Saturday, June 16, 2012

Weekly Whine: Jenny

This is a story about one of the most annoying residents I've ever had to work with. I've been hesitant to post it forever, because I was nervous about Jenny discovering it and realizing I was writing about her. I actually got to like Jenny a lot (later) and I don't want to hurt her feelings. But then I just figured, fuck it, she'll never read this.

Anyway, it gets a little long, but hopefully still entertaining:

I was doing a general rehab clinic rotation with a PGY2 resident named Jenny. I was a PGY3 but I hadn't done this clinic before, so it was both of our first times in the clinic.

Jenny was slow. Very slow. In general, I would see twice as many patients as she did. So if 9 patients were scheduled, I would see 6 and she would see 3. But okay, she was a year behind me, so I could sort of sympathize with her not being as fast as me.

Except what really bothered me was things like this: one day, when I got out from seeing my fifth patient with the attending (while she had only seen three), there was a new chart (for the final patient of the day) waiting in the bin, yet Jenny was just sitting there. She was totally done with her work, but she was making no move to see this final patient.

After I finished up the paperwork on my fifth patient, I said to Jenny, "Um, are you going to see that patient? Or should I see him?"

Jenny said, "Oh, whatever." Then she turned away. With the attending in the room, mind you!

I was like fuck this. I just went and saw the patient since they seemed easy anyway (which they were). But that was seriously rude. It's one thing if she's just slow, but to intentionally not see a patient that's waiting in order to make me see it? Lame.

She also tried to see a patient out of order because that patient had a smaller chart. At the time, I thought it was an honest mistake, but then later I wasn't sure.

She would consistently arrive late to clinic. Not very late, but never on time. Clinic started at 8:30 with two patients scheduled and she'd usually stroll in at 8:40 or 8:45.

On one occasion, I had already seen the first patient and staffed the case by 9AM. I was finishing up the scripts for the patient when I saw that our other 8:30 patient was just first being roomed (he was late due to a language barrier and having no insurance). My attending was in the room and was freaking out a little due to having to catch a plane after clinic.

I looked over at Jenny, who was on the phone with some attending from the wards, for some inexplicable reason. (She hasn't worked on the wards in two months.) My attending kept looking at her and grumbling, "What are they still doing on the phone??" Finally, I just went ahead and saw the second patient too.

I finished up with the second patient quickly and staffed him as well, and the nurse put out a THIRD chart to be seen. Jenny was STILL on the phone. I was looking at that chart and thinking, "You've got to be kidding me. I'm not seeing three patients before she even sees one! Does she want me to see this entire clinic by myself??" Finally, Jenny got off the phone and actually saw a patient.

Then at 11AM, she did something identical, except she was on the phone with her car insurance company. She didn't finish up with the 11AM patient until nearly noon and she claimed it was because they didn't room the patient till 11:20, except that I saw them put two charts out at 11 and I took one.

One reason Jenny was so slow was that she didn't write directly on the patient notes. She made notes on a scrap paper or in her head, then wrote the note after she left the room. It took for freaking ever.

And god forbid she got a patient with psychiatric issues. A patient with PSYCH PROBLEMS??? OMG, that means you can't see ANY MORE patients for the entire rest of clinic. When she saw 2 patients and I saw 7, I really wanted to strangle her.

After I had just seen two patients in a row while she was still working on her new patient with OMG PSYCH PROBLEMS (and she was just working on the NOTE--she was completely done seeing the patient), I came out of the room with what I thought would be my final patient of the day. I came out to see the chart for the last clinic patient just sitting in the bin while Jenny was STILL writing her goddamn note. I was completely shocked. Well, not that shocked, considering Jenny has pulled this shit multiple times before.

I was going to ask her if she planned to see the patient or if she just wanted me to do the entire clinic while she wrote one note. Then I looked over his shoulder and saw that her note on the new patient wasn't even halfway filled in! I was just like, Fuck it, and I saw the last patient. Just because Jenny was slow as ass, that didn't mean the attending should get punished and have to stay there forever.

But I was kind of passive aggressive about it and slammed the door.

The best part is that I finished seeing the final patient and came out, and she was STILL writing her note and not even close to done.

Jenny and I used to go to the main hospital together for lunch. I would have to drag her back because we'd have 3-4 patients scheduled at 1 and she'd only start to get up to leave at 1:15 if left to her own devices. I was so pissed off when she proudly announced to the table (including an attending) that she'd often shows up 30-45 minutes late for clinic. But that usually there wasn't a patient waiting. Why oh why could that be??? Possibly because *I* always got stuck seeing the first patient because she wasn't there??? I was nice enough not to say that in front of the attending.

And then, just as I'm practically physically pulling him out of her seat...

Jenny: "Wait, just one second..." [turns to attending] "Dr. S, what books would you recommend for physiatry residency?"

I swear, I thought she was teasing me or something. But she wasn't.

On another occasion, I had a bad cold, but still showed up to work (of course). As usual, Jenny showed up half an hour late, forcing me to take the first patient as usual. She did seem to have picked up speed slightly. I was only one patient ahead of her at about 11AM. My attending suggested Jenny might "pick up the slack" in clinic because I was sick, a statement which caused me to laugh.

So I had a new patient to present and see with the attending. Jenny and the attending had just finished seeing her patient, so Jenny was "next up" for a patient, and there was a patient chart sitting in the bin. But instead of seeing the waiting patient, Jenny decided to dictate her last patient (we dictated all new patients).

I was a little annoyed because I would never start dictating if a patient was waiting, but I figured it was the second to last patient and we were roughly on schedule. So I went with the attending to see my patient.

