Lev0phed

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If you hear the nurses complaining about Dr So and So admitting someone for a "BS" reason, ordering a "BS" test, or for putting someone on a specific unit, can you try to not participate?

Super cringeworthy when the nurses (including NPs) huddle together and whine about Dr. XYZ being "such an idiot" for doing something and then the attendings, residents, and (yes) even med students join along with them. Just STFU and ignore. I mean after all, you do realize that they're also probably talking garbage behind your back, right?

Recent convo:

Attending A: "We're getting a new ICU admit. Post-partum female 25 years. Vital signs stable etc. etc. etc."
Nurse A: "Oh my gawsh she DOES NOT need to be here!!!!"
Nurse B: "I know, Dr. OB is such an idiot."
Attending A: "Yeah, he is probably just too lazy to see her himself so pawning him off on us."
Nurse A: "UGHHHHH just put her in Room 3"

********10 mins later***

Intercom: "Code blue ICU room 3, code blue ICU room 3."
 

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Nurses: covering up their inferiority complexes with propaganda from the ANA and horizontal bullying since the 1980's
 
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Or we could stop bashing EVERYONE. Nurses have an important role and without them we would all be royally f**ked. Midlevels are filling a big shortage gap. Other physicians have insights that we may not have coming from other specialties. Not being a huge jerk to anyone whose goal is to help the patient which is a common goal that we should all be sharing should just be the standard and it is sad that it isn't
 

Psai

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Or we could stop bashing EVERYONE. Nurses have an important role and without them we would all be royally f**ked. Midlevels are filling a big shortage gap. Other physicians have insights that we may not have coming from other specialties. Not being a huge jerk to anyone whose goal is to help the patient which is a common goal that we should all be sharing should just be the standard and it is sad that it isn't
Are they? We consulted a specialty service the other day and got a emr response from an np in which the assessment and plan was basically "keep doing what you're doing" and didn't address any of our questions. They even listed out our questions in the beginning of their note. wtf?

Another one was hey we're in a tight spot and we were wondering about surgery. NP's response was we already saw this patient in their last hospitalization and they don't need surgery. I'm like but they're here in the hospital again and circumstances are very different...you guys actually caused the issue that got them admitted again. They don't even see the patient or drop a note.

Filling a shortage gap indeed.
 
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ProfMD

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Are they? We consulted a specialty service the other day and got a emr response from an np in which the assessment and plan was basically "keep doing what you're doing" and didn't address any of our questions. They even listed out our questions in the beginning of their note. wtf?

Another one was hey we're in a tight spot and we were wondering about surgery. NP's response was we already saw this patient in their last hospitalization and they don't need surgery. I'm like but they're here in the hospital again and circumstances are very different...you guys actually caused the issue that got them admitted again. They don't even see the patient or drop a note.

Filling a shortage gap indeed.
I get these same responses from residents and fellows from time to time.

If a junior level person (APN, resident, fellow) gives a non-answer or an answer that doesn't seem right, then it is time for an attending-to-attending call.
 

neusu

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I get these same responses from residents and fellows from time to time.

If a junior level person (APN, resident, fellow) gives a non-answer or an answer that doesn't seem right, then it is time for an attending-to-attending call.
Agreed. That being said, often the attending is not particularly in the loop with the plan and gives non-answers as well.
 

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They can just ignore a formal consult placed in the emr and refuse to see the patient? I've definitely gotten pushback from residents too but I hand the phone off to my senior resident and haven't had issues yet. After a discussion, they've always come to see my patients eventually.
 

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I get these same responses from residents and fellows from time to time.

If a junior level person (APN, resident, fellow) gives a non-answer or an answer that doesn't seem right, then it is time for an attending-to-attending call.
Of course as an attending (and chief resident before that) I'm frustrated by how useless those calls can be. Some of the most egregious behavior by residents gets a response of "yeah, this kid is a little sh-it, but he'll be off my service in a week or so, and I don't want to deal with it."

