Chronically overworked

[Mass Effect]

I'm not trying to 'beat anyone down' or encourage a 'toxic culture', I am simply highlighting the realites of medical practice that the stressors felt by medical students and junior doctors doesn't get any easier as a senior doctor

That's not true. Let me dispell this myth for everyone reading -- as an attending, you get to choose your job. I am in complete control of what I do and how much I work as are my friends in FM, IM, and gen surg. My surgeon friend is doing outpatient hernia repairs because he wants to be home with his family at decent hours. My IM friend is practicing in the same community where we did med school rotations and his work load is about 15 patients a day with half day a week of admin time. This whole "you have to work like a dog" mentality is purely false. You work like a dog because you choose to work like a dog, either because you like it, you like the money, or because you want to tell others you did.

The reality being that a career in medicine is hard work, and people should go in to it with a certain expectation and resilience concerning the demands of the job.

And there's that resilience nonsense again. I wish that word was retired from the English language.

Having said that I'm not using that as an excuse to dismiss the real issue of physician burnout and mental health, nor am I condoning the actions of this demanding preceptor. A good clinician should have enough insight and personal reflection to realise when they're overworked at the deteriment of his mental health and ability to provide good patient take, at which point they should step back and take time off or seek help.

So much victim blaming. It's not the OP's fault that his attending is a jerk. He shouldn't have to take time off because malignant personalities are allowed to "teach" students.

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[BigPikachu]

That's not true. Let me dispell this myth for everyone reading -- as an attending, you get to choose your job. I am in complete control of what I do and how much I work as are my friends in FM, IM, and gen surg. My surgeon friend is doing outpatient hernia repairs because he wants to be home with his family at decent hours. My IM friend is practicing in the same community where we did med school rotations and his work load is about 15 patients a day with half day a week of admin time. This whole "you have to work like a dog" mentality is purely false. You work like a dog because you choose to work like a dog, either because you like it, you like the money, or because you want to tell others you did.



And there's that resilience nonsense again. I wish that word was retired from the English language.



So much victim blaming. It's not the OP's fault that his attending is a jerk. He shouldn't have to take time off because malignant personalities are allowed to "teach" students.

It's true. I do choose to make myself available to work long and hard hours. But when you're one of two Family Physicians in a rural township of 5,000 people, who also runs the town hospital, you don't have a lot of choice because there's no-one else and I feel a sense of responsibility for the patients who I've known for decades to be there for them. I could cut down my hours and the State / City would have to hire another physician, but I'm also supporting two children who live in an expensive metropolitain city and go to college, and I have two mortgages to still pay off. That's the reality of life; everyone has different priorities; I am prepared to work hard for the patients I enjoy seeing, and I need the money to pay for my home and family; for me, working 50% part-time and just seeing a handful patients a day is not a realistic option.

Firstly, resilence is a word in the English language, and the reason it exists is because it defines people who are able to put up with day-to-day realities of a difficult job. In the real world, if I complained and freakedout everytime an Attending Specialist or a Senior Resident was condescending and vulgar towards me for a consult I'd ask for, or everytime the Hospital Medical Director told me angrily that my department is over-budget and I'm not meeting my KPIs for the month, I'd be in a mental breakdown and the human resource deparmtent would be so sick of dealing with me. The reason why I say "pick your battles" is because most of time I just put up with it and move on, but if it's more serious and affecting me badly I'd certainly lodge a formal complaint and provide feedback, and if needed be, take time off and/or speak to someone about it. Work unforunately is not an idealistic safe haven, there are going to be personalities and differing opinions that clash inevitably (and it's not like they can be sacked or fired that easily), and for better or worse, you need resilience to put up with these asshats in medicine. To put it simply: There will always be a more senior boss wherever you work (with the exception of private practice / your own business) who is ****ting down your neck at some point or another over some issue.

Assuming the "victim's" account is accurate, I entirely agree that it's wrong for the Attending to treat his juniors as slave monkeys. Nevertheless if you're the OP what possible actions could you take realistically? 1) Bite the bullet and put up with it for a few months and vent/confide in family/friends/forums, 2) Speak to his Attending directly, 3) Speak to his Program Director. I don't think what I'm proposing is unreasonable and "victim blaming", I'm simply presenting the perspsective that work is hard and stressful at times.

 

[Mass Effect]

It's true. I do choose to make myself available to work long and hard hours. But when you're one of two Family Physicians in a rural township of 5,000 people, who also runs the town hospital, you don't have a lot of choice

There's always a choice as an attending. For instance, you could choose not to live in that area or you could choose to scale back. We all make choices in life and your choices led you to this particular job. The OP isn't choosing his work load.

I could cut down my hours and the State / City would have to hire another physician, but I'm also supporting two children who live in an expensive metropolitain city and go to college, and I have two mortgages to still pay off. That's the reality of life.

The reality of life is what you make it. You choose to support your two kids who live in an expensive metro city and go to college. One could say most parents would too. But there are parents out there who have a college fund and anything outside that, scholarship pays/the kid pays/loans pay. There are also people who don't have two mortgages. There are people who don't even have one or if they did, they paid it off. Again, reality is what you make it.

Firstly, resilence is a word in the English language, and the reason it exists is because it defines people who are able to put up with day-to-day realities of a difficult job.

