Should I lie?

[upright]

<--3rd year on rotations. Every time I tell someone I want psych, be it med student, resident, or attending, I get a look like I queefed cabbage.

In the interest of my transcript, as well as any future letters of recommendation, should I just keep this plan close to the vest? Tell people I want peds?

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[nitemagi]

No.

Be as honest as you can be. "I'm planning on psych, but I don't know much about x, so open to seeing..."

If you're set on psych, say that. But then be up front that you'll need to know the important things about other specialties. Psychiatrists need to interface with every other specialty (consult-liaison, maternal mental health, etc), and so should be able to understand the language and basics of that specialty. A good psychiatrist is first a good doctor, and a good doctor understands each specialty. Sell it that way.

An alternative is "since I'm going into psych, this may be my only opportunity to see X, so that's exciting." I remember having a not-so-great Ob experience in med school, but I was excited to catch some babies, just to know I could do it.

 

[Therapist4Chnge]

Times you should lie:

1. "Honey...do I look fat in this dress?"
2. "Do you know what I pulled you over?"
3. "What are your intentions with my daughter?"

That's about it.

 

[pingouin]

No.

Be as honest as you can be. "I'm planning on psych, but I don't know much about x, so open to seeing..."

If you're set on psych, say that. But then be up front that you'll need to know the important things about other specialties. Psychiatrists need to interface with every other specialty (consult-liaison, maternal mental health, etc), and so should be able to understand the language and basics of that specialty. A good psychiatrist is first a good doctor, and a good doctor understands each specialty. Sell it that way.

An alternative is "since I'm going into psych, this may be my only opportunity to see X, so that's exciting." I remember having a not-so-great Ob experience in med school, but I was excited to catch some babies, just to know I could do it.

^^This. ALL of this.

If you read the Allo and Clinical Rotations forums, you'll see lots of advice suggesting that you be intentionally vague or even outright lie. That is such bad advice.

As nitemagi suggests here, I figured out where the overlap was between psychiatry and whatever rotation I was on. Sure, that could be tough on rotations like surg onc- until I thought about the many ways a woman may react to a breast cancer diagnosis. And the neurosurgeons gave me some good-natured ribbing before they acknowledged that they probably need more psychiatrists in their field to take care of them, not their patients. The OB/Gyns thought it was fabulous to have someone in clinic who actually wanted to listen to the 17 y/o pregnant girl about her psychosocial stressors. A particularly candid OB resident told me it was refreshing to hear me say I wanted to do something other than OB since he was sick of M3s trying to kiss his derriere when he knew darn well they were future internists.. or surgeons.. or whatever.

The most important things are to show up on time, be prepared for whatever you're doing that day, do it as well as you can, and pay attention. Most of this stuff you really never will see again- which is alternately a blessing and a curse. (Delivering babies was fun, but I could go the rest of my life without examining another nasty toe fungus.)

 

[nitemagi]

^^This. ALL of this.

If you read the Allo and Clinical Rotations forums, you'll see lots of advice suggesting that you be intentionally vague or even outright lie. That is such bad advice.

As nitemagi suggests here, I figured out where the overlap was between psychiatry and whatever rotation I was on. Sure, that could be tough on rotations like surg onc- until I thought about the many ways a woman may react to a breast cancer diagnosis. And the neurosurgeons gave me some good-natured ribbing before they acknowledged that they probably need more psychiatrists in their field to take care of them, not their patients. The OB/Gyns thought it was fabulous to have someone in clinic who actually wanted to listen to the 17 y/o pregnant girl about her psychosocial stressors. A particularly candid OB resident told me it was refreshing to hear me say I wanted to do something other than OB since he was sick of M3s trying to kiss his derriere when he knew darn well they were future internists.. or surgeons.. or whatever.

The most important things are to show up on time, be prepared for whatever you're doing that day, do it as well as you can, and pay attention. Most of this stuff you really never will see again- which is alternately a blessing and a curse. (Delivering babies was fun, but I could go the rest of my life without examining another nasty toe fungus.)

Exactly. People want you to be smart - meaning prepared and good at what you do, regardless of the rotation. A minority want you to be a narcissistic reflection of themselves, and you shouldn't sweat those people much. If you're sharp no matter the reputation, then you end up with letters of rec that say things like "I tried persuading him/her to go into surgical oncology, as we could use more physicians like him/her. He insists on going into psychiatry...will be an asset to whatever program he/she is in."

To sum up, you'll impress people more by being the kind of physician they want to be (capable, knowledgeable, empathic, sharp, efficient, conscientious), or that they would refer their family to, than lying or kissing ass.

 

[Ron Mexico]

nope. i tell everyone and i've gotten very positive response. if they think less of you, these people are narrow minded fools and they can go **** themselves.

 

[peppy]

Exactly. People want you to be smart - meaning prepared and good at what you do, regardless of the rotation. A minority want you to be a narcissistic reflection of themselves, and you shouldn't sweat those people much. If you're sharp no matter the reputation, then you end up with letters of rec that say things like "I tried persuading him/her to go into surgical oncology, as we could use more physicians like him/her. He insists on going into psychiatry...will be an asset to whatever program he/she is in."

I agree. When I was a med student, some people would say negative things to me about psych but in most cases they were just trying to make a joke or expressing their own frustrations about dealing with psych patients (Psych patients can be very frustrating to deal with from the perspective of an Emergency med doc or Family med doc).
If you work hard and show some interest in their specialty, most people won't hold it against you that you want to do psych.

I've had med students claim to be interested in psychiatry to me, and in a lot of cases I'm thinking "Come on, you don't have to say that. I don't really care. I'm just making conversation".
There was one case where a med student was SO good at interacting with psych patients that I thought it was kind of sad that she wasn't thinking of going into psych, but still it's not like I held that against her.

 

[F0nzie]

I picked several different specialties for my letters of rec for versatility- but to each his own. Regardless of your specialty of choice: study hard, work hard, be on time, stay late to help, be interested and your attendings will give you a good letter of rec if they observe your efforts. If the stereotype and initial impression is that psychiatry as a profession is laid back, relaxed, aloof, or as coined by attendings in my medical school "psychation" (rhymes with vacation), then you can make a big impression on attendings in other specialties if you do not conform to that stereotype. Regardless, you should try and identify your feelings when you say others have a "queefed cabbage" look. In psychiatry we are not as "respected or esteemed" as highly as other specialities. The question I have for you is do you need that level of respect to feel good about becoming a Psychiatrist?

