So umm stress

[Doctor Bagel]

---

Members do not see this ad.

So I think I'm hitting my first real big time (even though it's not really that big) 3rd year stress and am just looking for some sympathy/empathy I guess. I'm just started my Medicine clerkship a week ago, which was one of the things I thought I wanted to and something I was pretty excited about starting. The first week was pretty cool, and I felt like I learned stuff in a fun environment. Well, then we switched teams this week. I've got the same attending, who's great and really into teaching medical students, which is wonderful. However, the new senior on my team has the idea that because of this attending's preference for medical students to learn a lot and have autonomy and decision-making input, that I have to essentially spot every issue with my patients and that it's all essentially on me.

Now before some of you jump on me and say that should be my requirements, I'll say that I agree. However, I'm just getting the feeling that I have to do everything just right or we'll have dire consequences for the patient (the attending doesn't do something because I don't spot or present an issue correctly) or for the team (I drop the ball, and my team gets reamed for it). And it's Medicine, which means there are tons of things to know and learn, and I don't have it anywhere near all the way down yet. So anyway, I'm just feeling entirely stressed out and a little overwhelmed by these new team dynamics and am thinking I finally get why some people are so down on 3rd year.

 

[DragonWell]

I think a lot of people feel somewhat overwhelmed for the first few weeks of medicine - I know I did. Everything is new, patients' have tons of problems and the learning curve is steep. Hang in there, keep your eyes open, read as much as you can and I think you will find yourself feeling much more confident and knowledgeable by the end of your first month. You'll get better at identifying the problems that you need to manage and those which you only need to identify in the H&P and then keep in the back of your mind.

Also, once you've seen the same issue in a few different patients, you'll have a much better idea of how to approach it the next time you see it, and you can then start to expand your knowledge and focus on the things you aren't familiar with. The tough part is, in the beginning, it's all unfamiliar.

Probably obvious, but find yourself a good pocket guide you can work with - I know many people swear by Pocket Medicine, but I actually ended up using other books (Current Treatment guidelines, St Frances Guide, UptoDate) quite a a bit as well.

You might also eyeball this thread, if you haven't already.

 

[smq123]

However, the new senior on my team has the idea that because of this attending's preference for medical students to learn a lot and have autonomy and decision-making input, that I have to essentially spot every issue with my patients and that it's all essentially on me.

Now before some of you jump on me and say that should be my requirements, I'll say that I agree. However, I'm just getting the feeling that I have to do everything just right or we'll have dire consequences for the patient

I doubt that they'll actually leave everything all on you. That may be the impression that you're getting, but I'm sure that you're going to be having an intern or a resident double checking everything. After all, THEY don't want to get yelled at either (or, worst case scenario, named in a lawsuit).

It's just a way of trying to motivate you to think like an intern - i.e., think of an assessment and plan, instead of just gathering the subjective and objective parts.

 

[PreMedAdAG]

Third year is VERY stressful - even though most of what you do has NO impact on any of your patients (every once in a while it does).

Medicine is OVERWHELMING.... there are so many things to do/take care of - and I completely understand you feeling frustrated and frightened by all of it (esp. if you are thinking of going into it).

Don't fret, what you're going through is NORMAL...but third year is kind of like the 4th quarter of a close football game - you better gut it out or get out....


Best of luck to you and remember that voicing your stress/frustration and all that good stuff is better than bottling it up inside and pretending you are not bothered by it. Good luck and do your best, that's all anyone can ask from you - and I'm sure you are - even if people act like you're not 😉

 

[tacrum43]

However, the new senior on my team has the idea that because of this attending's preference for medical students to learn a lot and have autonomy and decision-making input, that I have to essentially spot every issue with my patients and that it's all essentially on me.

They know you're a third year, and as such are not an MD yet. When I was on my Medicine rotation, I tried to always review my A/P with my intern/resident before presenting. You may well have to look up stuff in Cecil's, Uptodate, pocket medicine, etc. in order to know what should be done next. Learning this stuff is why we're here, right?

The other thing is that either an intern or resident should really be doing their own assessment of every patient too, so if you miss something then they should cover it (and vice versa to some extent).

Obviously, you don't want to miss anything with your patients, but as a 3rd year, you're not expected to get it right 100% of the time (thank goodness). I think having fewer patients than an intern allows you to be much more thorough, thereby allowing you to really know your patients well and to not "miss" anything. This might result in some superfluous info, but that's okay.