No, resilience is a word that is supposed to define the strength to overcome adversity and difficult challenges, particularly as it pertains to psychological stressors. It has been weaponized to victim shame and blame, the implication being that if one complains about legitimate wrongs, it must be that they're just not "resilient" enough or they need to "build resilience" in order to cope as opposed to shaming the people who should be shamed (in this case, the attending). It's insulting and the word has lost all true meaning when it's been so unapologetically bastardized.

In the real world, if I complained and freakedout everytime an Attending Specialist or a Senior Resident / Registrar was condescending and vulgar towards me for a consult I'd ask for, I'd be in a mental breakdown

Again, you have a choice. Attendings don't have to put up with BS.

Assuming the "victim's" account is accurate, I entirely agree that it's wrong for the Attending to treat his juniors as slave monkeys. Nevertheless if you're the OP what possible actions could you take realistically? 1) Bite the bullet and put up with it for a few months and vent/confide in family/friends/forums, 2) Speak to his Attending directly, 3) Speak to his Program Director. Unforunately there are always going to be malignant turds with bad personalities in medicine, and they're not easy to get rid of.

They're easier to get rid of these days than ever before, in my opinion. No, they can't just get rid of these people, but they can certainly keep them out of medical education.

 

[Candidate2017]

It's true. I do choose to make myself available to work long and hard hours. .. I'm also supporting two children who live in an expensive metropolitain city and go to college, and I have two mortgages to still pay off.

Exactly. Choice. Which is what OP, a student, does not have. Money for two houses, enough left over to support two dependent adults in an expensive city and their college tuition. Nice to be an attending.

 

[BigPikachu]

It's a choice to study medicine. Just as much as it is a choice to get married, have children and support them, and invest my money appropriately. I put up with the hard and stressful work because I love my family and I enjoy caring for my patients. You have to make compromises and sacrifices. I could cut back and not support my children and relinquish my investment and passive income, but I'm not prepared to do that; I'm the breadwinner for the family and that's my choice, or more rather, my responsibility.

Just as much as it's a choice a civilian has a choice to join the military to become a soldier, but then is surprised that he gets shouted at by a Drill Instructor and have to work long lousy jobs at the barracks.

If you choose to do something then don't be surprised about the goods & bads that come with it, and the duties & responsibilities that come with it, which includes the hard work and commitment, and having to deal with your fair share of dickheads in medicine. Again, I'm not using this as an excuse to condone bad behaviour; I'm just simply pointing out that work, and life in general, is not meant to be just a happy fairytale walk in the park.

If you think your boss is an asshat abusive bully, then complain or put up with it. What I'm pointing out is that there are going to be many asshats along your path as a student, intern, resident and then as an attending. You can complain as much as you want, but eventually you'll get over it. Attendings who work in private practice don't have to put up with this so much, but I think people who work in hospitals still put up with their fair share of asshats. For instance, my hospital director (my boss) is a bit of a bully and difficult asshat, along with a handful of surgical fellows. There will always be a boss or colleague somewhere who is a demanding and overbearing turd. I, personally, am prepared to put up with it so long as they're not overly abusive or assaulting or discriminatory; that is the occasional shouting at or condescending attitude, I can put up with. Everyone has their breaking point and I guess each person has to find out where they draw the line.

 

[honey0102]

I think experiences like this can be helpful. No doubt that was a busy month for an outpatient primary care med student block. Hopefully, you got something out of it. Doctors are very busy. I thought I was busy in medical school, and boy was I wrong. Intern year was certainly worse than the rest of residency, but I can think back to very busy weeks in fellowship and now as attending. The work does not generally slow down.

The points of being handed over to some other doctor who is not the preceptor are a bit unsavory, unless the other doctor was teaching you.

I am a little alarmed about the number of patients you saw, and the feeling you did not have much oversight sometimes. I would like to think the preceptor did whatever was appropriate as she is ultimately responsible. I was not there so I cannot know either way.

It sounds like the month would have been more manageable if you felt you had ample time to study for the shelf. That alone would have alleviated a lot of stress.

Thanks. I agree with you. I do think she did what was good for patients, thankfully-but some of the other preceptors did not really teach per say-had me just kind of scribe. Which I didn't appreciate.

 

[Mass Effect]

It's a choice to study medicine. Just as much as it is a choice to get married, have children and support them, and invest my money appropriately. I put up with the hard and stressful work because I love my family and I enjoy caring for my patients. You have to make compromises and sacrifices. I could cut back and not support my children and relinquish my investment and passive income, but I'm not prepared to do that; I'm the breadwinner for the family and that's my choice, or more rather, my responsibility.

Just as much as it's a choice a civilian has a choice to join the military to become a soldier, but then is surprised that he gets shouted at by a Drill Instructor and have to work long lousy jobs at the barracks

Oh good lord. Medicine is not the military, no matter how many MASH reruns docs may watch. The attending is not a drill instructor. The OP has the right to enter into a profession that selected him and not be used and abused as free labor. Much like the tide turning in matters of sexual harassment, I suspect people seeing nothing wrong with this situation will soon find themselves on the wrong side of history.

If you choose to do something then don't be surprised about the goods & bads that come with it, and the duties & responsibilities that come with it, which includes the hard work and commitment, and having to deal with your fair share of dickheads in medicine. Again, I'm not using this as an excuse to condone bad behaviour;

Yes, you are using it as an excuse. Your point is, as you've stated in so many words, the attending may be wrong, but the OP should just go with the flow. How the OP reacts to the attending isn't the real issue for me. The issue, IMO, is how the attending is allowed to get away with such nonsense.

