Terminated from IM residency (PGY-2)

[GastriqueGraffin]

Losing a resident hurts the program in many ways. I doubt the decision was made on a whim. I really feel bad for the op and don't want to appear callous but I feel there is some lack of insight to see the full picture and not heeding multiple warnings. This is coming from a CMR who have experienced the troubled resident experience.

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[deleted480308]

OP, i would advise against dropping copy/paste from evals online. There is no upside and a ton of downsides

 

[nirvana88]

OP, i would advise against dropping copy/paste from evals online. There is no upside and a ton of downsides

What’s the worst that’ll happen? I’ll get double-fired?
I’m sorry if I come off as rude but I’m disappointed beyond measure. It’s not easy to do your best and be told you’re not good enough.

 

[deleted480308]

What’s the worst that’ll happen? I’ll get double-fired?
I’m sorry if I come off as rude but I’m disappointed beyond measure. It’s not easy to do your best and be told you’re not good enough.

But it is easier to burn bridges than build them.

 

[GastriqueGraffin]

Learning how to make people like you at work and want to work with you is so important in this job. It's never too late to learn something very big from this really terrible situation. You still have your entire career and life ahead of you but if you find that you make enemies or are teamed up against for no reason, I suggest you do some reflection.

 

[PlutoBoy]

I don’t have a problem with shutting up if I’m convinced logically by my superiors. That’s the reason I got the best evaluations from the senior most faculty. I’m copy pasting the evaluation from our chief of medicine so you might get an idea.

No offense but you need to learn when to bend even when you believe you are right.

Some fights are not worth having.

 

[el_duderino]

I don’t have a problem with shutting up if I’m convinced logically by my superiors.

You sound like my ten year old with ADHD, who won't do anything unless you spend time convincing him it's smart.

He has an IEP and professionals. So that hopefully he won't end up in your position because of it.

 

[skeptastic]

Very informative thread. I appreciate all contributions.

 

[nirvana88]

You sound like my ten year old with ADHD, who won't do anything unless you spend time convincing him it's smart.

He has an IEP and professionals. So that hopefully he won't end up in your position because of it.

“Do it because I said so” is the polar opposite of the scientific method. There’s a reason we have books, guidelines and experience; to think critically, have discussions, be open to opposing ideas and selecting the best course of action for the patient. I know that this makes me an irritating junior but only for a select few. I hope I have more open minded people in my future program.

 

[IMreshopeful]

“Do it because I said so” is the polar opposite of the scientific method. There’s a reason we have books, guidelines and experience; to think critically, have discussions, be open to opposing ideas and selecting the best course of action for the patient. I know that this makes me an irritating junior but only for a select few. I hope I have more open minded people in my future program.

Have you ever held a real job in your life aside from residency? Arguing with your superiors is a sure way to get on their bad side. It doesn’t matter sometimes how right you are if all you’re doing is burning bridges with everyone. I have a resident in my medical residency who acts like this and he has burned every possible bridge there is.

Also unless something is actually going to kill a patient (I’ve only personally run into this issue once as a resident) it’s not worth arguing about minor decisions. Or even major decisions for that matter. You can practice however you want when it’s done but in residency all you’re doing is looking like an annoying ****.

The simple fact that you don’t seem to understand this and are so unbelievably defiant about it makes me think that this decision wasn’t done without cause.

 

[GastriqueGraffin]

“Do it because I said so” is the polar opposite of the scientific method. There’s a reason we have books, guidelines and experience; to think critically, have discussions, be open to opposing ideas and selecting the best course of action for the patient. I know that this makes me an irritating junior but only for a select few. I hope I have more open minded people in my future program.

Unfortunately I don't think you get it or ever will get it. Medicine is as much an art as it is a science. Everyone has their own approach on many scenarios. Some are more evidence based than others and some may be more patient to explain everything than others. Your job as a resident is to learn by listening to superiors and reading on your own. These are people who have a lot more experience than you. Did you act this way as medical student?

 

[nirvana88]

Have you ever held a real job in your life aside from residency? Arguing with your superiors is a sure way to get on their bad side. It doesn’t matter sometimes how right you are if all you’re doing is burning bridges with everyone. I have a resident in my medical residency who acts like this and he has burned every possible bridge there is.

Also unless something is actually going to kill a patient (I’ve only personally run into this issue once as a resident) it’s not worth arguing about minor decisions. Or even major decisions for that matter. You can practice however you want when it’s done but in residency all you’re doing is looking like an annoying ****.

The simple fact that you don’t seem to understand this and are so unbelievably defiant about it makes me think that this decision wasn’t done without cause.

You seem to assume that I'm a dick to everybody. That's false. The overwhelming majority of my superiors was REALLY happy with my performance.

 

[nirvana88]

Unfortunately I don't think you get it or ever will get it. Medicine is as much an art as it is a science. Everyone has their own approach on many scenarios. Some are more evidence based than others and some may be more patient to explain everything than others. Your job as a resident is to learn by listening to superiors and reading on your own. These are people who have a lot more experience than you. Did you act this way as medical student?

No I did not. I was more of an observer as a student.
But that's not the point. Everybody here seems to assume that I'm an arrogant dick to my superiors. That's not true. While there were scenarios I could have kept my mouth shut, the overwhelming majority was really happy with me. I don't have a problem with being just a mindless drone either to get through residency but our program kept encouraging us to work like an HRO which I believed and thence got into trouble.
Moreover, my advisor who kept meeting with the CCC and was supposed to help me understand my problems, didn't have a frickin clue as to how I could make them happy. He was of the view that they had made up their minds and were not going to listen to anything good about me.

 

[IMreshopeful]

You seem to assume that I'm a dick to everybody. That's false. The overwhelming majority of my superiors was REALLY happy with my performance.

It doesn’t matter how nice you are. Rocking the boat unnecessarily will make you enemies in training. Keeping your head down and working within the system is the most fruitful approach.

 

[nirvana88]

It doesn’t matter how nice you are. Rocking the boat unnecessarily will make you enemies in training. Keeping your head down and working within the system is the most fruitful approach.

"Unnecessarily" is very subjective. Once I was admitting a patient from the ED with a stroke per the ED attending and radiologist. I disagreed, dug deeper, called the radiologist, made him rectify a mistake he made in reading the CT scan and treated the patient for DKA (which was the actual diagnosis the ED attending missed). I was not criticised for doing this but nor was I appreciated. I prevented patient harm by defying two attending physicians and nobody ever discussed the event openly. I am not hungry for appreciation but this made me feel like this attitude was not welcome. This is not how HROs should function. Again, I could've still been a worker bee but I was fooled into thinking our program was not dogmatic.

 

[Bobblehead]

This reply is primarily for future readers of this thread who are in jeopardy of being dismissed from their program. At its heart this dismissal appears to be due to an inability of the OP to develop insight into problematic interpersonal behaviors.