We came out of the room with my patient and Jenny was STILL dictating and the patient chart was still waiting. I fingered the chart and looked up at my attending, "Well, it's her turn, but I hate to keep the patient waiting, so maybe I'll just go ahead and see this guy."

"No, it's HER turn!" the attending said. "And this is a really difficult patient with a lot of psych issues. I mean, you can see him if you really want, but it's Jenny's turn."

So with the attending's blessing, I instead decided to go ahead and dictate my last patient.

I finished my dictation. Jenny was still only on the physical exam portion of her dictation.

I went to go to the bathroom and clear out some phlegm from my throat. I came back about five minutes later and Jenny was still dictating.

At this point, the nurse put out another patient chart, so I decided to go ahead and see the "crazy" patient.

See, the thing about Jenny was she acted like she was being a better clinician because she was so "careful," but at least I cared enough about the patients not to make them sit there and wait forever.

At the end of the first month, Jenny officially crossed a line.

Once again, she started dictating a new patient while there was a patient outside that was waiting to be seen. The attending actually tapped her on the shoulder and said, "Hey, there's a patient waiting." And Jenny just continued (slowly) dictating.

There was another junior resident who was in the room and the other resident's jaw dropped open. That resident later told me he couldn't believe the way Jenny was acting. I felt vindicated.

I felt sorry for the attending in all this. He was one of my favorite attendings and he had to stay later because Jenny did her dictations between patients rather than at the end of the day. I picked up the waiting patient's chart and said, "I can see the patient. It's really not a big deal."

"No, it's okay, it's not your turn," the attending said. "But it's been duly noted that you offered."

Don't think I allowed this all to take place without saying a word. I politely talked to Jenny several times about needing to pick up her speed. I had a talk with her about note-writing, because I still kept seeing her coming out of patients' rooms with blank notes. I said, "It's okay, you can write the note while talking to the patient! It's okay!" She was resistent.

She told me in some previous family med clinic she did, she wrote all the notes from scratch at the end of the day. I asked her how she remembered enough to write a decent note. She said, "Well, it's family med."

So....?

Then one day, a miracle happened:

I got back from lunch at a few minutes after 1, and I saw that one of the 1PM patients had already been roomed. But for some reason, their chart wasn't out. I was really perplexed. I started looking all over for the chart and finally asked the nurse what happened to it.

As it turned out, Jenny actually showed up on time to the clinic and was seeing the patient when I arrived! This had never once happened before, which is why it didn't even occur to me. I was more ready to believe that the chart vanished into thin air.

After that, things were a little better.

And Jenny, if you're reading this: I love you, girl, but you know you did all those things!

19 comments:

  1. Some one gave her an ass whooping she deserved. There's ppl like that all over the place. Sooner or later someone has to put their foot down and give it to them. I'm surprised it went on for so long. These people have to learn what they are doing wrong at some point in time.

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    1. There was another rotation where we had to dictate all the patient encounters, and i heard she used to type up notes for each patient, then read the notes when she dictated. It's painful just to think about. I wonder what she's like as an attending.

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  2. Fizzy, I think you and I should talk this over. You can reach me at 867-5309.

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    1. i wonder if it was dr grumpy who left this message :p

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  3. You were way over tolerant with her. I don't take that kind of crap well; in fact, I recently had to call a fellow intern's attention to an issue similar to this. I guess I prefer to be hated than to be taken advantage of.

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  4. Was Jenny from Minnesota ?

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  5. This is soooo frustrating!!! I don't understand... how did she not get in trouble with the attending?!

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  6. can someone explain me the ranks in hospital? e.g. attending, resident? thanks! it's just that i'm not familiar with the system

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    1. Jenna (no relation)June 16, 2012 at 5:52 PM

      It goes like this - Attending, Chief/senior resident, junior resident, intern, nurse, janitor, senior medical student (MS4), junior medical student (ms3).

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    2. Attending > Resident > Intern > Med Student

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    3. More like,

      Attending >>>>>>>>>> Resident > Intern >>>>>>>>>> Med Student

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  7. I'm surprised the attending put up with it for that long, as well. He seems like a nice attending...I want an attending like that some day :x

    I don't think I would have put up with that BS as patiently though. There's just no excuse to be that slow and unprofessional at work, doesn't matter if she's an MD or folding sweaters in retail.

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  8. To all the righteously indignant people who are shocked (SHOCKED, I TELL YOU!) that nobody said anything to Jenny, get ready for the rude awakening of residency. I'm told that one of the things that happens on a routine basis is that the person who shows up last end up having to do the least amount of work. Same for the person who goes slowest. It's just what happens in this kind of system.

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  9. Is this the reason I sit for an hour past my scheduled appointment time at the clinic I go to (family med). Staffed all by residents with usually only one or two attendings around.

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  10. Attending was afraid to confront since he did not want to get bad evaluation himself. Saw this multitude of times. Kudo's Fizzy for being stellar resident.

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    1. I don't think the attending cared about evals that much, considering he retired about two years after that. He was just a nice guy who never yelled at residents, no matter how much they deserved it.

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  11. It sounds like she has undiagnosed (or at least untreated) ADD -- the inattentive kind, not the hyperactive kind. If she's anything like me, she probably constantly tries to hurry up and constantly feels guilty for keeping everyone else waiting, but that's her default speed without medication. If you know and adult or child who is like this, you might want to get in touch with them about getting tested and treated -- it could make a world of difference for their confidence and productivity.

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  12. That may be a possibility Andrea, but you did read the part about her bragging about being able to come into clinic late every day?

    Sounds like good old fashioned laziness to me.

    Hopefully she didn't get a good evaluation from the attending.

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