 

[jamesearlejones]

I guess I'll be in the minority here, but I would not publicize your choice of specialty. I am NOT recommending outright lying. That never ends well. But I am recommending saying something along the lines of "I am keeping my options open to learn as much about each specialty as possible. I have had great experiences in psychiatry, x specialty, and y specialty. I can't see myself going into a, b, and c specialty." (You don't even have to include that last sentence). That's pretty much what I would tell people when they would ask me. What's the benefit in disclosing more? I see it as a benefit-risk analysis. I don't see there being any benefit of disclosing your choice and I see the risk being that you could upset some narcissistic attending or resident (and we all know there are plenty of them), who then at best marginalizes you the team and compromises your learning and at worst, goes out of his/her way to be a dick to you. That was at least how I weighed things when deciding what I was going to tell people. Now mind you, this is what I told people when I was a third year--by the time I got to fourth year, and had my application submitted, I had no problem telling people exactly what I was applying in.

 

[upright]

Regardless, you should try and identify your feelings when you say others have a "queefed cabbage" look. In psychiatry we are not as "respected or esteemed" as highly as other specialities. The question I have for you is do you need that level of respect to feel good about becoming a Psychiatrist?

I don't give a damn what another specialty thinks of me. But when that person lords my future in their hands, I have to give it consideration.

Thanks for the advice all. I'll continue to be open about it except with those I can tell are simply too unable to hang. Haters gonna hate.

 

[Ibid]

Times you should lie:

1. "Honey...do I look fat in this dress?"
2. "Do you know what I pulled you over?"
3. "What are your intentions with my daughter?"

That's about it.

"How many people have you slept with?" is a notable omission here.
As an aside the answer "I don't know I've lost count." goes down surpising badly.

 

[Therapist4Chnge]

"Can I give you a ballpark figure?"...goes over like a lead balloon.

 

[Ibid]

"Can I give you a ballpark figure?"...goes over like a lead balloon.

I see you have sat this test before as well. "Only three more and I'll beat my brothers record." gets full marks for obscurity but shows weakness in other areas and is generally regarded as unsatisfactory despite it's hopeful positive and upbeat overtones.

 

[digitlnoize]

I don't give a damn what another specialty thinks of me. But when that person lords my future in their hands, I have to give it consideration.

Thanks for the advice all. I'll continue to be open about it except with those I can tell are simply too unable to hang. Haters gonna hate.

During most of 3rd year, I used the "well, I'm not 100% sure, but I really liked my psych rotation and my __insert 2nd favorite rotation here__ (for me it was IM, I think). I've still got a lot of time left and a lot of specialties left to experience, so I'm still keeping an open mind at this point" line. Most people were cool with this and accepted it. Sometimes I offered it up as a challenge for them to convince me to do their specialty, and this seemed to go over very well. I did tell a couple of docs who are family friends (not MY family, but you get the idea) and they were very resistant to the idea. One even told me that I should go into medical tech consulting instead, which I totally don't agree with, despite my love for SDN.

As it got later in 3rd year, it became more difficult to do this. Unfortunately, I had 2 months of surgery at the very end of 3rd year. I was totally up front about it though, and they were cool with it. I just made it clear that although I was doing psych, I was willing to work hard and wasn't a *****, and it worked out alright. In particular, my 2nd surgeon was 200% in favor of the idea. He totally recognized both the need, and that psych was a great fit for me. Great surgeon and one of the best docs I worked with ever.

I would generally also recommend honesty, but I agree that it's hard when these people hold you life in their hands, and may have a bias against psych (which DOES exist, as much as that sucks). Just feel them out, use your "psych ninja skills" and determine the best course to take.

 

[Trismegistus4]

Don't lie. If the staff at your hospitals are good teachers, they know there's a shortage of psychiatrists, and they'll respect your choice and point up where psychiatry interacts with each of their respective fields. I encountered an occasional oddball who seemed unimpressed with my choice of specialties, but most people were fine with it, including most surgeons. I even had a OB/gyn attending tell me I deserved honors and offer to write me a letter of rec because she was so imprsessed with the success that I, a male student, had at making female patients feel comfortable with me being part of their gyn care--a rapport-building skill that is, obviously, important in psych. Once in a while you'll encounter someone who just doesn't like you, but some people are just jerks, and you have to let it roll off your back. (On my medicine clerkship one of the senior residents didn't like me, thought I was lazy and using my intention to do psych as an excuse, but I got a letter of rec from an attending on that same rotation.)

Also agree with what people are saying about the importance of knowing the basics of every field. Just tonight I had a borderline cutter manage to cut herself while on the inpatient unit, and who knows, if I hadn't done surgery/family medicine/ED I might not have been able to make the judgment that the lac wasn't deep enough to need immediate attention. So try to go into each rotation thinking, "there must be something I can learn here that I'll use later in my career."

 

[dl2dp2]

I'm going to be contrarian and say that you should "lie" if:
(1) you are a good liar and very good interpersonally.
(2) you are a gunner.
(3) you are gunning for a top program in psych.

While it's true that you know you want to go into psych, the best way to get H in as many rotation as possible is to act AS IF you want to go into that specialty during every single rotation you get through. I find it extraordinarily difficult to feign interest in a specialty, but some people I know who ended up in rad onc and derm are SO good at it. And I think that if you are that type, it's fantastic.

Possible side effects include:
(1) other med students might hate you--this means that not only do you need to "lie" to your attendings, you also need to lie to everyone else around you to make this "lie" complete.
(2) you burn out
(3) acting in a way has a weird way of altering your brain circuitry, be careful when your supposed "lie" end up becoming true. i.e. you end up in OBGYN 2 years down the line and thinking OH GOD NO.

The most important person to lie to is yourself. It's not lying when it's method acting.

 

[Ibid]

The most important person to lie to is yourself. It's not lying when it's method acting

If you are ever going to lie it is critical that for the time of the lie that you really do believe that what you are saying is in fact the truth.

I am quite sure that the earlier children learn to lie the better they eventually do in life.

Most CEO's are psychopaths imo.

 

[nitemagi]

If you are ever going to lie it is critical that for the time of the lie that you really do believe that what you are saying is in fact the truth.