 

[ShyRem]

My first day on medicine (which was last week): 😱
My second day on medicine: 😱

By the end of the week, I was much better. Hang in there.

 

[QofQuimica]

I *told* you surgery was better than medicine!

All kidding aside, I agree with everyone else that we all go through that feeling of being totally overwhelmed on medicine, DB. Just hang in there and keep trying; it *will* get better. Also, read about your patients' diseases, the drugs they're taking, differentials for their symptoms, etc. I used Step-Up to Medicine and really liked it. The other thing that you should be doing is following up on whether your patients are actually getting their meds. I was shocked at how often patients just didn't get something for, oh, no good reason at all. Oh, and remember to include prophylaxis and disposition in your A/P. Sometimes all I could put for disposition was "to discuss with attending," but at least that way they knew I was thinking about the need to get the pt out of the hospital eventually. 😛

 

[Doctor Bagel]

Lol, I'm actually missing ob and our super short soap notes. Maybe surgery won't be so bad. 😱 So I'm a little less stressed today. I've realized that my senior is just a tense guy, and that's really what's going on. He's nice, just tense. It didn't really help that our new team didn't start working together until a call night, which exacerbated frustrations a little.

Thanks for the tips/sympathy.

 

[Doctor Bagel]

So I'm taking back my comment about my senior being OK.

Latest saga -- today is the senior's day off, and he had asked me to look something up. The dude pages me and asks me to call him after we're done rounding just so he can specifically see if I looked this thing up. Which admittedly I had forgotten about because he asks me to look up 20 million things each day, all of which are crap and only peripherally related to my patients or stuff I need to know for the exam. So then he tells me that I need to be sure to read about my patients every day, which actually is what I did instead of looking up his stupid lame-o assignment. And then when we get off the phone, he calls me intern and tells her to make sure I look this stuff up. 😡 Lame, lame, lame. I know I should have looked the thing up but I was more curious about reading about the actual diagnosis and treatment for my patient.

Following that rant, do you think it would be appropriate to talk to him about this and let him know that I will look up stuff on my patient but that I want to focus on what's interesting to me and what is stuff I actually need to learn? If there's anything he specifically thinks I need to know for treatment of the patient or for the exam, then sure he can tell me. His eval on me counts for 12.5% of my grade. 🙁

 

[smq123]

Following that rant, do you think it would be appropriate to talk to him about this and let him know that I will look up stuff on my patient but that I want to focus on what's interesting to me and what is stuff I actually need to learn? If there's anything he specifically thinks I need to know for treatment of the patient or for the exam, then sure he can tell me. His eval on me counts for 12.5% of my grade. 🙁

😱😱

That approach rarely, if EVER, works out well.

A first semester MS3 telling a senior resident that she would "prefer" to focus on things that she self-designates to be "important"....yipes. That is not going to go over well, unless your resident is SUPER laid back and cool. Which, admittedly, does not seem to be the case here. 🙁

Sorry that you have to put up with this kind of crap. 🙁 🙁 🙁 Keep your chin up, learn as much as you can, and then walk away with your dignity intact. Good luck.

 

[LuckyBambooGirl]

I agree with the last poster, just go along with him and look up his stuff. You may find that it is something important/need to know after all. I'm sure it can't take up too much time. He does have a lot more experience with patients than you do, and it may be more relevant than you think! Then you can look up the stuff you are interested in too.

 

[Doctor Bagel]

Yeah, you guys are right. I'll just look up his crap and make him happy. And I know I dropped the ball on this one, but I think it's really weird that he would actually page me to pimp me. Now to kind of manipulate my way towards looking up good stuff, I guess I'll just proactively volunteer to look up a ton of stuff before he can ask me to look up stuff.

I think he's powertripping, so I'm not going to go out of my way to make him happy, but I will look up his stuff. And I'll probably come back here to bitch about him a few more times. Now my goal is lay low for the next 2 weeks until this guy's out of my life. I've also confirmed that my reaction to him is not at all unique, which makes me feel better for no good reason.

Oh yeah, other question -- he'll page us at night when we're not in the hospital and not on call. Do you think that's reasonable? I'm tempted to just not return the pages because I'm off service and then call him back in the morning.

