A few years ago, I used to supervise residents during an interdisciplinary clinic. The resident would work with me four days of the week. On Thursday morning, the residents would have lecture. Since there was no clinic in the afternoon on Thursdays, they basically had the afternoon off.
On one occasion, the interdisciplinary team was meeting to discuss one of the patients. Usually we had these meetings on Friday, but for whatever reason, we had to have the meeting on Thursday afternoon. This was an important meeting, which was supposed to last about an hour.
As I said, the resident generally had Thursday afternoon off because there was no clinic. But because there was this meeting, and the resident knew this patient very well, I asked her if she would come.
Basically, she looked at me like I was crazy and told me that she had Thursday afternoon off. And acted like I was being unreasonable for even having asked.
We had the meeting without her and life went on. But I was also always kind of peeved that she didn't show up. I'm sure if she was on an inpatient rotation, she wouldn't of got to have Thursday afternoon off. It wasn't like Thursday afternoon was protected time. She just expected the afternoon off.
There was a similar situation that happened while I was a resident. Another resident had a clinic that was ending at 2 PM, and an attending asked if he would stay an extra hour or two to help at an adjacent clinic that was overbooked. The resident refused, saying he had to look at cars or something, and the attending was so angry that he blocked that resident from becoming chief the next year.
The very fact that you had the meeting and "life went on" means that you were capable of handling it by yourself, though it may have been a slight inconvenience to you. You remember what it was like to be a resident. Afternoons off, protected time or not, are cherished. Though the resident should have come because an attending told her to, you shouldn't have asked. That was kind of rude on your part.
ReplyDeleteIt was rude of me to ask her to participate in a meeting regarding her patient? Actually, I sort of think that was one of the responsibilities of the rotation.
DeleteNo it wasn't Fizzy, they should know better. If they couldn't care less about the patient enough, then they dang sure aren't when they are the attending.
DeleteYou did right. Ask any patient.
@kennedyqueen: Attendings are "capable of handling it" by themselves. The team meeting was a training opportunity for the resident, not a means of reducing Fizzy's work. The whole point of residency is to learn how to work without supervision.
Delete@Fizzy: You were right. One word: Entitlement.
The only way you would have been wrong is if Thursday afternoon was protected educational or research time. And it is my understanding that by Medicare guidelines, residents must see at least 1 patient per day worked to justify the Medicare GME funds. It is not legal to protect an entire day for educational time.
I don't think it was rude to ask. Medicine is different- days off are transitory at best and "paperwork days" at worst. What was rude is how she responded. Though she was well within her rights to not attend, she could have been more polite about it.
ReplyDeleteIn medical training programs, human or veterinary, "time off" is not some completely sacred thing. If there are meetings that have to happen then, the resident should suck it up and come in. It's not like they had months-laid plans to be out of town or something. Ridiculous that they made a big deal of it at all, rather than just coming in.
ReplyDeleteWhat Daniel said
ReplyDeleteI think it was appropriate to ask. I think the resident should have attended and in this situation, I would have been peeved, too. However, I think had the situation been that she had scheduled something (like her own doctor's appointment or a mentoring meeting) on that afternoon, I would have been understanding.
ReplyDeleteI agree with Daniel and DVM.Pat - it was the resident's patient after all.
ReplyDeleteWhen a staff asks a resident to see a patient or attend a meeting or whatever, the resident should agree to do it and actually do it. Or, more precisely, if your boss asks you to do something, expect that you'll face some blowback if you don't actually do it.
ReplyDeleteThe resident in this situation was exhibiting a lack of "professionalism".
I had a similar situation on an away ICU rotation last year. I happened to be on call, and typically the on-call doesn't take the rotating pager until the afternoon so they can focus on knowing the current patients. A junior had been carrying it in the meantime, and early in the afternoon he'd been called to see a floor patient. He'd made sure the patient was stable but otherwise didn't complete an assessment let alone write a note.
So he returned to the unit and wanted to hand off the pager to me. He proceeded to ask me (his senior) to go finish seeing the patient. I told him that he probably should finish seeing this patient as he'd already started. He responded that he had a "lot of work to do" and "needed to grab a bite" and so forth. I was not impressed by this response but took the pager and went up to see the patient. So not only was he lazy (certainly everyone else was busy too), but he failed to listen to his senior while I was telling him that leaving tasks uncompleted and shunting them to your senior is absolutely the WRONG and UNPROFESSIONAL thing to do.