My biggest disappointment was the fact that I was mistaken to believe that critical thinking and a logical approach were welcome here. They just need mindless drones who don’t ask questions, just do what they’re told and keep their mouths shut while nodding their heads.

Furthermore, the attendings that did have something to say said I need to be more a reporter than an interpreter which is another way of saying “bend the knee”.

Medicine is hierarchical. That protects the people below from everything but truly egregious mistakes. That also means the person at the top gets to make the decisions. Part of training is learning to let certain things go.

I don’t know. I kept asking them and the best they could answer was “I want to trust you but I’m just having a lot of trouble trusting you”.

I was so engulfed by the fear of being dismissed that I didn’t always think about such decisions that deeply and made impulsive decisions often.

I hope I find a program that considers to take me as a PGY 2 before the next academic year.

I've been told by PDs that their decision in promotion from PGY-1 to PGY-2 in IM is based around the simple question "Can I trust you with a team/patients?" People that fail at this question are not promoted. Impulsive decisions made often are not conducive to building trust.

I don’t have a problem with shutting up if I’m convinced logically by my superiors.

I’m sorry if I come off as rude but I’m disappointed beyond measure.

“Do it because I said so” is the polar opposite of the scientific method. There’s a reason we have books, guidelines and experience; to think critically, have discussions, be open to opposing ideas and selecting the best course of action for the patient. I know that this makes me an irritating junior but only for a select few. I hope I have more open minded people in my future program.

You seem to assume that I'm a dick to everybody. That's false. The overwhelming majority of my superiors was REALLY happy with my performance.

You will encounter similar problems in any future program that agrees to take you on. Based on your public postings here I suspect you will not obtain a positive recommendation from your PD which will result in your inability to find any future programs that are willing to risk taking on a problem personality.

When you are told you have interpersonal relationship/professionalism issues make the changes that are being pointed out to you. Full stop. There are of course many nuances to this when you're in full practice and encounter toxic work situations but those nuances do not apply while you are in training. Full stop.

"Unnecessarily" is very subjective. Once I was admitting a patient from the ED with a stroke per the ED attending and radiologist. I disagreed, dug deeper, called the radiologist, made him rectify a mistake he made in reading the CT scan and treated the patient for DKA (which was the actual diagnosis the ED attending missed). I was not criticised for doing this but nor was I appreciated. I prevented patient harm by defying two attending physicians and nobody ever discussed the event openly. I am not hungry for appreciation but this made me feel like this attitude was not welcome. This is not how HROs should function. Again, I could've still been a worker bee but I was fooled into thinking our program was not dogmatic.

If you are truly vested in becoming a physician you need to take some time for soul searching and understand that you were not dismissed because they were out to screw you or because you were incompetent from a medical knowledge standpoint. You were dismissed because you were unable to engage in appropriate interpersonal relationships with people around you at work. I have seen many residents survive an IM residency although their clinical acumen wasn't top tier. They made it through because they were decent people, worked hard, asked for (perhaps excessive) help so they didn't harm patients and therefore were carried through to the end of residency because people got along with them. The three highlighted passages demonstrate personality defects in the way you are approaching others at your job.

 

[nirvana88]

This reply is primarily for future readers of this thread who are in jeopardy of being dismissed from their program. At its heart this dismissal appears to be due to an inability of the OP to develop insight into problematic interpersonal behaviors.

Medicine is hierarchical. That protects the people below from everything but truly egregious mistakes. That also means the person at the top gets to make the decisions. Part of training is learning to let certain things go.

I've been told by PDs that their decision in promotion from PGY-1 to PGY-2 in IM is based around the simple question "Can I trust you with a team/patients?" People that fail at this question are not promoted. Impulsive decisions made often are not conducive to building trust.

You will encounter similar problems in any future program that agrees to take you on. Based on your public postings here I suspect you will not obtain a positive recommendation from your PD which will result in your inability to find any future programs that are willing to risk taking on a problem personality.

When you are told you have interpersonal relationship/professionalism issues make the changes that are being pointed out to you. Full stop. There are of course many nuances to this when you're in full practice and encounter toxic work situations but those nuances do not apply while you are in training. Full stop.

If you are truly vested in becoming a physician you need to take some time for soul searching and understand that you were not dismissed because they were out to screw you or because you were incompetent from a medical knowledge standpoint. You were dismissed because you were unable to engage in appropriate interpersonal relationships with people around you at work. I have seen many residents survive an IM residency although their clinical acumen wasn't top tier. They made it through because they were decent people, worked hard, asked for (perhaps excessive) help so they didn't harm patients and therefore were carried through to the end of residency because people got along with them. The three highlighted passages demonstrate personality defects in the way you are approaching others at your job.

Yet again, you're assuming that I was surrounded by a crowd of angry coworkers who kept telling me what to do and I stuck up to them. That is not how it went down. The letters of deficiency only contained mistakes that I had already acknowledged. None of them ever said "you need to do this instead of that". They just said "you did that and it shows you are not serious". I'll give you an example.
I once had an extremely busy day in clinic and an extra patient was forced in the schedule. I happily agreed to see the patient as I had been trying to work extra to prove myself. The patient was morbidly obese and had a gluteal abscess. I discussed the option of weight loss at which point her husband did a facepalming gesture. That made the patient cry and and she started acting out that I called her fat (which I didn't). I kept apologizing to her if she felt offended but she didn't budge. She reported me to the clinic director. Later that day, the clinic director asked me if everything was okay and how she could help me. I said it would help if I was given more time with extra patients whenever all my patients showed up. A few days later, my advisor called me and asked me why I was complaining when all my patients show up (which couldn't be further from what I said). This incident was again mentioned in a letter even though it was nothing but a misunderstanding. No feedback, no suggested changes. Just "this happened and it shows you're not serious".
And to sum it all up, let me be completely open about this. I spent a day in a crisis center for suicidal ideation and the only thing that kept me from doing it was my religious faith. So if you're telling me that a system that forces an honest and hard-working physician to suicide is perfect, please save me the lecture.
My purpose of continuing to debate here is not to prove that this was unfair, it is going to yield nothing good. My sole purpose is to raise awareness that residents should not be treated like garbage the way I was. I don't know if I will ever work in the US again. I was a highly respected physician in my home country so I don't mind working there. My purpose of coming to the US was to obtain the best training but my experience with the first program has been far from it.

 

[drfunktacular]

OP I am sorry for your experience--that sucks. I might have suggested you do some things differently but at this point it doesn't matter, and it very well may not have made a difference at the time anyway.