I am quite sure that the earlier children learn to lie the better they eventually do in life.

Most CEO's are psychopaths imo.

I would distinguish between psychopaths and those who can compartmentalize well.

 

[Ibid]

I would distinguish between psychopaths and those who can compartmentalize well.

If you expanded on that i'd be really interested. I'm struggling to see this becasues it seems you are saying that it is adaptive to be able to apply different moral codes depending on the situation and context. So for instance a hit man could "do his/her job" and then go home and live an overtly happy family life, being faithful, attending church and so on. That person is not a pyschopath at home, just a good compartmentalist?

Sorry, just trying to understand.

 

[nitemagi]

If you expanded on that i'd be really interested. I'm struggling to see this becasues it seems you are saying that it is adaptive to be able to apply different moral codes depending on the situation and context. So for instance a hit man could "do his/her job" and then go home and live an overtly happy family life, being faithful, attending church and so on. That person is not a pyschopath at home, just a good compartmentalist?

Sorry, just trying to understand.

A psychopath (someone with "psychopathic personality disorder"), as I understand it, is not distinguished only by his/her actions. Prefacing this that I'm not forensically trained but have an ongoing interest in the field, read about it, go to meetings, etc. There is a core difference is their personality organization, and perhaps even their physiology. To simplify, they do not have the moral sense to push down in the first place. Some theorize their predatory behaviors are an effort to get themselves stimulated, because they're often indifferent or removed from most situations. When they're on the "hunt," they get calmer(including their VS), whereas most people would get more anxious and try to suppress it do to what they have to do.

Someone who compartmentalizes might be good at rationalizing their behavior, and push themselves to do things that if looked at from the outside be repulsive or easily judged as wrong. They might have a slow creep in ethical violations, and not realize they're crossing lines, because they've steadily locked away that emotional part of reactions. Physicians in general are probably very good at compartmentalizing, because we need to do that to do our jobs. This is different than doing predatory behavior because it "gets us off."

Some CEO's probably are psychopaths.
http://www.amazon.com/Snakes-Suits-When-Psychopaths-Work/dp/0061147893/

Some surgeons probably are, too. Meaning they have the core personality, though they've channeled it into something socially acceptable. But some might just have compartmentalized slowly their morals or ethics, for the purpose of succeeding through competition, rationalizing that the ends justify the means.

Antisocial behavior could theoretically be done by anyone. Just like malingering could, in certain circumstances. The difference though, might be in the risk of real violations, and the possibility of rehabilitation. Whopper, want to chime in on this one?

 

[Ibid]

...

Thank you, you certainly have the gift of perspicuity!

 

[pysch4sure]

Although I missed spelled 'psych' when I signed up for SDN, the spirit of my username remains: I am 100% sure that I'm going into psychiatry.

And yet I lie to most people about my preference

There's 2 reasons, but really it just boils down to practicality.

Reasons to Lie About Psychiatry:

#1- Patients and doctors alike think the phrase "I want to go into psychiatry" is synonymous with "Please tell me all your psychological issues right now even if it's not appropriate". Rounding in IM, seeing pts in the office for FM, all of this was made more difficult by telling people I wanted to be a psychiatrist

And I can't tell you how many times I've been asked, ESPECIALLY by surgeons, to 'analyze' them. They would say things like, "I bet you're analyzing me right now" when they said or did something prickish, which was virtually all the time. When I was honest about my taste in medicine, I ended up having to lie more and feed egos all day. So I don't think being honest was any better.

#2- It will get you a better clerkship grade during surgery. "But my surgical attendings were awesome and respected psychiatry!", I hear you cry. Well, the other 90% of medical students and I are jealous, because the the tendency of surgeons to be arses is not an isolated phenomenon. There are some great ones to be sure, but unless you know your attendings beforehand, I'd say the odds are against you.

And I know, psych residencies probably don't care if you 'honors' this area of medicine. But still, we are by careful design and selection a competitive people (med students), and the want to excel is about as strong as the urge to procreate! ;0 Well that's overstating it in my case, but not too far off for some of my classmates

 

[Saluki]

When I did gyn surgery I was open minded about my career options because I had loved labor and delivery. Nevertheless, the attendings and residents were mean and ruthless with me and to a lesser extent each other.

When I did general surgery, I knew I wanted to do child psych and said so. Everyone was really nice to me and gave me great evals, though a few of them tried to convince me to go into surgery instead.

I have drawn two conclusions. Gyn surgeons are mean, and that the nastiness or lack thereof has little to do with what you tell them and everything to do with who they are as people.

The one funny outcome, though, was one of the peds surgeons giving me a big speech on the shortage of child psychiatrists. He kept trying to tell me that there were only two child psychiatrists in our city. I tried to tell him that there were at least five at our institution alone without success. Then I gave up and just nodded

 

[DD214_DOC]

A psychopath (someone with "psychopathic personality disorder"), as I understand it, is not distinguished only by his/her actions. Prefacing this that I'm not forensically trained but have an ongoing interest in the field, read about it, go to meetings, etc. There is a core difference is their personality organization, and perhaps even their physiology. To simplify, they do not have the moral sense to push down in the first place. Some theorize their predatory behaviors are an effort to get themselves stimulated, because they're often indifferent or removed from most situations. When they're on the "hunt," they get calmer(including their VS), whereas most people would get more anxious and try to suppress it do to what they have to do.

Someone who compartmentalizes might be good at rationalizing their behavior, and push themselves to do things that if looked at from the outside be repulsive or easily judged as wrong. They might have a slow creep in ethical violations, and not realize they're crossing lines, because they've steadily locked away that emotional part of reactions. Physicians in general are probably very good at compartmentalizing, because we need to do that to do our jobs. This is different than doing predatory behavior because it "gets us off."

Some CEO's probably are psychopaths.
http://www.amazon.com/Snakes-Suits-When-Psychopaths-Work/dp/0061147893/

Some surgeons probably are, too. Meaning they have the core personality, though they've channeled it into something socially acceptable. But some might just have compartmentalized slowly their morals or ethics, for the purpose of succeeding through competition, rationalizing that the ends justify the means.

Antisocial behavior could theoretically be done by anyone. Just like malingering could, in certain circumstances. The difference though, might be in the risk of real violations, and the possibility of rehabilitation. Whopper, want to chime in on this one?