Another resident who observed this exchange commented that I put my "senior hat" on during it which is fair.
and should have written him up too for that behavior.
DeleteShe should have gone to the conference. That said, I would have been annoyed too to have my one free afternoon taken away. I'm sure you would have been too, when you were a resident. Not that it makes it ok for her to act unprofessionally.
ReplyDeleteI think it's a problem of expectation. If the people in my lab (I work in science) also finished our experiments early on Fridays, then it will become an assumed lab culture to get off at noon on Fridays. Eventually, we will start expecting Friday to be half day. At this time, I think the residents should think about their duties and be reminded what is within their contract and their job.
ReplyDeleteShe should have gone to the meeting because it was about her patient. That is what being a doctor is all about.
ReplyDeleteThis person is a physician? Her patient, easy rotation,an hour? I would have been fired from my training program. Suck it up and get to work girl.
ReplyDeleteYes indeed. The last few times I had "off" I got a few hours. Cry me a river, please.
DeleteI don't think you were wrong for thinking she needed to be there. I think, though, that the fact that you felt peeved about her response for quite some time afterwards means that in your mind, it wasn't really a question. You phrased it as a question, but you expected her to come.
ReplyDeleteTo me, her response would either suggest a lot of naivete on her part or an intrinsic lack of professionalism that would bite her over the course of her career. (If she was in my field-- I'm not in medicine.)
I'd also say that tone on both sides of the conversation can make a big difference in how those sorts of things go. People are more willing to make a sacrifice if the person doing the asking does it with a clear awareness that they're asking them to for an extra-- maybe you did that, maybe you didn't. And, for her part, people are a lot less likely to get ticked off when you say no to something if you do it politely or even apologetically.
I'm a resident now and that resident was dead wrong. It is totally inappropriate to disregard something an attending has asked you to do whether you think it is fair or not. That would be completely unacceptable in my program.
ReplyDeleteI don't think it was rude to ask, but I think all options were on the table at that point. She had the right to say yes or no. But always be mindful too, you never know what was going on in her personal life that day and maybe she was counting down the hours to her technical "off time" to go home and cry or something. Not trying to guilt trip you in any way! I think you had the right to ask, and you had an expectation, but she also had a right to respond (yes or no) and she also had her own expectations. :)
ReplyDeleteFinally. well said. Thank you
DeleteIt was phrased as a question, they answered the question.
ReplyDeleteAnd people's lives will not entirely revolve around just work. They may have had something else scheduled for that afternoon. I'm happy to change my schedule for work, but a bit of notice makes that easier for me to balance the responsibilities I otherwise have. I can call and change appointments for example.
(Yes I work in health too).
No you weren't wrong to ask. I'd have found it weird that I wasn't invited to a meeting on a patient I was working with! If she had other things planned, she should have respectfully explained why she could not be there, but to respond the way she did was rude & unprofessional.
ReplyDeleteAll that being said---as a resident, i recall a day on an outpatient rotation where the attendings we had been assigned to work with did not have patients scheduled (it was the day before a holiday, I think). so the two of us on the rotation thought we had the afternoon off and were gleefully left the hospital we were paged back by the secretary informting us that some other attending was pissed and wanted us beack immediately to see his patients. I was LIVID (but of course I went back and did what I was told)
You had a right to ask, and she had a right to say no and be respected for that answer. The resident has a right to previously promised time off, even if there is patient stuff to be done. There will never be an end to patient stuff to be done.
ReplyDeleteAs a staff physician just coming off maternity leave, I am amazed at how much my non-work life is seen as optional by the medical community. I had to re-schedule almost every one of my OB appointments because of things like this--last-minute or not-so-last-minute requests to cover for things or attend things that totally could have happened without me, which then disrupts my OB's schedule (and now, the pediatrician's) and made it nearly impossible for my husband (also an MD) to ever get the time off to accompany me. The morning I was induced, I had to do 42 t-cons for my husband just so he could get off in time to join me (and he was still late because a patient had a hold-up at the lab). My clinic started sending me t-cons again and requests to squeeze in "just this one patient" before I was even discharged. Now, when I'm asked to give up days/afternoons I had been scheduled to be off, it means figuring out last-minute childcare or (if I can't) finding a way to bring the kid in with me and keep her from disrupting everything. It's not humane or healthy long-term for the profession to expect our providers to treat their outside life as dispensable. It should not be considered unprofessional to opt out of extra patient care tasks that can happen without us.