For other people reading, one lesson that I would suggest you draw is that--like it or not, for better or for worse--American medicine historically is a rigidly hierarchical profession, and the training system is no different. If you're going to become a doctor (in America anyway) you just have to accept it. Believe it or not, it's much better now than it was 30 or 40 years ago. If you're a trainee, you're nearly always better served by just graciously accepting criticism from your superiors and modifying your behavior accordingly. Arguing or trying to convince people that you're right/they're wrong is almost always the wrong choice.

Are there going to be abusive jerks, power tripping, criticizing you, trying to ruin your career for their own enjoyment? Sure, there are people like that in every profession. But in this profession, some of those people (PDs, department chairs, deans, etc) hold real power over your ability to get through training and practice independently.

Obviously there is a certain line between constructive feedback (however exaggerated it might seem to you) and outright abuse, and I would not in any circumstance suggest that someone tolerate abuse. However, there are times when it can be difficult to tell the difference, and that's where going through the proper channels to have your complaints or grievances assessed or responded to formally is critical.

There are many lessons in medicine that are hard-earned with experience, and some of the lessons your superiors are trying to teach you through their feedback or criticism--even when it seems cruel--may actually be important lessons that will make you a better doctor in the end.

 

[GastriqueGraffin]

OP I am sorry for your experience--that sucks. I might have suggested you do some things differently but at this point it doesn't matter, and it very well may not have made a difference at the time anyway.

For other people reading, one lesson that I would suggest you draw is that--like it or not, for better or for worse--American medicine historically is a rigidly hierarchical profession, and the training system is no different. If you're going to become a doctor (in America anyway) you just have to accept it. Believe it or not, it's much better now than it was 30 or 40 years ago. If you're a trainee, you're nearly always better served by just graciously accepting criticism from your superiors and modifying your behavior accordingly. Arguing or trying to convince people that you're right/they're wrong is almost always the wrong choice.

Are there going to be abusive jerks, power tripping, criticizing you, trying to ruin your career for their own enjoyment? Sure, there are people like that in every profession. But in this profession, some of those people (PDs, department chairs, deans, etc) hold real power over your ability to get through training and practice independently.

Obviously there is a certain line between constructive feedback (however exaggerated it might seem to you) and outright abuse, and I would not in any circumstance suggest that someone tolerate abuse. However, there are times when it can be difficult to tell the difference, and that's where going through the proper channels to have your complaints or grievances assessed or responded to formally is critical.

There are many lessons in medicine that are hard-earned with experience, and some of the lessons your superiors are trying to teach you through their feedback or criticism--even when it seems cruel--may actually be important lessons that will make you a better doctor in the end.

Compared to some countries based on talking to IMGs, we are overly spoiled when it comes to back talking to attendings. Be a good soldier first then you can be the general later. Be liked and you will go far in this profession. Arrogance will get you nowhere.

 

[nirvana88]

Compared to some countries based on talking to IMGs, we are overly spoiled when it comes to back talking to attendings. Be a good soldier first then you can be the general later. Be liked and you will go far in this profession. Arrogance will get you nowhere.

I completely understand that. But if I really were that arrogant, I would hear it from everybody and nobody would have been surprised at my dismissal. Like I said so many times before, most people had nothing but praise for me.
Also, it's sad that most people who wish to sympathize with me are sending private messages while those patronizing me are doing so publicly. It shows the extent of fear involved in being a resident in the US. Thank you all, anyway.

 

[IMreshopeful]

I completely understand that. But if I really were that arrogant, I would hear it from everybody and nobody would have been surprised at my dismissal. Like I said so many times before, most people had nothing but praise for me.
Also, it's sad that most people who wish to sympathize with me are sending private messages while those patronizing me are doing so publicly. It shows the extent of fear involved in being a resident in the US. Thank you all, anyway.

I am sympathetic in the sense that it’s absolutely terrible to be in your position. However, I am not saying you were overtly arrogant. You may have been perceived as arrogant because you argued with attendings.

Either way, not much more to be said beating this dead horse.

 

[NewYorkDoctors]

to the OP:

Sorry to hear your situation.

Let me tell you my story. The theme is the PDs, APDs, chief residents will very often go use one sided hearsay from ANYONE else (even if it is an isolated incident and a "wrong place in the wrong time situation") besides yourself and use it as GUILTY IN THE COURT OF PUBLIC OPINION.

I was heavily recruited to join the academic university based IM program I went to. USMG, top shelves, honors all across, top USMLE, small time poster research. Was seen as a top intern and won intern of the year. Praised for having top medical knowledge and good bedside manner (!!! it was an emphasis in my medical school) and got many good reviews from attendings and the chief residents that year and was engaged into cardiology research with the faculty. Did grand rounds as an intern (!). Scored top of the intern class in the in service.

Cue to PGY-2... oh boy...

The wide consensus was the chief residents of my PGY2 year were the worst the program had seen for a long time. Not only were they meager in medical knowledge but also meager in pedigree, clinical acumen, and even personality. The "good residents" of their class all took fellowship ASAP. Think of a combination of a bureaucrat, Data (from Star Trek, only not as helpful), and a sycophant and you have these chief residents.

Year started off poorly after they gave me all of my four weeks of vacation in July and August. Why? Because I was a trooper and did not complain (unlike the other residents). By the time I complained about this, I was automatically labelled a "problem resident." Bad start to the year.

I was on the floors with a variety of preliminary interns and I did a Herculean effort of being a one man show to help them out (and to help myself out)
The program's response? You need to learn how to delegate and you can't do everything yourself. The reward for a job well done? (Solving hard cases, setting up patients on a silver platter for the consultants, engaging in discharge/social work stuff and always keeping my census low for the next call cycle, engaging in patient centered medical care and calling PMDs and families for updates) Being called a "problem resident."

Move on.. did some publications (small stuff nothing big, but in Pubmed). Gaining traction for fellowship. Wanted to keep my head down and just trudge onward.

Received VIP patients on my census. Rare disease great learning. Good bedside manner devolved into trying to get outlandish things done for the patient and family that the consultants wanted nothing to do with. Examples include getting prior authorization for free Glucerna (in retrospect, insurance companies do not pay for "food"), trying to "convince GI" to do a colonoscopy for fecal disimpaction after failing the standard digital disimpaction for which the patient complained no anesthesia was used and failing all the oral stimulant or osmotic laxatives, and other ridiculous items of business. Upon reporting it cannot be done or declining, was reported to administration by the VIP family. The administrators investigate and then label me a "problem resident."

Received dying cancer patients. Poor patients. I went out of my way to show the utmost care and concern for their symptoms and treatment. One patient on the ISTOP system registered as having multiple prescriptions for Opana from multiple physicians. Probably wanted to sell it to make some money for the family this patient would be leaving behind. Felt bad. But then I told the patient per hospital policy, I cannot give more prescriptions and maybe it should be brought up to the attending. Complained to hospital administration that I was not taking care of her pain. Automatically labelled a "problem resident."

