Sunday, January 30, 2011

Tales From Intern Year: Clueless

There is a med student who is rotating in neurology right now. Med students on our unit are generally super annoying because the unit is already super crowded. I've been brought to the brink of tears more than once because there was nowhere for me to sit and write notes/dictate.

So med students are not actually doing a job and they're basically just uselessly taking up space. Therefore, they annoy me.

A few days ago, I really wanted to strangle the med student though. He's been rotating with us for like a month, long enough to know how crowded it is. Yet he somehow thought it was a good idea to use the one of our only three seats as a place for him to study in the afternoon. This was studying he could have easily done ANYWHERE ELSE, including the cafeteria or his home or wherever. He was totally oblivious to the glares of all the nurses who had to stand as they did their charting.

I didn't say anything. Mostly because I was hoping someone tougher than me might tell him off and make him cry. That didn't happen though.

EDIT: Just to be clear, he wasn't MY med student. I didn't even know his name, since nobody ever bothered to introduce us.

It reminded me of a story from my intern year ER rotation, of the most clueless pre-med EVER:

His name was Jim (not his real name) and he was a college student following my ER attending during her shift. There were a lot of pre-meds shadowing attendings that month, and usually they were proficient in translating some foreign language and thus pretty helpful. But Jim was really clueless.

I had a patient who was actively miscarrying, passing huge grapefruit-sized blood clots. My attending was going to go into the room to do the pelvic exam and transvaginal ultrasound and Jim followed us in. I guess he was just trying to be helpful, but I think if you're a male it's appropriate to ask permission first before you walk into a room where a woman has her legs spread. I took him aside and said very nicely, "A lot of women feel uncomfortable having a male observe a pelvic exam, especially in this sensitive situation. I'd like to ask her first."

Jim replied, "But I have to follow the attending. I'll just stand at the other side of the room."

The room was about the size of the bathroom in my apartment and there were already too many people in the room. Instead of arguing further, I said to the woman, "Is it all right if this gentleman stays in the room."

She said it was OK, so I didn't make a big deal of it. He was, by the way, totally unhelpful during the exam because he couldn't find a freakin thing we asked him for. But whatever.

Later on, GYN came to do a D+C on the patient. They closed the curtain during the procedure but didn't close the door to the room because it was "suffocatingly hot." A nurse was screaming at them for keeping the door open, saying it was a violation of privacy, and said she was writing them up. (The patient, as far as I heard later, didn't care.)

After this incident, the GYN (who was very upset) came over to my attending and said, "Can I speak with you privately?" They went into an empty room together and shut the door behind them. And Jim tried to follow them!

I stopped him. I was like, "Jesus Christ, Jim, give them some privacy!" He tried to argue with me but quickly gave up.

Later he was talking about how he wanted to do an MD/PhD because he was most interested in genetics research, but he also wanted to do patient care. I said to him, "Are you sure you want to do patient care???" Because you don't seem to be much of a people person.


  1. So med students are not actually doing a job and they're basically just uselessly taking up space. Therefore, they annoy me.

    How do you think we feel? We have to be there, we have to learn, and when the residents and interns are "annoyed" with us just for existing it makes our job a little harder. Because we do have a job, which is to learn and turn into a doctor. I just got off an incredibly frustrating OB-Gyn rotation during which I learned almost nothing because the housestaff was "too busy" for the med students. Lets hope when I go back as an intern I've magically learned how to deliver a baby, since according to my school I learned how to do that this month.

  2. I agree with Lissa. I find YOU to be pretty "annoying" in your intro to this post. I'm assuming you were once a med student? Or did you come out of the womb as a fully formed MD?

    Yes, the med student who studies at one of the few desks is really clueless, but to say that all med students are annoying because they are useless and taking up space is pretty short-sighted. It's certainly not their faults that your work environment is crowded, and I'm sure that they would prefer to be somewhere else. Unfortunately someone has to teach them how to be doctors. Clearly this person is not you.

  3. I think med students CAN be helpful. In my particular hospital, which is very specialized, they are not helpful. All they do is shadow, they're not allowed to write notes, or do anything. I'm sure they hate it. There was a resident who was rotating there and even SHE said she was bored and felt in the way and useless all the time.

    I have a very busy job to do, and to have two or three extra people taking up space in a small area where they're likely learning very little and hate being there isn't useful for anyone.

    For the record, when I've worked with med students in the past, I've gone above and beyond to be nice to them and try to teach.

  4. Also, if you had over 20 patients to see a day, meaning 20 notes to write, and countless dictations to do, and every time you needed to sit down to do your work, there was a med student you didn't know sitting there, doing studying they could do anywhere else, or having a conversation about American Idol, you would slowly start to resent them too. Trust me.