 

[dilated]

Oh yeah, other question -- he'll page us at night when we're not in the hospital and not on call. Do you think that's reasonable? I'm tempted to just not return the pages because I'm off service and then call him back in the morning.

Um, WTF? Why are you even able to receive pages? When I walk out of the hospital and have no clinical responsibilities my pager immediately goes off. Attempts to page it will just get "pager is not checked in". And no, that's not reasonable, it's freaking creepy.

 

[smq123]

Oh yeah, other question -- he'll page us at night when we're not in the hospital and not on call. Do you think that's reasonable? I'm tempted to just not return the pages because I'm off service and then call him back in the morning.

He pages you when you're at home? WEIRD. What earthly purpose does he claim for paging you at night when you're not supposed to be working?

 

[Doctor Bagel]

Um, WTF? Why are you even able to receive pages? When I walk out of the hospital and have no clinical responsibilities my pager immediately goes off. Attempts to page it will just get "pager is not checked in". And no, that's not reasonable, it's freaking creepy.

Our pagers aren't linked to the hospitals. Each student gets her own pager from the school that works on all your services, and yep, at home. I like your system better.

 

[QofQuimica]

Sorry that you have such a lousy senior, DB. Unfortunately, like smq said, you are not in the position to tell anyone above you in the hierarchy what is or is not important. Forget trying to understand whys and wherefores, and just focus on getting through whatever this idiot wants done as quickly and efficiently as possible. Force yourself to be detail-oriented and even more anal than he is. What I do is keep a small notebook in my pocket and make a list of everything I have to get done. Any time someone tells me to make sure to look this up or do that, it goes on my list. I check each thing off as I do it. In the case of an a**hole senior like yours, I'd also keep some kind of hard copy as proof (ex. print out the article or resource you used to find out the answer, and bring an extra copy to shove in his face (nicely, of course ) if he challenges you). I agree with the others that your senior paging you at home is completely inappropriate if you are not on call or otherwise supposed to be at the hospital. Either turn your pager off at the end of the day like someone already suggested, or leave it in your white coat pocket at school. I do the latter.

When the going gets tough, just keep reminding yourself that one month from now, this person is going to mean nothing in your life. That, and get yourself a monthly calendar, hang it on your wall by the front door, cross off each day as soon as you get home, and enjoy watching the number of days left on this rotation dwindle to zero. Ain't no stopping the clock. 🙂

 

[Doctor Bagel]

Ain't no stopping the clock. 🙂

I'm starting to love that quote. 👍 I like your idea about printing stuff out, too. I guess my thing is I just feel so intruded on and as a whole don't respond well to micromanagement.

 

[tanqueray84]

Leave your pager in your car. I'm an intern and my pager doesn't enter my house. My time is my time. Period.

 

[Doctor Bagel]

Leave your pager in your car. I'm an intern and my pager doesn't enter my house. My time is my time. Period.

Good call, and advice I'm going to follow.

 

[Green Chimneys]

Leave your pager in your car. I'm an intern and my pager doesn't enter my house. My time is my time. Period.

The point is that you're an intern, and he's not. Although you do presumably get evaluated, you're not getting a grade, and you're not trying to look good. You just need to provide the best patient care possible and go home.

Bagel on the other hand is a medical student. If the senior is paging you at home, and you've set a precedent of answering those pages in the past, you can't stop. If you do, you look like the jerk in his eyes. You absolutely should return his pages, and you absolutely should do whatever it is he asks of you on your "time off." It is wildly inappropriate for him to be doing this to you, and I can definitely sympathize, but as the student you really have no recourse. Do what he asks, suffer through, fake sincerity, and GTFO internal medicine.

To minimize the chance of this happening on future rotations (though I doubt it will), I would start out by NOT answering pages at home. If you get called out for it at work, apologize and explain that you don't typically carry your pager when you leave the hospital. Hopefully that will clue them in that you're not on 24/7 home call. If they are still oblivious enough to insist, THEN you can start answering home pages. If you put yourself out as a doormat on day one, you can't expect to stand up and dust yourself off without ruffling a few feathers.

 

[Mr. Freeze]

I personally would rub a spoon in my buttcrack s/p dooty and use it to stir the coffee I religiously get him every morning with a smile. Then, once grades were back, I would slide copies of the pictures I took of myself (blurring out any identifiable buttcrack tats. Who knows.) doing this under the door to the resident call room or wherever it is he works. In fact, you won't even have to actually do it. Get all Ocean's Eleven and ****. He just has to think someone did. It'd make a better story, though, if you did.

