Resident abuse

[medresident]

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What is the best way to deal with abuse from your senior while an intern? What would you consider abuse?

I discussed an ongoing problem with the psychologist on staff who felt I should bring it up with the attending since it was beginning to affect patient care. I reluctantly did so but it seems to have only made things worse.

 

[yaah]

Have you approached the senior? Perhaps the issue is that he/she feels you are going behind their back to disparage or sabotage them? When dealing with "abuse" I would take the following steps:

1) Make sure their criticisms of you are not actually valid. What some people consider "abuse" is actually someone calling them on their faults and not letting them get away with stuff that others don't get away with.
2) Talk with the senior about their issues with you. Is it your work style? Work ethic? something you said? Something that can be fixed? If they deny there is a problem then say you think there is a problem with the way they treat you. Maybe they have no idea you are taking things poorly, or maybe they think they are helping you learn better and you can handle aggressive supervision.
3) If this fails, talk to your program director about your concerns. If you have already talked to the senior about it this will go much better.
4) If the program director blows you off or doesn't take action, make sure that statement #1 truly does not apply.
5) Go to your institution's ACGME.

 

[dragonfly99]

In my experience the best way to deal with this is just to work very hard and suck it up, also to try and pick up on anything your senior is disapproving of and fix it.

The thing is, you will have to work with people in life that you don't like, and some who don't like you or the way you do things. You just have to try to get along with them regardless. I think it might help us (here on SDN) if we knew what behavior(s) you are experiencing that you feel are abusive. If it's someone screaming and swearing at you, then I agree, but if it's just someone being critical of the way you do things, you may just have to deal with it and move on. Try to pick out which thing(s) are valid and correct them, but don't obsess about one person "not liking" you. It's just something we all have to deal with at times in life.

If you get into a power struggle with someone above you, almost 100% of the time they will win. Interns and med students don't win in these types of conflicts. Residents don't win if they get into disputes with fellows or attendings. Forget about how "unfair" it is and just try to get through. Otherwise you might get your head served up to you on a platter like John the Baptist.

 

[IndyXRT]

In my experience the best way to deal with this is just to work very hard and suck it up, also to try and pick up on anything your senior is disapproving of and fix it.

The thing is, you will have to work with people in life that you don't like, and some who don't like you or the way you do things. You just have to try to get along with them regardless. I think it might help us (here on SDN) if we knew what behavior(s) you are experiencing that you feel are abusive. If it's someone screaming and swearing at you, then I agree, but if it's just someone being critical of the way you do things, you may just have to deal with it and move on. Try to pick out which thing(s) are valid and correct them, but don't obsess about one person "not liking" you. It's just something we all have to deal with at times in life.

If you get into a power struggle with someone above you, almost 100% of the time they will win. Interns and med students don't win in these types of conflicts. Residents don't win if they get into disputes with fellows or attendings. Forget about how "unfair" it is and just try to get through. Otherwise you might get your head served up to you on a platter like John the Baptist.

Good advice. I think it is difficult to be more specific than this without knowing the behaviors in question.

 

[Winged Scapula]

Agreed - all the advise above is excellent.

There are certainly elements of residency that would be considered unprofessional and even abusive in other fields. Most of us have been on the receiving end more than once and just sucked it up. As noted, its hard to say if what you are experiencing is really abuse or negative feedback on your performance that you find uncomfortable.

 

[Doowai]

If they are yelling at your loud enough to be heard 30 feet away behind closed doors,about things irrelevant to job performance like about not walking the right way. Thats kind of abusive.

Steal expensive equipment from the hospital from an area with no security cameras, put it in their car and call the police anonymously saying you saw them take it. Just kidding haha

 

[medresident]

Good advice. I think it is difficult to be more specific than this without knowing the behaviors in question.

Thank you. I agree with your advice about trying to suck it up. I would rather not get into too much detail but can give some examples - as some of you suggested much is focused on my work and getting things done. I am concerned that the environment in this rotation is negatively affecting my effectiveness. Like many programs we have a high census and turnover rate. If something is not done yet because of higher priority work the senior starts berating me in front of everyone else. This goes on for a while and makes the situation worse because it is now taking time from getting my work done. During one of these long conversations I said I agreed with what she was saying but my senior replied ‘no you don’t…. It would be helpful to just say you did not do this yet – it is important it gets done today. The other intern on my team is frustrated too in being able to get everything done on a timely basis. Earlier in the rotation the senior told me that I was not getting any more complicated patients because I was not competent to handle it. When I went to the attending to talk about it I was told rather that my senior was told that I had almost all complicated patients and they needed to be distributed more evenly.

The other day when finishing up an admission and the initial orders I told my senior I wanted to go over it. The senior said she did not have time and was going home. Then she said she was going to put orders in the computer for the next day for the patient because she felt she could not trust me to do it. She brushed me aside, proceeded to put the orders in and left.

