MD & DO Sage advice you've gotten from Attendings?

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NicMouse64

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So I had an interesting situation today. Attending tells me to go learn how to do a blood draw from the nurse. I go to the nurse and tell her that I'd like to learn how to blood draw with her if she doesn't mind. She says "I do mind, I have better things to do than teach a medical student how to do a blood draw". I say ok and walk away. Attending asks me how my first blood draw was. I say I didn't do it. He asks why. I say nurse was busy. He says to go back and ask her again. I go back and say attending told me to ask you again. She says "oh so you tattled on me? I am definitely not going to teach you now." I go back to attending, he acts disappointed in a you will be a bad doctor kind of way.

At the end of the day attending says "even as an attending you won't be in charge of as much as you think. I knew that nurse would do that. I wanted you to feel like what I feel like everyday for just a few hours. Powerless against insurance companies, non-compliant patients, my EMR, and the occasional snarky nurse." I felt like an incompetent and powerless fool. He then went and taught me how to do a blood draw. He told me that I would be dealing with nurses that want to tear you down for the next 7 years at least.

What do you think about teaching M1s this lesson?

Anyone had any sage advice that has helped you big time in your career?
 
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For me, it was rather eye opening. My attending basically said picture yourself at 40. What do you want your life to be like? Call? Long hours in the OR? Hospital? Clinic? Do you have kids?

It was one of those things that gets me thinking more and more about a potential specialty. I had an OB attending who told me that her son when he was in kindergarten who said he had no parents because they were never around. I don’t want to me THAT mom.
 
Not advice in particular, but I like the attendings and I would say even inspired by attendings that have a relaxed, positive attitude and treat medical students with respect and pay attention to what you have to say. Most doctors treat the patients well but few of them have this arrogant attitude when it comes to medical students. And in particular, I noticed it in ob-gyn residents and attendings and that is definitely what I do not want be when I am a resident/attending.
 
afib123 said:
Not advice in particular, but I like the attendings and I would say even inspired by attendings that have a relaxed, positive attitude and treat medical students with respect and pay attention to what you have to say. Most doctors treat the patients well but few of them have this arrogant attitude when it comes to medical students. And in particular, I noticed it in ob-gyn residents and attendings and that is definitely what I do not want be when I am a resident/attending.
Click to expand...

I didn’t experience this at all on obgyn but the arrogance is strong on my surgery rotation. I had a patient who legit cried telling me how awful the attending was to them. I was appalled.
 
ciestar said:
I didn’t experience this at all on obgyn but the arrogance is strong on my surgery rotation. I had a patient who legit cried telling me how awful the attending was to them. I was appalled.
Click to expand...
I had one resident like that on surgery...made a child cry, didn't even try to console them (or show basic human consideration for the child or the family).
Not only did the nurse pull them aside to discuss their attitude, but the ED resident acknowledged it, stated outright that it was negatively impacting care, and supported me in getting out of the situation because it was getting tense.

Of course, after getting called out by multiple people, nurses and doctors alike, the resident reported ME directly to my med school for being unprofessional. They failed to report how, exactly, just that I spoke with the family and handled the situation unprofessionally, which really stung considering that I was the one left to salvage the family's impression of everyone by taking care of the kid while they openly asked wtf was wrong with the resident and I tried to smooth things over. Didn't talk to me, send an eval, talk to the clerkship director, etc...just straight to my med school's system for reporting unprofessional behavior. Classic shti running downhill.
Fortunately, the clerkship director decided, before even talking to me, that this sounded more like a resident problem than a med student problem (which is sad, if that was their conclusion from just the resident's side of the story) and nothing ever came of it.

So, while it was a bad experience, I remind myself that it was one person having one bad day, and every single other layer of care calling that out and not accepting it, neither for the patients nor for the medical student caught in the situation. Overall, I think it reflected well on my program, and definitely made me more willing to consider surgery.
 
ciestar said:
I didn’t experience this at all on obgyn but the arrogance is strong on my surgery rotation. I had a patient who legit cried telling me how awful the attending was to them. I was appalled.
Click to expand...

Absolutely ridiculous. Doctors like that need to be counselled that it is not appropriate. Even the arrogant doctors that are jerks to med students and sometimes residents treat the patients nicely.
 
^ It's my favorite law....
That and I wish medicine could embrace XIII a little more...
 
