Telling your attending to suck it?

[keepsmiling10]

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Ok, not quite. I have been getting very frustrated with my current rotation lately. Our curriculum is designed in such a manner so that we have 2 months of internal medicine. 1 month is devoted to long hospital hours where we are on call a lot and have relatively no time to read. The other is devoted to going to the hospital in the morning and afternoon and getting out fairly early (7-2ish usually) so that we can have the remainer of the day to read and prep for the shelf.

I am at a brand new site for my "less hours" rotation, so they don't exactly know how things should be working. However, I have been at the hospital almost every day until 5-6. the attending that I have been working with has been kind of ridiculous and will oftentimes have me go see a patient and then just follow him around or just sit around and wait for him until he basically feels like seeing the patient that am following. Yesterday, I saw a patient in the ER at 11:30 and had to wait around until 4:30 to present the patient to my attending. I have tried to read while on-site but I have trouble because there's really no quiet place to read, or I'm following the doc around while he writes his notes or answers phone calls or teaches me very important points like "make sure you tell the patient to start breathing again after you listen for carotid bruits." And I don't mean just mentions it, but I mean elaborates on such points. For anyone wondering, no I'm not an idiot and he has never observed me doing a physical exam so he's not just correcting my mistake.

Today I called him in the morning, presented the progress of my patient and then wrote the orders. Then, I waited for another doc to get out of a meeting so that I could round with him (understandable). My attending told me he still hadn't seen my patient and would page me when he got around to it. I got sick of it and asked him if there was anything else I'd be able to help with in regards to this patient because if there isn't, it would be helpful for me to leave and read in order to prepare for the shelf. However, I did this in front of the site director. I don't know if that was a bad move and now I'm afraid that my whole hard work this month is going to be screwed up.

What are your thoughts on standing up for yourself and asking to go read when you work hard, are staying longer hours than necessary and have literally been waiting around since 7 that morning to round on a patient which takes 15 min and have a shelf coming up?

 

[Scaredshizzles]

Ok, not quite. I have been getting very frustrated with my current rotation lately. Our curriculum is designed in such a manner so that we have 2 months of internal medicine. 1 month is devoted to long hospital hours where we are on call a lot and have relatively no time to read. The other is devoted to going to the hospital in the morning and afternoon and getting out fairly early (7-2ish usually) so that we can have the remainer of the day to read and prep for the shelf.

I am at a brand new site for my "less hours" rotation, so they don't exactly know how things should be working. However, I have been at the hospital almost every day until 5-6. the attending that I have been working with has been kind of ridiculous and will oftentimes have me go see a patient and then just follow him around or just sit around and wait for him until he basically feels like seeing the patient that am following. Yesterday, I saw a patient in the ER at 11:30 and had to wait around until 4:30 to present the patient to my attending. I have tried to read while on-site but I have trouble because there's really no quiet place to read, or I'm following the doc around while he writes his notes or answers phone calls or teaches me very important points like "make sure you tell the patient to start breathing again after you listen for carotid bruits." And I don't mean just mentions it, but I mean elaborates on such points. For anyone wondering, no I'm not an idiot and he has never observed me doing a physical exam so he's not just correcting my mistake.

Today I called him in the morning, presented the progress of my patient and then wrote the orders. Then, I waited for another doc to get out of a meeting so that I could round with him (understandable). My attending told me he still hadn't seen my patient and would page me when he got around to it. I got sick of it and asked him if there was anything else I'd be able to help with in regards to this patient because if there isn't, it would be helpful for me to leave and read in order to prepare for the shelf. However, I did this in front of the site director. I don't know if that was a bad move and now I'm afraid that my whole hard work this month is going to be screwed up.

What are your thoughts on standing up for yourself and asking to go read when you work hard, are staying longer hours than necessary and have literally been waiting around since 7 that morning to round on a patient which takes 15 min and have a shelf coming up?

Welcome to third year. But the bright side is if you stick around with a positive attitude, you learn a lot of useful stuff. It may or may not prepare you for the shelf, but that can't be your end all be all.