  5. I think most med students hate being on their neuro rotation as much as you hate having them there. Its the most dreaded rotation of med school at my institution.

    But you're situation sounds like its lose lose for both sides. If you don't want to say anything to the student, fine, but say something to the clerkship director then. Let him/her know they are in the way. But also let them know that there is so little they are able to do. No med student wants to be in the way, but we also don't want to be paying $40,000 plus to just stand around and be ignored.

  6. Some times as a medical student you think it's better to be seen because if you're not around, and instead in the library, the consultants will think you're taking all day off and not participating in the ward you're attached to.

    What we would do in surgery attachment last year was go in for the ward round in the morning to be seen, then go to the library to study for an exam that was coming up that really needed studied for.

    In some specialities med students really don't know anything useful. Neurology was a 2 week placement for my med school so was mainly teaching, but the few times we were on the ward was for patient based teaching because there was never any possible way we'd have been useful and would have only got in the way.

    The placements we get hands on are the peripheral placements where the wards are a little quieter and they appreciate someone able to do MMSEs or assessments etc.

    Remember, it sucks to know that the very corner of a nurses station you're standing in is more valuable than you actually are to the running of the ward, and that you're a hindrance to the very people you're hoping to one day be.

    Try to be gentle to us. We know we can't help, but we're willing to try any way possible, and if we are taking your seat, gently ask for it, and explain why you need it, or suggest a place we can go to study that'll be quieter for us to study (sounds like you're on our side).

  7. I am inclined to agree with your other commenters here. Med students car be useful, but only after being provided some guidance on what they're supposed to be doing. We don't like being in the way, and we do generally want to be useful and learn something.

    I agree that this student was irritating, but it wasn't because he was useless, it was because he talked back to you and wouldn't listen. That would have pissed me off too.

  8. Threehills: I actually LOVED my neuro rotation. I had great attendings, got to do procedures, and I just really like neurology in general. I doubt these med students are having a good time though. I felt intensely sorry for one girl this week: on Friday, she spent an hour and a half at a team meeting discussing patients she had never seen before, then was for some reason forced to attend an hour-long staff meeting where we argued about whether we should be alerted by the pharmacy for critical BNP values. This was boring for me, as staff. Learning value for her was zero. Unfortunately, we're at a private hospital and the clerkship director is unknown to me. There's nothing I can do about it, aside from whine on my blog.

    Mr.Mobius: I did consider that he was afraid to leave for that reason, except everyone from neurology had left for the day and never came back.

    OMDG: Another issue is that they're not MY med students. They're neurology's med students, so I'm not even supposed to have any sort of interaction with them. If they were assigned to me, I'd make an earnest effort, but I can't even pretend there's some sort of give and take. Basically, it's me having to be a meanie and telling a student I don't even know to stand up so I can sit.

  9. Another med student here. Honestly, I would have preferred you just told me. We know we're in the way, and I would much rather have someone ask me to move then give my angry glares all day. I think staring someone down is a lot more mean then just telling them. We can be oblivious. We can be annoying. But it doesn't help us out any, if no one will say anything.
    I just don't understand the reasoning behind this.

    He probably sat there all day wondering what he did to make people mad, and was doing his best to avoid everyone. You sat there all day angry about something that could have easily been solved by just saying hey, would you mind studying somewhere else? We only have a few chairs and it's frustrating to not be able to use them. Problem solved. No having to post a rant on your blog and offend a large majority of people reading your blog.

  10. Yeah Fizzy, Next time just tell him, and suggest that he go study some place less in the line of traffic. It's possible he will talk back, but in that case you can be irritated with him, AND yell at him, and not be even the least bit wrong. It's win win!

    The one I was referring to as the back talker was Jim. He sounded supremely annoying.

    And for the record, I LOVED my neuro rotation also, as you know. However we have a very committed course director who tries hard to make it a good experience for people. Sadly, some med students behave like assholes despite this.

  11. I think we've beat this dead horse enough.... It's frustrating for all involved when rotations provide no educational benefit for the students and instead add unnecessary stress to staff in certain departments. It's easy to become annoyed with students when they are in the way, but I think it's important to remember that most of them also feel the stress of being placed in situations where they feel useless. As for the students who sit around discussing American Idol, that's a whole other story! :)

  12. The reasons I didn't tell him were:

    1) He's a male, older than me, has a somewhat threatening appearance, and is slightly intimidating to me even though he's a med student

    2) I actually had a seat (that I was guarding with my life) so he wasn't directly annoying to me. I was more annoyed on other people's behalf.

