What happens to med students and interns/residents who don't respect the heirarchy?

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I'm suddenly recalling and pondering about an incident that occurred when I was shadowing. I don't want to say much in order to respect the privacy of those involved, but basically a med student got berated for a condescending email that was sent to a resident.

How serious is it to respect the hierarchy? Anyone willing to share any stories? I just want to learn more about this to get a better idea of what my career will look like.
 
Not sure what you are expecting to happen if you do NOT expect the hierarchy? Nothing good, that's for sure
 
PurpleBanana said:
I'm suddenly recalling and pondering about an incident that occurred when I was shadowing. I don't want to say much in order to respect the privacy of those involved, but basically a med student got berated for a condescending email that was sent to a resident.

How serious is it to respect the hierarchy? Anyone willing to share any stories? I just want to learn more about this to get a better idea of what my career will look like.
Click to expand...

There's a reason the hierarchy of medicine exists ... it's for patient safety. If you have med students overruling residents and attendings patients die. Furthermore, the training is long and arduous and you should give respect to those who are your seniors as they've been through more and know more than you.

For you as a med student your answer should almost always be "I'm sorry" if you're being berated regardless if you feel you're at fault or not. The other option is to not say anything back. A lot of people have trouble with this and those are the ones that get squashed. You have 0 power even as a resident. A bad eval remains and will doom your career. Bad word of mouth in residency will doom any chance you have at working at the desirable practices. Who do you think they call for reference when you're applying for jobs? Be a dick and no one wants to work with you. I'd rather deal with an incompetent resident who's teachable than a smart resident with an attitude problem.
 
PurpleBanana said:
I'm suddenly recalling and pondering about an incident that occurred when I was shadowing. I don't want to say much in order to respect the privacy of those involved, but basically a med student got berated for a condescending email that was sent to a resident.

How serious is it to respect the hierarchy? Anyone willing to share any stories? I just want to learn more about this to get a better idea of what my career will look like.
Click to expand...

I'm confused. A medical student wrote a condescending email and was told that that wasn't acceptable? Is that what happened?
 
mimelim said:
I'm confused. A medical student wrote a condescending email and was told that that wasn't acceptable? Is that what happened?
Click to expand...

Yes. But the way he was told was metaphorically a colonoscopy. The reason I made this post was just cause I wanted to start a discussion and see if anyone has any stories so that the rest of us could learn from it.

Sorry about this thread being kinda vague 🙁
 
PurpleBanana said:
Yes. But the way he was told was metaphorically a colonoscopy. The reason I made this post was just cause I wanted to start a discussion and see if anyone has any stories so that the rest of us could learn from it.

Sorry about this thread being kinda vague 🙁
Click to expand...

You mean he was told to shove the email up his ass? Why is communication so ****ing hard?

Details matter in all these cases. There are few black and white cases and when grey comes into the picture, what exactly happened matters.
 
Read "When Air Hits the Brain." IIRC the author ended up in neurosurgery because he respectfully challenged an attendings diagnosis on his first elective rotation and turned out to be correct, saving the patient an unnecessary and dangerous procedure.
 
PurpleBanana said:
I'm suddenly recalling and pondering about an incident that occurred when I was shadowing. I don't want to say much in order to respect the privacy of those involved, but basically a med student got berated for a condescending email that was sent to a resident.

How serious is it to respect the hierarchy? Anyone willing to share any stories? I just want to learn more about this to get a better idea of what my career will look like.
Click to expand...
A student behaving this way will have his butt in front of our Student Performance Committee ASAP.
 
"Squashed like bug, unless challenge is professional and with very good reason" is what frequently happens.
 
If you're ever condescending to anyone, but especially to someone more senior than you, you're pretty much digging your own grave. Be polite, be professional.

If you're a med student and you think the attending is doing something wrong, ask the resident why the attending is making that decision (present it as a learning opportunity for yourself rather than you thinking the attending is wrong). If you're a junior resident and you bring something up with your chief that gets ignored but you think that patient safety is at stake, then that's the time to escalate to the attending (again, respectfully and professionally).

So no, challenging the hierarchy is not a death sentence or prohibited in and of itself. However, being an ass is never the right answer.
 
ClimbsRox said:
Read "When Air Hits the Brain." IIRC the author ended up in neurosurgery because he respectfully challenged an attendings diagnosis on his first elective rotation and turned out to be correct, saving the patient an unnecessary and dangerous procedure.
Click to expand...
written in retrospect by a person who stands to look good after this "save"? without any corroboration from anyone else involved in the event? Color me surprised.
 
ClimbsRox said:
Read "When Air Hits the Brain." IIRC the author ended up in neurosurgery because he respectfully challenged an attendings diagnosis on his first elective rotation and turned out to be correct, saving the patient an unnecessary and dangerous procedure.
Click to expand...

It was a missed horner's syndrome due to issues related to lighting and pupillary dilation. However, note that he brought it up not to the attending, but 1) to the resident he was assigned to 2) in a respectful manner (as written) 3) had the resident come re-examine the patient in the current environmental conditions (dim lighting) and 4) the resident, after confirming the findings, spoke to the attending himself.