Although I have not read her books and only heard about her ideas second-hand, is this not the basis for how McWilliams breaks down personality organization by levels of functioning? Such as, someone with antisocial PD who is low-level functioning would be your typical murderer/criminal, but those who are higher functioning would be your law enforcement, lawyer, and corporate types? Of course, "antisocial" merely referring to the emotional detachment and ability to compartmentalize things? There are definitely accomplished, law-abiding citizens who have absolutely no problem hurting/killing another human if he feels it is justified, whether by internal or external factors.

 

[notdeadyet]

I always feel incredibly old fashioned in discussions like these...

Lying to get ahead at work is just bad juju. Yes, people do it all the time. You see these boot-lickers and yes-men in the business environment all the time. And they console themselves and justify their behavior by telling themselves, "Hey, the boss is an azzhole... this is how you gotta play the game" or "Hey, it's my career I'm talking about here."

But at the end of the day, they're still boot-lickers and yes-men.

You do not have to lie about who you are, what you're passionate about, or what you value to do well in 3rd year or beyond. Yes, this honesty will hurt you with a small sub-set of specific people. This honesty will also help you with a less-small sub-set of specific people.

You know the surgery-bound 3rd year who slobbers over the pediatricians and talks about wanting to be the next Patch Adams? You know how everyone rolls their eyes behind his back at his transparent performance? That happens with many of the attendings too. For every attending who falls for it, there's another (or 2 or 3) who do not and their evaluation suffers for it. Everyone seems to think they can game people better than they can, but keep in mind that these attendings have had 100x the interactions with people like you than you've had with people like them. And just as the passive "I'm thinking surgery" really doesn't endear you to many surgeons, the honest "I'm psychiatry-bound" won't hurt your standing with many.

At the end of the day, if you've been a boot-licker and apple-polisher your whole life with the conviction that you'll change your behavior "once you've arrived," trust me that it gets harder and harder to break the further you get ahead. Be yourself, be honest, and be sincere and see how it plays out. It actually works to your advantage most of the time, it takes less effort, and it's much better karma.

 

[whopper]

It will get you a better clerkship grade during surgery

As I mentioned several times, doctors can be a narcissistic group. There should be a professional ethic in medical school about doctors not trying to make negative judgments on students on what field inspires them.

My former PD (#1) in general residency told me that his own PD (#2) berated him and started screaming at him because he wanted to do clinical work, saying it was beneath his capabilities because he was a top-scorer in the PRITE and USMLE. #2 told #1 he needed to go into research and if he didn't he would be a "waste" of a doctor.

I can certainly see why a PD would encourage someone to look into research, even wanting a better scorer to go into it, but to make value and character judgments on #1 IMHO violated professional ethics. As much as I'd like to say such things are rare and non-existent, from my experience they are far from. I see this type of thing less and less with time though I'm not sure if it's because it's going down or because I haven't been a student/resident/fellow for almost three years and had the fortune of having a fellowship PD not have anything of this type attitude despite achieving some top honors in medicine.

 

[Doctor Bagel]

I'm in the tell the truth camp, too. And those people who say they don't know what they want to do, especially later in the year, make me suspicious. They're either full of crap, entirely indecisive people in general (which is kinda a bad thing) or too damn happy (I love all my rotations, bleh) for me to particularly relate to them. I'd much rather a student tell me he wants to do surgery or dermatology.

 

[LizzytheShrink]

I'm in the "lie ONLY if you are good at it and make sure you don't anger people" camp, because it's tricky to lie to people you work so closely with. They will realize you're just a politician who says what people want to hear, or a flake who waffles all the time, not a trustworthy solid individual. Personally, I've never lied about being a psychiatrist (except at a cocktail party populated with suburban moms) because I never saw anything less honorable or felt less respected because of it. You, original poster, should NOT lie, because the fact that you feel uncomfortable enough about it to post on a forum, pretty much r/o you being a sociopath.

I was disrespected a good bit in medical school by certian attendings, because of my choice to have two X chromosomes (yeah, mostly surgeons - "your tits are blocking the surgical field!" ahem) But when ever someone's mean to me out of their own insecurity and need to feel better, I am bullet-proof.

Why do you feel the need to even answer them? I mean really? It's not their business, unless he or she is your advisor. (If your advisor makes you feel like queefed cabbage, you need a new advisor lol) Think about it, why should you be made to feel put on the spot and uncomfortable because of someone's idle curiousity? Say "I'm not sure yet, I really like many different fields" (which I bet is NOT a lie), and don't belabor it. The longer you work in medicine, the more you will learn that it is best to be circumspect about what you reveal about your goals, and to whom. You never know what doors may close or open because of something you did or didn't say to others.

 

[digitlnoize]

Say "I'm not sure yet, I really like many different fields" (which I bet is NOT a lie), and don't belabor it.

This was my point. During 3rd year rotations, you SHOULD have an open mind, and be trying to feel out the different fields and learn as much about them as you can.

Thus, it shouldn't be a lie to say that you've enjoyed rotation X, Y, and Z, but that you want to experience the rest of 3rd year before making up your mind.

I am also NOT a fan of outright lying. If you've made up your mind, then say so, unless you really feel it will jeopardize your grade because of a douchebag attending (which is rare honestly, even among surgeons.)

Remember, surgeons are people too.

 

[pysch4sure]

Lying to get ahead at work is just bad juju. Yes, people do it all the time.. And they console themselves and justify their behavior by telling themselves, "Hey, the boss is an azzhole... this is how you gotta play the game" or "Hey, it's my career I'm talking about here."

But at the end of the day, they're still boot-lickers and yes-men...the honest "I'm psychiatry-bound" won't hurt your standing with many.

Here's an actual conversation:

Me: "Hello Sir, my name's <psych4sure>, and I'll be on your service this month. This is my first rotation as a med student, so I'm eager to learn from you."
Surgeon: "You think you have what it takes to be a surgeon?"
Me: "Not at all, but I am eager to learn about your profession as it's a fascinating and important branch of medicine."
Surgeon: "So what do you want to do?"
Me: "Well Sir, my research and clinical interests have thus far been in psychiatry."
Surgeon: "Psychiatry? What are you, a f*cking f*g?"