If you think your boss is an asshat abusive bully, then complain or put up with it. What I'm pointing out is that there are going to be many asshats along your path as a student, intern, resident and then as an attending. You can complain as much as you want, but eventually you'll get over it. Attendings who work in private practice don't have to put up with this so much, but I think people who work in hospitals still put up with their fair share of asshats. For instance, my hospital director (my boss) is a bit of a bully and difficult asshat, along with a handful of surgical fellows. There will always be a boss or colleague somewhere who is a demanding and overbearing turd. I, personally, am prepared to put up with it so long as they're not overly abusive or assaulting or discriminatory; that is the occasional shouting at or condescending attitude, I can put up with. Everyone has their breaking point and I guess each person has to find out where they draw the line.

The difference being, as an attending, you have a choice where you work and what your breaking point is. The OP doesn't.

 

[honey0102]

There's always a choice as an attending. For instance, you could choose not to live in that area or you could choose to scale back. We all make choices in life and your choices led you to this particular job. The OP isn't choosing his work load.



The reality of life is what you make it. You choose to support your two kids who live in an expensive metro city and go to college. One could say most parents would too. But there are parents out there who have a college fund and anything outside that, scholarship pays/the kid pays/loans pay. There are also people who don't have two mortgages. There are people who don't even have one or if they did, they paid it off. Again, reality is what you make it.



No, resilience is a word that is supposed to define the strength to overcome adversity and difficult challenges, particularly as it pertains to psychological stressors. It has been weaponized to victim shame and blame, the implication being that if one complains about legitimate wrongs, it must be that they're just not "resilient" enough or they need to "build resilience" in order to cope as opposed to shaming the people who should be shamed (in this case, the attending). It's insulting and the word has lost all true meaning when it's been so unapologetically bastardized.



Again, you have a choice. Attendings don't have to put up with BS.



They're easier to get rid of these days than ever before, in my opinion. No, they can't just get rid of these people, but they can certainly keep them out of medical education.

Thanks, @Mass Effect it's enlightening to know there are attendings like you out there. I really appreciate your well-reasoned responses on this thread

 

[Matthew9Thirtyfive]

Just as much as it's a choice a civilian has a choice to join the military to become a soldier, but then is surprised that he gets shouted at by a Drill Instructor and have to work long lousy jobs at the barracks.

Not a great analogy.

 

[BigPikachu]

Oh good lord. Medicine is not the military, no matter how many MASH reruns docs may watch. The attending is not a drill instructor. The OP has the right to enter into a profession that selected him and not be used and abused as free labor. Much like the tide turning in matters of sexual harassment, I suspect people seeing nothing wrong with this situation will soon find themselves on the wrong side of history.



Yes, you are using it as an excuse. Your point is, as you've stated in so many words, the attending may be wrong, but the OP should just go with the flow. How the OP reacts to the attending isn't the real issue for me. The issue, IMO, is how the attending is allowed to get away with such nonsense.



The difference being, as an attending, you have a choice where you work and what your breaking point is. The OP doesn't.

I never said Medicine was equivalent to the Military nor did I say Attendings are Drill Instructors. I was giving an example of where sometimes in any job, be that in Medicine or the Military or even working at McDonalds, you're given a lousy job to do by a demanding boss. Funnily enough I have worked in all three industries, and sometimes you just get bad bosses who delegate to you bad jobs to do for that roster cycle. I'm simply pointing out that's the reality of the working life. If I had a dollar everytime as an Intern or Resident or Attending I've been overworked with endless on-call shifts and taken advantage of by my bosses, I'd be a rich man. Of course this is not a culture to perpertuate, nor am I encouraging this notion of ritualistic hazing; by any modern workplace standard, it is wrong to overwork people with no conscious about how it's affecting their personal lives and mental health. My position is not dipusting this. My position is that don't pretend to be surprised that this happens and unforunately it's a commonplace reality to expect in any busy workplace, especially in Medicine where it is an industry that is already rife with perfecionist ambitious personalities that are chronically overworked and overburdened. Unfortunately, in my opinion and during my training, work only got busier and harder as I moved from Student to Intern to Resident; for better or worse, this is a realistic expectation of choosing a career in medicine; that is, the journey from Student to Attending is a tedious and arduous one. Now, I'm not sure if there's a easy quick solution to this, hospitals are trying to improve rostering practices as well as receiving feedback from its junior medical staff in tandem with re-educating senior medical staff about effective and appropriate medical education; but like most things, it takes time for a cultural change, especially in an extremely traditionally rigid field like medicine.