To address @libertyyne's statement above, in the preface to the novel, he adds the disclaimer that a lot of situations were altered or partially fictionalized, and he was using the anecdote to demonstrate one of the reasons he became interested in neurosurgery
 
ClimbsRox said:
Read "When Air Hits the Brain." IIRC the author ended up in neurosurgery because he respectfully challenged an attendings diagnosis on his first elective rotation and turned out to be correct, saving the patient an unnecessary and dangerous procedure.
Click to expand...
I have read this book, and author must have been training at the same hospital as I vividly recall one of the patients he describes. I also liked the part when he was training in England and described how incredibly detailed the neurological exams were. I was very sad when the patient died while waiting for his mra and the neurologist stated Hard Cheese These Aneurysms, when the patient was found expired.
 
Angus Avagadro said:
I have read this book, and author must have been training at the same hospital as I vividly recall one of the patients he describes. I also liked the part when he was training in England and described how incredibly detailed the neurological exams were. I was very sad when the patient died while waiting for his mra and the neurologist stated Hard Cheese These Aneurysms, when the patient was found expired.
Click to expand...
he was training at stanford IRRC.
 
To share my own experience, I recall as a pgy2, I was present when an arrogant bully of an attending was berating a nurse in the foulest of manners. I reminded him that he was inappropriate and should come back when he wanted to behave like a doctor. I'm a large man, and was rather fit at the time. He glared at me, said nothing and left. 5 min later my attending found me and absolutely blistered me for not realizing my station in life, and to find her immediately should this ever happen again. She indicated it was inappropriate for a resident to speak to an attending that way and in the future to seek her out and she would deal with this arrogant physician. It was an important lesson. Resident to resident was fine. Resident to nurse, or attending, not appropriate. Go through channels and let it be nurse to nurse or an attending to attending interaction. OP, the student was wrong. Should have gone to their resident for a complaint, rather than confront directly. If this was their resident, then go to chief resident or attending. Chain of command is important, and trainees should not challenge people above their experience level or in other fields.
 
Angus Avagadro said:
I believe Frank Vertosick, MD trained at the university of pittsburgh, did year training abroad in the UK
Click to expand...
My bad, I thought the original post had mentioned the paul kalanati book. The vertosick book was amazing.
 
PurpleBanana said:
I'm suddenly recalling and pondering about an incident that occurred when I was shadowing. I don't want to say much in order to respect the privacy of those involved, but basically a med student got berated for a condescending email that was sent to a resident.

How serious is it to respect the hierarchy? Anyone willing to share any stories? I just want to learn more about this to get a better idea of what my career will look like.
Click to expand...

PurpleBanana said:
Yes. But the way he was told was metaphorically a colonoscopy. The reason I made this post was just cause I wanted to start a discussion and see if anyone has any stories so that the rest of us could learn from it.

Sorry about this thread being kinda vague 🙁
Click to expand...

When you’re a med student it’s all positivity, all the time. There are 2 Acceptable answers to every question:

1) yes!!!!! *insert excessive enthusiasm*

2) I’m sorry but I’ll look it up/find someone who can help and get back to you ASAP.

Being anything less will earn you a bad eval. Being openly condescending or disrespectful to a superior?

That will end one of 2 ways:

1) as you saw...you will experience a trans-oral total colectomy without anesthesia.

2) you will be coldly ignored for the rest of the rotation. Consider yourself lucky.


If you want a story...when I was on IM, my partner M3 and I were sent to the ICU to check on our patient who’s just been transferred there.

We get to the ICU, find the patient, and see a young looking woman in scrubs doing a dressing change on our guy. My partner starts to chat up the woman, first about the patient then just making some (pretty awkward) small talk.

Then he says the magic words:

“I know were not supposed to ask nurses out, but I’d love to take you for coffee some time”

The woman snaps up and looks at this kid like he’d just uttered a racial slur. In so many words she informs him that she is the ICU attending and that he may want to re-consider many of his life decisions. But it gets better. She wasn’t just any ICU attending.

She was our attendings fiancé. He’d thought it would be funny to send the med students to bother her with a bunch of inane questions.

Our attending stayed professional and never said a word, but the student recieved quite a talking to from the higher ups.
 
The Knife & Gun Club said:
If you want a story...when I was on IM, my partner M3 and I were sent to the ICU to check on our patient who’s just been transferred there.

We get to the ICU, find the patient, and see a young looking woman in scrubs doing a dressing change on our guy. My partner starts to chat up the woman, first about the patient then just making some (pretty awkward) small talk.

Then he says the magic words:

“I know were not supposed to ask nurses out, but I’d love to take you for coffee some time”

The woman snaps up and looks at this kid like he’d just uttered a racial slur. In so many words she informs him that she is the ICU attending and that he may want to re-consider many of his life decisions. But it gets better. She wasn’t just any ICU attending.

She was our attendings fiancé. He’d thought it would be funny to send the med students to bother her with a bunch of inane questions.