It's apparent from reading this thread that many of you have had great experiences working with surgeons. That's great, and I am jealous. But the rest of us have adapted to the working conditions: lying is, in my view, an advantageous adaptation. Even you NotYetDead lie in order to be a functional adult. You have no right to insinuate that those who have adapted to the crappy conditions are 'boot-lickers'. If being honest about your professional interests worked for you, then that's great, count yourself as fortunate, and keep your judgements to yourself.

To me, this all boils down to the vulnerability of medical students (I also read that residents aren't exactly in a position of power either). We are at the mercy of our attendings, and complaining to someone higher up is not an option. What am I supposed to say to my school? Dr. ArseOfASurgeon was a meanie because I want to be a shrink? For those of us med students who want to be a doctor someday, that's not an option. This is because of the following equation:

Tenured specialist surgeon>>>>>>>>>>>>>>>>>>>>>>>>>>>scrub nurse>>>>>>>>>>CNA>>>>>guy who fills the coffee pot in the surgical lounge>>med student

And in terms of lying, I think that keeping my professional interests from *select* rotations is hardly equivocal to some PD that involves compartmentalizing. Thus far it was only my 2nd month of surgery that I've withheld information from.

I do think the conversation on antisocial PD and psychopathy is fascinating.

And I do stick by what I said regarding withholding my interests from non-psych patients merely because it slows down my day. I'm doing outpatient FM right now and I don't have time to listen about their chronic depression. It would be very rude to say "my interests are none of your business" or "I don't have time to tell you", so "I don't know" is just a lot more practical and polite.

 

[LizzytheShrink]

Remember, surgeons are people too.

Very true. Some of my best friends are surgeons, (and a few of them are douches lol)... if someone is truly messing with you in a way that threatens your evaluation and grades, you have to take it over his or her head. It's extremely rare for someone to be able to function as a physician yet be THAT out of control.

Despite all the icky comments I was exposed to, I only reported one of those guys (it seemed to be the culture at one surgical group at one hospital) because I felt like he really had an irrational problem with me. I just wanted the surgical director to be aware that it might be a problem. Guess what? He already knew it was a problem, before I ever started my rotation! It was very reassuring to know the guy was just a well known dickhead.

Lying puts a barrier up that could interfere with communication you need to be open to. It's not a good way to start your career. How will you ever be enthusiastic and enjoy a career in psychiatry, if you are ashamed of it, or allow others to make you ashamed?

 

[LizzytheShrink]

Here's an actual conversation:

Me: "Hello Sir, my name's <psych4sure>, and I'll be on your service this month. This is my first rotation as a med student, so I'm eager to learn from you."
Surgeon: "You think you have what it takes to be a surgeon?"
Me: "Not at all, but I am eager to learn about your profession as it's a fascinating and important branch of medicine."
Surgeon: "So what do you want to do?"
Me: "Well Sir, my research and clinical interests have thus far been in psychiatry."
Surgeon: "Psychiatry? What are you, a f*cking ***?"

See now, that's just unacceptable, rude behavior. You don't tell your supervisor "This guy is a meanie and hurt my poor feelings," you calmly, non-hysterically quote the above conversation and state it was wildly inappropriate and verging on harassment. But don't poly-report either - that makes you look like a whiner. There are asses you can ignore, and then there are those rare people whose behavior is unprofessional and plain injurious. Just make sure your own work and conduct is spotless and above reproach.

I do think the conversation on antisocial PD and psychopathy is fascinating.

Isn't it? Spoken like a true psychiatrist! I have done a lot of correctional psychiatry in the past. It's an issue that's near and dear to me.

And I do stick by what I said regarding withholding my interests from non-psych patients merely because it slows down my day. I'm doing outpatient FM right now and I don't have time to listen about their chronic depression. It would be very rude to say "my interests are none of your business" or "I don't have time to tell you", so "I don't know" is just a lot more practical and polite.

Of course you don't say "none yo biz," but in the course of FP practice, chronic depression is a bread and butter problem. If a FP ignored it, he or she would be doing a pretty lousy job. This is the main reason I finally decided against FP - the yeast infections and insulin prescriptions, the otitis media and chronic HTN were too much of a distraction from the interesting psych stuff. The best FP's are able to establish such a seamless balance. Not me.

 

[pysch4sure]

See now, that's just unacceptable, rude behavior. You don't tell your supervisor "This guy is a meanie and hurt my poor feelings," you calmly, non-hysterically quote the above conversation and state it was wildly inappropriate and verging on harassment.

That sounds like a great plan, and I wish it was viable. Trust me, I have some pretty awesome day dreams. But, it's not gonna happen. This gentleman is the specialist surgeon who makes buko $$$ for the hospital. He's also a chair. There is no way on God's green Earth that a med student has a shot at challenging him (see my previous equation). This powerful 'supervisor' you speak of does not exist. What would end up happening, best case scenario, is that he'd get a gentle talking to, and I would make enemies of all the surgical residents and surgical-wanna-be students.

Of course you don't say "none yo biz," but in the course of FP practice, chronic depression is a bread and butter problem. If a FP ignored it, he or she would be doing a pretty lousy job.

I'm not saying I ignore depression on my FM rotation. Rather, the questions are, "do you want to hurt yourself or someone else?", and "how's your mood today?". Beyond that, I don't care. She's here for a sore throat, diabetes management, etc. I have but a few minutes to come up with a treatment plan, and so her stable and treated depression doesn't really matter. So I don't want to get into a detailed psych history.

Which is why I totally agree with you, FM doesn't not go into enough depth when it comes to psychiatric problems. The issues they treat in FM are incredibly important, and I think they hold our nation's health in their hands.

But it's boring. Not my cuppa.

 

[LizzytheShrink]

That sounds like a great plan, and I wish it was viable. Trust me, I have some pretty awesome day dreams. But, it's not gonna happen. This gentleman is the specialist surgeon who makes buko $$$ for the hospital. He's also a chair. There is no way on God's green Earth that a med student has a shot at challenging him (see my previous equation). This powerful 'supervisor' you speak of does not exist. What would end up happening, best case scenario, is that he'd get a gentle talking to, and I would make enemies of all the surgical residents and surgical-wanna-be students.
....

No, I agree, you can't challenge the guy directly, it's impossible. He'll cut you right down.

