Sociall awkward surgeons

[train111]

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[Winged Scapula]

Socially awkward? No. As a matter of fact, I find surgeons *more* socially outgoing and skilled than many other specialties. Social skills require confidence which is something most surgeons have in spades.

Socially inappropriate? Yes, many in medicine are and surgeons, when pressed for time and due to our often assertive personality, can be.

I think there is a difference between the two. There may also be a difference between older and younger residents, and those who have prior lives before medicine. I frankly found older residents in all specialties tended to interact with others better.

I think you have unfortunately found yourself in a program which just doesn't fit for you. Most programs have a "personality" and like begets like. They are simply selecting for that type of resident. Somehow you slipped through the cracks.

 

[SLUser11]

Just wondering, does anyone think that surgery residents in general are just more socially awkward compared to residents in other specialties, like Internal Medicine or Peds? I've just found a hard time jiving with some of the residents in my program. I get along with everyone, but there are only a few that I actually click with, and in my opinion, they are the ones who are more socially ept, considerate, self-aware, and feeling-oriented people. It's just frustrating b/c some of the most well-liked residents are ones that I think are socially awkward. It's as if they're popular b/c they know how to be sarcastic, rude, and insulting to others - what I consider overall socially inappropriate and emotionally immature. It's amazing how they handle patient complaints, too - just so inappropriately at times and with a huge lack of empathy. In fact, all of my closest friends from prior to residency are in non-general surgical specialties. And when I'm on rotations where there's a mix of residents, e.g., EM, anesthesia, Urology, I actually tend to get along with them much better than general surgical residents (the exception are general surgical residents aiming for Pediatric Surgery as they seem to be very socially appropriate). I was wondering if anyone else feels that way. It's just been frustrating b/c my closest friends are still outside the residency program.

I'm not sure that you are using "awkward" correctly...especially since you go on to describe the same people as popular.

I will agree with you that some other specialties have a greater concentration of "feelings-oriented" residents, whether or not that's a good thing.

Are you a categorical surgery resident in this program you speak of?

Anyway, my advice is to try and fit into this fraternity of surgery residents, even if it means compromising your personal beliefs and morals. It's just really important to be popular, so you do what you gotta do. The best bet is to approach them with a story, such as "so I was bangin' this chick yesterday, right after last night's UFC fight...."

That usually works. If not, work in some hipster lingo such as "hangin' with my peeps" or "munchin' on some 'za."

 

[JackADeli]

Socially awkward? No. As a matter of fact, I find surgeons *more* socially outgoing and skilled than many other specialties. Social skills require confidence which is something most surgeons have in spades.

Socially inappropriate? Yes, many in medicine are and surgeons, when pressed for time and due to our often assertive personality, can be.

I think there is a difference between the two. There may also be a difference between older and younger residents, and those who have prior lives before medicine. I frankly found older residents in all specialties tended to interact with others better...

I must agree with WS. Just to add, surgery residents, IMHO, have their patience tested far more then most specialties. So, our interactions with colleagues with a generally lesser sense of urgency can beless then ideal. With time and maturity, we gain more patience... because we need more.

Just to spell it out, "we" are generally expected to answer our pagers in under 15 minutes during residency. We are expected to also call consults physician to physician. Our colleagues not in surgery are generally expected to answer in under an hour. So, you can imagine the "interface". We get a page from a non-surgery physician. We call it back promptly. We get a ward clerk that informs us the physician asked them an hour ago to "call a consult". So, irritated already (as the clerk has no information), we get the requesting physicians name and page them.... and wait the "customary hour" for a call back. And, we haven't even gotten into the consult by this point and the possibility that maybe, just maybe the request for consult submitted by a clerk with no information may be a real emergency and now THE PATIENT IS HURT... and this chain of delays and lost time has a cascade effect accross all our other patients, etc....

So, to an outsider it may seem we are impatient, etc.... In reality, we are forced to develop the level of patience of a Budhist Monk!

Thus, once done of residency, if you have achieved control of your emotions under these conditions, mastered the interface between the patient's need for urgent/emergent surgical care and the lack of urgency in calling the surgeon and bite your tongue, you get referrals. Think about that little saying that hangs over alot of secretaries' desks, i.e.
"Bad planning/failure to plan on your part does not constitute an emergency on my part".
Well, it is the oposite for a surgeon, i.e.
"Bad planning/failure to plan/communicate/call on your part almost always constitutes an emergency on our part".

