Problems with Attendings

[ChildNeuro]

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Has anyone had a particularly rough time on a clerkship, i.e. harassment, verbal abuse by an attending, and actually been able to do anything to rectify the situation? My most recent clinical cores and electives have been golden all the way through, but early on was abused alot, why does this happen? Does becoming a fourth year/more knowledgeable help alot? I must have subconciously figured out to neutralize mean attendings!

 

[Samoa]

What they sense is your level of confidence, not how knowledgeable you are.

I'm not convinced that I'm any smarter today, as a graduating 4th year, than I was halfway through my first rotation. On the contrary, I strongly suspect that I am in fact stupider than I was then.

 

[Tired]

Does becoming a fourth year/more knowledgeable help alot? I must have subconciously figured out to neutralize mean attendings!

I experienced quite a bit of nastiness from attendings and residents.

Was 4th year better? Yes. The sub-i's involved some put-downs and a lot of pimping, but the fact that I had volunteered for the rotations and was interested in the field seemed to give me a degree of credibility with the attendings that you just don't get in MS3 year. They might rag on you, but for me anyway, it seemed much more like I was "one of them".

And as far as the required 4th year rotations go, when they gave me crap, I pretty much blew them off, because what the hell did I care about their stupid field? All I needed was a pass on the exam.

 

[Hoo\/er]

Hey Child,

I don't know the answer to why some people like to hassle new students. I really couldn't even begin to try and understand that one. But, I have been hassled and in the begining it was hard to deal with it, especially when I didn't know what I was doing and really needed to depend on these people to actually teach me. Abusive + dependence did not make a good combination.

As I have figured out what I need to be doing, if someone gives me grief I just 'ignore' it and keep on going. Most people will stop when there is no reaction. I have also learned to smile alot more which seems to change weird dynamics. A big toothy smile works wonders.

Anyway, I have found that sometimes on a new rotation some people like to give me a hassle but it usually fades. Does this stuff stop in fourth year? I would imagine it never stops to some extent. There will always be someone who wants to get a rise out of someone else, some people are just hardwired that way. People get competitive, anxious, scared and these feelings can get funneled through aggressive behavior towards others who look 'soft.' That's life. I have also found that if I don't react to it, and remain professional, often these people come back around and are very good to me. At least, these have been my experiences.

Only in medicine do the "new guys" get hassled. Oh, wait. I think that happens on construction crews filled with high-school dropouts, too. Wow, docs really are "professional" huh?

 

[ericdamiansean]

Read up my post

http://forums.studentdoctor.net/showthread.php?t=392420

 

[velo]

What they sense is your level of confidence, not how knowledgeable you are.

I'm not convinced that I'm any smarter today, as a graduating 4th year, than I was halfway through my first rotation. On the contrary, I strongly suspect that I am in fact stupider than I was then.

I hear that, I feel as though I've been getting a little better at clinical medicine, and a little bit stupider, every month since 2nd year

 

[kito]

I'm not convinced that I'm any smarter today, as a graduating 4th year, than I was halfway through my first rotation. On the contrary, I strongly suspect that I am in fact stupider than I was then.

I've been getting progressively dumbers since Friday, October 13th 2006, the day I took my medicine shelf.

 

[Top Gun]

Has anyone had a particularly rough time on a clerkship, i.e. harassment, verbal abuse by an attending, and actually been able to do anything to rectify the situation? My most recent clinical cores and electives have been golden all the way through, but early on was abused alot, why does this happen? Does becoming a fourth year/more knowledgeable help alot? I must have subconciously figured out to neutralize mean attendings!

The reason they abuse you more at the beginning of third year is because they see you as fresh meat. You don't know a whole lot, and are not confident, and like dogs, the attendings and residents can smell fear and therefore attack. While your knowledge improves somewhat between then and fourth year, the main reason they give you less crap is because you learn how to act confident, if not be totally confident. Third year is just another rite of passage we all have to go through to become a doctor.

 

[Top Gun]

And you do get more confident as time goes on.

 

[ChildNeuro]

Interesting. I think that all of the attendings at a hospital I was at had a mean streak or something, ever since doing work at a different clinical envrionment things are much better, i.e. not fearing going into the hospital each day and actually enjoy helping people. Besides being more confident, I am also more useful, i.e. able to see more than a couple steps down the road and can actually help speed things up a lot. In the past I tried not reacting to the bully, but that just made it worst as sometimes they want to get a rise out of you . . . I think third year makes you hyper-aggressive to some extent as well. During my current rotation I was grabbing too many patients from the third years, actually subconciously! and had to be slowed down and allow them to graze on the grass some too.

 

[TheMightyAngus]

Does anyone feel that the abuse/wrath of surgeons and other attendings really compares to how you would be treated if you were in the military or if you were a competitive athlete?