In the interim, got certified in ALL of the bedside procedures by using my spare time and making connections in ICU or rheum or orthopedic surgery (that residents no longer have to get certified in these days, i.e. paracentesis, central line, A-line, arthrocentesis, USG IV placement, LP). Also started getting adept at POCUS and POC Echo and gave morning resident reports on it.

Also scored top in my PGY2 class in the in service and actually beat out all of the PGY3 that year in terms of absolute raw score.

LORs collected. Given assurances by the home cardiology program since I published with them and have good rapport with them...

Then during a social event for the residency class, one of the chief residents (a brute, a slob, and hardly a scholar.. USMLE Step 1 188, failing by modern standards) was drunk and overtly over flirting with a female coworker. I was already married with a kid then and thus could have minded my own business. But having worked with this coworker enough to know enough was enough so I told the chief to stop what he was doing and he was making a fool of himself. Then I threatened show him the door. However chivalrous I was, this led to the ULTIMATE SCARLET LETTER of "problem resident."

The next day the PD and chief of medicine said I had no idea how to be professional and placed me on probation.

LOL.

Passed over to be a chief resident despite "winning the popular vote". (Oh well... time for fellowship...)

PGY3 starts.

On my best behavior. Getting the best continuity of clinic patients, getting the lowest length of stay, cracking the toughest cases, getting best patient reviews, having more publications produced.

Applied for fellowship. A healthy number of interviews. Ranked home program highest. Due to certain financial and family obligations, can't travel too far. Given verbal assurances from cards PD.

In service top score of the PGY3. Top NATIONAL percentile 99 amongst PGY3.

Match Day.... Unmatched...

Quality of fellows accepted to home program? I'll save this for another vignette.

On further investigations, my closest advisors said the IM PD LOR was the likely poison pill letter and I have been blacklisted.

By now, the initial IMPD who was after me was fired and transferred. The APD (one of my mentors) assumes the role of PD, but cannot do anything more for me at this point.


I finish out the year strong. Financially I am in a good place so that freedom is everything.

End of year evaluations: informed I "rebounded" strong and was ranked number 1 resident in terms of overall growth and accomplishment. Encouraged to do hospitalist and try again to cards.

Decision: I will not be a hospitalist. I will carve my own path and show to everyone just how bureaucracy cannot hold me down.

Accepted an open Nephrology position somewhere else. Became the best nephrology fellow the program ever had (which is really not saying too much, but I am confident I set the bar high). Published a handful of nephrology papers.
Got a moonlighting PMD job and honed my skill as PMD.
SIMULTANEOUSLY did PCCM research and made new connections at a new place.

Overcoming fatigue and uncertainty, I have now matched into PCCM to start after I do nephrology.
I will eventually be an Intensive Primary Pulmonephrologist. (I made that term up)


Lesson of the story? As a resident, being in the wrong place at the wrong time will do you in. No redeeming qualities. Also just because one is a doctor does not mean one is wise, benevolent, or understanding. However, unless you ascend to that level, nothing can be done to change things.

Just rise above it all and carve your own path. Then when you run into these individuals again, you can let the results speak for themselves.

Also to the OP, sometimes new scenery and starting anew may be what it takes to relaunch your career.

Also to the OP, IM residency is not about training one to be the BEST IM doctor. It's about training one to be a hospitalist. Further, it's also a time to just do what your superior tells you to do. Independent thought is frowned upon. Anything that gets in the way of maximal RVUs is frowned upon. Just be a part of the cog. There's nothing you can do. All of the US Health Care system is like this. You want to make a difference? Go into private practice and do the best job you can and keep your patients away from the hospital. (That will be my MO)



ADDENDUM:

Lost in this long post is that the underlying moral of the story is that an IM resident needs to "play well with others." Many times, this means swallowing your ego and submitting. Don't worry, this doesn't mean the person you are submitting to is better than you persay. Just older and has been around the block longer.

The most "successful" IM residents often times just treat IM as a 3 year transition period to fellowship and "let the attending do all the work."

And medicine is HARDLY a meritocracy in the US. Even among the top academic research centers. Rather it is a plutocracy that reeks of nepotism, cronyism, and favoritism. Not unlike the Federal Government... but I digress.

At the end of the day, the reward for doing the RIGHT THING for your patient is the satisfaction of knowing you did the right thing and went above and beyond. Expecting a fat bonus on your paycheck or a promotion for that does not happen and would defeat the purpose of doctoring.

 

[nirvana88]

to the OP:

Sorry to hear your situation.

Let me tell you my story. The theme is the PDs, APDs, chief residents will very often go use one sided hearsay from ANYONE else (even if it is an isolated incident and a "wrong place in the wrong time situation") besides yourself and use it as GUILTY IN THE COURT OF PUBLIC OPINION.

I was heavily recruited to join the academic university based IM program I went to. USMG, top shelves, honors all across, top USMLE, small time poster research. Was seen as a top intern and won intern of the year. Praised for having top medical knowledge and good bedside manner (!!! it was an emphasis in my medical school) and got many good reviews from attendings and the chief residents that year and was engaged into cardiology research with the faculty. Did grand rounds as an intern (!). Scored top of the intern class in the in service.

Cue to PGY-2... oh boy...

The wide consensus was the chief residents of my PGY2 year were the worst the program had seen for a long time. Not only were they meager in medical knowledge but also meager in pedigree, clinical acumen, and even personality. The "good residents" of their class all took fellowship ASAP. Think of a combination of a bureaucrat, Data (from Star Trek, only not as helpful), and a sycophant and you have these chief residents.

Year started off poorly after they gave me all of my four weeks of vacation in July and August. Why? Because I was a trooper and did not complain (unlike the other residents). By the time I complained about this, I was automatically labelled a "problem resident." Bad start to the year.

I was on the floors with a variety of preliminary interns and I did a Herculean effort of being a one man show to help them out (and to help myself out)
The program's response? You need to learn how to delegate and you can't do everything yourself. The reward for a job well done? (Solving hard cases, setting up patients on a silver platter for the consultants, engaging in discharge/social work stuff and always keeping my census low for the next call cycle, engaging in patient centered medical care and calling PMDs and families for updates) Being called a "problem resident."

Move on.. did some publications (small stuff nothing big, but in Pubmed). Gaining traction for fellowship. Wanted to keep my head down and just trudge onward.

Received VIP patients on my census. Rare disease great learning. Good bedside manner devolved into trying to get outlandish things done for the patient and family that the consultants wanted nothing to do with. Examples include getting prior authorization for free Glucerna (in retrospect, insurance companies do not pay for "food"), trying to "convince GI" to do a colonoscopy for fecal disimpaction after failing the standard digital disimpaction for which the patient complained no anesthesia was used and failing all the oral stimulant or osmotic laxatives, and other ridiculous items of business. Upon reporting it cannot be done or declining, was reported to administration by the VIP family. The administrators investigate and then label me a "problem resident."