 

[dpmd]

Thus, once done of residency, if you have achieved control of your emotions under these conditions, mastered the interface between the patient's need for urgent/emergent surgical care and the lack of urgency in calling the surgeon and bite your tongue, you get referrals. Think about that little saying that hangs over alot of secretaries' desks, i.e.
"Bad planning/failure to plan on your part does not constitute an emergency on my part".
Well, it is the oposite for a surgeon, i.e.
"Bad planning/failure to plan/communicate/call on your part almost always constitutes an emergency on our part".

Like a patient a few days ago who was seen in the ER around midnight and a "consult surgeon in AM" order gets placed, so at 0700 when the clerk notices me finishing up rounds I get informed there is a hernia pt. Obstuctive symptoms, skin color changes and a white count so change around the schedule and get to deal with the smell of dead bowel that morning.

It sounds like your personality just doesn't mesh well with your colleagues. Or maybe your program is filled with a bunch of a-holes. Hard to say for sure. I have know some socially inept surgeons, but I have also met some rude IM folks, as well as an impatient pediatrician, and subspecialists with no empathy. There is variety in any field.

 

[VincentAdultman]

I must agree with WS. Just to add, surgery residents, IMHO, have their patience tested far more then most specialties. So, our interactions with colleagues with a generally lesser sense of urgency can beless then ideal. With time and maturity, we gain more patience... because we need more.

Just to spell it out, "we" are generally expected to answer our pagers in under 15 minutes during residency. We are expected to also call consults physician to physician. Our colleagues not in surgery are generally expected to answer in under an hour. So, you can imagine the "interface". We get a page from a non-surgery physician. We call it back promptly. We get a ward clerk that informs us the physician asked them an hour ago to "call a consult". So, irritated already (as the clerk has no information), we get the requesting physicians name and page them.... and wait the "customary hour" for a call back. And, we haven't even gotten into the consult by this point and the possibility that maybe, just maybe the request for consult submitted by a clerk with no information may be a real emergency and now THE PATIENT IS HURT... and this chain of delays and lost time has a cascade effect accross all our other patients, etc....

So, to an outsider it may seem we are impatient, etc.... In reality, we are forced to develop the level of patience of a Budhist Monk!

Thus, once done of residency, if you have achieved control of your emotions under these conditions, mastered the interface between the patient's need for urgent/emergent surgical care and the lack of urgency in calling the surgeon and bite your tongue, you get referrals. Think about that little saying that hangs over alot of secretaries' desks, i.e.
"Bad planning/failure to plan on your part does not constitute an emergency on my part".
Well, it is the oposite for a surgeon, i.e.
"Bad planning/failure to plan/communicate/call on your part almost always constitutes an emergency on our part".

LOL. Yes we a have an ortho consult for "leg pain, rule out compartment syndrome."

"OK, is the leg swollen/tight? Does the pt have pain with passive stretch?"

I don't know, I'm the ward clerk.

Awesome.

 

[Buzz Me]

I think one of the reasons General Surgery gets called for consults so often (despite the patient not actually having a surgical issue) is that the primary team knows that they'll promptly get a resident at the bedside. The "we only come in for emergency consults" excuse (as often used by other fields) doesn't fly.

 

[Dr.LeoSpaceman]

I think one of the reasons General Surgery gets called for consults so often (despite the patient not actually having a surgical issue) is that the primary team knows that they'll promptly get a resident at the bedside. The "we only come in for emergency consults" excuse (as often used by other fields) doesn't fly.

This is precisely the problem. Especially at hospitals where private medicine attendings admit but don't necessarily have resident coverage (or so I've learned in my experience). There is absolutely nothing more infuriating than a 5:45 consult on a medicine patient who was admitted through the ED via a phone call to the IM attending. More likely than not, you will be the first one to have seen the patient and do the workup. Those IM attendings know there is a surgery resident in house, so why should they bother to stay late (or come back in) to do the initial workup?

The moment I absolutely lost it, though, was when a ward clerk calls me on a weekend call and says "XXXX IM attending put in an order that says 'After patient's dialysis, call surgery resident on call to come pull femoral line.'" Of course, it wasn't our patient, or a patient we were even consulted on. I was absolutely enraged. Needless to say, I called him and said that was inappropriate, and I would not be pulling the line (after informing my chief of the situation). Sure, it would have only taken 5 minutes, but the pure laziness and disregard for my time were galling.

 

[goooooober]

Sure, it would have only taken 5 minutes, but the pure laziness and disregard for my time were galling.