Don't you have a dean? If your nemesis is the department chair, there is someone supervising medical education. He may not be your guy's "boss," but the Dean is responsible for the quality of the educational experience. It's not in his or her best interest to ignore true harassment. Anyone who speaks like that to subordinates is courting a lawsuit or other disciplinary action. Even if you ask the Dean not to take action, you are then on record with the school that this person was an problem for you, so if you wish to dispute an issue with your evaluation, you don't seem like you're crying after the fact. And the Dean may also be reassuring to you, which is the most important thing.

If you don't have a Dean or Director of Medical Education you feel comfortable making and appointment with, and speaking with, calmly and CONFIDENTIALLY about your concerns, your med school must be a hellhole... I don't know how else to properly handle it besides being calm and professional and using the chain of command appropriately. Hmmm...I've seen med students go the "car vandalizing" route... never turns out well for the vandalizer! Also remember, you always have the white-knuckle option... just like junior high, it's true torture, but in ten years, it will seem like it passed in 5 minutes.

And then when you're doing hospital consults and the surgical ICU is dying for you to show up in the middle of the night and manage someone's delirium, or help with a competency or brain death, they'll jump through hoops for YOU. Nothing those guys hate more than a crazy patient - and they love you when you show up! (they will still talk s*** about you, but not to your face, lol)

 

[LizzytheShrink]

And I can't tell you how many times I've been asked, ESPECIALLY by surgeons, to 'analyze' them. They would say things like, "I bet you're analyzing me right now" when they said or did something prickish, which was virtually all the time. When I was honest about my taste in medicine, I ended up having to lie more and feed egos all day. So I don't think being honest was any better.

ha ha! I have heard that so many times, I have a reflex response. "No way, I can't do that unless you have a pre-cert. Where's your insurance card?"

 

[Doctor Bagel]

Tenured specialist surgeon>>>>>>>>>>>>>>>>>>>>>>>>>>>scrub nurse>>>>>>>>>>CNA>>>>>guy who fills the coffee pot in the surgical lounge>>med student

2nd year resident here, and I feel about the same way about my importance in the world. I think maybe I outrank med students and the people who work in the cafeteria, but that's about it. From the nurses who page me endlessly to order laxatives and bacitracin to an attending who just sent me a totally uncalled for scathing email, I have absolutely no power.

But then I guess maybe the power that you (and I) have is not feeling like everyone needs to be ecstatic about your work. This attending is an a&&hole, but he's not going to fail you for doing psychiatry. You might get a C or a pass or whatever but psych programs generally don't care about that. And I can occasionally defend myself and make some enemies and still (probably) not get fired. We have no power, but these other people don't have quite as much power over our future as sometimes it seems like they do.

Anyway, forgive my nightfloat ramblings. Your statement in your post just hit exactly how I was feeling today. Medical school and residency suck. But maybe we can eek out some human dignity in the process, which can include not lying to please others.

 

[Ibid]

This is because of the following equation:

Tenured specialist surgeon>>>>>>>>>>>>>>>>>>>>>>>>>>>scrub nurse>>>>>>>>>>CNA>>>>>guy who fills the coffee pot in the surgical lounge>>med student

Nearly correct. guy who fills the coffee pot in the surgical lounge>>insert coffee pot>> med student.

A few years ago I was in an MDT meeting that was particularily well attended. The room filled up and eventually all the chairs were taken. The room had no table or other surfaces so when the tray with the tea, coffee and orange juice arrived.....somebody had to give up their seat so a place could be found.

The med student was asked if they could find something else to do. The poor guy had to give up his seat for some tea, coffee and a milk jug. I don't think I will ever forget it.

 

[notdeadyet]

It's apparent from reading this thread that many of you have had great experiences working with surgeons. That's great, and I am jealous.

I'm jealous too. I haven't had great experiences with surgeons. But I didn't feign career interest in their specialty either. They usually just shrugged and accepted that. Even the narcissists were fine with it ("if he's not into surgery, he's not worth of basking in its greatness" or somesuch).

But the rest of us have adapted to the working conditions: lying is, in my view, an advantageous adaptation. Even you NotYetDead lie in order to be a functional adult. You have no right to insinuate that those who have adapted to the crappy conditions are 'boot-lickers'.

Sorry, but lying for the sake of making a favorable impression on a superior in the workplace is pretty much the definition of "boot-licking." Calling it an adaptation is fine if that brings you happiness, but it's something that's done because you feel it gives you advantage, not because it's necessary. This isn't so much a criticism of anyone as a suggestions to consider an alternative that will likely work out as well (or better) with attending evaluations and just feel better on the soul.

Being honest and authentic only looks dangerous to those who don't do it. It's really not a big deal and it saves soooooo much anguish. I can't help but notice that those who found medical school most gut-wrenching and draining were those who tried to play the game of play-acting and lying to impress everyone rather than just being themselves.

To me, this all boils down to the vulnerability of medical students (I also read that residents aren't exactly in a position of power either).

Very true. And new hire attendings have to answer to senior attendings have to answer to Chief's, etc. That's what I meant about deciding if you want to be an authentic person in the workplace now. Boot-licking now leads to book-licking later and by the time you reach a point that there's no boots to lick many years later (if ever), it's become an ingrained lifestyle.

We are at the mercy of our attendings, and complaining to someone higher up is not an option.

It is and there's an appropriate way to do it. LizzytheShrink gave some excellent advice.

The med student was asked if they could find something else to do. The poor guy had to give up his seat for some tea, coffee and a milk jug. I don't think I will ever forget it.

I love this story. I will use it liberally.

 

[whopper]

Wife's cousin is a top-scorer in the USMLE, was at the top of her class in medical school and she went through the same bull because she went into Pediatrics. She too got the discouragement as if that field was beneath her.

That's the entire reason why she went into medical school in the first place, to treat children. This paradigm that is prevalent in medicine on doctors making value judgments based on such little information is a load of crock.

What a person does in response to this bull is up to them. I wish I could say to just be honest, and I would like to see that but I've seen too many egocentric and narcisstic doctors that could open or close doors and not respect others in a professional manner.

I had a doctor onetime get mad at me because I wasn't impresssed with his Jaguar (among other things but that was a stickler for him), and he took a lot of things personally. It's doctors like that that cause me to refrain from telling you to just simply be honest.

 

[pysch4sure]

Sorry, but lying for the sake of making a favorable impression on a superior in the workplace is pretty much the definition of "boot-licking."

You're not understanding. Trying to avoid being called a f*cking f@g isn't really the same as being a suck up.

