What do you do when Attending is senile?

[whatshername]

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I am an intern on an internal medicine rotation in Virginia. My Attending is up there in age and avoids any medical question possible. Fellow interns and I have concluded that the avoidance of questions stems from his lack of medical knowledge. An intelligent fellow intern of mine tested him with a question that he clearly should have known the answer to, but gave an incorrect answer. To dodge medical questions thrown his way, he cracks a joke, usually about the "old days." He is continually referring back to the "old days." Due to this, I get no guidance, no teaching, and am left where I started, clueless. He is a possible danger to his patients. What do I do?!

 

[Tired]

The first thing is learn to spell "senile" so that when you write it in the chart people don't laugh at you.

 

[whatshername]

geez I just posted it. give me a sec

 

[Tired]

geez I just posted it. give me a sec

Sorry.

Personally, I wouldn't do anything, except make sure he didn't kill anyone.

 

[elwademd]

some attendings will give you a "back in the day" story, to show you their perspective of how it used to be done... in a way to tell/show you one way of approaching a case. so, you're probably getting some guidance... just not the directed guidance/teaching that you really seek.

with that said, it's your job to perform to the best of your abilities. unfortunately, you're supposed to be getting teaching as well (as the acgme says that we residents are supposed to get teaching will providing service. and in fact, if we're only providing service, that's a problem. again, according to the acgme.)

if you really feel that this particular attending doesn't have it, you should think about approaching with more seniority than yourself about it. as an intern, i can imagine that many other teaching attendings and the program director may feel that you're "just the intern" and not take your claims seriously. your chief resident may be the best person to approach about the situation.

 

[almostfamous]

Sorry.

Personally, I wouldn't do anything, except make sure he didn't kill anyone.

go ahead and let him, just make sure it happens when you aren't around. then the medical staff/hospital ceo/lawsuits will take care of the problem.

 

[snoopy brown]

An intelligent fellow intern of mine tested him with a question that he clearly should have known the answer to, but gave an incorrect answer.

It's a tricky situation because we've all had attendings where we've questioned their competence or knowledge. At the same time isn't it rather rude to go around "testing" them? I mean as an intern you will find that as you get further away from stuff like for example the Krebs cycle, you will learn that your MS-2 knows it better than your attending. And often MS-2s forget that it's not totally relevant to most people to know the Krebs cycle so they say, "amazing, today I asked my attending a simple question about the third enzymatic step and he didn't know even what it was! Even I know it!!"

Then also, if he really is that old you have to remember that a 90 year old attending trained before the explosion of medical knowledge (WTF is DNA?) and the truth is that most people don't really keep up with stuff rigorously unless they're actively teaching or researching. CME is a joke for most people, just something they do to fulfill a credit. I suspect were you in the same position you'd do no better. I've had many attendings joke that back in the '40s the only drugs they had to know were aspirin and penicillin and you either got better or you didn't.

Lastly we're all of varying intellect anyways. I'm not the top of my class and never was. I'm nice and smack in the middle. If someone who knows more than me really wants to show off I'm sure they can embarrass me for a while. Until I blind side them with a roundhouse kick. If you know that you know more than him then just chill out, Einstein. Your day will come, too. Clearly he's not killing people because he's still practicing after 50 years, so get a clue.

 

[Tired]

go ahead and let him, just make sure it happens when you aren't around. then the medical staff/hospital ceo/lawsuits will take care of the problem.

C'mon, you know very well that all it takes is your name on the chart, and you'll be named in the suit.

If I have to be sued, I hope it's as an intern. "I have to go to the deposition" is a sure-fire way to get out of a day's worth of scut work. 😀

 

[NotAProgDirector]

If your hospital has an anonymous "impaired physician" reporting system, that is another way to address this issue. It all depends on exactly how "anonymous" it is, of course.

 

[deleted87716]

If your hospital has an anonymous "impaired physician" reporting system, that is another way to address this issue. It all depends on exactly how "anonymous" it is, of course.

I'm not sure that failing to answer reverse-pimping questions on rounds is necessarily evidence of "impairment." It's possible to practice safely and competently without encyclopedic knowledge of the latest evidence-based medicine. Find out what your attending does know, instead of what they don't know. It's quite likely you can still learn something from them.

 

[NKMU]

I was on a MICU rotation with an old attending (80ish) who would come in for daily rounds. He didn't practice any more, he just rounded with the residents. He taught NOTHING, complained ceaselessly about how no one looks at their patients' urine samples anymore, and complained every day about this "damn heparin drug you all have everyone on." His only function was to make the entire team feel stupid. Even the other attendings would frequently step in and (politely) tell him to shut the hell up.

I didn't complain during the rotation because at least it helped to break up the mega-boring rounds. We'd only ever get through two or three patients d/t his berating and complaining, and then I'd excuse myself for noon conference.

 

[deleted87716]

Remember, no man is completely useless. He may always serve as a bad example. 😉

 

[SoCuteMD]

complained every day about this "damn heparin drug you all have everyone on."

He had a point, you know! "Back in my day we just let natural selection take its course and let everyone die of massive PEs!"

 

[Gastrapathy]

If your hospital has an anonymous "impaired physician" reporting system, that is another way to address this issue. It all depends on exactly how "anonymous" it is, of course.