I like that word. I am going to use it starting today. By the way, I have never ever been galling or socially awkward except that one time........

Oh well, I am sure she has forgotten all about it by now.

 

[maxheadroom]

This is precisely the problem. Especially at hospitals where private medicine attendings admit but don't necessarily have resident coverage (or so I've learned in my experience). There is absolutely nothing more infuriating than a 5:45 consult on a medicine patient who was admitted through the ED via a phone call to the IM attending. More likely than not, you will be the first one to have seen the patient and do the workup. Those IM attendings know there is a surgery resident in house, so why should they bother to stay late (or come back in) to do the initial workup?

The moment I absolutely lost it, though, was when a ward clerk calls me on a weekend call and says "XXXX IM attending put in an order that says 'After patient's dialysis, call surgery resident on call to come pull femoral line.'" Of course, it wasn't our patient, or a patient we were even consulted on. I was absolutely enraged. Needless to say, I called him and said that was inappropriate, and I would not be pulling the line (after informing my chief of the situation). Sure, it would have only taken 5 minutes, but the pure laziness and disregard for my time were galling.

This happened ALL THE TIME in the General Surgery years of my training. Lazy-ass PCP admits the patient via the ED and consults General Surgery for any number of bull**** things. Or the 2 a.m. call for a central line. Or any number of other "I don't want to take care of my patient right now" consults.

When a new Surgery PD came in (right after I finished), he laid down the law with the community attendings that the Surgery residents were not there for bogus crap like that and he would call them at 2 a.m. and tell them to go to hell and leave his residents alone if the patient wasn't surgical. It was pretty sweet to watch.

Around the same time, the hospitals mandated physician to physician contact in order to consult another service. No more unit clerk calling a consultant. That also made a huge impact when some lazy-ass had to actually call another physician and explain why s/he couldn't do his/her job.

 

[VATSallfolks]

I definitely disagree with surgical residents being socially awkward. Along the lines of the replies before mine, surgery residents are trained to be efficient, problem based practitioners. Outside of answering a question or decision making (to cut or not to cut in most cases) I'd say I see my fellow residents be much more responsive, human and "equal level" conversing than do some of my medical friends. IMHO, medical guys never come off their better than thou theme during patient interactions where as surgeons can identify with specific personalities easier. I guess i agree with the old sterotype of the surgeon who can be very likable (jock) but at the same time stoic and the medicine type being a little more erudite (nerdy). bottom line.

 

[45408]

The only consults we can do with a unit clerk making the call are things like "consult IR for a PICC" or "consult medicine for diabetes management." Pretty much everything else gets a call. If we (surgery) don't get called by a physician, there's no consult.

 

[maxheadroom]

The only consults we can do with a unit clerk making the call are things like "consult IR for a PICC" or "consult medicine for diabetes management." Pretty much everything else gets a call. If we (surgery) don't get called by a physician, there's no consult.

Disagree.

I'll agree on the stuff for IR, although as a junior resident I found that my patients often moved to the front of the line for a perc-drain, PICC, or any other procedure when I went down to Angio and talked to whoever was working that day. But, the fact is that those guys don't really want/expect much interaction with the provider who requests their services.

If you're letting the unit clerk call IM for diabetes management, I would encourage you to make that call yourself. Most of the time it will take you less than five minutes and the physician whom you're calling will appreciate hearing from you (who actually knows something about the patient) instead of the unit clerk.

Also, when you perpetuate the courtesy of physicians calling physicians, even for silly crap consults like diabetes management, you perpetuate a culture of better patient care by sharing information directly with your consultant.

Out in practice (even in academics), you'll find that calling the other doctor expedites a whole lot of crap for both you and your patients. When somebody consults me (either inpatient or outpatient), I call the provider after I've seen the patient and tell them what my plan is. PCPs love that and are much more interested in sending their patients to the specialist who keeps them in the loop and involves them in their patient's care.

 

[JackADeli]

I think one of the reasons General Surgery gets called for consults so often (despite the patient not actually having a surgical issue) is that the primary team knows that they'll promptly get a resident at the bedside. The "we only come in for emergency consults" excuse (as often used by other fields) doesn't fly.

No need to just think it, know it. I have been told as much from non-surgical colleagues in residency and in practice on numerous occasions.

For example, I was out to dinner with an IM colleague of mine. She and I have been close friends for some time. So, she gets this page from the ED. I listen to her.

