pretentious charlatans!

[Ali Purinol]

Does anybody else run into other students whose attitudes reek of grandiosity? Do you ever catch some student ranting and raving about something that they (obviously) don't know much about, but just pretend like they do in an attempt to better their self image?

I run into few students like this, but when I do it is extremely unsettling. The worst this year has to be third year students that are finally getting to have some patient contact. All of a sudden its as if they're running the wards! It is my understanding that third year students are "on call" at times. Sure, and the reason I put "on call" is because they're obviously not actually taking call. I mean, who in their right mind would ever call on a third year med student that barely has enough background knowledge to know how beta-blockers work or how emphysema is suposed to present?

It disturbs me to see things like this going on at such an early stage of some "future" doctors' careers. I am starting to put faces to the words "pompous charlatan" and "quack."

Tell me what you think!

 

[The Buff]

I think the only time I'd "request" to be on call is never. If people are actually asking for call at your school, they really are a bunch of idiots.

 

[Ashers]

Call is generally required depending on the rotation. Some rotations it's overnight in house call, where you're not even allowed to go home, and in some you go home, but the residents can call you in if they want, and in others, you stay until a certain time (later than the students not on call), go home, then come back early to round.

I've asked residents if I could take call before, but on my elective in a specialty that I want to go into where there was no call for M3s and most of the M4s on the rotation don't want to take call. The resident didn't call me in because the only calls came in way late, and since it was elective call on a Sunday night, he figured he'd see me before 5AM anyway to round.

Edit: When I was asking to take call, it was when there was nothing going on for the service (ortho trauma), and they were sending me home at 2:30pm; basically, I was bored and not doing much other than looking up labs. I figured maybe more stuff would happen on the weekends.

 

[AwesomO]

I know people who do it. If you do it gets you a nice glowing eval. I've never done it myself, heck I barely tolerated the call I was scheduled for.

I mean, who in their right mind would ever call on a third year med student that barely has enough background knowledge to know how beta-blockers work or how emphysema is suposed to present?

I would hope a first year would know how beta-blockers work, it is in the name
You do see nurses, PAs, and others in the hospital ask for med student input. In fact it happens quite often. You have to be careful though sometimes the staff will just want someones ok to do something. ie is it OK to give this patient XXXXXXX? If you say yes then it may be documented Dr. Ali Purinol ordered 500 MG of XXXXX. Then if something goes down they will say you misrepresented yourself as a Dr when you were just a student. Most of the time though they are genuinely curious about something and will ask you figuring you read about it in med school.

What exactly is bugging you about these people? Truth be told once you have completed your medicine rotation you are not that much different than a new intern in terms of medical knowledge and the hospital workings.
-A new intern will see the pt write orders and call up to his senior resident and present the patient get the seniors input if they want any additional labs, then proceed.
-A med student at the end of his medicine rotation will see the patient write orders and call and present to the senior or intern who will come down take a quick look at the patient and possibly add in an additional labs then sign the note then proceed.
Same thing when rounding. The only difference is a student can't actually sign the orders but they can write it out and have the resident sign it. So if you're a decent student you do pretty much run the wards.

 

[AwesomO]

Call is generally required depending on the rotation. Some rotations it's overnight in house call, where you're not even allowed to go home, and in some you go home, but the residents can call you in if they want, and in others, you stay until a certain time (later than the students not on call), go home, then come back early to round.

What the heck kind of cush call is that? I always had the stay in the hospital 30-36 hours straight call. 😡

 

[Ashers]

What the heck kind of cush call is that? I always had the stay in the hospital 30-36 hours straight call. 😡

I would prefer that, then you at least get a post call day to make appointments and stuff. I've only ever had call on OB/gyn where it was in house, and I have peds surg in January which is also in-house call.

Most of the other surgery services have the at home call. Peds and IM use the call where you leave around 12 and come in early, and if you're on call on the weekend, you come in then too, but I'm not the expert on those since I haven't had the big 3 (surg, peds, IM) yet.

Edit: My school has a rule that students aren't allowed to work more than 30 consecutive hours, and the 80hr week average for the month.

 

[Venous]

What the heck kind of cush call is that? I always had the stay in the hospital 30-36 hours straight call. 😡

are you talking about as a student or an intern??? 36 hours for a student, that's nuts!

 

[The Buff]

are you talking about as a student or an intern??? 36 hours for a student, that's nuts!

Ha, I am an M3 and looking at 36 hours straight starting tomorrow (this is the rule for call, not an exception). Gotta love gen surg. Oh, and there is no such thing as a "post-call day" where I come from, just two regular days linked by working overnight.

 

[AwesomO]

I would prefer that, then you at least get a post call day to make appointments and stuff.