NicMouse64 said:
So I had an interesting situation today. Attending tells me to go learn how to do a blood draw from the nurse. I go to the nurse and tell her that I'd like to learn how to blood draw with her if she doesn't mind. She says "I do mind, I have better things to do than teach a medical student how to do a blood draw". I say ok and walk away. Attending asks me how my first blood draw was. I say I didn't do it. He asks why. I say nurse was busy. He says to go back and ask her again. I go back and say attending told me to ask you again. She says "oh so you tattled on me? I am definitely not going to teach you now." I go back to attending, he acts disappointed in a you will be a bad doctor kind of way.

At the end of the day attending says "even as an attending you won't be in charge of as much as you think. I knew that nurse would do that. I wanted you to feel like what I feel like everyday for just a few hours. Powerless against insurance companies, non-compliant patients, my EMR, and the occasional snarky nurse." I felt like an incompetent and powerless fool. He then went and taught me how to do a blood draw. He told me that I would be dealing with nurses that want to tear you down for the next 7 years at least.

What do you think about teaching M1s this lesson?

Anyone had any sage advice that has helped you big time in your career?
Click to expand...
That doc and that hospital suck
 
1. You will be able to afford anything you want, not everything you want
2. Trust only what you verify
3. Don’t take it home.
4. This is a job. A high stakes job, but still a job. You owe people integrity and competence. You do not owe anyone miracles or free stuff. This is not a movie.
5. Don’t buy into the team model to the point that you abdicate your place as the medical authority. No one is trying to “collaborate” with you or be your peer when the subpoenas show up. You can be polite as people but you are not equals in medicine
6. You can always walk. There is another place, somewhere, that wants you and don’t let any admin convince you otherwise. Life is too short
 
OrthoTraumaMD said:
OP, I don’t think this was sage advice at all or the right thing for your attending to do. To be frank, you would have learned about the relationship between residents and nurses soon enough. It makes no sense for him to send you to a bitchy nurse for no reason. I think that attending just wanted somebody to share the pain, but it seems extremely unhelpful for your education.

As for sage advice, I’ve gotten three in my career.

One from a nurse, when I was hesitant and struggling with putting in my first Foley in a male patient: “grab it like you own it.” It became my approach to life.

One from my senior resident, when I was amazed about how confident he looked at reducing a rare dislocation (called luxatio erecta). He did it successfully, and I thought he had done it before, and then he confessed that he had not. He said, “fake it till you make it, otherwise the patient will never trust you and you will never learn.”

And the last came from an attending: “surgery is bad, bro.” It taught me to respect the operating room as a dangerous place, to always consider nonoperative management first, and to never take a patient to the operating room unless I was sure that was the best option. This is a very different style than most people in my field, who are trigger-happy about operating. Which is exactly why I am in academia; I would never survive or make any money in private practice, where the goal is to operate on everything that stands still long enough.
Click to expand...
I'm a big boy I can handle it. It's also an older doc so I think his mentality of medical education is a bit old school. It was fine, I think it did prepare me mentally for lose-lose situations in the future. Some situations just suck and you can't do sh** to make it any better. But yeah nowadays I think this approach is less acceptable.
 
From a senior neurosurgery resident when I was a med student. "Don't make excuses. Never say 'it'll never happen again' cause you can't be sure of that." Good advice for residency. Don't make excuses when you do something wrong, don't try to blame others or some other stuff that happened that distracted you. We're in a field where mistakes kill. Learn from your mistakes, own it, and strive to be better.
 
1. What bugs do diabetic foot wounds grow? EKHP

2. What is the most common psych diagnosis? KWAB

Abbreviations in next post. See if you can guess them before you scroll
 
sb247 said:
1. You will be able to afford anything you want, not everything you want
2. Trust only what you verify
3. Don’t take it home.
4. This is a job. A high stakes job, but still a job. You owe people integrity and competence. You do not owe anyone miracles or free stuff. This is not a movie.
5. Don’t buy into the team model to the point that you abdicate your place as the medical authority. No one is trying to “collaborate” with you or be your peer when the subpoenas show up. You can be polite as people but you are not equals in medicine
6. You can always walk. There is another place, somewhere, that wants you and don’t let any admin convince you otherwise. Life is too short
Click to expand...

The first one is not even close to true, none of us will ever be able to afford a private Boeing 737 jet for example..
 