Received dying cancer patients. Poor patients. I went out of my way to show the utmost care and concern for their symptoms and treatment. One patient on the ISTOP system registered as having multiple prescriptions for Opana from multiple physicians. Probably wanted to sell it to make some money for the family this patient would be leaving behind. Felt bad. But then I told the patient per hospital policy, I cannot give more prescriptions and maybe it should be brought up to the attending. Complained to hospital administration that I was not taking care of her pain. Automatically labelled a "problem resident."

In the interim, got certified in ALL of the bedside procedures by using my spare time and making connections in ICU or rheum or orthopedic surgery (that residents no longer have to get certified in these days, i.e. paracentesis, central line, A-line, arthrocentesis, USG IV placement, LP). Also started getting adept at POCUS and POC Echo and gave morning resident reports on it.

Also scored top in my PGY2 class in the in service and actually beat out all of the PGY3 that year in terms of absolute raw score.

LORs collected. Given assurances by the home cardiology program since I published with them and have good rapport with them...

Then during a social event for the residency class, one of the chief residents (a brute, a slob, and hardly a scholar.. USMLE Step 1 188, failing by modern standards) was drunk and overtly over flirting with a female coworker. I was already married with a kid then and thus could have minded my own business. But having worked with this coworker enough to know enough was enough so I told the chief to stop what he was doing and he was making a fool of himself. Then I threatened show him the door. However chivalrous I was, this led to the ULTIMATE SCARLET LETTER of "problem resident."

The next day the PD and chief of medicine said I had no idea how to be professional and placed me on probation.

LOL.

Passed over to be a chief resident despite "winning the popular vote". (Oh well... time for fellowship...)

PGY3 starts.

On my best behavior. Getting the best continuity of clinic patients, getting the lowest length of stay, cracking the toughest cases, getting best patient reviews, having more publications produced.

Applied for fellowship. A healthy number of interviews. Ranked home program highest. Due to certain financial and family obligations, can't travel too far. Given verbal assurances from cards PD.

In service top score of the PGY3. Top NATIONAL percentile 99 amongst PGY3.

Match Day.... Unmatched...

Quality of fellows accepted to home program? I'll save this for another vignette.

On further investigations, my closest advisors said the IM PD LOR was the likely poison pill letter and I have been blacklisted.

By now, the initial IMPD who was after me was fired and transferred. The APD (one of my mentors) assumes the role of PD, but cannot do anything more for me at this point.


I finish out the year strong. Financially I am in a good place so that freedom is everything.

End of year evaluations: informed I "rebounded" strong and was ranked number 1 resident in terms of overall growth and accomplishment. Encouraged to do hospitalist and try again to cards.

Decision: I will not be a hospitalist. I will carve my own path and show to everyone just how bureaucracy cannot hold me down.

Accepted an open Nephrology position somewhere else. Became the best nephrology fellow the program ever had (which is really not saying too much, but I am confident I set the bar high). Published a handful of nephrology papers.
Got a moonlighting PMD job and honed my skill as PMD.
SIMULTANEOUSLY did PCCM research and made new connections at a new place.

Overcoming fatigue and uncertainty, I have now matched into PCCM to start after I do nephrology.
I will eventually be an Intensive Primary Pulmonephrologist. (I made that term up)


Lesson of the story? As a resident, being in the wrong place at the wrong time will do you in. No redeeming qualities. Also just because one is a doctor does not mean one is wise, benevolent, or understanding. However, unless you ascend to that level, nothing can be done to change things.

Just rise above it all and carve your own path. Then when you run into these individuals again, you can let the results speak for themselves.

Also to the OP, sometimes new scenery and starting anew may be what it takes to relaunch your career.

Also to the OP, IM residency is not about training one to be the BEST IM doctor. It's about training one to be a hospitalist. Further, it's also a time to just do what your superior tells you to do. Independent thought is frowned upon. Anything that gets in the way of maximal RVUs is frowned upon. Just be a part of the cog. There's nothing you can do. All of the US Health Care system is like this. You want to make a difference? Go into private practice and do the best job you can and keep your patients away from the hospital. (That will be my MO)

Thank you so much for sharing this. It made me feel better.

 

[jhamaican]

Can tell from responses that you still don't get it.

You are not a special or unique snowflake

Tow the line. Get in line. Don't step out of line.

Your critical thinking skills are not a head above the rest.

Perception is everything.

Medicine is a hierarchy like the military, know your place.

Your attendings and PD have seen hundreds of residents before you , and will see hundreds after you are gone.

Without an attitude adjustment you will never succeed. In medicine or god forbid, a job outside.

Get over yourself.

 

[nirvana88]

Can tell from responses that you still don't get it.

You are not a special or unique snowflake

Tow the line. Get in line. Don't step out of line.

Your critical thinking skills are not a head above the rest.

Perception is everything.

Your attendings and PD have seen hundreds of residents before you , and will see hundreds after you are gone.

Without an attitude adjustment you will never succeed. In medicine or god forbid, a job outside.

Get over yourself.

I have no problem with shutting up and getting in line. And I never claimed to be a unique snowflake. I just always fought for what I believed to be right.
The thing is- if you're working as a dogmatic hierarchy, don't portray yourself as an HRO or pretend to give a damn about resident wellness. It's the hypocrisy that I find the most unsettling.

 

[nirvana88]

And before someone else says "you still don't get it", please accompany it with a theory as to why the attendings who were supporting me (including my advisor who would defend me in front of the PD) didn't "get it" either. Thank you.

 

[jhamaican]

I have no problem with shutting up and getting in line. And I never claimed to be a unique snowflake. I just always fought for what I believed to be right.
The thing is- if you're working as a dogmatic hierarchy, don't portray yourself as an HRO or pretend to give a damn about resident wellness. It's the hypocrisy that I find the most unsettling.

honestly just trying to give you advice and help you.

I was the person you were in medical school.

learned these lessons the hard way.

Made some serious adjustments for residency.

The bold part is where you are confused. As a resident, you don't stand up for what you believe is right as you don't know what is right or wrong yet at this point in your training. You do not yet have the sufficient experience. It is not your license on the line.

when in Rome, do as the Romans do.

You will come to appreciate why things are done a certain way once you have more experience.

I feel my previous self in your posts, and it pains me that you had this poor outcome.

I was on the same path before attitude adjustments were made.

I radically changed my attitude and outlook from medical school to residency and am now set to attend a "top tier" (for whatever that is worth) GI fellowship next year. Problem residents do not get desirable jobs or fellowship positions.

if more than even a handful (2-3+) of evaluations are negative or suggest a problematic resident, this is too many! At this point it is irrelevant how many good evaluations you have. This is not a balancing act. The good is expected and the norm!

I wish the best for you.