 

[IndyXRT]

Thank you. I agree with your advice about trying to suck it up. I would rather not get into too much detail but can give some examples - as some of you suggested much is focused on my work and getting things done.

I certainly feel for you. Learning to do things in the alotted time was one of the most difficult parts of residency for me, and I can't say that I was ever super at doing this. However, I did get better as time went on. It is very frustrating, when you feel completely overwhelmed, to be told to "be more efficient." Try not to let it get to you too much.

Try to think of ways to streamline what you do (making lists for each patient always helped me, as did showing up early to get a start on the day). In fact, if you ask your resident and/or attending for help in learning to be more efficient (it will take some effort to ask this with a straight face), they might be more receptive and give you some of their own tips. Best of luck, and hang in there.

 

[3dtp]

Thank you. I agree with your advice about trying to suck it up. I would rather not get into too much detail but can give some examples - as some of you suggested much is focused on my work and getting things done. I am concerned that the environment in this rotation is negatively affecting my effectiveness. Like many programs we have a high census and turnover rate. If something is not done yet because of higher priority work the senior starts berating me in front of everyone else. This goes on for a while and makes the situation worse because it is now taking time from getting my work done. During one of these long conversations I said I agreed with what she was saying but my senior replied ‘no you don’t…. It would be helpful to just say you did not do this yet – it is important it gets done today. The other intern on my team is frustrated too in being able to get everything done on a timely basis. Earlier in the rotation the senior told me that I was not getting any more complicated patients because I was not competent to handle it. When I went to the attending to talk about it I was told rather that my senior was told that I had almost all complicated patients and they needed to be distributed more evenly.

The other day when finishing up an admission and the initial orders I told my senior I wanted to go over it. The senior said she did not have time and was going home. Then she said she was going to put orders in the computer for the next day for the patient because she felt she could not trust me to do it. She brushed me aside, proceeded to put the orders in and left.

I worked for just such an [donkey]. There is no pleasing them. I like the suggestion to ask them with a straight face for help in learning to be more efficient. Do not antagonize them if you can avoid it. As you learned, it does make things worse.

The reality is that medicine has set up a system to breed school yard bullies, and they are temporarily in charge. You can accept the occasional bloody noses until you are in a position to change the system or try to change things, but the way things are structured as I was told, "medicine has a heirarchy and you are at the bottom of the sheetpile. Live with it." by the PD.

I personally, along with Panda Bear and others find this anathema, and Winged's observation that medicine tolerates what most outside of this field would consider abusive and unprofessional is correct. This is what we need to change, and change to medicine comes glacially.

 

[Xanderain]

That sounds like abuse and disrespect to me. Where I work, the seniors and the interns are a TEAM. If one intern is bogged down, the other intern, or the senior helps them out, and vise versa. As one of my mentors told me (after telling me of his story of abuse he experienced): "You can survive anything for a year. You get to make the decision as to the kind of senior you want to be."

So don't be a dick like her when you are in her position! 🙂

 

[sandraf]

That sounds like abuse and disrespect to me. Where I work, the seniors and the interns are a TEAM. If one intern is bogged down, the other intern, or the senior helps them out, and vise versa. As one of my mentors told me (after telling me of his story of abuse he experienced): "You can survive anything for a year. You get to make the decision as to the kind of senior you want to be."

So don't be a dick like her when you are in her position! 🙂

I agree. Change the pattern when it's your turn. One way or another, you'll benefit from it, too. 🙂

 

[maxheadroom]

That sounds like abuse and disrespect to me. Where I work, the seniors and the interns are a TEAM. If one intern is bogged down, the other intern, or the senior helps them out, and vise versa. As one of my mentors told me (after telling me of his story of abuse he experienced): "You can survive anything for a year. You get to make the decision as to the kind of senior you want to be."

So don't be a dick like her when you are in her position! 🙂

My co-resident and I had a rough intern experience, mostly because the seniors wouldn't give us support on call. Consequently, we had to learn a whole lot on our own -- definitely not the best way to learn and not great for patient care, either. When we made it to our senior years, we made a conscious decision to break the pattern that our program had. We went and saw every patient after the junior saw them and never gave them a hard time if they called and said that they needed help. I think the culture of our program has changed because of it. It meant more work for us as seniors and chiefs, but it also means that the juniors learn the important stuff right the first time and the patients get the right care.

 

[dragonfly99]

OK, so the resident is behaving inappropriately.
I agree with indyXRT and 3dtp's advice. That's about all you can do...plus realize you're only stuck with this person for a month or so. What you need to do is damage control and try to avoid getting a totally crappy evaluation...this means be really nice to anyone other than your resident who is also evaluating you (i.e. the attending and your cointern, nurses, etc.).