But that's just me. Maybe there are easier ways. You could like, talk to him or something. 😴

 

[LuckyBambooGirl]

Bagel on the other hand is a medical student. If the senior is paging you at home, and you've set a precedent of answering those pages in the past, you can't stop. If you do, you look like the jerk in his eyes. You absolutely should return his pages, and you absolutely should do whatever it is he asks of you on your "time off." It is wildly inappropriate for him to be doing this to you, and I can definitely sympathize, but as the student you really have no recourse. Do what he asks, suffer through, fake sincerity, and GTFO internal medicine.

I think this is taking it too far! I would not answer pages in the middle of the night!! Though he may have forgotten what it was like, your senior was once a medical student and should know that you are not supposed to be at his beck and call 24 hours a day!

 

[lord_jeebus]

It depends on what you're getting paged for.

Sometimes we page our students to tell them we decided to round earlier after they went home, or to round on a different patient because their patients got transferred to MICU or Surgery, or that we're inviting them to join us for margaritas and tacos, and I don't it's unreasonable to expect them to get the message.

If you're getting paged about stuff you were supposed to look up...that's a different issue.

 

[dragonfly99]

It would be extremely inappropriate for you to tell the resident you don't feel like looking up things he told you to look up. How long does it take? 1/2 hour? 1 hour? Come on. If you can't handle this you'll get your a-- kicked when you are an intern.

I would have been happy when I was a med student if my residents had paid 1/2 this much attention to teaching me. You are damn lucky.

I do agree that paging you a lot at home is over the top, but it actually could be kind of nice if he wanted to discuss what you were reading.

Like I said, many med students just get ignored, etc. and not taught at all. So you are one of the lucky ones.

 

[group_theory]

I would bring this up with the clerkship director. Let him/her be aware of what's going on, and what issues you are dealing with. Having the clerkship director involved will help if you get evaluated from the senior resident with comments like "doesn't care about patient, doesn't follow-up on patient, doesn't look up relevant stuff". The clerkship director might just go to your attending for his/her input and throw out the comments if your attending doesn't agree with them.

(if these comments ever make it to your dean's letter/MSPE - it will KILL your application)


If you're a 3rd year student on medicine, an intern should technically still be following that patient (and is the one responsible for patient care). If you forget to check labs, or call a consultant, or call transport so that certain imaging gets done - your intern should be the one doing it. Yes, it is additional work for the intern (hence the comment in House of God about medical students) - but its also a learning experience for the intern on how to be in a supervisory role. Ideally, you will go over your assessment/plan with the intern in the morning before rounds, go over any active issues, the intern will guide you and give you additional guidance ... and on rounds, you will present the patient and your a/p, and if anything is missing, the intern and/or senior resident will jump in.

If you're a sub-I/AI - then you technically are at the "same" level as the intern and should run things by the senior resident. (although I believe you get to have a lighter patient load).


Medicine is a very broad field for medical students. But after a couple days or weeks, you will get the hang of things.

Off the top of my head, these are the things that I would make sure I want my MS3 to learn how to manage and treat

(inpatient)
COPD
Asthma
Pneumonia (CAP vs Hospital acquired)
Electrolytes imbalances (sodium, potassium, magnesium, calcium)
Acute Renal Failure
Sepsis
CHF
Diabetes (including DKA)
Abdominal pain (non-surgical causes)
Change of mental status
Chest Pain workup
Acid-Base disorder
Dehydration
Shortness of Breath (workup)

I would also want my MS3 to learn how to read EKGs, tele monitors, CXRs, KUBs, and maybe CTs of the Head and Chest.

 

[Doctor Bagel]

So, more from the tales of the crazy team. Our team had call last night which I missed because I had to go to my longitudinal clinic (special requirement at my school that trumps all other academic demands). I offered to go in after I got out of the clinic (usually about 10 pm), and my senior told me not to worry about it. However, he said he would call me that night and assign me new patients. Well, since he hadn't called me by the time I got home, I paged him, but he didn't return my page. I assumed from that lack of page return that I hadn't been assigned new patients, but of course I showed up and had been assigned a brand new patient. We also were rounding earlier than usual but I hadn't been told that either. Luckily my other two patients had left our service (discharged or sent to ICU), so I was able to actually round my patient and get most of the info. However, I missed one minor point (did the patient smoke -- note, she wasn't in there for anything cardiac/respiratory related). Then my intern proceeded to bitch at me for not knowing that one point, which I realized later was projection -- read on.

