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What do you log as work hours?
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Councilor, always entertaining reading of your experiences. Like several other posters I question the completeness of your description of what transpired concerning that hospitalist. As an attending I have a rule when dealing with an argumentative resident: "get your attending on the phone". That's it.
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I gave the cliff notes. More detail would potentially out the people involved. Such a phone call didn't occur. My personal view, as stated, is it would actually not have been well received. I will leave it at that.
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"Wouldn't have been well received"... hmmm. Really? Fisticuffs in front of the nurses?
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No. More like "$&@&! WTF are you waking me up for this $&@&? My G-d damn $&@&ing senior resident is standing right $&@&ing next to you and he $&@&ing knows the plan! WTF was your $&@&ing name again?" (Although probably with a lot more additional flowery language. Alas, we will never know). 🙂
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Well, they really must not care for hospitalists at your place. Anyway, we've really strayed from the OP post...
By the way, if an attending spoke to me that way on the phone concerning a patient (I'd be quiet during his rant), I would have said, "Be here at 6:30am, Conference Room 6 on the 12th floor. You, me, our PDs, and our department heads are going to have a talk about "the plan", and how attending relationships with your residents are going to be handled going forward. (I would have said this in a normal voice with the resident standing there next to me). Or, you will be suspended from the teaching service by noon".
By the way, if an attending spoke to me that way on the phone concerning a patient (I'd be quiet during his rant), I would have said, "Be here at 6:30am, Conference Room 6 on the 12th floor. You, me, our PDs, and our department heads are going to have a talk about "the plan", and how attending relationships with your residents are going to be handled going forward. (I would have said this in a normal voice with the resident standing there next to me). Or, you will be suspended from the teaching service by noon".
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It's unprofessional yes, but as I mentioned above, in some hospitals where 90% of the revenues are generated by 1-2 services, the other services are viewed as more ancillary and sometimes aren't in the drivers seat in these interactions. As mentioned above the hospitalist didn't make such a phone call but did, in fact, ultimately experience a "be here at 6:30" meeting that went very differently than you are suggesting...
Anyway this is redundant. I suspect we have all witnessed differences in hierarchy and hospital politics at various facilities, and it's naive to think the lay of the land is universal.
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There is only one "drivers seat" in attending / resident interaction. As I intimated above, that hospitalist may have been "in the wrong" medically; if so, that was what was rightly dealt with upstairs. And if so, the resident should have called his attending the moment he had a medical treatment issue with that hospitalist. My senior residents, especially, are to call me 24/7 if they get into a patient care issue with an attending.
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In my experience and yours, this is true. In Law's it isn't. The thought of attendings always getting to outrank residents probably seems as bizarre to him, as the thought of the hypothetical phone call he describes seems bizarre to you and me. Never the twain shall meet. Luckily there's a bunch of hospitals out there, and we're all likely to end up staying at the sort of place we are already used to.
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Agree with 22031 Alum above-- there isn't one set of hospital hierarchy or politics at play in this great big nation.
As for you encouraging your senior residents to call you if they get into issues, I don't doubt you feel this way, but I know many residents, that as they get more senior, expect/hope to have to wake up attendings less and less with each passing year, and consider it a personal failing to have to wake someone up for something they ought to be able to handle. That's part of the growing up process of call -- by the end the attending should be rarely getting calls that aren't life or death. And that's so even if the attendings say they can be called for this kind of stuff.
I think there's a difference between holding your ground, and losing it, and many seniors would (appropriately IMHO) only make the call if they really felt they needed backup. I also note there's likely a big difference in how quick a "senior" resident might call if we are talking a 3rd year "senior" resident versus, say, a 5th or 6th year "senior" resident. In the current situation the resident held his ground, the patient plan wasn't ultimately changed, and the animosity was dealt with in the day time -- I am not sure why the attending being woken up would have added much to the equation other than adding an annoyed sleep-deprived person into the mix and the issue coming to a head earlier.
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