Ticking off consultants

[NinerNiner999]

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So lately, I've had a couple of harsh consultant interactions (being accused of being antagonistic, rude, and confrontational) despite being polite and denying my "confrontational" attitude multiple times. Is it common for other specialties to become "burned out" towards the end of each year, or is it more common for me to be toxic and not even know it?

NOTE - This is not even CLOSE to referring to EM as a burnout field - I am very happy, just don't feel like others see it...

Fatty McFattypants, M.D.

 

[DrQuinn]

I think if you're dealing with residents, attitudes and grumpiness do come out around the late winter/spring until the end of the academic year. People are pretty laid back the first 5-6 months... I think it has to do with being "gung-ho" about being a new intern or being the new "senior" on the service.

I knwo I was feeling down and "burnt out" around the late winter time during my internship... but I think most people, in all the specialties, felt that way PGY-1 year. Now that I'm on the threshold of a PGY-3, I look back on the PGY-2 year and have loved every minute of it... even PICU call.

Developing the communications to talk to consultants is a skill that takes a while to learn, and you need to be able to "read" each consultant and what information they want. It is probably institution spefic... and most definately specialty and resident specific as well.

I'm sure the vast majority of the other consultants you have called down dont' consider you rude.... Fatty McFattypants.
Q

 

[GeneralVeers]

The only consultants I've ever had a problem with has been OB/GYN residents at Methodist Hospital. They ask so many questions because they don't want to come down and see the patient.

During our 4th year rotation we actually had to call the consulting resident and staff directly. It was somewhat intimidating being a student and having to talk to a staff cardiologist, but it was useful for learning how to communicate.

 

[Annette]

Could it be a mix? Maybe a domino effect? Think back, were these interactions on the same day? Same consultants? No matter how good we are at interactions, we can all improve, especially if a program director dictates so!

 

[southerndoc]

Our internal medicine residents are really good (probably among the top in the nation), but they sometimes have occasional lapses in judgment. I overheard one of the other residents ask an IM resident if he even went to medical school when he said a patient didn't need to be admitted (I won't go into specifics).

It's that kind of thing that doesn't foster a great relationship with other residents. Sure, we all have residents (and attendings) who don't think a patient doesn't need to come in or thinks we should do more in the ED before sending a patient upstairs. When that occurs, I'm usually nice about it. If it's not incredibly busy and it's a reasonable request, I'll do it (usually sending extra labs).

Remember, the toes you step on today might be attached to the arse you kiss tomorrow. I believe in the philosophy of being nice to consultants and admitting residents, and they in turn are usually nice to me.

In my year of internship, I have had only 3 instances of problems with consultants/attendings and residents. One was a surgery resident who was having a bad day and later apologized for saying something that was completely out of line unrelated to patient care, another was from an attending that sent a patient in for a VQ scan without any risk factors, and the third one was one I will always remember. A vascular surgeon who wanted me to "ice" a patient with an expanding neck hematoma after attempting to have a bowel movement. Oh, I forgot to mention he was 3 days out from a carotid endarterectomy. He took a hint and came in to see the patient when my attending called him back to let him know the patient just smoked a tube and would need an ICU bed.

 

[roja]

I tend to agree with southerndoc. and not just because southern manners have been deeply engrained in me.

You know as an ER doc that people are going to come at you at times with a bad attitude. Its just one of the downsides (or perks, depending on your personality). Hey, if I was some normal hour working type person, I would NOT want to get called at 3am. So, I try and be a little empathetic.

Same with residents I deal with. My job creates more work for them. I try adn be empathetic. *shrug* it works. I have had no serious confrontations with any consultant yet. *knocks on wood* I have had certain somewhat confrontational consults compliment me to the ED director.

Being firm about an admission or a consult is not the same as coming at someone with attitude. I have once or twice had to tell a resident to come and see the patient before they ask for things out of the ordinary. Or had to explain that a patient can indeed go to the floor without an IV if the patient is refusing.

But you can be firm adn nice all at the same time. It doesn't hurt that we have admitting privilages and no service is allowed to refuse an admission.

I am also VERY honest when its a soft admit- like social or attending driven- and I say that upfront. That way when I have a 'real' admit, they know its for real.

Some people are just asses. And will confront you no matter how nice you are. And you just have to try adn never loose your cool. I vent later over a nice cold hoegarden. 😀

 

[tonem]

Just a funny observation but....

I've noticed that the same fellows that bitch and moan about legitimate consults in the ED totally kiss my butt when I make what I consider to be "lame" consults (ie: surgical attending doesn't wanna deal with chronic afib) in the SICU.