Obviously, things seem pretty black and white to you. The term 'splitting' comes to mind...

Being honest and authentic only looks dangerous to those who don't do it.

Congrats, as you do not lie or withhold the truth to anyone ever, you are therefore 100% 'authentic' and honest. You may in fact be the Second Coming. Or a Jim Carrey movie.

Time to try out this ignore button...

 

[pysch4sure]

Also remember, you always have the white-knuckle option... just like junior high, it's true torture, but in ten years, it will seem like it passed in 5 minutes.

This is the option I went with. You are right, time will pass, and honestly, it now just seems like a blur of a distant memory. And it was only 4 months ago.

As for not taking action or standing up for myself, I don't think 'liar' best fits me, but rather 'coward'. I'm not saying that I would change anything if I did it again, because I wouldn't. I have a family so I'd rather not risk it. I am confident that if the surgeon is going around calling students f@gs that some bad karma will hit him someday soon.

Dr Bagel, I am fascinated by your comments about your status as a resident. One would think you gain some influence having the title Dr.! Surely they have to take orders from you, right? To use your example, how can the nurses force you to order laxatives?

And Ibid, you succinctly summed up my experiences with your story. I'll laugh at that years from now, but currently it's a little too close to home

 

[notdeadyet]

You're not understanding. Trying to avoid being called a f*cking f@g isn't really the same as being a suck up.

Obviously, things seem pretty black and white to you. The term 'splitting' comes to mind...

Take care, psych4sure. Aside from everything else, 3rd year passes quickly. Fourth year can be a dream if you let it (why take ICU rotations going into psych?). Intern year can be a bit of a drain, depending on program, but it sure beats being a student.

As others have said, it does keep getting better.

 

[LizzytheShrink]

This is the option I went with. You are right, time will pass, and honestly, it now just seems like a blur of a distant memory. And it was only 4 months ago.

As for not taking action or standing up for myself, I don't think 'liar' best fits me, but rather 'coward'. I'm not saying that I would change anything if I did it again, because I wouldn't. I have a family so I'd rather not risk it. I am confident that if the surgeon is going around calling students f@gs that some bad karma will hit him someday soon.

Exactamundo. our motto in residency was "what goes around comes around," and it was ALWAYS true. This guy will get his comeuppance. In 2011 you can't bandy those kind of words around in a professional setting. He's courting disaster.

Dr Bagel, I am fascinated by your comments about your status as a resident. One would think you gain some influence having the title Dr.! Surely they have to take orders from you, right? To use your example, how can the nurses force you to order laxatives?

ahhhhh they have their ways of getting what they want...

but seriously, the hierarchy placing doctors "above" nurses is sort of old-fashioned to me. it is better thought of as a team structure. most nurses know what they're doing. if it's an experienced nurse that I know is solid, if he/she "tells" me the patient needs a laxative etc, he/she is probably right. If you believe the nurse is really not asking for the correct thing, just give your rational coherent reason why, and (usually) she/he feels listened to and respected. I've learned so much about the nuts and bolts of patient care, over the years, from experienced, smart nurses.

those nurses have been there for years and they see students and residents of all stripes come and go. They have dealt with some awful doctors, so they don't automatically hand you true respect. I've heard them talk about other doctors, so I'm sure they've talked about me. I found that if you're respected by the nursing staff, your life is 2000% easier. And they get you presents!

I'd never think of nurses as below me in the hospital hierarchy. They might literally take a bullet for you. When I was an attending at a small community hospital in PA, an ex-patient came to the Partial Hospital acting agitated and loud and yelling to see one of the other staff psychiatrists. (none of us were physically there that time of day, doing clinics and consults, working at prison, etc). The partial hospital nurse manager came out and tried to speak with him in the waiting area to calm him down and figure out what his deal was. As the receptionist called security and watched, he shot the nurse in the heart and she died instantly. That kinda stuff really puts things into perspective, y'know? Our political and interpersonal struggles are revealed as petty in the scheme of things.

wow I'm old, and I want my license back, and I have to go STUDY!!!!

 

[Doctor Bagel]

Dr Bagel, I am fascinated by your comments about your status as a resident. One would think you gain some influence having the title Dr.! Surely they have to take orders from you, right? To use your example, how can the nurses force you to order laxatives?

They can't force me to, but they can certainly page me about it at inappropriate times, and I've got to respond to their page. The other night one of the hospitals I was covering literally paged me every 30 minutes about things that were not very important. I had to take it. The order isn't the harm; the inconsiderate page is. And if I say anything about it, they can always retaliate by just paging me more. Yay!

That plus getting a very disrespectful email from an attending kind of put me over the edge into hating being a resident. I agree that overall being a resident is better than being a 3rd year medical student (not better than basic sciences, though, which was a time when I really did have control over my life and my work), but it's still all around lame a lot of the time. And I'm still stuck there pretty much at the bottom with most of the people I interact with, which is not cool considering all the time, money and effort I've put into this endeavor.

Admittedly I am on nightfloat, and I'm slogging through the hardest year of residency in my program (2nd year). Hopefully that explains some of my negative thoughts about work and about my current work position.

 

[F0nzie]

[YOUTUBE]N-TZ8Z5S9rI[/YOUTUBE]

 

[whopper]

most nurses know what they're doing. if it's an experienced nurse that I know is solid, if he/she "tells" me the patient needs a laxative etc, he/she is probably right

Today a patient assaulted another on the unit and the charge nurse, a guy that IMHO is good at what he does, called the treating psychiatrist who then ordered Haldol 2.5 IM and nothing else.

We both have an opinion that the treating psychiatrist doesn't know what he's doing, and the patient was extremely agitated and violent. The nurse and I looked at each other knowing that the medication was likely not enough, but I'm not allowed to intervene given that it's not my patient, and the nurse could not do anything other than follow the doctor's orders.

I have empathy for good nurses in positions like this. Reminds me of being a resident and being forced to follow the orders of an attending that I knew was wrong.

I'd never think of nurses as below me in the hospital hierarchy. They might literally take a bullet for you.

Totally agree in addition you may make some good friends.

I have encountered toxic environments where the nurses were literally bullying the doctors. While they can exist, they are less common than the other situation, the doctor bullying the nurses, and this is often a sign a bad nurse manager. In any case, I haven't yet encountered this as an attending and only saw this as a resident with them bullying residents and attendings. I wouldn't tolerate it now because I'm in the fortunate position of being able to pick and choose where I work. Someone did that to me now I could just easily leave and tell the management why and heads would roll.