She grumbles a little and then asks, "well does he have any abdominal pain?".
Then, after a brief pause, she says over the phone, "good, call a surgery consult".

I was a little taken back to be sure. She looked at me and explained how she understood that I probably lost a little respect for her, but...

she went on to explain this is what they practice in the communities, "The unwritten rule is surgeons must from time to time take crap consults to buy us some time... that is why you guys only operate on 1 out of 10 consults if your lucky...".
She further explained how surgeons are really the ~ED bouncers. "Every one expects surgeons to be a little gruff and to the point. A surgeon can clear the consult from the ED faster then a medicine doctor and can make the ED do their job" more so then IM.

The explanations, rationalizations, "how we learned in residency", "we had service size caps, etc, etc, etc.... continued for awhile. In fact, I gulped my beer down very fast just so the server could interupt and offer another. I ordered a salad, ate fast, skipped the sweets, had no apetite, very bad case of GERD that night. We are still social in the hospital but don't have much interaction outside.

 

[Buzz Me]

Absolutely ridiculous. Why can't people just do their jobs? It amazes me how lazy some people can be. No one wants to be a doctor anymore.

 

[Winged Scapula]

The moment I absolutely lost it, though, was when a ward clerk calls me on a weekend call and says "XXXX IM attending put in an order that says 'After patient's dialysis, call surgery resident on call to come pull femoral line.'" Of course, it wasn't our patient, or a patient we were even consulted on. I was absolutely enraged. Needless to say, I called him and said that was inappropriate, and I would not be pulling the line (after informing my chief of the situation). Sure, it would have only taken 5 minutes, but the pure laziness and disregard for my time were galling.

Yep, been there, done that.

As a matter of fact, I recall one instance when the dialysis NURSE called me to remove the dialysis catheter, a task I KNEW they always did.

When I inquired as to why I was being called, she replied that her shift was over and she didn't have time to stay.

Let's just say that while I didn't hang up on her, I made my displeasure known and also let the nephrology group (after discussing with my attendings) that we were not in house to remove catheters because the nurses have poor time management skills.

 

[Smurfette]

Totally dealt with the "call surgery resident in the middle of the night or on a weekend" BS all the time. Was worst at the private hospital we occasionally rotated at. Personal high(low)lights there included:

1. consulted to remove the stitch from a central line that was both placed and removed by non-surgeons (I refused)
2. consulted for recurrent epistaxis on a patient for whom the ENT had pulled the nasal packing out of 3 hours previous. ENT went home on that lovely saturday afternoon and refused to come back when called that the nosebleed restarted, telling the unit clerk to call the surgery resident to replace the packing. (I refused since the patient was stable. And I had a few choice words about it, since it took far too long to communicate my refusal to the clerk AND then the upset RN while I was slammed in the ER at the time.)
3. consulted for hematuria after a patient GU was already following pulled out his truly ginormous (I think a 24Fr) foley with balloon still inflated (i.e. self-TURP). The GU guy told the clerk to call surgery. I refused to see the consult, but stopped by the room to check it out since they said it was brisk bleeding, which was an understatement....he went to the OR....with GU. The GU guy started screaming at the RN when she called him back to say I wouldn't do it so I got on the phone to explain the amount of blood and that there was no freaking way I was going to get a foley back into HIS patient. As a side note, if any of you has ever seen how big the fully inflated balloon is on a 24 Fr foley is....ye-ouch!
4. the too-many-to-count middle of the night floor consults for BS belly pain which were actually a way to get a note and orders in the chart for the on-call guy sleeping at home....and the note was often essentially copied by him in the AM as the H&P. I eventually started writing "pt examined, no acute surgical issues, mgmt per primary MD, formal consult to follow" and holding onto the formal note until after his AM rounds.
5. I was paged to pronounce a patient dead (yes, this is a true story that happened to me)....whom we had never seen or been involved in his care. Of course, this was at like 4 am, and I refused to pronounce a patient and sign a death certificate for another service's patient (not to mention if there was any malpractice involved, my name would now be on the chart for NO good reason). They paged again 30 min later and I again politely refused and was told the in-house IM MD on-call was insistent that surgery deal with it. Found out the primary service was...you guessed it...IM. Got a third page some time later....by this time my team was there for rounds and the chief went NUTS. At this point the RNs were calling us since they wanted the patient pronounced so they could transport the patient to the morgue since no one else was willing. We felt bad for the patient's family, but obviously there was no way the chief was going to agree to that!