NicMouse64 said:
So I had an interesting situation today. Attending tells me to go learn how to do a blood draw from the nurse. I go to the nurse and tell her that I'd like to learn how to blood draw with her if she doesn't mind. She says "I do mind, I have better things to do than teach a medical student how to do a blood draw". I say ok and walk away. Attending asks me how my first blood draw was. I say I didn't do it. He asks why. I say nurse was busy. He says to go back and ask her again. I go back and say attending told me to ask you again. She says "oh so you tattled on me? I am definitely not going to teach you now." I go back to attending, he acts disappointed in a you will be a bad doctor kind of way.

At the end of the day attending says "even as an attending you won't be in charge of as much as you think. I knew that nurse would do that. I wanted you to feel like what I feel like everyday for just a few hours. Powerless against insurance companies, non-compliant patients, my EMR, and the occasional snarky nurse." I felt like an incompetent and powerless fool. He then went and taught me how to do a blood draw. He told me that I would be dealing with nurses that want to tear you down for the next 7 years at least.

What do you think about teaching M1s this lesson?

Anyone had any sage advice that has helped you big time in your career?
Click to expand...
This is really sad!!!
I cannot believe this kind of stuff is acceptable.
The entire system is SOOO jacked. I cant believe they are still finding people to go through this nonsense.
If you did that to a nursing student it would be a big deal
 
Mr.S said:
This is really sad!!!
I cannot believe this kind of stuff is acceptable.
The entire system is SOOO jacked. I cant believe they are still finding people to go through this nonsense.
If you did that to a nursing student it would be a big deal
Click to expand...
We are supposed to be tougher, and I'd rather know I need to fix deficits in pride now rather than 3rd year. I know this is the internet and the way I said it may have made it seem sad or like misconduct, but the lesson I think was important. He didn't mean any "harm" and has been a great mentor thus far. The relationship context wasn't explained, but the way I told it, I can see how people may misconstrue.
 
"It doesn't matter how many hours you work or how many papers you publish. This is a job, and you need to have a life outside the hospital. If the hospital is your life, you'll wake up one day and realize you have nothing else."

Also, the cliched but nevertheless relevant "when you look back on life, you'll never wish you worked more."
 
OrthoTraumaMD said:
OP, I don’t think this was sage advice at all or the right thing for your attending to do. To be frank, you would have learned about the relationship between residents and nurses soon enough. It makes no sense for him to send you to a bitchy nurse for no reason. I think that attending just wanted somebody to share the pain, but it seems extremely unhelpful for your education.

As for sage advice, I’ve gotten three in my career.

One from a nurse, when I was hesitant and struggling with putting in my first Foley in a male patient: “grab it like you own it.” It became my approach to life.

One from my senior resident, when I was amazed about how confident he looked at reducing a rare dislocation (called luxatio erecta). He did it successfully, and I thought he had done it before, and then he confessed that he had not. He said, “fake it till you make it, otherwise the patient will never trust you and you will never learn.”

And the last came from an attending: “surgery is bad, bro.” It taught me to respect the operating room as a dangerous place, to always consider nonoperative management first, and to never take a patient to the operating room unless I was sure that was the best option. This is a very different style than most people in my field, who are trigger-happy about operating. Which is exactly why I am in academia; I would never survive or make any money in private practice, where the goal is to operate on everything that stands still long enough.
Click to expand...

What kind of anesthesia have you seen at private hospitals? All of our patients can stand still long enough... well they lay still but you get the point.
 
OrthoTraumaMD said:
My point exactly LOL… Private practice guys operate on everything, regardless of whether they should or not.
Click to expand...

I know and I was kidding. There’s definitely a spectrum. There some real quality people in the community that hold themselves to academic standards... I think there will be less incentive to misbehave as more doctors become employed or even salaried. Sad reality but much of that blame is on us. And by US I mean those who ruined it for our generation lol.
 
sella.turcica said:
"There is nothing you can teach me", when I thought I could/should correct him.
Click to expand...

This is particularly true in surgery. When an intern suggests “maybe we could do X,” rest assured, I’ve thought of X, Y, Z, and the five steps forward for each.
 
OrthoTraumaMD said:
This is particularly true in surgery. When an intern suggests “maybe we could do X,” rest assured, I’ve thought of X, Y, Z, and the five steps forward for each.
Click to expand...
I'd say that's true everywhere but it's a great setup for a teaching moment
 
OrthoTraumaMD said:
One from my senior resident, when I was amazed about how confident he looked at reducing a rare dislocation (called luxatio erecta). He did it successfully, and I thought he had done it before, and then he confessed that he had not. He said, “fake it till you make it, otherwise the patient will never trust you and you will never learn.”
Click to expand...
When patients ask if I've done a procedure before I do it, I always say, "Don't worry, I've done this a number of times."