As a resident, the way the command structure worked, if I complained it wouldn't make a diference because the checks and balances involved attendings, nurse managers and the nurses. There was no real collaboration between the GME and nurses. Besides, if the attending was too freaking weak to stand up, you think a resident was going to get anywhere? Another part of the problem was I knew the attendings in those specific scenarios blew, the nurse manager was dysfunctional, and part of the reason why the nurses were acting in that manner was because the entire setup stunk. Not an excuse but it wasn't completely their fault.

 

[Doctor Bagel]

As a resident, the way the command structure worked, if I complained it wouldn't make a diference because the checks and balances involved attendings, nurse managers and the nurses. There was no real collaboration between the GME and nurses.

This is pretty much my opinion on life right now. I guess the part that smarts is that I really feel like I have no control over my work life in any way, which naturally creates frustration. I took this happiness quiz about a week ago and scored miserably low in regards to work because I answered in the affirmative about feeling like I don't have autonomy and about feeling like I don't have control over my schedule. Things that are true for all residents, sure, but things that apparently cause unhappiness in work for almost everyone.

As for the hierarchical stuff, I don't think nurses are beneath me either. However, I feel like I'm beneath pretty much everyone, and I'd like to at least by on par with somebody in this work structure. I guess the good news is that in 2.5 years I'll have some control over my work life. And next year, I won't be working that often at 2 am, so I won't get paged about a laxative (which you don't need at 2 am) or an antibiotic ointment (which honestly wasn't needed until the next bandage change the next morning).

 

[nitemagi]

This is pretty much my opinion on life right now. I guess the part that smarts is that I really feel like I have no control over my work life in any way, which naturally creates frustration. I took this happiness quiz about a week ago and scored miserably low in regards to work because I answered in the affirmative about feeling like I don't have autonomy and about feeling like I don't have control over my schedule. Things that are true for all residents, sure, but things that apparently cause unhappiness in work for almost everyone.

As for the hierarchical stuff, I don't think nurses are beneath me either. However, I feel like I'm beneath pretty much everyone, and I'd like to at least by on par with somebody in this work structure. I guess the good news is that in 2.5 years I'll have some control over my work life. And next year, I won't be working that often at 2 am, so I won't get paged about a laxative (which you don't need at 2 am) or an antibiotic ointment (which honestly wasn't needed until the next bandage change the next morning).

Comes in time, as does the realization that "control" is an illusion. There's management of a problem and minimizing it. There isn't control.

People on this thread need to get off the pity train. Residency is hard and in some ways thankless. And the nature of the beast as a student is being homeless - you never feel like you're fully welcome, fully know what you're doing. If you flip the perspective though, you can see this as learning experiences - to play well with others, to tolerate uncertainty and a lack of guidance, to find your own goals and recognize it's YOUR education, and that 20 years from now, no one's going to give a **** what you said on a 3rd year rotation in medical school.

 

[Doctor Bagel]

Comes in time, as does the realization that "control" is an illusion. There's management of a problem and minimizing it. There isn't control.

People on this thread need to get off the pity train. Residency is hard and in some ways thankless. And the nature of the beast as a student is being homeless - you never feel like you're fully welcome, fully know what you're doing. If you flip the perspective though, you can see this as learning experiences - to play well with others, to tolerate uncertainty and a lack of guidance, to find your own goals and recognize it's YOUR education, and that 20 years from now, no one's going to give a **** what you said on a 3rd year rotation in medical school.

Ah, I'm enjoying the pity train, so I'm not sure why I need to get off it. And about control, I honestly had a lot more control in my work life in the job I had before medical school, so we can wax philosophical, but there are varying degrees of control in work. Getting paged constantly is pretty much always a situation with no control over your time, which to me is a huge negative.

Moving away from the pity front, tonight is my last night of nightfloat forever. And I'm thinking I probably won't do overnight moonlighting gigs next year (control, yay!), so I'm moving away from this part of my life.

And MS3s, 4th year is coming, which is a great thing. And nitemagi is right -- no one cares about random comments during 3rd year rotations. You're not going to sabotage your career if you annoy some random surgeon by saying you want to do psychiatry. Do well on your psych rotation, get good psychiatry letters, get some good non-psychiatry letters, apply = succeed.

 

[digitlnoize]

no one cares about random comments during 3rd year rotations. You're not going to sabotage your career if you annoy some random surgeon...

I don't think anyone is afraid of that. But I can tell you from experience that there ARE some doctors out there (and some surgeons) who WILL fail students on rotations out of spite. It's never happened to me (thank god), but I've seen it happen to friends.

I know the arguments: a surgeon shouldn't be able to fail you just because you said you wanted to do psych. Yeah. I know. But, in some places, that can still happen. This may be more of a problem at certain schools and in certain rotation structures, and I think might be more of a problem at DO schools, like mine, where the doctor doesn't actually work for the school and there's very little actual contact between them and the school and very little way for the school to discipline someone who is abusive to students. The school is under pressure to have enough rotation spots for students to rotate at, so they might be "forced" to keep the horrible person...because a horrible teacher is better than none...at least as far as accreditation goes. It could also be a big problem in the situation someone described above, where the powerful mega-grant surgeon chair can't be questioned and is malignant.

The fear of failing a rotation is pretty strong. My rotation grades were 100% subjective, based on my attendings' impression of me. I know some schools blend the subjective grade and the NBME shelf grade, but our grade was 100% subjective + pass/fail shelf. So, if the attending decided to fail us, there's nothing you can do but retake the rotation...which isn't always possible if you've already burned your vacation month, for example.

An "interruption in your medical education" caused by a rotation failure (and even a lone rotation failure) can have a HUGE impact on one's career and match prospects. So, it's definitely a concern some of us have to deal with.

That being said, there are certainly much bigger things to worry about.

For the record, I was very upfront with both of my surgeons I worked with about my psychiatry interest and they were both very understanding and supportive, despite one being your "typical" surgeon. But by that point in the year, the end of 3rd year, I knew 1000% for sure. Much earlier in the year, I simply said that I really enjoyed my psych rotation (which was true) but that I was going to give everything a try before making a final decision (also true). Which is, I think, the best way to handle it.