    3) I have been working there less time than anyone else and I figured it wasn't my place to say something.

    4) He's been rotating here FOREVER and I really felt he should have figured it out all on his own.

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  14. Your post reminded me of some of the passive aggressive residents I have had the misfortune of working with as a student. Little is worse than receiving no instruction, being ignored, and never knowing quite why the person is so annoyed. Often, the harder I tried, the worse it became.

  15. "1) He's a male, older than me, has a somewhat threatening appearance, and is slightly intimidating to me even though he's a med student"

    Your coat is longer. That's all that matters.

  16. Threehills: Except neither of us wear one :)

    Myoclonicjerk: You understand that this was not a med student assigned to me in any way or even in my field, right? I was no more responsible for teaching him than I would be for teaching a random person on the bus. Likewise, I probably wouldn't feel comfortable asking him to move if he was sitting on a bus and a 95 year old lady was teetering over him. I expect people to have common sense and courtesy... I'm not that nosy person who tells people to move when they're being idiots.

    My post was about being clueless. If you've been on a rotation for a whole month and seen how crowded it is and how much competition there is for seats, why would you think this was a good place to study? Maybe you can feel sorry for him, but the guy was clearly either clueless or inconsiderate.

    That said, I have every intention of talking to that med student's preceptor next week to tell her to gently remind the student that it's a crowded area and he should study elsewhere.

  17. Hmm, I guess I *didn't* actually make it clear that this wasn't my med student. He wasn't. I actually didn't even know his name.

    I don't accept med students at this point b/c I feel it's not a good learning environment.

  18. You seriously need to re-read everything you have written here and then take a few moments to consider the implications. You hold the position of authority, and yet are scared to exert it even in a polite manner. The situation at hand wasn't affecting you, yet you are so fired up about it that you feel the need to publicize it online. You assume that the student should have learned to pick a better place to study, but don't take the moment to consider that many other people may have made the same assumption, and as such no one has said a thing before (assuming the guy was even thinking or acting deliberately at that moment). Lastly, you choose to take a passive aggressive approach and essentially rat the guy out rather than just politely pulling him aside and saying that wasn't the best time or place to study. Sorry, but the problem here is with you, not the student.

  19. David: A lot of attendings would have yelled at him and humiliated him in front of everyone. I didn't do that.

    Writing about someone on your personal blog is not like posting a news bulletin on CNN. He will never see this, nor will anyone who knows him. A limited number of people will see this. I gave no identifying info about the guy, so it's not like people would know it's him and be whispering about him. It's a way for me to vent "privately" and then be nicer to him in real life. And I do think it's appropriate to talk to the person who's supervising him rather than yelling at him myself, because I'm not sure if he sees me as any sort of authority figure.

    Finally, I posted it online not because I was so fired up and burning with anger, but because I thought it was interesting and a good cautionary tale for others to learn by. The people commenting seem much angrier than I ever was.

  20. Fizzy, chill out.

    People feel better when they push the other down. In this case, you give them the free pass to push you down.

    Please Fizzy, remember the golden rule: "Treat people the way you want to be treated".

    POLITENESS go very far in this. Fizzy, you are a bit "afraid" of the pre-med guy. Ask yourself, WHAT THE WORST THING COULD HE DO TO YOU? physically assault you? I dare him, I double dare him to do that. He will be out of the hospital quicker than the drug junkies.

    Keep a POSITIVE attitude, Fizzy. I felt you are very tense in workplace. I apologize if I'm wrong. But just take a deep breath, relax and treat people the very same way YOU want to be treated.

    PS: Too many capitalized words but I just want to get my thought across.


  21. Duy: The thing is, I don't think I'd start yelling at someone for stuff they'd post in their blog, unless it was really bad... like saying, "Kill all the _____!" I like to make poke fun at myself and others, and I'm not offended that easily. I thought this was an interesting story that people might find amusing and that's why I posted it. But unfortunately, now I feel like I need to limit my postings and will no longer be sharing certain stories that people might have enjoyed.

    I do get stressed at work sometimes, but generally most people describe me as extremely laid back. On a particularly stressful rotation as a PGY3, I remember my med student commented in amazement, "You never get stressed!" I think part of what helps me is venting my frustrations in a written format. But not *here* again, obviously :)

  22. Look Fizzy, if writing is how you reduce stresses, then by all mean, keep doing it. This is your blog, people come and go. Do whatever make you happy.