As far as hours, if your clerkship specifically spells out the hours for the second half of the rotation (as opposed to a tradition started by students to try to get out early the last few weeks to study for the shelf), then you should probably have set out the parameters on the first or second day of the rotation instead of waiting.

If the hours aren't spelled out in the syllabus, then you can try to make a request at some point, saying that you usually have trouble on standardized exams (doesn't matter if you score 99th percentile on every one of them---it is all relative) and was hoping you could go home a little early to try to study. Most sites would recognize that a student failing their exams is kind of a poor reflection on the site. However, if your attending is never around earlier in the day, you are kind of stuck because it will effect your grade if you never have any interaction with the attending.

 

[BigRedBeta]

That's unfortunate, but really...reading's overrated.

The way I look at it, the books will always be there, but you only have the time in front of the attending to get the eval you want. I'm assuming you have weekends, you said you're not on call and perhaps most importantly, you seem to have a lot of down time. It may not be quiet at the hospital, but seriously sack up and get over it. If it's that big of issue, get some noise-canceling headphones.

As for getting above the entry level teaching - ask questions to drive the discussion where you want it. Come up with a whole list of topics and ask questions that show off your understanding and get him to think at a higher level.

 

[SLUser11]

The other is devoted to going to the hospital in the morning and afternoon and getting out fairly early (7-2ish usually) so that we can have the remainer of the day to read and prep for the shelf.

These "7-2ish" days seem like a very odd and very weak policy, and I'd be surprised if it was truly spelled out in your syllabus instead of the product of student word of mouth.

If it is true, realize that the majority of medical students do not get this special treatment, and are still expected to perform well on the shelf exam.

Yesterday, I saw a patient in the ER at 11:30 and had to wait around until 4:30 to present the patient to my attending. I have tried to read while on-site but I have trouble because there's really no quiet place to read......

While I agree that this is stupid and low-yield, this is what A LOT of med students do across the US. As someone else mentioned, welcome to 3rd year. It is a very unfair year of education.

However, what you will need to learn for this rotation and beyond (including other rotations and then residency) is how to study in less-than-ideal environments, as it sounds like you have a lot of down time on a daily basis with which to study.

I got sick of it and asked him if there was anything else I'd be able to help with in regards to this patient because if there isn't, it would be helpful for me to leave and read in order to prepare for the shelf. However, I did this in front of the site director. I don't know if that was a bad move and now I'm afraid that my whole hard work this month is going to be screwed up.

Bad move....no matter what your intention, it probably made you look weak and disinterested. I agree that you weren't essential, and that your time could be better spent in the library, but....once again....3rd year is completely unfair.

What are your thoughts on standing up for yourself and asking to go read when you work hard, are staying longer hours than necessary and have literally been waiting around since 7 that morning to round on a patient which takes 15 min and have a shelf coming up?

I don't see anything in your post that insinuates that you've worked especially hard. I also don't think that you are "standing up for yourself" in some necessary glorious fashion.


I understand if you find my post too harsh. Realize, however, that my opinion is shared by a lot of the people that evaluate you, and you should be careful not to complain about having to work past 2pm, as it will paint you in a negative light.

 

[dilated]

I don't see anything in your post that insinuates that you've worked especially hard. I also don't think that you are "standing up for yourself" in some necessary glorious fashion.


I understand if you find my post too harsh. Realize, however, that my opinion is shared by a lot of the people that evaluate you, and you should be careful not to complain about having to work past 2pm, as it will paint you in a negative light.

Who gives a crap. Life is too short to spend it toadying and harming your education just in hopes that someone will circle all 5s before writing "needs to read more" instead of all 3s.

On these rotations where you have massive amounts of time where you're not doing anything at all I eventually realized you just need to step up and tactfully say "if there's anything to do I'll happily do it, if not let me go the hell home". Nobody has ever seemed to care, but if they did I strongly suspect they would have been the bad evaluation type anyway.