We actually started a BS consult list (complete with the offending physician) to give the chairman at that hospital, who thankfully always supported us and had our backs when it came to refusal to see consults as long as the chief resident had been informed. I think the guy who tried to get surgery to pronounce the patient got into some serious disciplinary action....

 

[maxheadroom]

4. the too-many-to-count middle of the night floor consults for BS belly pain which were actually a way to get a note and orders in the chart for the on-call guy sleeping at home....and the note was often essentially copied by him in the AM as the H&P. I eventually started writing "pt examined, no acute surgical issues, mgmt per primary MD, formal consult to follow" and holding onto the formal note until after his AM rounds.

Saw several of those and we developed a similar system. More importantly, we would get the PCP on the phone and talk his ear off at 3 a.m. We figured if you kept him talking on the phone for 5 minutes that you'd disturbed his sleep enough to keep him from falling back asleep.

Had one guy who tried to cosign surgical intern's BS consult notes as his admitting H&P. Several of these notes were anonymously forwarded to the Medical Executive Committee and he almost lost privileges.

 

[ACSurgeon]

Oh boy... what am I getting into!

 

[JackADeli]

...4. the too-many-to-count middle of the night ...consults for BS ...which were actually a way to get a note....and the note was often essentially copied by him in the AM as the H&P. I eventually started ...holding onto the formal note until after his AM rounds....

Yes, this one is particularly foul. Definately one that truelly grinds me. I have seen it accross several specialties. I have seen them dictate their billable note directly from my hand written consult/H&P. In my book, that is insurance fraud.

One particlular bad actor had this practice. He actually had some residents under him. He didn't actually see the patients. This fact became clear to me early on... I started to notice my consults were looking almost word for word like his evaluations and/or H&Ps. I then discovered there was a particular filing cabinet in which the residents were to collect the other services consults and file, "so he could dictate later". So, I was called for three consults. I whipped through them quickly and reviewed the cases with his residents. I then walked off with the consults in pocket and left a brief paragraph on the charts.

First, I got a call from the resident asking about my "long form consult". I informed the resident it was in my coat and would be on the chart by next day. I offered to go back through the case if they wanted. Resident declined.

Next, several hours later (after lunch I presume). I was called by the attending asking, "why have you refused to perform a consult?". I informed the attending I completed all three consults, hence the paragraphs in the chart and had reviewed with the residents. He grumbled and said some confusing things about assuring paperwork was in order or something and not the usual protocols, etc... But, he eventually said OK and got off the phone.

Finally, I got a phone call about three days later from billing. The gist of it was that I had somehow "misplaced" Dr "x"s H&Ps and this was costly, etc.... To which, I asked for a supevisor. I asked were this "misplaced" story came from.... Dr x. I then proceded to inform them that they have a significant problem on their hands. I explained his "protocol" and filing cabinet and issues of ~plagarism in medical documentation. I pointed out that a chart audit may cost a pretty penny. I also pointed out that RRC/ACGME may not be happy with his resident supervision conduct, etc...

Well, Dr "x" was somewhat important player... but seemed to vanish from these resident's program within about 48 hours. There was alot of gossip and a scramble to replace him. The filing cabinet disappeared too ... only it vanished within hours of my conversation with the billing division manager/supervisor.

PS: after that incident, I started dictating my "long form" consult directly (i.e. using the form template but not actually writing on it) and writing a paragraph in the chart stating "x, y, z and see dictation for complete consult".

 

[maxheadroom]

PS: after that incident, I started dictating my "long form" consult directly (i.e. using the form template but not actually writing on it) and writing a paragraph in the chart stating "x, y, z and see dictation for complete consult".

That's precisely what we did. Left a basic explanation of what our diagnosis and plan was and nothing else. And then we could dictate the consult but not release it until it had been reviewed (to keep the primary from using the dictation).

 

[45408]

Disagree.

I'll agree on the stuff for IR, although as a junior resident I found that my patients often moved to the front of the line for a perc-drain, PICC, or any other procedure when I went down to Angio and talked to whoever was working that day. But, the fact is that those guys don't really want/expect much interaction with the provider who requests their services.

If it is anything that is more complicated than something like a PICC, we often do talk to them, or at least their NP.

If you're letting the unit clerk call IM for diabetes management, I would encourage you to make that call yourself. Most of the time it will take you less than five minutes and the physician whom you're calling will appreciate hearing from you (who actually knows something about the patient) instead of the unit clerk.