Everyone has a "choice", not just Attendings. Students, and for that matter Interns and Residents, always have a choice. As I've already mentioned multiple times, they can say 'No, I'm not comfortable with this...' and directly feedback or complain to their Attending or through a safer avenue of their Program Director or Student Support. Most medical schools, hospitalis, and specialist training programs are setup to safely and confidentially receive the concerns of students and junior doctors. I think we're mistaking choice with privelege; everyone has free will and choice to do whatever they want (unless you're living in some tyrannical state), if you're an Attending you simply have more privelege given that you sit higher on the chain-of-command and have completed all your medical training requirements and earn more money. The OP can choose to 'put-up' with his current Attending for the term and provide critical feedback at the end of his rotation, but if the OP feels he's been mistreated, by all means, he should raise that concern immediately and have this matter investigated or have himself relocated to another Attending for the clinical rotation; that is his choice. I would certainly have concerns if the Attending refused to listen to feedback and/or the Medical School refused to investigate, but I don't think the OP Student has made that choice yet to escalate the issue. I do appreciate that when you're more junior and lower on the chain-of-command you feel submissive and obliged to entertain every will and whim of your superiors, but there's always a choice you can refuse to do a task if it's unreasonable or wrong; let me disband this 'myth' that only seniors have 'choices'; it's your life you can choose to live it anyway you want at any time, just be prepared to aceept the outcomes of your decisions. In my time in academic and clinical medicine, I've generally seen people either: speak directly to their supervisors to arrive at an amicable resolution or they just bite the bullet for that clinical term and move on; the ones I worry about are the ones who go quietly into a dark place and just resign or give-up medicine altogether. The key to this is that if you're unhappy you need to speak-up; people can't help you if you don't say something. And, I guess, if we are to change this 'toxic' culture in medicine, it's to keep an open dialogue.

I don't think what I'm saying is 'victim blaming or shaming'. I'm just putting forward a my perspective on the matter. I am of course empathetic to the mistreatment of the OP, and I do agree with the other posters, that supervisors like these should not be in medical education unless they're retrained to better understand how to teach juniors appropriately. Having said that, if we are to be fair, we haven't heard the Attending's side to the story who does not have a voice in this forum. There's always two sides of the coin in complaints and why it's not necessarily within the scope of a public forum to cast judgement on who's necessarily right or wrong without listening to all the facts of the case. Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory.

 

[hallowmann]

Not a great analogy.

To be completely honest, neither is conflating OP's experiences on that rotation with sexual harassment in the workplace/the metoo movement or slavery for that matter, yet both have been brought up in other posts.

 

[honey0102]

I never said Medicine was equivalent to the Military nor did I say Attendings are Drill Instructors. I was giving an example of where sometimes in any job, be that in Medicine or the Military or even working at McDonalds, you're given a lousy job to do by a demanding boss. Funnily enough I have worked in all three industries, and sometimes you just get bad bosses who delegate to you bad jobs to do for that roster cycle. I'm simply pointing out that's the reality of the working life. If I had a dollar everytime as an Intern or Resident or Attending I've been overworked with endless on-call shifts and taken advantage of by my bosses, I'd be a rich man. Of course this is not a culture to perpertuate, nor am I encouraging this notion of ritualistic hazing; by any modern workplace standard, it is wrong to overwork people with no conscious about how it's affecting their personal lives and mental health. My position is not dipusting this. My position is that don't pretend to be surprised that this happens and unforunately it's a commonplace reality to expect in any busy workplace, especially in Medicine where it is an industry that is already rife with perfecionist ambitious personalities that are chronically overworked and overburdened. Unfortunately, in my opinion and during my training, work only got busier and harder as I moved from Student to Intern to Resident; for better or worse, this is a realistic expectation of choosing a career in medicine; that is, the journey from Student to Attending is a tedious and arduous one. Now, I'm not sure if there's a easy quick solution to this, hospitals are trying to improve rostering practices as well as receiving feedback from its junior medical staff in tandem with re-educating senior medical staff about effective and appropriate medical education; but like most things, it takes time for a cultural change, especially in an extremely traditionally rigid field like medicine.

Everyone has a "choice", not just Attendings. Students, and for that matter Interns and Residents, always have a choice. As I've already mentioned multiple times, they can say 'No, I'm not comfortable with this...' and directly feedback or complain to their Attending or through a safer avenue of their Program Director or Student Support. Most medical schools, hospitalis, and specialist training programs are setup to safely and confidentially receive the concerns of students and junior doctors. I think we're mistaking choice with privelege; everyone has free will and choice to do whatever they want (unless you're living in some tyrannical state), if you're an Attending you simply have more privelege given that you sit higher on the chain-of-command and have completed all your medical training requirements and earn more money. The OP can choose to 'put-up' with his current Attending for the term and provide critical feedback at the end of his rotation, but if the OP feels he's been mistreated, by all means, he should raise that concern immediately and have this matter investigated or have himself relocated to another Attending for the clinical rotation; that is his choice. I would certainly have concerns if the Attending refused to listen to feedback and/or the Medical School refused to investigate, but I don't think the OP Student has made that choice yet to escalate the issue. I do appreciate that when you're more junior and lower on the chain-of-command you feel submissive and obliged to entertain every will and whim of your superiors, but there's always a choice you can refuse to do a task if it's unreasonable or wrong; let me disband this 'myth' that only seniors have 'choices'; it's your life you can choose to live it anyway you want at any time, just be prepared to aceept the outcomes of your decisions. In my time in academic and clinical medicine, I've generally seen people either: speak directly to their supervisors to arrive at an amicable resolution or they just bite the bullet for that clinical term and move on; the ones I worry about are the ones who go quietly into a dark place and just resign or give-up medicine altogether. The key to this is that if you're unhappy you need to speak-up; people can't help you if you don't say something. And, I guess, if we are to change this 'toxic' culture in medicine, it's to keep an open dialogue.