When I was in GME, I was desperate for those lighter rotations and the ability to catch up on enough sleep to be functional and enough life stuff (taxes, car maintenance, grocery shopping, and, yes, having a social and family life) to carry me through the rotations where I did nothing outside of the hospital but sleep. In your book Baby City, that's when I lost what remained of my sympathy with your protagonist--when she declared it unreasonable for the med student to ask for an evening off for her mother's birthday. So much of your humor revolves around the absurd level of disrespect you endured as a trainee, and yet you seem to have drunk the kool-aid that, since it's common, it must be okay. If we as doctors can't respect each other as humans, how in the world do we expect patients, nurses, and administrators to?
I agree with you in theory. I would have had a little bit more sympathy for the resident if she had not been on an extremely cushy rotation in an extremely cushy residency. If she had a reason like a doctors appointment or childcare responsibilities, that too would've been a different situation.
DeleteInterestingly, the situation you talked about in my book was something that happened to me when I was a medical student. So I was actually Caroline in that situation. I agree that Emily acted completely inappropriately, a fact that she quickly recognized after-the-fact, and it was clearly due to being incredibly overworked herself. No, she didn't do the right thing, but you could see how a resident who is worked to the bone might snap and not be sympathetic to a medical student in that situation. That's part of what the book is about. I was trying to look at a situation that happened to me from the perspective of the other person and attempt to empathize.
I still agree with Fizzy on this one. I am a resident in a "not cushy" specialty. My personal mantra all the time is "I signed up for this." Even residents in "not cushy" specialties occasionally have an easier rotation where there is some potential for a free afternoon or morning here and there. I still never schedule anything important like a doctor's appointment in that time without first clearing it with our scheduling chiefs. That time is a nice bonus, but there is always the possibility that you can be pulled to cover something else...so basically don't count on it. It is still shocking to me that Fizzy's resident didn't agree to come in for a 1 hour meeting. That is part of her job as a resident, period.
DeleteAlso, missing a family birthday celebration is pretty much par for the course in medical school and residency...I always feel lucky when I can make it but my family and non-residency friends don't count on it. Again, "I signed up for this."
I love my job (even when I'm exhausted), and I have accepted the above as the reality of the situation. I always encourage my junior residents to do the same. It makes it easier.
When I was a resident, I absolutely would have attended this meeting and think it was very appropriate to ask. I would only have missed if I had already scheduled another meeting or appointment.
ReplyDeleteI admit I am a little concerned about burnout with some of these comments.
ReplyDeleteBurnout comes from doing pointless bureaucratic work and trying to meet impossible expectations, not from taking care of your own patients and working six days a week. And If anyone is struggling to understand why women are payed less in medicine than men, see the post by anonymous on November 19 at 1539.
Delete- Surgical resident
The reason women earn less than men in the workplace is multifactorial. But even women who don't have children earn less money than men do.
ReplyDeleteYes, it is indeed multifactorial, I grossly oversimplified above. Unfortunately only a post-menopausal childless woman is exempt from being dinged by the childcare discount.
DeleteIn one of the mortality & morbidity meeting one of my px was to be discussed (though the morbidity was intra-op mainly and I f/u her in the ward). I prepared the case & had to take a taxi for one & half hour drive just to attend. Because
Delete1. I was post call in
2. a different city
3. different hospital & department
at the time of the meeting.
My evaluation was done already. But I thought I owned to the team.
But there are moments when I lazy up & I really really really need the afternoon for myself. Sometimes we sacrifices something important ( like attending a seminar on one of our px ) so we can refresh & be more focus.
Being lazy once in a while is an enthusiasm booster for me. This is how I stay focus & interested (or at least pretend to be)
*although I wouldn't call the resident lazy, she was not. She had the right to say no & the right to be respected for her decision. Oh & the right to be informed about the meeting. Honestly i'll be upset if I didn't know.