And is in my experience their personality is more important to the type of eval you get than your actual performance because most third years are largely interchangeable compared to the wide gulf between "guy who always gives 5s" and "guy who always gives 2s".

 

[SLUser11]

....most third years are largely interchangeable compared to the wide gulf between "guy who always gives 5s" and "guy who always gives 2s".

Absolutely. I agree 100%. This is part of the reason why 3rd year is generally unfair.

Still, I don't know what to think about your comment that sticking around on the wards instead of hiding in the library is "harming your education." Maybe it's harming your shelf score....but in the grand scheme of things, you can read a book anytime. You get very little exposure to most of medicine outside of your chosen specialty....

 

[SouthernSurgeon]

I don't see anything in your post that insinuates that you've worked especially hard. I also don't think that you are "standing up for yourself" in some necessary glorious fashion.

Agree. Also, the OP seems to have a rather inflated view of the value of his/her own time while not respecting the fact that the attending likely has a lot of demands on their time.

 

[Doctor Bagel]

Yep, third year sucks, and I hear on being frustrated with waiting around and not getting a lot done, but that is kinda part of the deal. As mentioned above, if your schedule isn't specifically designed for you to get off at 2, then I think it's just one of those things where you're stuck with a more crappy rotation than the other students. Mention it in the eval, but I wouldn't expect lots of sympathy from the attending.

Now since you're probably stuck with this being at the hospital longer, I'm wondering if you just haven't found a better place/situation to study. Have you checked out the hospital library? Even parts of the cafeteria can be pretty quiet. Also, since you're just waiting for a page, could you head out to a local coffee shop and then head back?

 

[Droopy Snoopy]

Agree. Also, the OP seems to have a rather inflated view of the value of his/her own time while not respecting the fact that the attending likely has a lot of demands on their time.

No kidding. Like the attending is sitting in his office playing spider solitaire thinking up ways to mess with his medical students. That said, it's your education. If you feel you're not getting your money's worth I think you're well within your rights to try and fix the problem, evaluation be damned. But tactfully I hope.

 

[JustPlainBill]

Wow, you're not at a certain hospital in Ft. Worth, are you? Sounds like you've got an attending I had....liked to show up at around 3:30/4:00pm and then spend about an hour per patient....with most of the hour being a lecture on history,philosophy,art,agriculture,economics, etc. Ok the first 3 days.....but it went on for a month and the same topics were lectured over....repeatedly. So you got 12 to 14 hour days and then had to study. I learned to hit the cafeteria, tell the residents in a gentle fashion that if there was nothing else, I was going to study and left them my phone number. So I was there at the required 07:00, finished my rounds by 08:30 and then hit the cafe. It got a little interesting when the residents tried to fill the time by 'table rounds'....they were just trying to find ways to fill time while waiting on the doc.....

Seriously, third year is all about knowing where you fit on the totem pole...the absolute bottom, below nurses, nursing students, orderlies,patient transporters, etc.....and what was supposed to have been a good bedside teaching experience is lost when the attending doesn't know how to teach or doesn't want to and is doing it for the stipend. I've quickly figured out that third year is all about learning how to interview patients and being comfortable with scut. Volunteer to be a scut monkey, try to take the best out of everything---if nothing else, learn how long you can expect to hold a retractor with your arms asleep and your fingers numb before you drop it off of the surgical field and get yelled at by the team.....or maybe how quickly you can get a complete physical done - it sucks but it's a rite of passage.

 

[Scaredshizzles]

Wow, you're not at a certain hospital in Ft. Worth, are you? Sounds like you've got an attending I had....liked to show up at around 3:30/4:00pm and then spend about an hour per patient....with most of the hour being a lecture on history,philosophy,art,agriculture,economics, etc. Ok the first 3 days.....but it went on for a month and the same topics were lectured over....repeatedly.

What sux is even on totally non-medical topics, you feel obligated to defer to your hierarchy in the hospital.