They can just ignore a formal consult placed in the emr and refuse to see the patient? I've definitely gotten pushback from residents too but I hand the phone off to my senior resident and haven't had issues yet. After a discussion, they've always come to see my patients eventually.
Yeah, honestly that type of communication was sadly more effective between senior/chief residents than attendings (who are just there to get their inpatient time over with and go back to their clinics and research). It helped that I had a pretty good relationship with the medicine service chiefs, and we could hash out any issues that came up between consults, and could stamp out any attitude problems pretty quickly. Younger residents usually don't understand the fact that often there's a reason that the service is consulting us, even if they're communicating it in a really stupid way, especially for psych complaints.

...of course right after I left, one of the single worst offenders when it came to bad consult behaviors somehow became one of the IM chiefs. I felt bad for the people replacing me.
 
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ProfMD

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They can just ignore a formal consult placed in the emr and refuse to see the patient? I've definitely gotten pushback from residents too but I hand the phone off to my senior resident and haven't had issues yet. After a discussion, they've always come to see my patients eventually.
Can they? In some places, yes - depends on your hospital's policies. Should they? Nope.

One approach I found works well is to ask the person's name and tell them you are documenting in the chart that they did not feel that a consult was needed. This kind of a potential medicolegal threat usual gets people to come see the patient.
 

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Can they? In some places, yes - depends on your hospital's policies. Should they? Nope.

One approach I found works well is to ask the person's name and tell them you are documenting in the chart that they did not feel that a consult was needed. This kind of a potential medicolegal threat usual gets people to come see the patient.
Thanks for the tip, I'll try it. I'm still getting used to the games people play to try to get out of doing the damn consults.
 
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mcloaf

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Nurses: covering up their inferiority complexes with propaganda from the ANA and horizontal bullying since the 1980's
Dude didn't you start medical school like last week?
 
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mcloaf

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so what scrub, doesnt take an almighty upperclassman to realize nurses are d00shes
Lmao this guy giving commentary about inferiority complexes. OK bro, stay hard.
 

Amygdarya

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so what scrub, doesnt take an almighty upperclassman to realize nurses are d00shes
And this is precisely the attitude that will make your clinical rotations and residency miserable, Mr. I-figured-it-all-out-before-starting-med-school. Oh scratch that, this kind of attitude will make all of your adult life miserable. I suggest adjusting your attitude - for your own sake.
 

psychMDhopefully

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I'm seeing that 3rd year so far is more about learning hospital politics BS than it is about actual patient care. Every year in medical education, you think that the NEXT year is gonna be the year you actually learn something, but na. Nurses and techs gossip way too much, thats like all they f'ing do and they want you to join in but somebody, usually physicians and physicians in training have to be the f'ing professionals in the room, and thus some of my time as a med student is learning how to divert gossip talk when nurses and techs bring it to me. My resentment of the medical education process grows every year, you could make a competent doctor in half the time with half the stress, rant over.
 

psychMDhopefully

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Or we could stop bashing EVERYONE. Nurses have an important role and without them we would all be royally f**ked. Midlevels are filling a big shortage gap. Other physicians have insights that we may not have coming from other specialties. Not being a huge jerk to anyone whose goal is to help the patient which is a common goal that we should all be sharing should just be the standard and it is sad that it isn't

Tell that to the nurses, they are usually the ones talking crap, physicians usually are too busy and have other stuff to do.
 

sloop

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Thanks for the tip, I'll try it. I'm still getting used to the games people play to try to get out of doing the damn consults.
It's kind of a two way street though. People shouldn't be rejecting consults but primaries should be at least trying to formulate a coherent reason for consult.

I've done a decent amount of psych consult work so far in med school and some people will consult without any idea about the reason for consult.

About half of these, the teams try but just don't really know enough about the patient psychiatrically to formulate a question—this is fine and I just call the resident to clarify/help them formulate a reason.

The other half consists of teams dancing around the fact that their real reason for consulting you is inappropriate and they know it—often it's some dispo bull**** that their social workers are supposed to be able to deal with but for some reason can't/won't or the hospital is full and they want to unload their osteomyelitis patient with stable bipolar who still needs repeat blood cultures and IV antibiotics to the inpatient psych unit.
 

giantswing

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Tell that to the nurses, they are usually the ones talking crap, physicians usually are too busy and have other stuff to do.
A big cheese at a meeting said that nurses fill out something like 98% of the "get you in trouble" forms (the forms that are for "systemic improvement" that really become a threat when someone won't do what you want them to do in the name of "patient care"). Shocker.
 
