Wednesday, January 18, 2012

You need to read more

Who has gotten an evaluation saying that they need to read more?

*raises hand*

Before internship, I never had. I guess I was reading enough as a med student or else nobody cared how much I was reading.

Then on my first month of internship, my resident Jessica seemed to mistake my lack of confidence for stupidity. I know there are people who march into internship being totally confident, but I wasn't one of them. I was terrified of harming a patient, so I probably asked way too many questions. I was scared to give Tylenol without asking if it was okay first.

After a few days (or hours) of annoying questions from me, Jessica couldn't take it anymore. She started yelling at me that I was the dumbest intern on the planet. And worse, I was dumb because I didn't care enough to learn. Really, it was kind of the opposite. I cared so much that I felt the need to verify every little thing.

Anyway, at the end of the month, this was Jessica's evaluation of me, which I saved so that it could still hurt my feelings decades later:

No attempts to seek additional information about patient care plan/disease process. No resources utilized for most patients. Was asked multiple times through the month how she was directing her self learning but no books/resources actually obtain. She stated she planned to get UpToDate, the red Stanford book/blue Harvard book.

By the end of the month Fizzy showed some improvement but overall her medical knowledge is insufficient. In feedback, I encouraged her to read vehemently, to seek pocket resources to guide her day to day, and to be more complete in her patient work ups.

Ouch, right? That was by far the worst eval I'd ever gotten in my life. I knew my knowledge base wasn't terrible because I did extremely well on Step 2. And the truth of the matter was that I actually had the "blue Harvard book" well before the end of the rotation and showed it to her in response to her pestering me. I also told her that I had ordered UpToDate, but along with the rest of the residents in the hospital, our order was delayed due to administrative bullshit. That was apparently my fault though. And also, I guess my palm pilot (remember those?) packed with information was totally useless if I don't have the two books she considered important.

Still, it made me feel pretty bad. But later I talked to many other residents who have gotten the "needs to read more" comments, and I've come to the conclusion that there are some people who simply think their underlings need to be reading 100% of the time. Like while eating, on the toilet, etc.


  1. Has anyone in medicine not gotten the comment that they need to read more?

  2. Once an attending told me that I was "incompetent and scary" and that I needed to read more. Oh, and that the 1 year old JAMA article I found describing how to deal with endocrinopathies post SAH (he was there for DI post-SAH) was "just lucky." Of course, I honored that shelf, and got all of the questions she ever asked me correct, AND got glowing evals from my other attendings, so I'm not sure where she got this impression from.

    Oh wait, I know. We had this patient with gastroparesis who was complaining of 10/10 pain but sitting there perfectly comfortably when I and the intern saw him. We said in the note that he didn't appear to be in 10/10 pain. Apparently when the attending saw him, he was writhing around in agony.


    Whenever I see her in the hospital, it still makes me angry, and that was 4 years ago. The only saving grace was that I wrote her a scathing eval as well -- before I ever saw what she'd written about me.

  3. Solitary: I had gotten it verbally before that point, like during a surgery when I couldn't answer a question. And in residency, for sure. But that was the only time I've ever gotten a comment like that in writing.

    OMDG: I think when people behave like that, it says more about them than it does about you. I heard that Jessica was mean to other people aside from me and that it got worse the next year. Honestly, I don't think I was a stellar intern that month... I probably sort of sucked. But I was in my very first month! I was supposed to suck!

  4. A shout out for the medics to ck the sidebar of for other medic blogs of note.

    The amused medic also is crayzy about cartoons but also was where I found the link to THIS BLOG, A Cartoon Guide to Becoming a Doctor...


  5. Are you saying that when you are on the toilet or eating that's ALL you do? You are obviously wasting a lot of valuable time throughout your day!


  6. If you are quoting that eval as written, I can think of some comments about this resident's command of written English. "I encouraged her to read vehemently." ????

  7. My preceptor when I started in the ER told me I was going to kill someone someday after I hadn't adjusted an Insulin drip based on admitting orders I hadn't seen because she was holding them in her hands. On my first ever DKA and/or ICU patient. Some people are just egotistical enough to think that they've always known everything.

  8. Hahahaha... funny. You should have been reading while you were sleeping, I guess you didn't think of that!

  9. I'm in the middle of my Medical Technology clinical rotation. While on Spring break, I'm taking the time to go back through and read up on what I haven't been able to for months (which is why this comment is so far from the original post date). Thank-you. This post made me feel so much better about having a couple of crappy things said/written on evaluations this year. It is a comfort to know that you were able to achieve your goals in the end even with a few people being jerks. It is absolutely the encouragement I need to get through these last few months. I admire you guys for having to deal with the BS for much longer than I will have to.

  10. I have gotten this evaluation almost exactly in my 1st rotation in my 3rd yr of med school, but add "don't think she is a fit for internal medicine and would be better in PT."What the hell? This is all types of wrong.This evaluation was my wonderful intro into 3rd yr: that I wasn't good enough to be a doctor and better in physical therapy (I totally goggled that after I read it to my great surprise of the backhanded slap I was going to receive). I repeat this is an evaluation from my first rotation in 3rd yr.... I felt the same way you did, I was more afraid about doing things wrong and asking maybe to many question about everything because I wanted to learn (not to mention completely lost on how to write notes and H&P's). But this was seen as stupidity.... It really hurt me to know that another doctor could be so cruel to someone starting out. I had no confidence for sometime because of this. It affected my performance in the rotation too. I had just passed my STEP 1 and full of aspirations of finally moving on to 3rd yr to being completely demoralized. This is part of our culture must change...Attendings have to learn to write constructive criticism not rude comments like these. It is ridiculous that you and I have a bitter taste in our mouth when we even think of what they wrote about us months to years later. Thank you for posting this. I thought I was the only one to get something similar to what was written about me. It is comforting to know that you move on and continue to fight through training. I just feel that I will never forget what that attending wrote.... But I have to find my own inner strength and forget what that attending "thought of me" or anyone else thinks. I wouldn't have made it this far if I was not "smart" enough! Maybe this will help me for residency.Develop a thicker skin. Or maybe show residency program, when I start to apply next yr, that I over came such a horrid experienced and persevered!