 

[medsurg2010]

Despite the fact that I'm really jealous that your school even has work hour limits (we have 12 weeks of internal medicine, 8 weeks inpatient with q4 call and daily lectures from 4-6pm, so you never get out before 6pm, period...)


Here's what worked for me: I went to the store and bought a giant jar of earplugs (the kind for the rifle range). Then I bring one book with me during the day, currently using IM Case files. I leave my phone on vibrate in my pocket 😀 so I can take calls from the residents, then I sit with my earplugs in total silence and read wherever I am (ER, call room, waiting room, cafeteria, hallway, locker room, stairwell (best spot)) and read. I've been really productive since I started this... and people don't really bug you when you have earplugs in...

learn to deal with being at the hospital a lot because as far as I can tell intern year is no 8-2pm job. Good luck, grasshopper

 

[QofQuimica]

I have tried to read while on-site but I have trouble because there's really no quiet place to read

Earplugs are my secret to success when I can't focus because there is too much surrounding noise. They're cheap and you can easily stick them in your pocket. If you have long hair, no one will even know when you're wearing them. If you don't, just be judicious when you use them (i.e., not when your attending is trying to teach you the finer points of how to tell the patient to start breathing again).

What are your thoughts on standing up for yourself and asking to go read when you work hard, are staying longer hours than necessary and have literally been waiting around since 7 that morning to round on a patient which takes 15 min and have a shelf coming up?

Sometimes you draw the short straw and have to work more hours than other students on the same rotations; this happens to all of us at some point. On some other rotation, you will be the lucky one who gets to leave early.

At the risk of sounding overly preachy, your work time does not belong to you when you're on a rotation. It belongs to the people who are teaching you. Assuming they are not asking you to do anything that is immoral or illegal, you stay when they tell you to stay, go where they tell you to go, do what they tell you to do, and read on your own time (or if you're lucky enough to have a nice attending/resident, whenever they give you some time). If they never tell you to go read, then you read when and where you can.

If you want to read during your downtime each day (sounds like a good idea to me), then figure out some other way to focus if you don't like my earplug idea. Or, get up half an hour earlier in the mornings and read before you come in. Or, go sit in an empty patient room somewhere if the nurses won't shoo you out. Heck, go sit in a stairwell if that's the quietest place you can find. There are probably 100 things you could do to get yourself some quiet reading time while you wait to be paged that won't require you to antagonize the attending or make you look like a whiner.

In any case, hang in there. Some rotations are just the pits, even if they're ostensibly easy ones. 🙂

 

[BigRedBeta]

At the risk of sounding overly preachy, your work time does not belong to you when you're on a rotation. It belongs to the people who are teaching you. Assuming they are not asking you to do anything that is immoral or illegal, you stay when they tell you to stay, go where they tell you to go, do what they tell you to do, and read on your own time (or if you're lucky enough to have a nice attending/resident, whenever they give you some time). If they never tell you to go read, then you read when and where you can.

Amen to this! The sooner one realizes that the biggest difference between 2nd and 3rd years (and this continues on into residency) is the loss of control of your schedule, the better.

 

[Regnvejr]

...I got sick of it and asked him if there was anything else I'd be able to help with in regards to this patient because if there isn't, it would be helpful for me to leave and read in order to prepare for the shelf. However, I did this in front of the site director. I don't know if that was a bad move and now I'm afraid that my whole hard work this month is going to be screwed up.

What are your thoughts on standing up for yourself and asking to go read when you work hard, are staying longer hours than necessary and have literally been waiting around since 7 that morning to round on a patient which takes 15 min and have a shelf coming up?

Nothing wrong with what you did. As a student, you are not primary responsible for the patients. As resident, it is a whole different story, but for now, your job is to pass and move on.

Very few people would object to you asking time to study for a test. They would object to you looking like you don't like to work, or look like you don't care about the patients. As long as that's covered, you are expected to learn, even when that means library time.

Ask the attending if, when you wait, could you go to the library as long as a nurse pages you when the attending shows up (Then leave a big note with your pager number on the chart and let the patient's nurse know. That should be conscientious enough).