Thursday, October 3, 2013

Working with residents

I have to be honest, as an attending, I don't love working with residents. I'm certain that it's a failing on my part, but I feel like a large percentage of the residents I've worked with have been kind of.... well, maybe not lazy exactly. But definitely a little reluctant to do work.

Me: "I need you to help me present this trauma patient during the team conference this week on Friday. Your consult note on the patient didn't have that much information, so it would really help if you were there."

Resident: "Well, nobody gave me any instructions at all when I started this rotation!" (it was actually the third time she'd done the rotation and she was a senior resident)

Me: "Um, well, my fault then. Still, I need your help."

Resident: "I won't be here Friday. It's my bridal shower."

Me: "Oh, how nice. Um, well, how about Tuesday we can call a short meeting to discuss the patient?"

Resident: "That's our lecture day."

Me: "But your lectures are only in the morning, right?"

Resident: "Well, until 2."

Me: "And what do you have after that?"

Resident: "Nothing."

Me: "So how about we discuss the patient after your lectures are over?"

Resident: [stares at me in horror]


  1. It may have something to do with the specialty :)
    I dunno why anyone would want to be matched into physiatry unless they wanted laid back hours...

    1. LOL! I wanted to comment that maybe the resident was actually Fizzy herself, but that seemed kind of bitchy. Oops! I guess I just said it anyway.

    2. Sounds like Fizzy's residents suck. Maybe the program they come from sucks, too. I'm a senior physiatry resident in a competitive program. My co-residents are generally academically inclined, thoughtful, and range from moderately-to-incredibly hard-working. We'd *love* laid back hours, but on most rotations the hours run long. I can't imagine the behavior Fizzy describes in any of us.

      In a way it's great for us b/c we come across as rock stars for knowing and doing things we consider basic, but on the other hand it annoys me that some of these lesser residents represent our field. Residents need time off to study/sleep/eat/exercise, but plentiful encounters with patients who have both common and rare conditions are essential to making us competent docs.

  2. Back when I was a resident we had to work during bridal showers. I had mine at the hospital, and opened gifts while I was rounding in the ICU. Sometimes I had patients help me, at least the ones who could use both arms.

    1. During my residency, I had my wedding in PACU in between cases. Consummated in the call room before rounds.

    2. Dr. Grumpy, you had a bridal shower? Am I mistaken that bridal showers are for ladies? Where I trained only the nurses/staff had showers. Residents do that kind of thing on their own limited time outside of the hospital.

  3. I'm amazed at how lazy your residents sound. Even on my easiest rotation I would never mind staying until at least 4pm.

  4. Back when men were men, women were nurses and giants walked the halls, we had little time for personal lives. I got a half day off on Christmas Eve to buy presents for my family and a new pair of shoes.

  5. Tell the resident as a plus they could go get lunch first but then remind them that doesn't mean they can actually eat it until your meeting is over! : )

  6. Your residents need a swift kick in the pants.

    a surgery resident

  7. Her bridal shower is all day Friday? I trust she got that time-off pre-approved with sufficient notice.

    And we don't have lecture *days* in Canada! Just academic half-days once a week. It doesn't even start til 2pm.

    In any case, the cardinal rule of residency is that you must always do what your staff tells you to do. If it sounds like a request, it isn't. Provided this isn't one of those ethics scenarios where the clearly intoxicated attending surgeon wants to operate and you, as the resident, are the ONLY ONE able to stop them from HARMING a patient, that's the rule.

  8. The residents sound exactly like Fizzy has described herself, both during her residency and now that she is an attending. This is not true of all physiatrists. One of my friends is married to a physiatrist who completed his residency in the mid-1990s. He is not lazy. If I ever had need of a physiatrist, I would ask him for a recommendation.

  9. I'm not sure what I've said to make people think I'd act that way. I'm the most reliable and agreeable doc you could meet.

  10. 1. Why does everybody think this was a PM&R resident? Fizzy said "third time rotating". The specialties are still fairly open.

    2. Why do some people think that's how Fizzy acts? I'm not Fizzy and can't speak in her behalf, but that for some reason offends ME. She has never given that impression in her blog.

    To graduate high school, people (generally) have to write English exams that include contextual understanding and interpretation. Did some of you not pass this exam?

  11. I'm just out of residency. I think it's easy to lose sight of how soul-killing and exhausting the whole process is. Granted, maybe this is a lazy resident. Maybe you've had a bad run of lazy residents. But I don't think residents in general are lazy. Most of the ones I've worked with at my community hospital have been great.

    Scene: It's the end of the shift, and the resident and I have been busting our assess in a single-coverage ED all day. We've reduced an elbow, done two spinal taps, and put in a central line, as well as the normal crush of abdominal pains, vaginal bleeding, headaches, dental pains, and "just don't feel right." It's an hour after her time and I'm trying to get her out.

    ME: We have a lull. You did great today. Good job with that elbow. I'll check the film. You should get out of here.

    RESIDENT: Welllll . . . I am technically supposed to be at [other site] for overnight call in ten minutes. But if you need me.

    ME [stares in horror]: They have you working all night after a shift in the ED? That's not cool! ACGME guidelines say 12 hours max when working in the ED.

    RESIDENT: Oh, they know. They never have me start there and then come here.

    ME: So it's OK to do that job completely exhausted? [Shakes head.]

    There's a huge nostalgia bias that afflicts teachers from Socrates down the line that says "These kids are crap; we were better." The ubiquity of this lament, by itself, suggests it can't be generally true. I really think the kids are all right.