Are med students just soft because most of them have never been in a hostile/aggressive environment? I tend to think this to be true.

 

[Top Gun]

Does anyone feel that the abuse/wrath of surgeons and other attendings really compares to how you would be treated if you were in the military or if you were a competitive athlete?

Are med students just soft because most of them have never been in a hostile/aggressive environment? I tend to think this to be true.

I would tend to agree. Its kind of like boot camp for med students. And yes, a lot of med students are pretty soft, especially since some of them have never had any actual work experience.

 

[cbass1350]

I think that the terms 'abuse' and 'harassment' are somewhat subjective. What do you mean by attending abuse? You mean the guy pulled out his belt and lashed you in the middle of rounds? Or do you mean that an attending pimped you during rounds and when you didn't know the answer he simply told you that you should?

Similarly what is harassment to one person might not be so to another. I've noticed that some medical students are pretty defensive and are quick to take things personally. This is especially true of sub I's. One student might think he/she is being singled out when they are being given a large patient load while another might not.

Again, if students like that they are being singled out or abused by their superiors, it really helps to be specific. I'm not saying it never happens, but more often, it's the med student who is being over-sensitive. I'm not sure about the specifics in the OPs case, though. He might have some legitimate complaints.

 

[jdh71]

Does anyone feel that the abuse/wrath of surgeons and other attendings really compares to how you would be treated if you were in the military or if you were a competitive athlete?

Are med students just soft because most of them have never been in a hostile/aggressive environment? I tend to think this to be true.

Interesting question. I treated much worse by college football coaches then I ever was by an attending, but attending harassment still "felt" worse . . .

Once I started seeing these bad attitude folks as nothing more than oppourtunities for growth, they stopped having any power over me. "Yes you are right, I was wrong" works well and diffuses many situations. I cringe every time I see a student try and give an excuse for anything. Explain nothing, admit wrongness, never do it again - repeat if necessary for new conflict. Somewhere along the way the hastling has stopped. Don't know why exactly . . .

 

[CaptKirk]

Currently halfway through my surgery selective (requirement at my school). I picked Urology because it beat general surgery and I heard students get to do some suturing, etc (a skill I definitely need to work on). Attending is a jerk. Takes every opportunity to slam me he can get. If I watch him do something even just one time, he expects me to be able to do it next time and if I can he'll say something like, "so you were just standing there last time, you didn't watch at all." Get this, he even told me the board score of the student who is doing research with him, I guess to make me feel bad or something? Anyway, he's a big jerk and only reinforces my decision to head into Radiology, where people are nice. There are some nice surgeons out there... but it is by far the exception, not the rule... in my experience. (Whereas I always leave the reading room happy and feeling good about life.) 2 more weeks to go...

 

[Top Gun]

Currently halfway through my surgery selective (requirement at my school). I picked Urology because it beat general surgery and I heard students get to do some suturing, etc (a skill I definitely need to work on). Attending is a jerk. Takes every opportunity to slam me he can get. If I watch him do something even just one time, he expects me to be able to do it next time and if I can he'll say something like, "so you were just standing there last time, you didn't watch at all." Get this, he even told me the board score of the student who is doing research with him, I guess to make me feel bad or something?

Your attending is old-school. In years past, the mantra for learning procedures was "see one, do one, teach one." I had an attending once who told me that doctors are expected to see a procedure once, then do one unassisted, then teach one. So the attitude still prevails in certain circles, although it is not typical of all attendings and residents.
As for telling you the board score of the student doing research with him, that is very inappropriate on his part. I hope you didn't tell this particular attending your board score. Unless, of course, yours happens to be better than that of the other student. In that case, the joke's on the attending.

 

[FutureInternist]

I had an attending once who told me that doctors are expected to see a procedure once, then do one unassisted, then teach one.

Exactly....who really needs the full 5 years of a general surgery residency. Just see everything once and in a month and you're on your way

 

[Top Gun]

Exactly....who really needs the full 5 years of a general surgery residency. Just see everything once and in a month and you're on your way

I didn't say I agreed with her. I was just quoting what she said.

 

[CaptKirk]

No, I've learned a lot about in the last couple weeks... especially when not to try to "scoop" your attending. He wants to feel superior and make his field out to be something that I could never do, even if I wanted to. Fine with me, it's really better if I just let him think that. So, no, I most certainly did not tell him my board score. As for mine being better... it depends; if he was referring to his student's Step 1 then his was better... if he was referring to Step 2 then mine was better... the conversation started when his nurse asked me if I had taken Step 2 and what the highest possible score is... that was when he jumped in and bragged about the score of the student doing his research - so I don't know if it refers to Step 1 or 2.