 

[Aloha Kid]

You need sneak a tape recorder in you coat pocket and record all the conversations that occur. Forward it to your program director, chief resident(s), chief of medical education, and hospital administration. Tuck yourself in nice and tight and let the bomb go off.

OR

Slash her tires

OR

You could just suck it up, eat the bitterness, and let time heal all wounds.

 

[dragonfly99]

<You need sneak a tape recorder in you coat pocket and record all the conversations that occur. Forward it to your program director, chief resident(s), chief of medical education, and hospital administration. Tuck yourself in nice and tight and let the bomb go off.>

I guess that's not a terribly awful idea, but I doubt the powers that be would do anything about this resident/senior. The simple fact is most just don't want to deal with any sort of conflict, and just want any problems to "go away". So don't make YOURSELF the center of any problems/controversies. That is my advice. But if you want to record conversations with your senior in case you need ammunition for later (i.e. if you end up with a completely horrible evaluation and it rears its ugly head in a later evaluation) I guess you could do that. Usually these things should not be made into a tempest in a teapot. Even if this resident hates you, unless you get multiple bad evals in a row probably there won't be many repercussions for you. Remember that if you tick off this resident even more, she may possibly hurt you more later...remember, someone above you in the hierarchy can pretty much always hurt you more. Luckily, most people are basically nice and don't WANT to hurt you.

 

[OTD]

Ok, OK I see everyone on here is into the new "we're all the bestest and greatest around" latest PC BS.

Now this may or may not apply to this particular situation, but there is a difference in trying to straighten out a piss poor resident and abuse.

I know in this new "me" generation that got trophys for just being on the team that they don't like any kind of feedback except "you're the best", but sometimes resident/med student sucks. If they suck they need a swift kick in the pants cause they need to get the job done. If they still can't get it done they need to find another field. Not everybody should be a doctor.

As I said, this may or may not have anything to do with this particular situation, this one may indeed be abuse. However, the greatest majority of the time when a med student/resident speaks of abuse in reality they are performing poorly and can't take any feedback that doesn't go along with their "trophy for being there" mentality.

It just seemed that everyone was ignoring the elephant in the room.

 

[dragonfly99]

Um, no, I disagree.
I don't think the resident telling the intern she doesn't have time to go over the orders (when the team is postcall and ready to go home) and saying she's going to "put in the orders for tomorrow because I don't think you can do it right" qualifies as constructive feedback. She's just being a b*tch, unless the story is made up. And I can say b*tch because I'm a women. So there 🙂

 

[OTD]

In my view, if the Sr really did put in the orders him/herself then that means they really DIDN'T trust the intern to be able to handle it or they wouldn't have made more work for themselves. The Sr put the orders in right then, the orders in question were to be carried out the next day.

Whether that lack of trust is justified or not is debatable, but no Sr would do more work unless they really thought the intern wasn't up to par.

Not saying this particular intern is or isn't up to par, but interns that are NOT up to par should expect to hear about it until they DO come up to par.

This is serious business.

I don't believe in abuse in the least, but I do believe in correction.

This generation doesn't understand the difference nor the concept of personal responsibility/accountability.

 

[dragonfly99]

<Whether that lack of trust is justified or not is debatable, but no Sr would do more work unless they really thought the intern wasn't up to par.>

I don't think that's really true. Some people just aren't good at delegating, and find it easier to do things themselves than delegate to someone else, and/or spend the extra 5-10 minutes to TEACH the intern the correct way to do something.

<Not saying this particular intern is or isn't up to par, but interns that are NOT up to par should expect to hear about it until they DO come up to par.>

I agree with this. Others on this thread also agreed.

What I disagree with is the general approach. Most med students and interns want to do well, IMHO, and I've found they are willing to do what they need to do to get there (with rare exceptions). At least that has been the case at the teaching hospitals where I've trained. Some people do not have any patience, however, and since there basically isn't much of any education of residents and attendings r.e. how to teach, some people are not very good at it.

And I'm not sure what age(s) you meant by "this generation". I'm 34, and I had a real job before med school and residency, and I consider myself hard working. I had med school rotations that were 120 hours/week and I went through a medicine residency that I think has some of the longest hrs. vs. most other IM residencies, and I think the behavior described above sounds over the top and isn't something I would think is acceptable teaching of the intern.

 

[neurochirrurgie]

Abuse? I think it depends on our perspective. Just think that those 'unpleasant' things happen to make you wiser, more mature, and definitely not something that you'd do someday when you have the 'power'. That's why, we make our own parameters, not seeking someone else's approval..well, maybe sometimes, but so we know that we're here to study how to do things that we like the most....
So, please yourself, work extra hard disregarding what your supervisor would think..
Do it for yourself and your patients....
It'll make you a better person..