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Psai

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It's kind of a two way street though. People shouldn't be rejecting consults but primaries should be at least trying to formulate a coherent reason for consult.

I've done a decent amount of psych consult work so far in med school and some people will consult without any idea about the reason for consult.

About half of these, the teams try but just don't really know enough about the patient psychiatrically to formulate a question—this is fine and I just call the resident to clarify/help them formulate a reason.

The other half consists of teams dancing around the fact that their real reason for consulting you is inappropriate and they know it—often it's some dispo bull**** that their social workers are supposed to be able to deal with but for some reason can't/won't or the hospital is full and they want to unload their osteomyelitis patient with stable bipolar who still needs repeat blood cultures and IV antibiotics to the inpatient psych unit.
Bro let's assume that I finished medical school and have an idea about how to call consults. I had a clear question about a surgical solution for a complication caused by the surgical team. We're too busy dealing with all their patients dumped on our service to play the dispo game.
 
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sloop

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Bro let's assume that I finished medical school and have an idea about how to call consults. I had a clear question about a surgical solution for a complication caused by the surgical team. We're too busy dealing with all their patients dumped on our service to play the dispo game.
Sorry, I don't think I made this clear in the original post.

I wasn't trying to accuse you of doing what I described. I'm just saying that I've encountered what I described far too often. I'm sure that you actually don't do this—from what I can tell from posts on this board you seem like a very competent, considerate physician—but there is a minority of internal medicine, family, and surgery doctors who think that the psych service is the hospital's backup social workers for when things aren't getting done and the patient has a psych history.

Again, not accusing anybody. Most consults are totally appropriate, even ones where the reason for consult is not clearly stated, but there are inappropriate ones.
 
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Law2Doc

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If a junior level person (APN, resident, fellow) gives a non-answer or an answer that doesn't seem right, then it is time for an attending-to-attending call.
IMHO, residents should really view "attending to attending calls" as personal failures rather than the way some view it -- as the cavalry riding in. The goal is really to have residents in each discipline making as many of the hard calls and day to day decisions and running the service themselves, working things out with the other services, not being obstinate but trying to make good, informed decisions (and if it does get to an attending to attending level, not then cowering behind the attendings legs thinking "haha, my daddy is tougher than your daddy".) Some attendings probably don't give residents enough of a leash to listen to reason and make their own decisions and so force them to continue down a bad path, insisting "my attending wants this", even when it's clear it's a bad idea, and that's probably the attendings fault. In other cases residents do have the ability to make common sense calls on their own but simply don't like being rebuked, or don't want to deviate from what they considered the plan. So attending to attending calls, though sometimes necessary are really something that in the ideal would be minimized. The fewer of those an attending has to participate in usually signals a better crop of residents.
 

ProfMD

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IMHO, residents should really view "attending to attending calls" as personal failures rather than the way some view it -- as the cavalry riding in. The goal is really to have residents in each discipline making as many of the hard calls and day to day decisions and running the service themselves, working things out with the other services, not being obstinate but trying to make good, informed decisions (and if it does get to an attending to attending level, not then cowering behind the attendings legs thinking "haha, my daddy is tougher than your daddy".) Some attendings probably don't give residents enough of a leash to listen to reason and make their own decisions and so force them to continue down a bad path, insisting "my attending wants this", even when it's clear it's a bad idea, and that's probably the attendings fault. In other cases residents do have the ability to make common sense calls on their own but simply don't like being rebuked, or don't want to deviate from what they considered the plan. So attending to attending calls, though sometimes necessary are really something that in the ideal would be minimized. The fewer of those an attending has to participate in usually signals a better crop of residents.
I do agree with you. However, patient care still needs to be high on the priority list which is why attendings do need to get involved when other services' residents aren't doing their jobs.

