Lately in some posts I wrote about my own residency, I got some negative comments about requests I'd made of my attendings. Apparently, some people feel that asking an attending to lift even a little finger is unacceptable. Like if you needed a piece of information, and the resident would have to run across town to get it versus the attending having to make one quick phone call, that resident better get on his running shoes.
And I quote:
"Interns do scut work. Attendings don't."
Here's a novel idea:
Residents are not slaves.
And on a similar note, attendings are not gods.
The purpose of residency is to learn, not to provide cheap labor. The job of residents is not to do scutwork. If they do scutwork, it's to free time up for the attending to teach. That is the exchange, or at least, it should be. The more scutwork you hand to residents, the more teaching you ought to provide. When I supervise residents, I always try to split the unpleasant work.
I've noticed an interesting pattern though: the more attendings seem to rely on residents for scutwork, the less interested they seem in teaching. Why is that?
I've noticed an interesting pattern though: the more attendings seem to rely on residents for scutwork, the less interested they seem in teaching. Why is that?
ReplyDeleteProbably because attendings who are focussed on developing better doctors both do more teaching and find ways to reduce the need for scutwork in general (I'm not a doctor but can't admin staff and nurses pick up a lot of that?). Doctors who instead see residency as a form of cheap labor and a way of 'weeding out' bad doctors will have little incentive to improve residents or their work conditions.
Why would attendings differ on that? Possibly a belief in tradition (it was hard for me so...), a lack or imagination or empathy, or a misguided belief that making life hard for attendings now will make them better doctors.
That is...making life hard for residents now will make them better doctors.
DeleteWould be nice if blogger supported editing.
Laziness is the common denominator, although tradition and lack of empathy probably contribute. I'm willing to bet that the attendings who demand or expect residents to perform all the scutwork and lack an interest in teaching are the ones who, as residents, tried to weasel out of work or pawn their work off on other residents (or the med students)
DeleteIt's a foundation- the scut work is the boring, mundane, unpleasant part of the job. If you learn the things that get missed, you learn to not miss them. You have to build the foundation of a building before you put the pretty eye-catching stuff on top. It isn't abuse- it IS teaching. Privates don't tell Generals to hold a head. There ARE perks to being the boss in ALL fields. There should be. Rewards experience and encourages people to succeed. Chip- nurses and doctors are not interchangeable. They have different roles. There is nursing scut and there is doctor scut. Nurses have enough to do. They are not there to clean up after docs.
ReplyDeleteSo, for example, being the lone person signing like 30 restraint orders on every weekend call at a hospital is a necessary learning experience in order to be a physician? I couldn't be a good doctor if I didn't take out all those charts one by one and sign my name? That's teaching?
DeleteThis is completely unrelated to this post, but have you thought of making the Cartoon Guide to Becoming a Doctor available on the Kindle?
ReplyDeleteI attempted it, but the formatting was kind of annoying so I quickly gave up.
DeleteDon't bother. Right now, Kindle does not support magnification of graphics, just text...so the writing in your cartoons would be unreadable. In fact, the pictures themselves would probably be just as hard to see.
DeleteI try to minimize the scutwork for residents and med students that work with me. When I do ask them to do scutwork (usually transcribing my findings in complex cases), I thank them sincerely and make a point to pay it back in teaching on less busy days. I've not gotten the impression any students feel an imposition on these occasions.
ReplyDeletePM&R is the only specialty I've seen in which the attendings kindly split some of the scut work with residents. In internal medicine I (or my co-residents) did it ALL -- it was viewed as part of the learning process. In PM&R we often split scut with the attendings to finish our main work early and get ready for admissions.
ReplyDeleteI agree with Anon1 that I learned more by doing it all in IM, and that has served me well in PM&R. Some students/residents just aren't that conscientious until things they miss bounce back to them (as when running a service). The practice of medicine involves a ton of scut. If I had known just how much it involves for the attendings I would not have gone into any field of medicine (since most attendings don't have residents and thus do all the scut themselves, anyway).
I think there's a different structure in IM than in PM&R. In IM, usually there's a hierarchy of med students under interns under residents under fellow (maybe) under attending. Everybody has carefully assigned roles. As an intern, asking an attending to do scutwork for me would have been like asking the President to do it.
DeleteWhereas in PM&R, one resident and one attending often work together, side by side, doing a lot of the same work. So when all the scut just gets automatically handed off to the resident, it's much more noticeable and it a little offensive.
In all honesty, I have chosen not to have a resident right now, because I felt too guilty giving them all the scut, and I didn't have time to do my share of scut and to give the teaching I feel residents deserve. Maybe in the future...
I love this post. While I do think that grossing in 30 bloody placentas on a Monday morning might free up the attending to do research or teach, and there is a certain badge to be worn in doing all this scutwork during training, I got really frustrated with the attendings that would dish out the scutwork and not give in return. I too found that the laziest attendings gave out the most scutwork. I got pretty inventive in skillfully and graciously avoiding them, as I advanced in my training.
ReplyDeleteIt may be a perpetuation of abuse sort of thing, a kind of rationalization. It's a sort of "this is how it was for me, and by making you go through it, I can feel that this is fine and normal." But as mentioned above, it could also be laziness. You go through 3-5 years of being treated like a slave, hate it, but then you get to avoid doing a lot of that work for the rest of your career because that work is left to the residents? That would make it understandable that there's little desire to try and change the situation.
ReplyDelete