    Don't try to please others because you will never can. I love your blog because after long immunology studies, I need some funny pictures to laugh about. Your blog is cool. Keep up the pictures drawing. At least people won't take drawing seriously :-)


  23. Has anyone ever considered that the med student in question might actually be kind of a jerk?

    I'm a med student, and I have rotated through clinics where space was precious, and you'd better believe I would be on my feet the second a nurse, resident, doctor, or MA walked into the room needing a place to sit. Without anyone needing to ask. On day one. Because I know my place in the pecking order, and also because I know I add no value to the clinic. I also know that plenty of my classmates are privileged morons who I can imagine taking a seat because they feel they somehow deserve it more than the nurses. I'd be willing to bet that one of those clowns was the med student in question. And I'll defend the right of anyone to post inflammatory blogs about those jerks anytime of day or night, and I will love to read them. :)

  24. Leah: I've definitely gotten the vibe from this guy that he was a bit of a jerk.

    It's funny that everyone is so upset about calling med students annoying, because I was so acutely aware of my annoying-ness when I was a med student. In fact, there was one call on peds where I actually tried to be as annoying as possible to my resident so he'd get fed up with me and send me home. It worked.

  25. @Leah: Can we really make that assumption? Without any other information, how can we tell he's not just naive or unsure of where to sit? I know for my first week in OB, I stayed parked in the nurses station, because I assumed I was supposed to stay in sight of the residents/attendings at all times should we be needed to do something. It was only when the chief resident called us aside and told us we could stay in the back did we clear out.

    My point is, it could just have easily been ignorant as malicious.

  26. I have no idea why people are getting so worked up over this blog. I mean seriously. Med students are annoying- all of us who have been med students should know that. And if you dont, and then you become a resident and get med students you should learn that at some point. Now. Not all of them are annoying, and IF you have the time, it can be fun to teach. But when a million things are going on and they are in the way- irritating.

    I personally think the clinical portion of med school was fairly useless and basically a way to add up a larger amount of student debt for little payout in terms of learning- regardless of how much you want to be involved in learning.

    I also tend to be lightweight on my students. If Im super busy and they are just going to be doing nothing valuable I send them home. If they are irritating to me on a day- I send them home. If they are just doing a rotation in my field as a space filler- I send them home. I feel like there are much more important things to do than sit on a unit and stare at the wall.

    For gods sakes, they are going to be spending every waking moment at the hospital for the next 3+ years. Let them have time to study and be kids. The punishment for choosing to be a doctor will arrive soon enough.

  27. iamnothouse: I have been around this student for a while, and I'm still on the fence about whether or not he's a jerk. He doesn't make an effort to talk to anyone, but could just be reserved.

    moonpanther6: I totally agree that the clinical portion of med school was very useless at times. I think it was necessary in learning how things work in a hospital, abbreviations, etc. It would have been hard staring internship not knowing what a CBC was. But some of the rotations went on way too long, and I question the utility of that 10th laparoscopic BSO that I had to stand in the corner of the room and observe. I also question the utility of writing labs on a whole unit of patients I had never met. The learning curve is ridiculously steep in internship, and any deficiency you have from med school is quickly bridged.

  28. I found the problem:

    "I didn't say anything."

    I have a solution:

    Politely (or rudely if you want to be "that resident") ask him to move and explain why.

    This way, we minimize the energy spent on passive-aggressive blog posts that don't solve the problem in favor of minimal energy exerted on a few breaths of words that do. Efficiency!

    Beware the seductive lures of turning you into the passive-aggressive, "now read my mind, med student minion or I will bitch about you to all my peers and make you look like an asshole without you even knowing it" resident that you most likely hated as a Med Student.

  29. Old Grunt: Interesting idea, which absolutely nobody has suggested yet.

  30. Yeah, well; when the truth is smacking you in the face....

    Is that mean old med student still sitting in your chair?

  31. *Well you sure didn't bother to introduce yourself to him either, so you really can't can't blame it on anyone else.

    *Instead of silently resenting them, talking behind their backs, or being rude, which you can only do on your blog we see, how about politely ASKING them to move or explaining to them the obvious space restrictions so it won't happen again? Simple as that. I don't see how you can pull him to the side twice about the patient and then the private convo, but you are too scared to do the same over a CHAIR.

    *I totally agree David!!

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  33. Chris: I 100% encourage you to do that on your next wards rotation. I think it will go over really well and you'll get a very good grade!

  34. As a med student, I honestly think the lesson here is to be more aware of the rotation environment as well as be respectful of the 'hierarchy' (even going as far as placing nurses above yourself in the order, as they are actually doing work and you are not). I do not see why the past posts were going crazy about the whole passive-aggressive thing: he HAS been there for around a month and I completely agree that it is expected he knows these things.

    A little kind advice would have helped to show him the problem but I think telling whoever is in charge of him works just as well (probably the least that can be done).