As a PD, do you really think its appropriate or fair for someone with as little perspective as a August intern to report someone? It can be harmful to one's professional reputation to have your conduct reviewed, regardless of the outcome. There are lots of other providers, including senior housestaff who should have more perspective on this physician's performance. I'd recommend that the intern talk to the residents on the service before making any type of formal complaint, anonymous or otherwise.

 

[Tired]

As a PD, do you really think its appropriate or fair for someone with as little perspective as a August intern to report someone? It can be harmful to one's professional reputation to have your conduct reviewed, regardless of the outcome. There are lots of other providers, including senior housestaff who should have more perspective on this physician's performance. I'd recommend that the intern talk to the residents on the service before making any type of formal complaint, anonymous or otherwise.

The flip side is that the moment you ask anyone's advice or perspective, if you do end up reporting it, it will definitely not be anonymous.

 

[NotAProgDirector]

As a PD, do you really think its appropriate or fair for someone with as little perspective as a August intern to report someone? It can be harmful to one's professional reputation to have your conduct reviewed, regardless of the outcome. There are lots of other providers, including senior housestaff who should have more perspective on this physician's performance. I'd recommend that the intern talk to the residents on the service before making any type of formal complaint, anonymous or otherwise.

A very good point. I guess I was just trying to point out that physicians can become impaired due to memory problems, and this definitely needs to be addressed. As an intern, concerns would be best forwarded to a chief resident or PD.

 

[PrincessofBlood]

A very good point. I guess I was just trying to point out that physicians can become impaired due to memory problems, and this definitely needs to be addressed. As an intern, concerns would be best forwarded to a chief resident or PD.

I know of older physician who trained back in the day when there was a rotating internship, he just "decided" to be a surgeon back before there were residencies, he figured out he couldn't do it (too many dead patients?) and went into another field, he really didn't know what he was doing, and another doctor had to rewrite some of his orders. . . but I don't think anyone died or made a complaint, but I guess he was sort of impaired. Anyway. . . I don't think the above physician has a memory problem but 100% agree with the above poster if you don't really care about being uptodate or do teaching or research then your skills degrade, every year out of residency means like a one percent increase in mortality for your patients according to one study! I don't think though that not being able to answer an intern's pimp questions will be enough though, considering that most interns can't answer half of what physicians ask, you need something concrete, otherwise it is sort of a witch hunt IMHO

 

[snoopy brown]

Bashing attendings is wrong, I demand formal apologies all around.

 

[PeepshowJohnny]

...complained every day about this "damn heparin drug you all have everyone on."

Oh my goodness, that just made my day.

 

[jennyboo]

These can be good situations if you have a good resident you can touch base with. Manage the patient as you and your resident see fit, tell the attending what you plan to do, let him nod and get on with it.

If you are clueless, your resident is clueless and your attending is clueless, then you're all in trouble. But if you guys are able to direct the patient's management, you'll be done with your work and you might even get outta there sooner than if you had a hands-on attending. So enjoy the extra freedom and free time while you can.

And definitely make use of the attending evaluations they assign you. If there is greater concern about issues that can improve your teamwork while you still have this attending, your resident can perhaps raise the point with the chief / program director / attending.

 

[deleted87716]

But if you guys are able to direct the patient's management, you'll be done with your work and you might even get outta there sooner than if you had a hands-on attending.

It can definitely be a mixed blessing. When I was a third-year med student, I did an IM rotation at the local VAMC. My attending was an older nephrologist, and pretty much everything he talked about on rounds came back to the kidney, no matter how tangential it might be to the patient's actual pathology (which made for some rough pimping, as renal physiology wasn't my strong suit). Anyway, he was essentially useless for anything non-renal, so the residents ended up managing most of the patients, and called consults for the stuff that was over their head.

Of course, we had it better than the team that was led by a dermatologist. 😉

 

[Faebinder]

Aricept 5 mg q daily. Mix with diet Lipton Green Tea before presenting to the attending-patient on their way home after work. Continue dosage for 4 weeks. Increase to 10 mg for 2 more weeks if no sx improvement. Follow-up with SDN board/threads in 6 weeks.

 

[gutonc]

It can definitely be a mixed blessing. When I was a third-year med student, I did an IM rotation at the local VAMC. My attending was an older nephrologist, and pretty much everything he talked about on rounds came back to the kidney, no matter how tangential it might be to the patient's actual pathology (which made for some rough pimping, as renal physiology wasn't my strong suit). Anyway, he was essentially useless for anything non-renal, so the residents ended up managing most of the patients, and called consults for the stuff that was over their head.

I had essentially the same experience as an MS3 but w/ an endocrinologist at the county hospital who was obsessed w/ the thyroid. Present a 72yo COPDer w/ FEV1 of 0.4L who presented short of breath and he'd want to know the TSH, free T4 and T3RU. Tell him about the PFTs and either his eyes would glaze over or he would fall asleep (which happened pretty much every day). The only parts of the physical exam he wanted to hear about were the thyroid size, presence of thyroid bruits and the JVP (it's near the thyroid which is why I guess it even crossed his mind). Otherwise, he wasn't interested. Fortunately, the residents I was with on that rotation were good and pretty much able to run the team alone.

 

[carrigallen]

I had the same thing with a 80 year old hemotologist attending - for whom every patient had 'Paroxymal Nocturnal Hemoglobinuria' until proven otherwise.
Usually I think these attendings are harmless, because although they do not provide much guidance, at least they do not interfere with the management of the patient.