So we're rounding, and we hit a patient that my intern had admitted last night. She didn't know one detail about the patient's medications. She and the senior then got into this weird pissy thing between them and the attending and wound up really making the attending mad. The attending got so bugged by them that he actually asked them to leave and stop rounding with us. 😱 So they're getting on me for messing stuff up, and they're messing up stuff, too. And apparently they're driving the attending every bit as crazy as they're driving me.

I'm just so glad I don't have to go in this weekend because I figure things would trickle down my way.

 

[QofQuimica]

I would only go to the clerkship director if you are sure s/he will more than likely support you. If you think there is a realistic chance that you'll be pegged as a troublemaker and dismissed out of hand, save yourself the time and aggravation, and just look up whatever crap the resident wants you to look up. Bring the papers with you on rounds so you can hand them out. Oh, and make sure to get a smoking hx next time, and present that during rounds too. 🙂

Do you have a Maxwell's, DB? It has a list of all the info you should be getting during a full H & P. That book has saved me on multiple occasions when I was having one of those WTF moments.

 

[Doctor Bagel]

Do you have a Maxwell's, DB? It has a list of all the info you should be getting during a full H & P. That book has saved me on multiple occasions when I was having one of those WTF moments.

I do, and I wonder if I should reference it when I'm researching patients that I'm not admitting. That's been part of my problem this week -- I didn't get to admit any patients on any of our calls because I've been away due to other school/clerkship obligations. The drag on that is that I feel like I'm walking in in the middle where I'm doing a progress note without doing an H&P and having to jump into everything the next morning without the time to really evaluate things and talk to the patient much. Again, I know this is not an excuse. I'm not doing this stuff as well as I should be doing, but the constant criticism is really dragging me down. I seriously don't even want to go in in the morning.

Anyway, that's my pity party. I'll continue to try to do better but still expect pretty constant criticism. Who'd have known my medicine people would be more malignant than the people on ob? 😱

But editing to add that I have the weekend off, so I shouldn't be thinking about this stuff.

 

[thorg12]

best of luck db. i feel bad about whats going on. i always forgot little stuff that youd only know if you did the h&p ie obsure family hx, social hx etc(and i forgot even if i did the hp) Just say dont know and ill look it up. if you really want to u can photocopy the hp. i did this if i had the feeling of its gonna be a bad day bc i know nothin about this pt. best of luck. ur team will hopefully change soon. let us know how it goes.

 

[smq123]

That's been part of my problem this week -- I didn't get to admit any patients on any of our calls because I've been away due to other school/clerkship obligations. The drag on that is that I feel like I'm walking in in the middle where I'm doing a progress note without doing an H&P and having to jump into everything the next morning without the time to really evaluate things and talk to the patient much.

Sorry about that. 🙁 That was definitely one of the hardest skills for me to master as an MS3 - rounding on patients that I had never seen before, and knew nothing about.

It IS great practice though - it teaches you what things are really important, and how to be faster at summarizing a patient's history. It used to take me half an hour of reading the chart before I felt like I had even a tenuous grip on a patient's history. But, now, it takes me 5-10 minutes - and this will probably come in handy when I'm a resident.

Anyway, that's my pity party. I'll continue to try to do better but still expect pretty constant criticism. Who'd have known my medicine people would be more malignant than the people on ob? 😱

I know, it's always a surprise. My intern on PEDS, of all things, was much more toxic than my chief on L&D and my trauma chief combined.

I offered to go in after I got out of the clinic (usually about 10 pm), and my senior told me not to worry about it. However, he said he would call me that night and assign me new patients. Well, since he hadn't called me by the time I got home, I paged him, but he didn't return my page. I assumed from that lack of page return that I hadn't been assigned new patients, but of course I showed up and had been assigned a brand new patient. We also were rounding earlier than usual but I hadn't been told that either.