They actually make it quite complicated to call the hospitalists with consults, because there's some central office that deals out the consults to them, rather than a fixed call schedule. I wouldn't mind calling them.

she went on to explain this is what they practice in the communities, "The unwritten rule is surgeons must from time to time take crap consults to buy us some time... that is why you guys only operate on 1 out of 10 consults if your lucky...".
She further explained how surgeons are really the ~ED bouncers. "Every one expects surgeons to be a little gruff and to the point. A surgeon can clear the consult from the ED faster then a medicine doctor and can make the ED do their job" more so then IM.

That's some serious bull****. We're lucky enough not to have community medicine docs admitting here, so the hospitalist admitting the pt is always here too.

Had one guy who tried to cosign surgical intern's BS consult notes as his admitting H&P. Several of these notes were anonymously forwarded to the Medical Executive Committee and he almost lost privileges.

that's awesome. You would think he would at least *try* to be sneaky about it and dictate a nearly verbatim copy or something rather than just saying "PT SEEN AND EXAMINED. AGREE WITH ABOVE."

PS: after that incident, I started dictating my "long form" consult directly (i.e. using the form template but not actually writing on it) and writing a paragraph in the chart stating "x, y, z and see dictation for complete consult".

I dictate most of my complicated surgery consults. The appies and free air ones are usually short enough to just write down, but the circuitous stories in patients with lengthy histories are just faster for me to dictate. Plus, they're easier for everyone to read, and it's easier for me to find them in our computer later.

 

[Buzz Me]

At hospitals with electronic note systems (I first noticed this at the VA a few years ago), I've often found ER/IM attendings' H&Ps directly copied and pasted from my own...just with a few points on the assessment and plan changed. And sometimes, not even that.

 

[45408]

I went to an M&M about a VA patient whose PCP had been copy/pasting his own progress notes on the same patient, whilst ignoring the fact that now in 2010, the note said "Will arrange f/u testing in 2008," and the patient developed a recurrence of cancer.

 

[JackADeli]

I went to an M&M about a VA patient whose PCP had been copy/pasting his own progress notes on the same patient, whilst ignoring the fact that now in 2010, the note said "Will arrange f/u testing in 2008," and the patient developed a recurrence of cancer.

That's classic.

But, I just want to add this is NOT unique to PCP or ED. This thread started as discussing surgeon personality, etc... I think the recent twist in the thread shows some of the unique nature of prolonged conversations over time. I hope we don't get too far down the path of pointing fingers, etc... I will say, for the record, I have seen the above conduct and conduct (i.e. failure to examine, copying the work of colleagues unchecked) described throughout this thread accross specialties. Thus, I tried to leave out the specialty of the file cabinet bandit story recalled above... I have seen very agregious conduct from surgeons.

It is important to recognize the prolonged follow-up scenario raised above makes for shock & awe moments [and may often be reported in reference to PCP at surgical events/conferences/etc] but is made possible because the PCP often has the longest follow-up and has numerous issues to follow. The moments I have seen in surgical fields are as agregious if not more because it was the primary if not the only reason the surgeon was actually seeing the patient in follow-up!

I think the take home message is we need to hold ourselves accountable and not just look the other way as colleagues may be conducting themselves in this manner. It not only endangers or hurts patients but enables the culprit to profit through ~fraudulent acts.

EMR are very tempting and can lead us to follow an easy/lazy path. Plenty of insurance fraud cases have occured from the temptation as such. I have cut & pasted from others notes, but have confirmed the information with the patient or family. In cases in which confirmation was not feasible, I referenced the source, ie. "as per documented in X, Y, Z physician's H&P....". There is a line bewteen using EMRs to be efficient limiting duplicate work and being just lazy and cheating....

 

[dienekes88]

At hospitals with electronic note systems (I first noticed this at the VA a few years ago), I've often found ER/IM attendings' H&Ps directly copied and pasted from my own...just with a few points on the assessment and plan changed. And sometimes, not even that.

Haha. How much of your note was copied from the medical student's?

 

[Winged Scapula]

Haha. How much of your note was copied from the medical student's?

Since medical student notes aren't often in the chart (either because hospital policy forbids it or the student is holding it to present from), residents may not copy student notes. Sounds like it's different at your place.

 

[JackADeli]

Haha. How much of your note was copied from the medical student's?

Since medical student notes aren't often in the chart (either because hospital policy forbids it or the student is holding it to present from), residents may not copy student notes. Sounds like it's different at your place.