Um no trust me you don't want that. I thought call would be no big deal since I had insomnia issues through undergrad and thought I could function well without sleep BUT running around doing work all night leaves you feeling much different than tossing and turning in bed all night. Whenever I had to stay up all night the next morning/day I found myself unusually diaphoretic, hungry (can't sleep so body needs something and that something is junk food and lots of it!), and uncoordinated. Strangely enough you can fight through all of this in the hospital and make it through the day. You'll feel tired but it doesn't really hit you till you get in your car and go home. Driving home after a busy call night was always an adventure. Me personally I find myself not paying as much attention to the road, a friend of mine would routinely fall asleep at stop signs and red lights only to awaken to the sound of honking horns. Then once you get home it's about 1 pm (assuming you made it out at 12 and had something to eat). You then go to sleep have your circadian rhythm so disturbed that you wake up at 7 pm eat dinner, watch a little TV (er I mean read) then go back to sleep so you can wake up at 5 AM or earlier.
So if you had a busy night you basically lose the day that is post call. It never existed you don't run errands or go to appointments that day. All you do is sleep.

Edit: My school has a rule that students aren't allowed to work more than 30 consecutive hours, and the 80hr week average for the month.

If I was still a third year I would so hate your guts right now

are you talking about as a student or an intern??? 36 hours for a student, that's nuts!

Heres the irony 36 hours is illegal for an intern but plenty fine for a student. Heck a buddy of mine holds the record for 42 hours and that was his first day(s) of third year😱. It's really not that hard to go over 30 hours. For example you were on call last night? Sure we'll let you out at noon but don't forget you have mandatory lectures from 1 to 5. Or OK you're post call but your attending has a surgery scheduled at 1130 so you have to scrub in. Or I see that you are post call but I we have this really interesting learning case that is going to be admited would you like to stay and see it? Or since there is no work hour regulation for students some rotations just say "screw it" and have no post call policy what so ever. You come in do call then work the next day like normal.

We all go through it and if nothing else it gets you ready for intern year.

 

[smq123]

I run into few students like this, but when I do it is extremely unsettling. The worst this year has to be third year students that are finally getting to have some patient contact. All of a sudden its as if they're running the wards! It is my understanding that third year students are "on call" at times. Sure, and the reason I put "on call" is because they're obviously not actually taking call. Apparently its a request that the student makes so they can be present for the opportunity of learning. I mean, who in their right mind would ever call on a third year med student that barely has enough background knowledge to know how beta-blockers work or how emphysema is suposed to present?

If you don't know how emphysema is supposed to present by the time you're a third year, then how did you manage to pass Step 1?

Depending on your school and rotation site, "taking call" is not an option. You can't ask for it - because taking call is a requirement for passing the rotation.

Actually, in some cases, as the med student you know the patient better than the nurse does, and you know the patient MUCH better than the night float intern does. I've had people ask me if Mr. Jones is having some mental status changes. (Nope - he's just always been that weird, even pre-operatively. )

 

[Ashers]

Um no trust me you don't want that. I thought call would be no big deal since I had insomnia issues through undergrad and thought I could function well without sleep BUT running around doing work all night leaves you feeling much different than tossing and turning in bed all night. Whenever I had to stay up all night the next morning/day I found myself unusually diaphoretic, hungry (can't sleep so body needs something and that something is junk food and lots of it!), and uncoordinated. Strangely enough you can fight through all of this in the hospital and make it through the day. You'll feel tired but it doesn't really hit you till you get in your car and go home. Driving home after a busy call night was always an adventure. Me personally I find myself not paying as much attention to the road, a friend of mine would routinely fall asleep at stop signs and red lights only to awaken to the sound of honking horns. Then once you get home it's about 1 pm (assuming you made it out at 12 and had something to eat). You then go to sleep have your circadian rhythm so disturbed that you wake up at 7 pm eat dinner, watch a little TV (er I mean read) then go back to sleep so you can wake up at 5 AM or earlier.
So if you had a busy night you basically lose the day that is post call. It never existed you don't run errands or go to appointments that day. All you do is sleep.

I've already done a rotation with overnight call (OB/gyn) and I, usually, wasn't able to sleep because it was so busy. For me it works, since then I get the rest of the day off for appointments that I won't make during clinical times. I just don't like Saturday call.

I can definitely see it sucking at places that don't have the work hour rules for students too.

 

[AmoryBlaine]

Med students like to feel important and usually inflate their roles/responsibilites.

Probably the worst example I ever saw was a kid who would shadow an orthopod as an M2 and describe it as "taking Ortho call." Give me a break.

 

[SomeDoc]

I mean, who in their right mind would ever call on a third year med student that barely has enough background knowledge to know how beta-blockers work or how emphysema is suposed to present?
.... Tell me what you think!

Sorry, but I highly doubt that.

 

[njbmd]

Sorry, but I highly doubt that.

