One thing I always found really obnoxious in residency was how you have to bow down to your eccentric attendings' little quirks.
For example, I had one attending who made us always put the plan FIRST in our H&P, rather than last, like every other doctor on the planet does it.
I had another attending who never let us call drugs by their brand name. If we said Ambien, he'd look at us like we just said something in a Martian language.
If you want to do some aspect of your job in a stupid, pointless way, that's fine. But I think it's ridiculous to impose that on other people, just because they're temporarily your underling. I mean, the point of residency is to learn how to be a doctor. And being forced to write the plan first in an H&P does nothing to get you closer to that goal.
I always said that as an attending, I would never do that. But the truth is, it's a little hard not to impose your will a little bit and make the residents do things the way you think is best.
For instance, one thing that drives me crazy is when people make their assessment and plan one big paragraph. I hate big paragraphs. It ought to be numbered! How can anyone understand it if it's not numbered?? Being numbered makes it so much easier to read!
But that's not too anal, is it?
No,not anal at all, it's more legible. Providing, of course, that the handwriting is decipherable in the first place..ReplyDelete
I agree with all you said except the bit about having to use generic drug names.ReplyDelete
Maybe it's an American thing, but here in the UK everyone is encouraged to use the generic name all the time apart from certain special drugs where brand affects the absorption or dosing of it such as your anti-epileptics or inhalers (eg Spiriva or Seretide). No point prescribing an expensive brand name if the pharmacist can arrange for the same drug to be given generic or using a cheaper brand, saving everyone money.
Well, it's one thing to prescribe the generics rather than the brand, but some generic names are kind of long and hard to say, and I think it's reasonable to use brand names in conversation.Delete
I have to google the brand names for my drugs in order to know them, all I know when they're prescribed is the generic name. The prescription bottle doesn't even list the brand name, and the one brand name drug I have has a label right over where the brand name should be with the prescribing instructions. I'm not sure if that's a Canada thing - do bottles in the US list the brand name on them if you're not getting it in the brand packet?Delete
The generic drug thing is something we're just expected to do where I'm in school.ReplyDelete
As for the other stuff, some bosses are sucky micromanagers who want things done in ridiculous ways. I'm sure some people who work for you think some of your requests are stupid too (even if they are not). That's just life. Isn't it much better to be the boss though, at least from that standpoint?
I agree that it's annoying to acquiesce to an attending's idiosyncrasies--especially during 3rd or 4th year of medical school when you're just trying to get a general handle on things.ReplyDelete
However, it's definitely good to be exposed to a variety of styles and approaches so you can determine for yourself that which works best, in case you never conceived of it.
Perhaps a compromise would be to yield to the attending's quirks for the first week or so, and a tacet agreement could be reached thereafter that the resident/student could adopt the alternative or revert.
However, I definitely agree with the numbering system. Nobody wants to read a novel, and it's way more efficient for everyone!
I think this is a slippery slope. What you think is an annoying quirk may be integral to another person's work. If your "plan first" attending has been doing it that way for 50 years, it's his right to demand that of his learners. It's one of the things you have to love or hate about medicine: it's a hierarchy, like the military, and you follow the rules because the people who are teaching them to you deserve your respect. I know I sound preachy, but I think it's important to remember that.ReplyDelete
Exactly... it's a slippery slope. If an attending can ask you to write the plan first, then why can't they ask you to write the entire H&P in reverse order... first plan, then assessment, then physical, then history. Why can't they ask you to do everything completely backwards just to bend to their whims? Where do you draw the line?Delete
I kind of think you need to give attendings the benefit of the doubt that they are not going to do something insane. So the slippery slope is that one person says an idiosyncrasy is crazy but their own are not.Delete
As Mr. Mobius, I also agree with you on everything except the brand names thing.ReplyDelete
I'm from Portugal and here we also use the generic name/active principle. If you are presenting a case, discussing it with a colleague or writing a patient's diary, you should say/write, for instance, tiotropium bromide instead of Spiriva. Of course, when speaking informally, sometimes people use the brand name, especially if you assume the other person knows what the drug is, but the correct and usual way here is to use the generic name. Furthermore, we have to prescribe using the generic name, with a few exceptions.
I agree that, generally, the generic names are a little easier to work with. Except for when you're dealing with both dimenhydrinate and diphenhydramine. That's just asking for trouble. ;)ReplyDelete
Also, numbered lists? YES.
Regarding the brand name thing, I could argue that it's actually very important for residents and students to learn brand names of medications. Because at least half the time, if you ask a patient if he's on sertraline, he'll say no, but yes to Zoloft. Arguably, it's *more* important to know the brand names, because you can often figure out the purpose of a generic med by its suffix, but not so with the brand names. In an outpatient setting, I think patients would lose confidence in you if you couldn't identify meds by their brand names. And good luck getting your patients to say "tiotropium bromide" rather than Spiriva.... they're not getting a grade from you :)ReplyDelete
Of course patients use brand names (although we are seeing more and more of them using generic names because generic prescription is increasiing) and it's logic that you should know them when speaking to them. I try to know the most used brand names and of course I won't say to a patient "Here is a prescription for tiotropium bromide"! The situations I was referring to (and I though it was clear by my previous post) were when (quote) "presenting a case, discussing it with a colleague or writing a patient's diary".Delete
And, with the dozens of brand names for the same drug out there, one could also argue that it's more important to know the generic name, because, for instance, ibuprofen could bem, here, "Brufen", "Spidifen", "Trifene", "Nurofen"... Or acetaminophen/paracetamol could be "Ben-U-Ron", "Panadol", "Panasorbe"... At least with the generic name, you can always guarantee that the other doctor or health professional knows what you are talking about.
We have a branding issue in the US, no question. How many patient's claim that generics don't work for them? Crazy.ReplyDelete
I hate having to bend to the irrational will of preceptors, but like you said, where to draw the line? I guess it is good to get different exposures so you know what works and what doesn't. What doesn't kill you I guess.
I don't know if you guys feel this quirk as annoying as I feel but we had an attending who would constantly reach for the phone I mean her hands would reach out to her pocket every few seconds and fumble with her cell phone and then she would just talk to us while looking at her phone . Even when we would try to talk to her she would be constantly looking at her phone and sometimes it annoys me but then the catch is that she would have got every word of whatever I had talked. I mean I get the fact that she is a good multi tasker but somehow it makes me feel that what I have to say is less 'important' or something (?)ReplyDelete