I know that when a med-student writes a note and presents it, we then follow into the patient room and review the materials just presented. That is, assuming I or another member of the team (i.e. my resident) was not there with the med-student while he/she was interviewing and/or examining the patient. My med-students do often serve as a high level scribe under the residents supervision. I expect myself or the residents to review the material and make corrections to the students work both on physicial exam and written notes/presentations.

 

[dienekes88]

Since medical student notes aren't often in the chart (either because hospital policy forbids it or the student is holding it to present from), residents may not copy student notes. Sounds like it's different at your place.

I know that when a med-student writes a note and presents it, we then follow into the patient room and review the materials just presented. That is, assuming I or another member of the team (i.e. my resident) was not there with the med-student while he/she was interviewing and/or examining the patient. My med-students do often serve as a high level scribe under the residents supervision. I expect myself or the residents to review the material and make corrections to the students work both on physicial exam and written notes/presentations.

Just a joke.

I haven't even rotated on surgery yet.

 

[Winged Scapula]

Just a joke.

I haven't even rotated on surgery yet.

Gotcha...sorry. You'd be suprised at the number of medical
Students who come to this forum full of bravado and criticism, somehow thinking that makes them more "surgeon-like."

 

[JackADeli]

Just a joke.

I haven't even rotated on surgery yet.

Ok, when you do rotate, I encourage you to have the expectations I have outlined.... that is supervision, observation, correction, and all other forms of teaching. Your note may very well be a work of scribing... But, you are there to learn and be more then just a secretary.

 

[dienekes88]

Gotcha...sorry. You'd be suprised at the number of medical
Students who come to this forum full of bravado and criticism, somehow thinking that makes them more "surgeon-like."

Don' worry abouddit.

Ok, when you do rotate, I encourage you to have the expectations I have outlined.... that is supervision, observation, correction, and all other forms of teaching. Your note may very well be a work of scribing... But, you are there to learn and be more then just a secretary.

Of course

I consider myself less scribe and more automaton anyway.

Will. Follow. Orders. *buzz buzz* Commence. Program: Pre-round @4AM. *beeeeep*

 

[JackADeli]

...I consider myself less scribe and more automaton anyway.

Will. Follow. Orders. *buzz buzz* Commence. Program: Pre-round @4AM. *beeeeep*

I guess you are planning a career in surgery

 

[45408]

Haha. How much of your note was copied from the medical student's?

Generally speaking, as long as you add an appropriate addendum, it's pretty much par for the course for an upper level person to use the lower level person's note. Rules vary widely as to whether or not you can use any part of a med student's note, but for some things, as long as you add "Pt seen and examined with student/resident, agree with assessment and plan" or some such variant as required by your institution/payor, you're in the clear.

Just make sure they didn't write something stupid.

 

[Buzz Me]

Often my "addendum" to the med student's note is so long it's basically a note in and of itself. Or the "...agree with the above assessment and plan except for..." bit gets so long it's comical.

 

[deegs]

Often my "addendum" to the med student's note is so long it's basically a note in and of itself. Or the "...agree with the above assessment and plan except for..." bit gets so long it's comical.

With our EMR, i just edit the med stud note to transform it into something intelligent, and then sign "agree with above edited note". some students require more editing than others......

 

[myhandsarecold]

question. so i just finished surgery and i actually fell in love with it and apparently I have "natural talent"; previously considered derm. anyways. i'm geeky and also gay and i just feel like i dont fit in with the surgery people. do programs discriminate out people like me? are there any programs out there where it wouldnt even matter? i feel like i would be setting myself up for 5 years of awkwardness and misery if I go into surgery, but i only dont want to pass up a surgical career either

 

[Apollyon]

question. so i just finished surgery and i actually fell in love with it and apparently I have "natural talent"; previously considered derm. anyways. i'm geeky and also gay and i just feel like i dont fit in with the surgery people. do programs discriminate out people like me? are there any programs out there where it wouldnt even matter? i feel like i would be setting myself up for 5 years of awkwardness and misery if I go into surgery, but i only dont want to pass up a surgical career either

If you wear "gay" on your sleeve, you're going to be discriminated against/made fun of/made to feel uncomfortable/unwelcome at a majority of places. A goodly number of surgical residents don't have much time to have sex with men or women during residency. Ironic humor is your mention of "awkwardness and misery".

If you have surgical talent and aren't saying in every other breath how you're not dating a guy, it won't be an issue.