I don't think what I'm saying is 'victim blaming or shaming'. I'm just putting forward a my perspective on the matter. I am of course empathetic to the mistreatment of the OP, and I do agree with the other posters, that supervisors like these should not be in medical education unless they're retrained to better understand how to teach juniors appropriately. Having said that, if we are to be fair, we haven't heard the Attending's side to the story who does not have a voice in this forum. There's always two sides of the coin in complaints and why it's not necessarily within the scope of a public forum to cast judgement on who's necessarily right or wrong without listening to all the facts of the case. Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory.

"Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory." -yes, I 100% agree. I have received such feedback before, took it well, improved-in my Dean's letter they'd even comment on how I took it well and improved. Not this preceptor per say (they didn't really give me many tips to improve when asked)-but previous ones.
And I am honestly telling the story fairly here. Not leaving things out. I objectively described what the situation was.
But, it's over now, onto a new rotation

 

[Matthew9Thirtyfive]

To be completely honest, neither is conflating OP's experiences on that rotation with sexual harassment in the workplace/the metoo movement or slavery for that matter, yet both have been brought up in other posts.

Oh, I agree.

 

[hallowmann]

"Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory." -yes, I 100% agree. I have received such feedback before, took it well, improved-in my Dean's letter they'd even comment on how I took it well and improved. Not this preceptor per say (they didn't really give me many tips to improve when asked)-but previous ones.
And I am honestly telling the story fairly here. Not leaving things out. I objectively described what the situation was.
But, it's over now, onto a new rotation

Good luck! Hope you have a good rest of med school. Do you know what field you're interested in?

I will say that for as hard as residency is, doing something you actually enjoy most days absolutely makes up for it.

 

[Perrotfish]

Just as much as it's a choice a civilian has a choice to join the military to become a soldier, but then is surprised that he gets shouted at by a Drill Instructor and have to work long lousy jobs at the barracks.

There are a lot of attendings who have served in the military

There are a lot of attendings who cite the military when trying to justify abusive or stupid medical training

They are rarely the same people

 

[Lawpy]

There are a lot of attendings who have served in the military

There are a lot of attendings who cite the military when trying to justify abusive or stupid medical training

They are rarely the same people

That makes sense, although i really wish attendings stop defending their abusive and malignant behavior by comparing it to military since that's *****ic.

 

[Matthew9Thirtyfive]

That makes sense, although i really wish attendings stop defending their abusive and malignant behavior by comparing it to military since that's *****ic.

Like he said, the people with actual military experience rarely do that.

 

[BigPikachu]

"Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory." -yes, I 100% agree. I have received such feedback before, took it well, improved-in my Dean's letter they'd even comment on how I took it well and improved. Not this preceptor per say (they didn't really give me many tips to improve when asked)-but previous ones.
And I am honestly telling the story fairly here. Not leaving things out. I objectively described what the situation was.
But, it's over now, onto a new rotation

I'm glad to hear that you made it through that rotation. Despite some of us having conflicting opinions on this forum, I'm sure all of us wish you all the best. Hopefully that preceptor is a rare occurence for future clerkships and rotations, and that the School can feedback to the preceptor about looking after his/her students better. I know that having a bad supervisor can really taint your perspective for that specialty, or medicine altogether; and again, I'm sorry to hear that you were mistreated. Let me reassure you that Family Medicine is not normally that bad. Good luck! and Happy new Year!

 

[Mass Effect]

To be completely honest, neither is conflating OP's experiences on that rotation with sexual harassment in the workplace/the metoo movement or slavery for that matter, yet both have been brought up in other posts.

I actually think the sexual harassment analogy was very much appropriate. The metoo movement isn't just about sexual harassment. It's about a toxic work environment and the psychological harms of abusing your power over others.

 

[Mass Effect]

I never said Medicine was equivalent to the Military nor did I say Attendings are Drill Instructors. I was giving an example of where sometimes in any job, be that in Medicine or the Military or even working at McDonalds, you're given a lousy job to do by a demanding boss. Funnily enough I have worked in all three industries, and sometimes you just get bad bosses who delegate to you bad jobs to do for that roster cycle. I'm simply pointing out that's the reality of the working life. If I had a dollar everytime as an Intern or Resident or Attending I've been overworked with endless on-call shifts and taken advantage of by my bosses, I'd be a rich man. Of course this is not a culture to perpertuate, nor am I encouraging this notion of ritualistic hazing; by any modern workplace standard, it is wrong to overwork people with no conscious about how it's affecting their personal lives and mental health. My position is not dipusting this. My position is that don't pretend to be surprised that this happens and unforunately it's a commonplace reality to expect in any busy workplace, especially in Medicine where it is an industry that is already rife with perfecionist ambitious personalities that are chronically overworked and overburdened. Unfortunately, in my opinion and during my training, work only got busier and harder as I moved from Student to Intern to Resident; for better or worse, this is a realistic expectation of choosing a career in medicine; that is, the journey from Student to Attending is a tedious and arduous one. Now, I'm not sure if there's a easy quick solution to this, hospitals are trying to improve rostering practices as well as receiving feedback from its junior medical staff in tandem with re-educating senior medical staff about effective and appropriate medical education; but like most things, it takes time for a cultural change, especially in an extremely traditionally rigid field like medicine.