And to @sloop 's point, the situation he described happens routinely. My service gets calls fairly regularly from the ED and other inpatient services where there is no actual question, they just want us to see the patient. The other thing that drives me crazy is when we get a call that starts with "I got in sign out that I was supposed to call you .." and the person calling has not seen the patient now knows anything about it he patient.
 

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My service gets calls fairly regularly from the ED and other inpatient services where there is no actual question, they just want us to see the patient. The other thing that drives me crazy is when we get a call that starts with "I got in sign out that I was supposed to call you .." and the person calling has not seen the patient now knows anything about it he patient.
I love hearing the ED doc/PA/NP say, "Wow, you got down here so quickly, I haven't had a chance to see the patient yet!"

I'm sorry, I guess that's bashing.

The truth is, there is plenty of laziness and occasional incompetence in the hospital. I agree with not bashing other physicians in front of nurses or patients or whatever. But you damn well better believe I'm going to bash Dr. So-and-So in anesthesia who couldn't fiberoptically intubate a Pringle's can to my co-residents or fellow or sometimes attending.
 

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...The other thing that drives me crazy is when we get a call that starts with "I got in sign out that I was supposed to call you .." and the person calling has not seen the patient now knows anything about it he patient.
It all stems from the fact that residents "need to take ownership" of their patients. If the system is working, they shouldn't view themselves as completely mindless cogs in a machine run by the attending, but rather on the scene trouble shooters. "This was handed off to me -- haven't even seen the patient" only passes for an excuse because some attendings allow it, and there's no repercussions for being the guy playing the "ignorance" card. If you'd be uncomfortable presenting a patient to your own attending without having seen him, you should be doubly uncomfortable doing the same to another teams people. That notion, however, is the job of the residents supervising attending to instil, and frankly if he gets pulled into an attending to attending call over that, the resident really ought to end up in his doghouse. But unfortunately this slides too often and that's why blindly saying "my attending wants it" and "haven't even seen the patient" or "this got signed off to me, know nothing about it" are sadly still part of the residency toolbox.
 

criticalelement

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My resentment of the medical education process grows every year, you could make a competent doctor in half the time with half the stress, rant over.
You dont know what the word resentment means son. Wait a few years... you will be voting for the most conservative candidate you can find..
 
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Psai

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You dont know what the word resentment means son. Wait a few years... you will be voting for the most conservative candidate you can find..
It's funny to watch the interns come in all doe eyed and happy into residency and then realize how much money uncle sam takes from their first paycheck. There was much wailing and gnashing of teeth. Then they look at the people that their money goes to.
 

ProfMD

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It's funny to watch the interns come in all doe eyed and happy into residency and then realize how much money uncle sam takes from their first paycheck. There was much wailing and gnashing of teeth. Then they look at the people that their money goes to.
You mean themselves? They are all paid by Medicare, after all.
 

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You mean themselves? They are all paid by Medicare, after all.
Don't make me laugh. We put much more money into the government than we ever get out of it.

And you think it makes sense to have people to pay themselves for the care of other people? It's absurd.
 

ProfMD

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Don't make me laugh. We put much more money into the government than we ever get out of it.

And you think it makes sense to have people to pay themselves for the care of other people? It's absurd.
Over the course of a lifetime you do pay more than you get - that's the nature of being in a high paying profession.

Unless you had a lucrative job pre medical school though, as a resident you are still on the net positive from the government end of the spectrum.
 

Commer_Knocker

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Over the course of a lifetime you do pay more than you get - that's the nature of being in a high paying profession.

Unless you had a lucrative job pre medical school though, as a resident you are still on the net positive from the government end of the spectrum.
Can you explain that? Are you talking about total income? Or income derived from government payments(Medicare/caid, etc)?

If you mean total income, I doubt it. Even if you're in the highest tax bracket, you'd be paying like 40%, assuming state and local income taxes are as high as they can be. Once you factor in property and sales tax it might be close to 50, but I doubt it's more. I don't count social security and Medicare, since you get money paid into that back at the end.
 

ProfMD

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Can you explain that? Are you talking about total income? Or income derived from government payments(Medicare/caid, etc)?