I agree with the above statement. As a former resident, I can tell you that most if not all of the students who rotated with me during third year knew everything about their assigned patients and their patient's disease processes from presentation to treatment. They made it a point to learn everything that they could and they kept up with their reading. It was up to us, as residents to guide them through the treatment processes but they knew what they were talking about and were not "pretentious charlatans".


Rather than rant about the behavior of others, you may want to emulate some of this behavior as it makes for a strong third year which is good to have if you want to match into a strong residency program. As a third year and especially as a fourth-year, I wanted to do as much as I could because you get one shot at these years in medical school and every experience counts.

I also sent medical student home to rest (or read) too as learning is the main reason they were on my service. Sometimes, especially after admitting several patients, it is a better use of their time to go home or back to their call room to study rather than follow me around. I also have no problems calling students if their is a good procedure for them to observe.

 

[Ali Purinol]

Rather than rant about the behavior of others, you may want to emulate some of this behavior as it makes for a strong third year which is good to have if you want to match into a strong residency program. As a third year and especially as a fourth-year, I wanted to do as much as I could because you get one shot at these years in medical school and every experience counts.

I also sent medical student home to rest (or read) too as learning is the main reason they were on my service. Sometimes, especially after admitting several patients, it is a better use of their time to go home or back to their call room to study rather than follow me around. I also have no problems calling students if their is a good procedure for them to observe.

I agree that in most instances it is not considerate to comment on the behaviors of others. As a person whose "higher up" on the chain, you probably don't get to witness when a student tries inflate his/her responsibility and claim "no holidays for third years" and "we work much harder than those little ones in year 1 and two."

I realize the duties of a third and fourth year is not merely to fill the printer paper when it runs out or get some new pens when the old ones stop working. In all fairness to them, they do have a considerable amount of knowledge that may help in solving the patients problems. Those are the types of students I would like to emulate: the honest, sincere students that understand how much they know and how much they DONT KNOW.

It is the "pretentious charlatan" whose true character is otherwise invisible to the attendings and residents that I DO NOT admire. I say invisible because they know that the attendings and residents know more than they do, so acting in such a pompous manner would get them nowhere and probably leave a bad impression. Moreover, the social interaction between a resident and a "pretentious" student lacks the informational advantage that the student seeks.

So, the charlatan knows that incorrectly explaining some pathologic disease to a lay person, or a student "lower" on the chain, can make him/her sound smarter than he/she really is and get away without being revealed.

I agree with AmoryBlain, some like to inflate their responsibilities. Like njbmd said, their objective is to learn. The bottom line: you've got to crawl before you walk." The baby diaper commercial comes to mind when I think of these students, but in this case it would go "Mommy Wow! I'm a third year now!" ha ha

Lastly, there are only a few that act in this displeasing way and most students are the of the sincere type... as far as I can tell. Ha, and thanks for the tip on how to match into a strong residency program.

 

[njbmd]

It is the "pretentious charlatan" whose true character is otherwise invisible to the attendings and residents that I DO NOT admire. I say invisible because they know that the attendings and residents know more than they do, so acting in such a pompous manner would get them nowhere and probably leave a bad impression. Moreover, the social interaction between a resident and a "pretentious" student lacks the informational advantage that the student seeks.

So, the charlatan knows that incorrectly explaining some pathologic disease to a lay person, or a student "lower" on the chain, can make him/her sound smarter than he/she really is and get away without being revealed.

I and most of my attending colleagues did not "fall out of a stupid tree". We have seen quite a bit and we know the boasters and the "brown-nosing" folks pretty well. My guess is that you would be quite surprised to learn that we have far more insight into what goes on in the dynamics between the medical students that you would believe. These people as you describe are far from "invisible" to us. Sometimes that "lay" person is far from being unable to know when someone is telling them the truth. Patients are pretty smart and pretty knowledgable especially when it comes to medical students.

Pretentiousness is pretty easy to spot especially to those of us who have some teaching experience. We are not easily "duped" and trust me on this one, you are NOT doing anything to my patients unless I know what you are about and that you know what you are talking about. That's the bottom line because I have the license here.

My major goals in academia and medicine is keeping my own work in order and to this end I don't and didn't particularly worry about anyone else that didn't directly affect me and my learning. It didn't and still doesn't make any difference to me what another person says or does as long as it isn't detrimental to my patients. In short, either a student gets the job done or they don't. What they say or believe is not of consequence but what they do is and what they write more so.

There are loads of folks walking around who believe that they are "God's Gift to Medicine and Society". My thoughts on these folks, "enjoy whatever world keeps you happy and stay away from me and my patients".

 

[Ali Purinol]

Thanks for the input!

 

[Slide]

Hmm, my general impression was that if you didn't know things like how beta-blockers worked or how emphysema presents when asked so during the middle of rotations, not only would it lead to a bad eval, but also show you haven't been doing your job.