Everyone has a "choice", not just Attendings. Students, and for that matter Interns and Residents, always have a choice. As I've already mentioned multiple times, they can say 'No, I'm not comfortable with this...' and directly feedback or complain to their Attending or through a safer avenue of their Program Director or Student Support. Most medical schools, hospitalis, and specialist training programs are setup to safely and confidentially receive the concerns of students and junior doctors. I think we're mistaking choice with privelege; everyone has free will and choice to do whatever they want (unless you're living in some tyrannical state), if you're an Attending you simply have more privelege given that you sit higher on the chain-of-command and have completed all your medical training requirements and earn more money. The OP can choose to 'put-up' with his current Attending for the term and provide critical feedback at the end of his rotation, but if the OP feels he's been mistreated, by all means, he should raise that concern immediately and have this matter investigated or have himself relocated to another Attending for the clinical rotation; that is his choice. I would certainly have concerns if the Attending refused to listen to feedback and/or the Medical School refused to investigate, but I don't think the OP Student has made that choice yet to escalate the issue. I do appreciate that when you're more junior and lower on the chain-of-command you feel submissive and obliged to entertain every will and whim of your superiors, but there's always a choice you can refuse to do a task if it's unreasonable or wrong; let me disband this 'myth' that only seniors have 'choices'; it's your life you can choose to live it anyway you want at any time, just be prepared to aceept the outcomes of your decisions. In my time in academic and clinical medicine, I've generally seen people either: speak directly to their supervisors to arrive at an amicable resolution or they just bite the bullet for that clinical term and move on; the ones I worry about are the ones who go quietly into a dark place and just resign or give-up medicine altogether. The key to this is that if you're unhappy you need to speak-up; people can't help you if you don't say something. And, I guess, if we are to change this 'toxic' culture in medicine, it's to keep an open dialogue.

I don't think what I'm saying is 'victim blaming or shaming'. I'm just putting forward a my perspective on the matter. I am of course empathetic to the mistreatment of the OP, and I do agree with the other posters, that supervisors like these should not be in medical education unless they're retrained to better understand how to teach juniors appropriately. Having said that, if we are to be fair, we haven't heard the Attending's side to the story who does not have a voice in this forum. There's always two sides of the coin in complaints and why it's not necessarily within the scope of a public forum to cast judgement on who's necessarily right or wrong without listening to all the facts of the case. Also on a side note, I would just like to make clear that hard work and receiving critical feedback in a reasonable way from a colleague or boss about performance is not to be misconstrued as bullying or harrassment or discriminatory.

We're going around in circles and to be honest, your posts are longer than some of my psychiatric formulations, so let's just agree to disagree and move on.

 

[Matthew9Thirtyfive]

I actually think the sexual harassment analogy was very much appropriate. The metoo movement isn't just about sexual harassment. It's about a toxic work environment and the psychological harms of abusing your power over others.

Which seems like a bit of a stretch to compare it to OPs situation.

 

[Mass Effect]

Which seems like a bit of a stretch to compare it to OPs situation.

I think it's on the same spectrum.

 

[Matthew9Thirtyfive]

I think it's on the same spectrum.

I'd love to hear what you think about what like 90% of enlisted folks deal with on a daily basis for years then.

To be clear, I'm not saying that clinical rotations are like the military or should be run that way. They aren't and shouldn't.

 

[Mass Effect]

I'd love to hear what you think about what like 90% of enlisted folks deal with on a daily basis for years then.

To be clear, I'm not saying that clinical rotations are like the military or should be run that way. They aren't and shouldn't.

Since I was never in the military, I can't comment on what they deal with, but military life has no relevance to civilian medical education. The reason metoo is different is in relation to the toxic work environment created when there's an abuse of power.

 

[Matthew9Thirtyfive]

Since I was never in the military, I can't comment on what they deal with, but military life has no relevance to civilian medical education. The reason metoo is different is in relation to the toxic work environment created when there's an abuse of power.

That's my point. If you think this is on the spectrum of abuse and sexual harassment, then you would probably be horrified what enlisted folks deal with sometimes. The relevance is that just because something sucks and might not be appropriate for the situation (i.e., a med school rotation) doesn't make it abuse. Sometimes it just sucks. That doesn't excuse it or mean the OP should just roll over, but we don't have to call everything abuse. There is absolutely a crazy power differential in the military that goes way beyond a med student and a preceptor, so it's quite relevant.

And yes, I know the dictionary definition of the word can just refer to being overused, so technically being made to stay late and write a bunch of notes is "abuse." But the word has a charged meaning that goes beyond being overworked. There are ways the OP could have handled it that were mentioned above (e.g., talking to clerkship coordinator, etc.). Not Monday-morning quarterbacking her, just bringing them up as an example.

But OP has moved on from the rotation (thank God), and none of us are likely to change anyone's mind so it might be best to just let this die a natural death.

 

[Mass Effect]

That's my point. If you think this is on the spectrum of abuse and sexual harassment, then you would probably be horrified what enlisted folks deal with sometimes

But since I'm not in the military, I'm not making the comparison and I don't think it's relevant to this.

The relevance is that just because something sucks and might not be appropriate for the situation (i.e., a med school rotation) doesn't make it abuse. Sometimes it just sucks.

Yes, sometimes it just sucks. Sometimes it's abuse. This situation is an abuse of power, imo.

That doesn't excuse it or mean the OP should just roll over, but we don't have to call everything abuse. There is absolutely a crazy power differential in the military that goes way beyond a med student and a preceptor, so it's quite relevant.