Is there another med student on your team with you? I have been exceptionally lucky and have always had residents that would keep me "in the loop" - but, sadly, that doesn't always happen to all med students. I think that when there are several med students on the team, it's up to them to look out for each other. If there is another med student, talk to them and let them know (nicely) that you'd appreciate it if they'd give you a heads up next time the team is going to round earlier than you thought. Not only is it a nice thing to do, but it's good practice for when you're a resident.

I find it ironic, though, that your resident thinks that it is okay to page you at night and make sure that you're reading on the topic that he assigned you....and yet can't take the time to page you and let you know that the team is rounding earlier than expected the next day. 🙄 Nice.

 

[group_theory]

So, more from the tales of the crazy team. Our team had call last night which I missed because I had to go to my longitudinal clinic (special requirement at my school that trumps all other academic demands). I offered to go in after I got out of the clinic (usually about 10 pm), and my senior told me not to worry about it. However, he said he would call me that night and assign me new patients. Well, since he hadn't called me by the time I got home, I paged him, but he didn't return my page. I assumed from that lack of page return that I hadn't been assigned new patients, but of course I showed up and had been assigned a brand new patient. We also were rounding earlier than usual but I hadn't been told that either. Luckily my other two patients had left our service (discharged or sent to ICU), so I was able to actually round my patient and get most of the info. However, I missed one minor point (did the patient smoke -- note, she wasn't in there for anything cardiac/respiratory related). Then my intern proceeded to bitch at me for not knowing that one point, which I realized later was projection -- read on.

So we're rounding, and we hit a patient that my intern had admitted last night. She didn't know one detail about the patient's medications. She and the senior then got into this weird pissy thing between them and the attending and wound up really making the attending mad. The attending got so bugged by them that he actually asked them to leave and stop rounding with us. 😱 So they're getting on me for messing stuff up, and they're messing up stuff, too. And apparently they're driving the attending every bit as crazy as they're driving me.

I'm just so glad I don't have to go in this weekend because I figure things would trickle down my way.

Wow - sounds like a pretty dysfunctional team. Sorry to hear that. Hopefully your experiences in medicine won't be clouded by this negative interactions. Hopefully you will get a chance to work with a good team.

 

[RxnMan]

...However, I'm just getting the feeling that I have to do everything just right or we'll have dire consequences for the patient (the attending doesn't do something because I don't spot or present an issue correctly) or for the team (I drop the ball, and my team gets reamed for it)...

Your job is to do the best you can as a novice (it's just what we all are) and to learn. You cannot do anything that affects patient care - the system is designed with back-ups (residents, interns, attendings) and should be fine with or without you. If your team gets reamed for it, it is the resident's fault. You are blameless, as anyone who entrusts the 3rd year with anything is circumventing the back-ups above.

I've felt everything you've written, and you should put stress on yourself to do well, but realize you aren't going to kill anyone and you can't control everything - by the amount of training you and I have recieved so far, we are expected to screw up!

 

[Doctor Bagel]

So I talked to other students who have rotated with this senior, and they had the exact same experience as me. I concluded the guy just didn't like me, but I guess that's just how he is. They also mentioned he didn't ding them in evals.

Now the new suck of my rotation is that I've realized everyone on my team hates each other. The attending doesn't like the senior and one of the interns, and the two interns don't like each other. We're just an altogether unhappy crew, and I am definitely not having "fun," which is apparently what is supposed to be happening. 🙄

I'm really curious about how I'm going to feel about this rotation when I get on a new team.

 

[Doctor Bagel]

I am almost done with this team and couldn't be happier. Just had my last call and remembered exactly why I'm not a fan of this senior. One of his new criticisms of me is that I'm not "aggressive" enough about paging him at night and in the morning to ask for new patients or to discuss my patients. That would be less of a problem if I could actually stand talking to him. Not to mention that one incident I wrote about above where he didn't return my page. And he got reamed by a patient today for basically being an *******, and his completely inappropriate response was to argue with the patient about her opinion about him. 🙄

2 more days ....

Editing to add that I did broach this issue with the clerkship director during a scheduled one on one meeting that we all had with him. He had heard stories about the whole attending/resident throw down I wrote about above and also about issues between the senior and the sub-I on our team. At the time that I had talked to him I wasn't hating my senior as much but mentioned that I did have some difficulty working with him. The clerkship director said he had heard similar complaints and mentioned that this senior has a very black and white approach to things, which can make working with him frustrating.