 

[deleted480308]

And before someone else says "you still don't get it", please accompany it with a theory as to why the attendings who were supporting me (including my advisor who would defend me in front of the PD) didn't "get it" either. Thank you.

Those attendings aren’t posting verbatim identifiable evaluations to a public internet thread highly trafficked by PDs when in such a vulnerable position that they still need that PD to help them move on with their career. We’re trying to help you

 

[Crayola227]

Where I disagree is that I directly clashed a few times with my seniors and attendings and saved a couple of lives. Most of the time I got a pat on the back for it, and the times I didn't, well, I wasn't wrong even if no one loved it.

That's pretty rare, and most of the time when people are crossing their superiors it's a pissing match, and people just want to be right when it doesn't really make a big difference at the end of the day.

It's called picking your battles. If you don't do it right you will lose the war.

 

[drfunktacular]

As a resident, you don't stand up for what you believe is right as you don't know what is right or wrong yet at this point in your training. You do not yet have the sufficient experience. It is not your license on the line

Many residents could save themselves a lot of grief if they recognized this fact

 

[nirvana88]

honestly just trying to give you advice and help you.

I was the person you were in medical school.

learned these lessons the hard way.

Made some serious adjustments for residency.

The bold part is where you are confused. As a resident, you don't stand up for what you believe is right as you don't know what is right or wrong yet at this point in your training. You do not yet have the sufficient experience. It is not your license on the line.

when in Rome, do as the Romans do.

You will come to appreciate why things are done a certain way once you have more experience.

I feel my previous self in your posts, and it pains me that you had this poor outcome.

I was on the same path before attitude adjustments were made.

I radically changed my attitude and outlook from medical school to residency and am now set to attend a "top tier" (for whatever that is worth) GI fellowship next year. Problem residents do not get desirable jobs or fellowship positions.

if more than even a handful (2-3+) of evaluations are negative or suggest a problematic resident, this is too many! At this point it is irrelevant how many good evaluations you have. This is not a balancing act. The good is expected and the norm!

I wish the best for you.

Thank you for your kind words but I must disagree with you yet again. My attitude was never brought up as a problem. The reasons quoted in my dismissal were always mistakes I acknowledged/ everybody made commonly. Moreover, "you don't know what is right or wrong" is where I would appreciate a logical conversation about patient management rather than "because I said so". I never try to prove myself right, rather make sure that the best course of action is being taken for the patient. I wouldn't mind losing my career if that's the cost of saving a patient's kidneys or even life.

Consequentially, this brings me back to the reason I will keep debating on this thread forever. I know that my career in the US is most likely over. But even if one PD or administrator reads this and thinks "you know, that resident really does not deserve to be kicked out", I would feel like I served my purpose. In contrary to how most of you perceive me (a pretentious prick), I have nothing to prove myself for. I do not mind sacrificing my career if that's the cost of saving some other resident's career or even life.

 

[parcus]

Thank you for your kind words but I must disagree with you yet again. My attitude was never brought up as a problem. The reasons quoted in my dismissal were always mistakes I acknowledged/ everybody made commonly. Moreover, "you don't know what is right or wrong" is where I would appreciate a logical conversation about patient management rather than "because I said so". I never try to prove myself right, rather make sure that the best course of action is being taken for the patient. I wouldn't mind losing my career if that's the cost of saving a patient's kidneys or even life.

Consequentially, this brings me back to the reason I will keep debating on this thread forever. I know that my career in the US is most likely over. But even if one PD or administrator reads this and thinks "you know, that resident really does not deserve to be kicked out", I would feel like I served my purpose. In contrary to how most of you perceive me (a pretentious prick), I have nothing to prove myself for. I do not mind sacrificing my career if that's the cost of saving some other resident's career or even life.

Reread post 23 from aProgramDirector, it explains your situation pretty well. Just curious, were you not able to find an open PGY1 spot? Or did you not look for it?

 

[nirvana88]

Reread post 23 from aProgramDirector, it explains your situation pretty well. Just curious, were you not able to find an open PGY1 spot? Or did you not look for it?

I appreciate his/ her comments. And understand the extent of doubt involved. But I know that I tried my best. Unfortunately there isn't a part of my body that could be biopsied to prove that. It's just that when you keep asking others for feedback and they have nothing to suggest, you're not left with many options to "change". Like I said before, I was mainly criticized for mistakes and never really told "do this instead of that". The only suggestion I did get was to be more passive (but that was not what I was dismissed for, or at least it was never quoted by the administration). Furthermore, I used to feel like I was betraying the patient's trust and myself by not suggesting a better course of action.
I have not yet looked into PGY-1 spots, though that would be my last option in I don't find any PGY-2 spot.

 

[NewYorkDoctors]

I appreciate his/ her comments. And understand the extent of doubt involved. But I know that I tried my best. Unfortunately there isn't a part of my body that could be biopsied to prove that. It's just that when you keep asking others for feedback and they have nothing to suggest, you're not left with many options to "change". Like I said before, I was mainly criticized for mistakes and never really told "do this instead of that". The only suggestion I did get was to be more passive (but that was not what I was dismissed for, or at least it was never quoted by the administration). Furthermore, I used to feel like I was betraying the patient's trust and myself by not suggesting a better course of action.
I have not yet looked into PGY-1 spots, though that would be my last option in I don't find any PGY-2 spot.

In my side gig as GIM attending, I have been able to reflect back on residency and some of the very vague and seemingly useless advice that was given to me by various attendings. It always seemed like "Do as I say, but not as I do."

It takes either a degree of blissful ignorance to go along with it (as most do).
It takes some reflection at the end of it all to realize what many of your attendings, faculty, and program director(s) wanted was just never concretely spelled out.

Instead of "You need to read more." - It should be... "Your comments and assessment are not incorrect but I sense they are based from your understanding of the topic from medical school and USMLE studying. I suggest you look at this landmark paper by XYZ et al and then we can discuss this tomorrow. Further you are not wrong to suggest Treatment X, but based on this data we can discuss if Treatment Y is an optimal treatment for our particular patient or not."

Instead of "You need to delegate more." - It should be... "Please make sure you are stimulating the growth of your junior house staff so they can receive the same degree of growth as you have>"

In retrospect, a headstrong individual like myself (and possibly yourself OP) would have appreciated it more if something like this were said more often:
"Yeah I know you make a good point. But we are not the primary care physicians who will longitudinally focus on this patient once discharged. We have to cross every T and dot every I and prevent the readmission. We have to undertake this more circuitous route in order to ensure this. Trust me I have the experience. I know from a by the books perspective this is not the ideal way. But based on real life, medicolegal factors, and fulfilling the Press Ganey scores, we have to go about this method of doctoring. Once you finish residency, I encourage you to do a subspecialty to avoid this excess government regulation on our noble profession."