 

[Smurfette]

We had several LGBT residents in my program (general surgery) as well as one openly gay attending in our dept. For the most part, it was a complete non-issue; all were good residents and that was the main thing everyone cared about, not sexual orientation. And some of these individuals were 'flamboyant' or 'drama-queen' types who didn't fit the "surgery" mold, although they definitely kept it toned down around patients and in the OR. (as a side note, one of them ranked our program #1 after he came to the dinner the night before the residency interview and heard us talking so casually about our 'out' faculty member and his partner that it was clear we had zero issues with it).

Do not let your sexual orientation be a factor in choosing a specialty. You are who you are and your orientation is one of many things that define you. Most people take a while to get settled and get to know all their co-workers before talking about personal stuff anyhow. Realistically, you will find individuals who don't like you no matter what you go into (whether they dislike you for your gender, orientation, race, appearance, personality, where you're from, etc.). These people are the exception, not the rule; life's too short to waste your time worrying about them....then again, I'm a female surgeon and have thick skin.

 

[SLUser11]

question. so i just finished surgery and i actually fell in love with it and apparently I have "natural talent"; previously considered derm. anyways. i'm geeky and also gay and i just feel like i dont fit in with the surgery people. do programs discriminate out people like me? are there any programs out there where it wouldnt even matter? i feel like i would be setting myself up for 5 years of awkwardness and misery if I go into surgery, but i only dont want to pass up a surgical career either

Being geeky is par for the course in surgery...we're doctors, after all.

As for being gay, I hate to say it but it may be a problem at some places. Certain programs are still old boys clubs, and alternative lifestyles are secretly frowned upon. I definitely don't think it should stop you, though, from pursuing a career in surgery.

I would find out from your resources which programs are considered more "gay-friendly." I specifically remember reading on the Case Western website (5-6 years ago) that they supported alternative lifestyles.

In the end, it's your personal life, and that is personal, so you don't really have to tell anybody. Most people recommend being as conservative as possible when interviewing for programs. Anecdotally, one of my friends from med school is gay and relatively flamboyant. He made no efforts to hide that, and did not match into OBGYN. It's not the same, but similar.

 

[agranulocytosis]

Never mind. Stupid question on my part.

 

[blue2000]

question. so i just finished surgery and i actually fell in love with it and apparently I have "natural talent"; previously considered derm. anyways. i'm geeky and also gay and i just feel like i dont fit in with the surgery people. do programs discriminate out people like me? are there any programs out there where it wouldnt even matter? i feel like i would be setting myself up for 5 years of awkwardness and misery if I go into surgery, but i only dont want to pass up a surgical career either

Being gay is NOT a contraindication to pursuing a career in general surgery. I would imagine that there are programs that are more or less accepting. I was part of a residency program where there are several gay/lesbian residents, and as far as I can tell as a straight person, it seems as though there aren't too many issues. It is slightly awkward when nurse after nurse asks me if a particular resident is single....I'm not really sure if I should tell them how much I like his boyfriend.

I'm sure there are not some secret gay surgery message boards out there, but word of mouth may be helpful in figuring out what programs to apply too. Additionally I am hypothesizing here, but programs that are thought to be "female friendly" (whatever that means) may also be gay friendly, in that they have a track record of accepting "alternative lifestyles" I of course am talking about the alternative lifestyle of having two X chromosomes.

 

[myhandsarecold]

thnx. i'm actually not out and very masculine in the outside. our program has a lot of females in it and the female attendings are very pro-female, anti-macho which is probably why i liked the rotation, aside from surgery itself. but outside the OR, i just can't block all the anti-gay talk from the male staff/residents which makes for a very uncomfortable/hostile environment and i imagine a lot of programs to be like. i'm still going to apply but will be sure to look thoroughly into the culture within the institution...

 

[JackADeli]

...but outside the OR, i just can't block all the anti-gay talk from the male staff/residents which makes for a very uncomfortable/hostile environment and i imagine a lot of programs to be like. i'm still going to apply but will be sure to look thoroughly into the culture within the institution...

That sort of environment is unfortunate. I can not speak for all places, but the tide (like general public AND military opinion) in general is changing. As was true when women started increasing in presence in residencies, it is less and less tolerated in more and more programs. At present, you need to find a place that you will "fit". That means you would be well advised to not go to a program that the social environment would be unpleasant and/or hostile. There are other programs out there.

Good luck and best wishes,
JAD