If you mean total income, I doubt it. Even if you're in the highest tax bracket, you'd be paying like 40%, assuming state and local income taxes are as high as they can be. Once you factor in property and sales tax it might be close to 50, but I doubt it's more. I don't count social security and Medicare, since you get money paid into that back at the end.
The original comment was that new residents who are initially excited to get a paycheck, are disappointed that so much is taken out in taxes. There was an additional comment about how that tax money goes to support the poor, etc.

I pointed out that the residents' paychecks come from a government program, so they are benefitting from other peoples' taxes.

I was referring to the fact that GME is funded through Medicare. But, it is funded through a program in Medicare that purely subsidizes GME and is not tied to reimburesement for medical care provided.

As residents, they are getting more from this government program than they give back in the form of taxes.

However, once they graduate from residency and secure jobs, these same physicians will pay much more in taxes than they ever received from any government program .
 

Commer_Knocker

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The original comment was that new residents who are initially excited to get a paycheck, are disappointed that so much is taken out in taxes. There was an additional comment about how that tax money goes to support the poor, etc.

I pointed out that the residents' paychecks come from a government program, so they are benefitting from other peoples' taxes.

I was referring to the fact that GME is funded through Medicare. But, it is funded through a program in Medicare that purely subsidizes GME and is not tied to reimburesement for medical care provided.

As residents, they are getting more from this government program than they give back in the form of taxes.

However, once they graduate from residency and secure jobs, these same physicians will pay much more in taxes than they ever received from any government program .
Ah, I see. Makes perfect sense now.
 

psychMDhopefully

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It's funny to watch the interns come in all doe eyed and happy into residency and then realize how much money uncle sam takes from their first paycheck. There was much wailing and gnashing of teeth. Then they look at the people that their money goes to.

Most taxes go to the military budget and infrastructure. Only a small portion of your money goes to Felica or Becky Sue and their 5 kids. Or the perfectly able bodied people on disability.
 

psychMDhopefully

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Then how do these people on food stamps have better phones than me?

You don't have to be jobless to get food stamps, just paid a low wage and/ or have a lot of kids. That $270 check they get every week from their part time minimum wage job goes to stupid crap like fancy phones and Jordans, they are late on rent, bills, have no emergency funds, use FS to buy food, and drive crappy cars with no insurance that can break down at any moment and cause them to lose that $8hr job. Poor people live for today, so they will keep buying their fancy **** and hope their car doesn't break down.
 

mcloaf

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You don't have to be jobless to get food stamps, just paid a low wage and/ or have a lot of kids. That $270 check they get every week from their part time minimum wage job goes to stupid crap like fancy phones and Jordans, they are late on rent, bills, have no emergency funds, use FS to buy food, and drive crappy cars with no insurance that can break down at any moment and cause them to lose that $8hr job. Poor people live for today, so they will keep buying their fancy **** and hope their car doesn't break down.
How many people on food stamps do you know/regularly spend time around?
 

QualityProcess

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because when your internet argument constructed on an assumption or generalization fails, you gradually redefine the target cohort until the target of your comment snaps back at you. e-victory is yours
 
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QualityProcess

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how do I do this? sick of thinking about how I'm going to trick a fellowship program into accepting me while I'm still filling out ERAS for residency
 

psychMDhopefully

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how do I do this? sick of thinking about how I'm going to trick a fellowship program into accepting me while I'm still filling out ERAS for residency
I wish I knew, Id be a lot less stressed. The funny thing is people who are well off tend to look down on poor people, but each population has its virtues and vices. Sometimes its great to just enjoy your youth, indulge in things that feel good now, and not have to worry about exams, deadlines, and being chronically fatigued from the workload of medical education. On the other hand poor people tend to have a low sense of self worth, feel they have no purpose in life, and the work they do is unimportant. With highly educated well off people, especially those in medicine, society worships you ( not as much as they use to but still) and pays you well as a physician, so there is a sense of self worth and purpose there. But then chasing academics for years and years before you know it you are in your mid 30s, you look back at you life and realize you neglected, family, romance, hobbies, and personal health and hapiness.
 
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