And I'm sure there's abuse in the military as well. But just because it happens there doesn't mean it's okay that it happens here.

And yes, I know the dictionary definition of the word can just refer to being overused, so technically being made to stay late and write a bunch of notes is "abuse." But the word has a charged meaning that goes beyond being overworked

Just because it has a charged meaning doesn't mean it shouldn't be used when used appropriately. In this case, we're not using the literal definition of being overused. I'm using abuse to mean that the attending, who wields a great deal of power over the student is making the student do a significant amount of work, not only for him/herself but also for his/her colleagues. To me, that's abuse of power. You may disagree, but that's my opinion.

There are ways the OP could have handled it that were mentioned above (e.g., talking to clerkship coordinator, etc.). Not Monday-morning quarterbacking her, just bringing them up as an example.

Yes, and I also mentioned the evaluation and I agree with some of the other suggestions. My argument is that this type of behavior (of the attending's) shouldn't be justified or excused and the OP shouldn't be made to feel like it's a failing in him/her that he/she didn't want to do all this work.

But OP has moved on from the rotation (thank God), and none of us are likely to change anyone's mind so it might be best to just let this die a natural death.

On that we can agree.

 

[Matthew9Thirtyfive]

But since I'm not in the military, I'm not making the comparison and I don't think it's relevant to this.

It is, you just don't realize it because you haven't experienced it.

Yes, sometimes it just sucks. Sometimes it's abuse. This situation is an abuse of power, imo.

Depends on how the preceptor is acting, imo. If they use medical students that way because they feel like they can force them to do whatever they want without a high risk of repercussion based on the power differential, then I agree.

And I'm sure there's abuse in the military as well. But just because it happens there doesn't mean it's okay that it happens here.

Didn't say that.

Just because it has a charged meaning doesn't mean it shouldn't be used when used appropriately. In this case, we're not using the literal definition of being overused. I'm using abuse to mean that the attending, who wields a great deal of power over the student is making the student do a significant amount of work, not only for him/herself but also for his/her colleagues. To me, that's abuse of power. You may disagree, but that's my opinion.

You're entitled to your opinion, I just don't necessarily agree. Again, for me it depends on the intent here.

Yes, and I also mentioned the evaluation and I agree with some of the other suggestions. My argument is that this type of behavior (of the attending's) shouldn't be justified or excused and the OP shouldn't be made to feel like it's a failing in him/her that he/she didn't want to do all this work.

Agreed.

 

[Free411]

You can tell in this forum which attendings are the biggest perpetuators of this BS. This sounds like a horrendous learning experience. The OP is exactly right.

 

[Mass Effect]

It is, you just don't realize it because you haven't experienced it.

So just a few posts above, you said it wasn't a good analogy to compare military to being a med student and now you're saying it is relevant. I'm confused by what you actually think.

 

[sunshinefl]

Like he said, the people with actual military experience rarely do that.

I'd love to hear what you think about what like 90% of enlisted folks deal with on a daily basis for years then.

To be clear, I'm not saying that clinical rotations are like the military or should be run that way. They aren't and shouldn't.

So why do you keep bringing the military up to try and counter @Mass Effect ’s posts?? What does what the military does have to do with anything?

 

[LoGo]

Haha why is this thread lingering around so long.

TLDR:
- med students need to work hard
- staff shouldn’t abuse their power over med students
- some supervisors suck
- some med students suck
- residency sucks
- s**t happens

 

[Matthew9Thirtyfive]

So just a few posts above, you said it wasn't a good analogy to compare military to being a med student and now you're saying it is relevant. I'm confused by what you actually think.

What I meant was that we shouldn't compare med school to the military in the sense that rotations, residency, etc. do not need to be run by the military. The part I was saying is relevant is the power differential that occurs and the abuses of power that can happen because of it.

 

[Matthew9Thirtyfive]

So why do you keep bringing the military up to try and counter @Mass Effect ’s posts?? What does what the military does have to do with anything?

I can see why that was confusing lol. I don't personally think the military is a good analogy for a med student rotation because civilian medicine is so different from the military, and no med school rotation or training program needs to be run like a military organization. There is a huge power differential between enlisted folks and the people who are in charge of them, and that creates the potential for abuse of power that have literally resulted in deaths. Being in the military wasn't the point--the power differential is the point that's relevant there. People choose to do both, but once you sign a contract for the military you can't just leave. And in situations where the people in charge of you are on a power trip, they can make your life absolutely miserable for years at a time with no recourse.

That's my point. It's not a good analogy to this situation. Imo, working long hours for a month in med school because your preceptor is a dick isn't an abuse of power in my opinion unless that preceptor is intentionally trying to get work out of the med student that isn't appropriate using the fear of retribution via a poor eval, etc. If that was the case, then yes, it was an abuse of power. But to be clear, whether it was an abuse of power or not, it was still wrong.

Edited to hopefully make more sense.

 

[Lawpy]

You can tell in this forum which attendings are the biggest perpetuators of this BS. This sounds like a horrendous learning experience. The OP is exactly right.

I'm just hoping for an end to malignant behaviors and emvironment in healthcare but i don't know.

 

[Matthew9Thirtyfive]

I'm just hoping for an end to malignant behaviors and emvironment in healthcare but i don't know.

There are malignant people in every field. You would have to find a way to screen for them and keep them out. Not going to happen.