 

[PeepshowJohnny]

Basically, I don't think these situations are EVER rectified. The attending's the fourth years tell the third years to watch out for are always the same. No administration ever goes to them and says "Hey, straighten up." It's usually just easier to make subtle adjustments. Oh, student got a low score on his evaluation from Dr. Jerkface? Well, the program director just bumps up his score to compensate. Heaven forbid he call Dr. Jerkface on his crappy grading techniques. Dr. Deebag is verbally abusive to his students? Well, we just won't put students with him anymore instead of requiring him to alter his attitude.

The problem is that they've got to have a place for all these medical students. Start pissing off people, and not only will they not take students, but neither will their friends or partners, and soon you just don't have enough attendings to take students.

 

[t33sg1rl]

Basically, I don't think these situations are EVER rectified. The attending's the fourth years tell the third years to watch out for are always the same. No administration ever goes to them and says "Hey, straighten up." It's usually just easier to make subtle adjustments. Oh, student got a low score on his evaluation from Dr. Jerkface? Well, the program director just bumps up his score to compensate. Heaven forbid he call Dr. Jerkface on his crappy grading techniques. Dr. Deebag is verbally abusive to his students? Well, we just won't put students with him anymore instead of requiring him to alter his attitude.

The problem is that they've got to have a place for all these medical students. Start pissing off people, and not only will they not take students, but neither will their friends or partners, and soon you just don't have enough attendings to take students.

OK so I need some advice, being currently rotating with Dr. Jerkface. Dr. Jerkface is a litte short with the resident and the other student. I don't think he realizes that the intern and I are even on the team-he mostly ignores us. Dr. Jerkface is generally in a crabby mood and he's lectured us on how he hates being on service, hates interns and residents, hates this hospital, etc. All of this is OK, though obviously it doesn't put a spring in my step at 6 am as I walk through the door. The problem is that Dr. Jerkface is downright mean to patients-seriously, this guy makes Dr. House look like Patch Adams. He never, ever, introduces himself, shakes hands, or looks in a patient's eyes. He walks into the patient's room, gownless and gloveless (MRSA sign on door notwithstanding), asks the resident "So this is the guy with the bloody diarrhea?", pokes the patient's abdomen, says "Okay" and leaves the room. We have a patient on water restriction for hyponatremia and he's actually screamed at him about it. His idea of delivering bad news is "We're sending you to hospice tomorrow morning."

I don't think Dr. Jerkface ever gives out good evals so I'm sunk there anyway. Is there anything I can do about his bedside manner? Has anyone ever reported an attending and NOT gotten themselves into a mess? Dr. Jerkface has worked in the department in which I intend to match for 20+ years.

 

[PeepshowJohnny]

Dr. Jerkface has worked in the department in which I intend to match for 20+ years.

Nope. You're sunk.

If he hasn't been bounced already, he won't be unless he REALLY does something bad. He's already so rooted in that anyone who dares to raise a voice against him will be shouted down by his numerous colleagues he's friends with (one of them who is probably the department chief). He might even be the guy the rest of the department dumps on (hence why he's mean to everybody else) but even then they won't stand for one of their own being attacked by a mere student/intern.

The only way this guy gets in trouble is if he does something REALLY bad. As in sleeps with a medical student and gets caught, pisses off the hospital CEO's wife, or falsifies records. Just gotta grin and bear it. You can probably talk with who is ever in charge of handing out grades and explain your situation, but I'm sure they've heard it all before and they'll give you a pat on the head and say diplomatically "We know this guys a jackass, we won't let his bad evaluation effect your final grade, just don't make a scence about it because we don't want the department mad at us".

 

[fakin' the funk]

Your attending is old-school. In years past, the mantra for learning procedures was "see one, do one, teach one." I had an attending once who told me that doctors are expected to see a procedure once, then do one unassisted, then teach one.

See one-do one-teach one is the biggest load of crap ever perpetuated on med students and residents.

It might apply to the simplest of procedures with quick learners. But can you imagine central lines being taught like this? The hospital would be overflowing with carotid sticks and pneumothoraces!

 

[PeepshowJohnny]

See one-do one-teach one is the biggest load of crap ever perpetuated on med students and residents.

It might apply to the simplest of procedures with quick learners. But can you imagine central lines being taught like this? The hospital would be overflowing with carotid sticks and pneumothoraces!

Wow, the correct plural of pneumothorax! You're a smart one!

That said, yeah, I like how "See one, do one, teach one" magically stops applying to an attending when YOU show them how to do something.

(I was showing an attending how to use a software program on the hospital computer and he just found it impossible to grasp.)

 

[AwesomO]

Does anyone feel that the abuse/wrath of surgeons and other attendings really compares to how you would be treated if you were in the military or if you were a competitive athlete?

Are med students just soft because most of them have never been in a hostile/aggressive environment? I tend to think this to be true.

Panda seems to address this pretty well http://pandabearmd.com/blog/2007/07/09/tell-it-to-the-marines/