What they don't know is that that number is usually 0.
 
OrthoTraumaMD said:
This is particularly true in surgery. When an intern suggests “maybe we could do X,” rest assured, I’ve thought of X, Y, Z, and the five steps forward for each.
Click to expand...

Fair, but one of my proudest moments as a medical student was suggesting the off-label use of a drug to treat a patient with an uncommon combination of symptoms, and the attending telling me "I didn't think of that. Great idea."

Looking back, I'm almost certain he had "thought of that." But back then it made my week.
 
mrbreakfast said:
Fair, but one of my proudest moments as a medical student was suggesting the off-label use of a drug to treat a patient with an uncommon combination of symptoms, and the attending telling me "I didn't think of that. Great idea."

Looking back, I'm almost certain he had "thought of that." But back then it made my week.
Click to expand...

I dig that. The only time when it becomes annoying is when I’m struggling to get something in the OR... I don’t need the suggestion at that exact moment, haha.
 
Too many to count. One that sticks out as a student:

Beware of the black boxes in the hospital - those things that you order but may not know how they play out on the ground. As a medical student you have more time than you will ever have to explore these, and once you’ve looked at a few you’ll be more sensitive to them later.

The example that started it was an insulin drip with a nurse managed protocol; he had me go hang with the nurse and see how it works and then figure out how it could go awry.

Since then I’ve come across more of these than I can remember. As a physician you really have to know how everything works, from literally every piece of equipment you use in the OR to every order you write.
 
If something looks or smells like poop, it’s probably poop. No further confirmatory testing is required.
 
I had a very nice surgeon when describing the dance of 6 hands in an abdomen told me (paraphrase coming).... "I'm predicable because I know what I'm going to do and the other surgeon can be proactive because they know what I'm going to do next. Even if they are being proactive and moving without talking, they are still very predictable because we both know what we are doing. Don't take this the wrong way but no one in there knows how little you know about what's supposed to happen next. So no one needs "proactive" out of you. We need predictable. If I move your hand it needs to be there until I say it doesn't. I don't need you to adjust for me or anticipate me because then I have to start questioning if what you are about to do will help or hurt. No one has time or energy for all that. Be predictable. That's the goal."
 
sb247 said:
I had a very nice surgeon when describing the dance of 6 hands in an abdomen told me (paraphrase coming).... "I'm predicable because I know what I'm going to do and the other surgeon can be proactive because they know what I'm going to do next. Even if they are being proactive and moving without talking, they are still very predictable because we both know what we are doing. Don't take this the wrong way but no one in there knows how little you know about what's supposed to happen next. So no one needs "proactive" out of you. We need predictable. If I move your hand it needs to be there until I say it doesn't. I don't need you to adjust for me or anticipate me because then I have to start questioning if what you are about to do will help or hurt. No one has time or energy for all that. Be predictable. That's the goal."
Click to expand...

I wish my surgery attendings had told me that! I was chastised for not being proactive enough at the beginning of my surgery rotation. I was told that I have two hands and both hands should always be doing something to help. If I ever find one of those hands not doing something then I need to immediately figure out what it can be doing and do it quickly.
 
sb247 said:
I had a very nice surgeon when describing the dance of 6 hands in an abdomen told me (paraphrase coming).... "I'm predicable because I know what I'm going to do and the other surgeon can be proactive because they know what I'm going to do next. Even if they are being proactive and moving without talking, they are still very predictable because we both know what we are doing. Don't take this the wrong way but no one in there knows how little you know about what's supposed to happen next. So no one needs "proactive" out of you. We need predictable. If I move your hand it needs to be there until I say it doesn't. I don't need you to adjust for me or anticipate me because then I have to start questioning if what you are about to do will help or hurt. No one has time or energy for all that. Be predictable. That's the goal."
Click to expand...
My favorite attending that I've worked with thus far balanced this really well. They'd get to the point where I needed to do something, and then give me a chance to do it before just doing it themselves. "OK mehc012, show me what I need to see next." If I failed, they'd adjust my hands. "mehc012, do you think you can do what [PGY2] did in the last case? Give it a try. First, do x..." And the next time we had the same kind of operation: "OK mehc012, do your part" and watch me go through the sequence they'd shown me in a prior surgery. They basically would give me permission to try to be proactive and involved, without telling me what to do or how (to see if I could figure it out myself), so that I didn't have to guess when to act and they didn't have to worry about me being unpredictable, but I also got a chance to show that I knew what to do without being told.
 
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