Perhaps this is another example that the Gen Xers think the Millennials are Charmin Soft. Whether that is the case or not, if a trainee is expected to accept constructive criticism well, the teacher must be able to actually GIVE constructive criticism. There is no better litmus test of a faculty member who is just too lazy (or busy...) to give any kind of constructive help than when a Letter of Recommendation request LAGS well into the ERAS application cycle. The EtCO2 didn't change colors fast enough for those faculty members...


The recent wave of Allopathic Medical Schools (that are not university, big research based schools) have been focusing much of Patient Centered Medical Care and treating the patient first and doing cost conscious care... ABIM even emphasizes this... but the true pressures of the real world financial aspect of hospital medicine are highly incompatible with this and when a hotshot upstart resident is trying to abide by "best practices," it becomes seen as an infringement on the autonomy and control of the attending (who likely trained in a prior generation where it was all about order every test under the sun, keep the patient admitted for 3 weeks wait until the consolidation goes awway and document negative fevers x48 hours and negative cultures x a bajilliion... seriously they practiced this way as early as the 80s). Animal instincts kick in and instead of rationally solving the issue, the "problem resident" complaint is the path of least resistance.


Anyway the point of this is not to point fingers at anyone.. but to highlight to the OP that attendings and faculty and PDs are not perfect people. They are swamped with their own administrative duties and want to go home to their families and watch TV or engage in their own research and have their own problems. They are not your guidance counselor persay and see an infringement on the "model resident" as an extra burden of work which can be done without.

You just have to work well with others and work around this.

 

[nirvana88]

In my side gig as GIM attending, I have been able to reflect back on residency and some of the very vague and seemingly useless advice that was given to me by various attendings. It always seemed like "Do as I say, but not as I do."

It takes either a degree of blissful ignorance to go along with it (as most do).
It takes some reflection at the end of it all to realize what many of your attendings, faculty, and program director(s) wanted was just never concretely spelled out.

Instead of "You need to read more." - It should be... "Your comments and assessment are not incorrect but I sense they are based from your understanding of the topic from medical school and USMLE studying. I suggest you look at this landmark paper by XYZ et al and then we can discuss this tomorrow. Further you are not wrong to suggest Treatment X, but based on this data we can discuss if Treatment Y is an optimal treatment for our particular patient or not."

Instead of "You need to delegate more." - It should be... "Please make sure you are stimulating the growth of your junior house staff so they can receive the same degree of growth as you have>"

In retrospect, a headstrong individual like myself (and possibly yourself OP) would have appreciated it more if something like this were said more often:
"Yeah I know you make a good point. But we are not the primary care physicians who will longitudinally focus on this patient once discharged. We have to cross every T and dot every I and prevent the readmission. We have to undertake this more circuitous route in order to ensure this. Trust me I have the experience. I know from a by the books perspective this is not the ideal way. But based on real life, medicolegal factors, and fulfilling the Press Ganey scores, we have to go about this method of doctoring. Once you finish residency, I encourage you to do a subspecialty to avoid this excess government regulation on our noble profession."


Perhaps this is another example that the Gen Xers think the Millennials are Charmin Soft. Whether that is the case or not, if a trainee is expected to accept constructive criticism well, the teacher must be able to actually GIVE constructive criticism. There is no better litmus test of a faculty member who is just too lazy (or busy...) to give any kind of constructive help than when a Letter of Recommendation request LAGS well into the ERAS application cycle. The EtCO2 didn't change colors fast enough for those faculty members...


The recent wave of Allopathic Medical Schools (that are not university, big research based schools) have been focusing much of Patient Centered Medical Care and treating the patient first and doing cost conscious care... ABIM even emphasizes this... but the true pressures of the real world financial aspect of hospital medicine are highly incompatible with this and when a hotshot upstart resident is trying to abide by "best practices," it becomes seen as an infringement on the autonomy and control of the attending (who likely trained in a prior generation where it was all about order every test under the sun, keep the patient admitted for 3 weeks wait until the consolidation goes awway and document negative fevers x48 hours and negative cultures x a bajilliion... seriously they practiced this way as early as the 80s). Animal instincts kick in and instead of rationally solving the issue, the "problem resident" complaint is the path of least resistance.


Anyway the point of this is not to point fingers at anyone.. but to highlight to the OP that attendings and faculty and PDs are not perfect people. They are swamped with their own administrative duties and want to go home to their families and watch TV or engage in their own research and have their own problems. They are not your guidance counselor persay and see an infringement on the "model resident" as an extra burden of work which can be done without.

You just have to work well with others and work around this.

Thank you for sharing this. You made some excellent points. This is exactly what I believe should be addressed. Problems should be solved with constructive feedback and harmony rather than just getting rid of the weakest link. If we accept each other as fallible beings while striving to be better, we would be able to promote a much healthier work environment in hospitals.

 

[NewYorkDoctors]

Thank you for sharing this. You made some excellent points. This is exactly what I believe should be addressed. Problems should be solved with constructive feedback and harmony rather than just getting rid of the weakest link. If we accept each other as fallible beings while striving to be better, we would be able to promote a much healthier work environment in hospitals.

But you can’t so anything about this right now . You need to find another position , redefine yourself , carve out another career path , then don’t ever ever become like the horrible bosses attendings and PDs out there (like the movie and it’s sequel).

 

[nirvana88]

But you can’t so anything about this right now . You need to find another position , redefine yourself , carve out another career path , then don’t ever ever become like the horrible bosses attendings and PDs out there (like the movie and it’s sequel).

That is what I intend to do. If I do find another spot, I'll try to be more of a fly on the wall. I know there will be times where I might argue where I would fear a patient is in severe jeopardy but I know I'll keep my head down more than in the past.
If I do make it through residency, it would definitely give me the opportunity to make a difference.

 

[NewYorkDoctors]

That is what I intend to do. If I do find another spot, I'll try to be more of a fly on the wall. I know there will be times where I might argue where I would fear a patient is in severe jeopardy but I know I'll keep my head down more than in the past.
If I do make it through residency, it would definitely give me the opportunity to make a difference.

If a patient is in severe jeopardy , rapid response and icu consultation .

If a patient may have things you feel are unaddressed , then the “heroic” thing for you to do is pick up the phone and call the PMD and sign out the loose threads (When I see a discharged patient I get nothing from the hospital ... if I’m lucky I get test results)

If you want to save people from imminent death , do an icu fellowship after residency .

Don’t argue with your bosses again . Find another hobby like trolling on an Internet forum (a non-medical one perhaps)

 

[GastriqueGraffin]

Humble yourself, smile, ask how you can help, know what your supervisors want (will the specific attending want discharge, consults, prolonged stays, etc). If you want to bring up a point do it in an informed and questioning way but drop it after it's been noted and in the end agree with your attending. It is their name on the patient's admission and if they mess up it's ultimately on them. Your job is to help them and learn.