Our attending stayed professional and never said a word, but the student recieved quite a talking to from the higher ups.
Click to expand...

🤣🤣🤣

I love when doctors pull pranks.
 
The Knife & Gun Club said:
When you’re a med student it’s all positivity, all the time. There are 2 Acceptable answers to every question:

1) yes!!!!! *insert excessive enthusiasm*

2) I’m sorry but I’ll look it up/find someone who can help and get back to you ASAP.

Being anything less will earn you a bad eval. Being openly condescending or disrespectful to a superior?

That will end one of 2 ways:

1) as you saw...you will experience a trans-oral total colectomy without anesthesia.

2) you will be coldly ignored for the rest of the rotation. Consider yourself lucky.


If you want a story...when I was on IM, my partner M3 and I were sent to the ICU to check on our patient who’s just been transferred there.

We get to the ICU, find the patient, and see a young looking woman in scrubs doing a dressing change on our guy. My partner starts to chat up the woman, first about the patient then just making some (pretty awkward) small talk.

Then he says the magic words:

“I know were not supposed to ask nurses out, but I’d love to take you for coffee some time”

The woman snaps up and looks at this kid like he’d just uttered a racial slur. In so many words she informs him that she is the ICU attending and that he may want to re-consider many of his life decisions. But it gets better. She wasn’t just any ICU attending.

She was our attendings fiancé. He’d thought it would be funny to send the med students to bother her with a bunch of inane questions.

Our attending stayed professional and never said a word, but the student recieved quite a talking to from the higher ups.
Click to expand...
Lmaooooooooooo
 
I could probably write a novel about this, but won't. I didn't have any issues during residency with this. At my program, there aren't any malignant personalities (at least that I know of yet). I encourage medical students to speak up whether to me, the attending, or anyone else. I don't have much of an ego, and care more about patient care and outcomes than my ego. I do realize there are plenty of big egos in medicine though, and see how this can be problematic. I don't necessarily agree with all of it, but it is what it is. I can only do what's in my power with the people around me.

While this isn't a medicine topic, this is a perfect example of why hierarchies aren't necessarily the best thing and how collaboration can help you overcome things that were considered technically impossible: United Airlines Flight 232 - Wikipedia
 
Planes2Doc said:
I could probably write a novel about this, but won't. I didn't have any issues during residency with this. At my program, there aren't any malignant personalities (at least that I know of yet). I encourage medical students to speak up whether to me, the attending, or anyone else. I don't have much of an ego, and care more about patient care and outcomes than my ego. I do realize there are plenty of big egos in medicine though, and see how this can be problematic. I don't necessarily agree with all of it, but it is what it is. I can only do what's in my power with the people around me.

While this isn't a medicine topic, this is a perfect example of why hierarchies aren't necessarily the best thing and how collaboration can help you overcome things that were considered technically impossible: United Airlines Flight 232 - Wikipedia
Click to expand...

The problem isnt that hierarchy exists ... They exist for the exact reason of patient safety. Are you going to just let med students or brand new interns do things unsupervised? The problem is the individual's take on hierarchy. Someone who has a big ego and think themselves infallible is a bigger problem than the hierarchy itself. Sure collaboration is good and in terms of training purposes it's needed to help the trainee develop the skills of an independent practitioner. However, doing away with hierarchy completely is not the answer. I can count on one hand the times a trainee or CRNA found something I missed but I can count on both hands and feet and yours as well the times I've caught something they missed. And in my field of Anesthesia any missed error easily leads to patient death or injury. So I'm a firm believer of the need for hierarchy in medicine especially when it's in a training setting.
 
The Knife & Gun Club said:
When you’re a med student it’s all positivity, all the time. There are 2 Acceptable answers to every question:

1) yes!!!!! *insert excessive enthusiasm*

2) I’m sorry but I’ll look it up/find someone who can help and get back to you ASAP.

Being anything less will earn you a bad eval. Being openly condescending or disrespectful to a superior?

That will end one of 2 ways:

1) as you saw...you will experience a trans-oral total colectomy without anesthesia.

2) you will be coldly ignored for the rest of the rotation. Consider yourself lucky.


If you want a story...when I was on IM, my partner M3 and I were sent to the ICU to check on our patient who’s just been transferred there.

We get to the ICU, find the patient, and see a young looking woman in scrubs doing a dressing change on our guy. My partner starts to chat up the woman, first about the patient then just making some (pretty awkward) small talk.

Then he says the magic words:

“I know were not supposed to ask nurses out, but I’d love to take you for coffee some time”

The woman snaps up and looks at this kid like he’d just uttered a racial slur. In so many words she informs him that she is the ICU attending and that he may want to re-consider many of his life decisions. But it gets better. She wasn’t just any ICU attending.

She was our attendings fiancé. He’d thought it would be funny to send the med students to bother her with a bunch of inane questions.

Our attending stayed professional and never said a word, but the student recieved quite a talking to from the higher ups.
Click to expand...

OQ4QeVl.gif
 
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