in my list. The "number (3)" people. They want to make everything an argument. They want to argue with residents. They want to argue with their colleagues. The even want to argue with the surgeons. People start to avoid these people, because they can't even have a polite conversation without it turning into some sort of disagreement ("It's a nice day today, isn't it?", "Well, not really, it's going to rain later.") This particular guy even started giving unsolicited pointers to the attending surgeon during our third case that same day when he was having a little trouble getting a view on his scope. Unbelievable.
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I think a big part of residency, in addition to learning what to do, is to carefully observe certain people and trying to learn what not to do. There are some basic human interpersonal skills that, I believe, some people just can't be taught. I'm spending a large part of my time, at this point, picking up on things that I think are "slick", and also thinking about how I would've done something differently than my attending.
What's been disappointing to me is learning that you can't always have an open conversation with every person about what you think may have been a better way to do something. If you disagree with them, and you express it, they start to store these things up. Like Jet says, there's a lot of "water cooler" talk going on behind your back. Impressions are formed. Behaviors are observed. Character traits are assigned. Just as I've done here. It pays to learn how to play the game early on, and play it well. Most importantly, as a resident (or junior attending) one should recognize that you have no power. It sucks, but that's just the way it is. Apologize a lot if confronted about a perceived (or real) judgment issue, even if you weren't necessarily "wrong". Know when to keep your mouth shut. Ultimately, you gotta look out for #1, which is yourself.
-copro
Can I do this residency in just 2 years? 