 

[nirvana88]

If a patient is in severe jeopardy , rapid response and icu consultation .

If a patient may have things you feel are unaddressed , then the “heroic” thing for you to do is pick up the phone and call the PMD and sign out the loose threads (When I see a discharged patient I get nothing from the hospital ... if I’m lucky I get test results)

If you want to save people from imminent death , do an icu fellowship after residency .

Don’t argue with your bosses again . Find another hobby like trolling on an Internet forum (a non-medical one perhaps)

I meant severe jeopardy like the patient who was admitted for a stroke but actually had DKA. Had I agreed with the attending, the patient would have had a bad outcome. The only reason I was able to save the patient was that the radiologist corrected their mistake.
But I get it. Hopefully if I get another spot, I'll try my best to blend in the crowd. The system is not worth fighting as a resident.

 

[drfunktacular]

Don’t argue with your bosses again

This

 

[hello1234!]

If u disagree with an attending and are concerned about the safety of a patient, there are ways to express your concern without being precieved as confrontational. It’s ok to defend what is right for the pt, but there is a way of doing this and approaching the attending that still shows that you understand that it is their liscense and ultimately their decision.

 

[deleted480308]

I meant severe jeopardy like the patient who was admitted for a stroke but actually had DKA. Had I agreed with the attending, the patient would have had a bad outcome. The only reason I was able to save the patient was that the radiologist corrected their mistake.
But I get it. Hopefully if I get another spot, I'll try my best to blend in the crowd. The system is not worth fighting as a resident.

I’m confused by this story. Patients can have both and basic entry labs would have shown clear dka. It’s not like having dka means a stroke is wrong or a radiologist saying stroke means dka can’t happen.

I also find it rather rare that a radiologist would overcall an acute stroke on imaging

 

[nirvana88]

I’m confused by this story. Patients can have both and basic entry labs would have shown clear dka. It’s not like having dka means a stroke is wrong or a radiologist saying stroke means dka can’t happen.

I also find it rather rare that a radiologist would overcall an acute stroke on imaging

The patient came in for slurred speech and generalized weakness. ED attending ordered a CT head that was read as "Acute stroke" and I was called for the admission. When I examined the patient, I saw no evidence of a stroke and found 450+ blood sugar, acetone breath smell and an anion gap. When I brought them up to the attending, they said it's normal for an uncontrolled diabetic to have that. Upon detailed history, the patient told me they had a stroke 2 years ago. I reviewed past scans and found the stroke was an old one. I called the radiologist and they quickly re-read the stroke as an old one. Meanwhile, I had also ordered urine ketones which came back positive.

 

[GastriqueGraffin]

The patient came in for slurred speech and generalized weakness. ED attending ordered a CT head that was read as "Acute stroke" and I was called for the admission. When I examined the patient, I saw no evidence of a stroke and found 450+ blood sugar, acetone breath smell and an anion gap. When I brought them up to the attending, they said it's normal for an uncontrolled diabetic to have that. Upon detailed history, the patient told me they had a stroke 2 years ago. I reviewed past scans and found the stroke was an old one. I called the radiologist and they quickly re-read the stroke as an old one. Meanwhile, I had also ordered urine ketones which came back positive.

He could have had a TIA. He could also have had a mild DKA. My guess is he was out of the window for TPA for the "stroke" and his gap was not high enough to warrant insulin drip. Management would not change regardless of who was more right. The point is medicine is an art as much as a science and your role there is to be supportive. When it's your license, maybe then you'll understand and refuse to work with trainees because of experiences such as the one you provided your attending.

 

[nirvana88]

He could have had a TIA. He could also have had a mild DKA. My guess is he was out of the window for TPA for the "stroke" and his gap was not high enough to warrant insulin drip. Management would not change regardless of who was more right. The point is medicine is an art as much as a science and your role there is to be supportive. When it's your license, maybe then you'll understand and refuse to work with trainees because of experiences such as the one you provided your attending.

The patient having another stroke in the exact same place is extremely unlikely.
Anyway, there's no point discussing it. The most convincing argument I've heard in this thread is the one about the license being theirs. That kind of convinced me to tone down in the future.

 

[DrMetal]

I spent a day in a crisis center for suicidal ideation and the only thing that kept me from doing it was my religious faith. So if you're telling me that a system that forces an honest and hard-working physician to suicide is perfect, please save me the lecture.

I'm not sure if this thread is helping you more than it is hurting (or aggravating) you. Since you've admitted now that you have had some mental health concerns because of your situation, it might be a good idea to wrap it up here and continue seeking help in 'real-life', with counselors and what not. Also: you've probably broken your anonymity, and this may not bode well for you if they find out you've been posting everything here (I personally don't feel posting here is a bad thing, but your superiors (and future superiors) might disagree).

 

[nirvana88]

I'm not sure if this thread is helping you more than it is hurting (or aggravating) you. Since you've admitted now that you have had some mental health concerns because of your situation, it might be a good idea to wrap it up here and continue seeking help in 'real-life', with counselors and what not. Also: you've probably broken your anonymity, and this may not bode well for you if they find out you've been posting everything here (I personally don't feel posting here is a bad thing, but your superiors (and future superiors) might disagree).

The fact that we lie to each other's faces but have to put on masks to speak the truth means we need to change this culture. Anyway, I don't mind breaking anonymity. I've been taught to always speak the truth and I don't mind being punished for it.

 

[DrMetal]

The fact that we lie to each other's faces but have to put on masks to speak the truth means we need to change this culture.

This is true in many walks of life, not just medicine. We often put on masks. If you were a junior lawyer working in a law firm or doing a government clerkship, you'd have very similar problems. The problem with speaking the 'truth' is that we can't always come to agree on what that truth is. 'Truth' can be a very relative term.

I've been taught to always speak the truth and I don't mind being punished for it.

Well I hate to break it to you, but that's exactly what's happening. You don't mind getting kicked out of residency? That's a heavy price to pay in my opinion.

Look, the chances of someone changing your mind and personality on this forum are about as good as the chances of my Lakers winning the NBA championship this year. Seek some good professional help, we can all use some.

 

[rokshana]

My insight seems to be poor because I kept begging my attendings for feedback and they kept saying I was perfect/ near perfect. All I wanted was a logical argument for my dismissal and nobody in my program was able to provide that to me.
Moreover, the shock and awe in those attendings and the common thought that this was unfair didn’t help either. The argument that “If there’s smoke, there is a fire” is not good enough to fire somebody.
Furthermore, the attendings that did have something to say said I need to be more a reporter than an interpreter which is another way of saying “bend the knee”.

sorry but i smell a little BS here...in the RIME scheme, an intern is expected to be able to be an interpreter ...reporter is a 3rd-4th year med student.