 

[Mass Effect]

What I meant was that we shouldn't compare med school to the military in the sense that rotations, residency, etc. do not need to be run by the military. The part I was saying is relevant is the power differential that occurs and the abuses of power that can happen because of it.

Who cares that it happens in the military? That doesn't mean it isn't just as meaningful when it happens other places. I'm a psychiatrist. When one person comes in with a week of being abused, I don't discount it by saying "then I'd love to hear what you'd say to my patient who's been abused all her life." Just because it happens in the military doesn't mean it should happen, even to a smaller extent, in medical education. The bottom line is that attendings who abuse their power should be held accountable. Period.

 

[Matthew9Thirtyfive]

Who cares that it happens in the military? That doesn't mean it isn't just as meaningful when it happens other places. I'm a psychiatrist. When one person comes in with a week of being abused, I don't discount it by saying "then I'd love to hear what you'd say to my patient who's been abused all her life." Just because it happens in the military doesn't mean it should happen, even to a smaller extent, in medical education. The bottom line is that attendings who abuse their power should be held accountable. Period.

At this point I'm thinking you're intentionally not understanding, because I have said multiple times that I'm not saying just because it happens elsewhere doesn't mean it's okay or less meaningful. I literally just said that a couple posts ago. I have also said that even if it's not abuse, it's still wrong and the attending needs to be made aware that it's not appropriate.

Since you apparently just want to argue against a straw man, I'm going to stop here. Have a good night.

 

[Lawpy]

There are malignant people in every field. You would have to find a way to screen for them and keep them out. Not going to happen.

What about slamming them in evals and hopefully get them removed from med education? I saw this suggested here before and thought it's a good idea.

I guess the short term solution is to plan in advance and try to avoid them as much as possible.

 

[Matthew9Thirtyfive]

What about slamming them in evals and hopefully get them removed from med education? I saw this suggested here before and thought it's a good idea.

I guess the short term solution is to plan in advance and try to avoid them as much as possible.

That’s what I would do. Maybe nothing will happen, but nothing can change if no one reports it.

 

[BigPikachu]

You can tell in this forum which attendings are the biggest perpetuators of this BS. This sounds like a horrendous learning experience. The OP is exactly right.

Don't judge what you don't know. I supervise medical students at our hospital, and I think I'm quite kind to them (compared to what I went through with my training). I always ask if they want to see the patient on their own or if they prefer to see the patient with me; they get to do stuff within their comfort zone. I actively try and call them in for the interesting cases and ask them to go if it's just boring cases where their time is better spent in private study. I don't grill them to embarass them, I teach them in a very cordial and informal way. I do all the paperwork, unless they're keen to do some. I never keep them after-hours and most of the time I let them go home early. And I always allocate a time each week for informal feedback and to see how they're coping with the other Attendings and Residents. I would like to think I have a reasonably open-door policy with my students and junior doctors. Just because I'm expressing a viewpoint of hard work, does not mean that I'm an abusive asshat.

 

[Mass Effect]

At this point I'm thinking you're intentionally not understanding,

This is precisely what I think about you, so yes, let's leave it there.

 

[Free411]

Don't judge what you don't know. I supervise medical students at our hospital, and I think I'm quite kind to them (compared to what I went through with my training). I always ask if they want to see the patient on their own or if they prefer to see the patient with me; they get to do stuff within their comfort zone. I actively try and call them in for the interesting cases and ask them to go if it's just boring cases where their time is better spent in private study. I don't grill them to embarass them, I teach them in a very cordial and informal way. I do all the paperwork, unless they're keen to do some. I never keep them after-hours and most of the time I let them go home early. And I always allocate a time each week for informal feedback and to see how they're coping with the other Attendings and Residents. I would like to think I have a reasonably open-door policy with my students and junior doctors. Just because I'm expressing a viewpoint of hard work, does not mean that I'm an abusive asshat.

Reading this post, you clearly don't apply to the people I'm talking about. If you go earlier in this forum, there are few posters who are practically justifying this behavior and making the OP feel as if he/she should be fine with this. You sound like a wonderful attending to be quite honest.

 

[VA Hopeful Dr]

Reading this post, you clearly don't apply to the people I'm talking about. If you go earlier in this forum, there are few posters who are practically justifying this behavior and making the OP feel as if he/she should be fine with this. You sound like a wonderful attending to be quite honest.

I approach my students in a very similar way to what @BigPikachu describes, but I also think the rotation sounded like a great one (minus the scribing for other attendings which I'll agree isn't cool). So maybe cool it with the generalizations

 

[Free411]

I approach my students in a very similar way to what @BigPikachu describes, but I also think the rotation sounded like a great one (minus the scribing for other attendings which I'll agree isn't cool). So maybe cool it with the generalizations

"It sounds great other than things that don't make it great." You hear yourself? Listen, if what I'm saying doesn't apply to you don't get offended. You are probably a good attending also. I've been in the OP's situation before and it sucks when people are telling you you should be happy about your experience despite knowing deep down that it's a waste of time.

 

[VA Hopeful Dr]

"It sounds great other than things that don't make it great." You hear yourself? Listen, if what I'm saying doesn't apply to you don't get offended. You are probably a good attending also. I've been in the OP's situation before and it sucks when people are telling you you should be happy about your experience despite knowing deep down that it's a waste of time.

Did you read the OP at all? The scribing for other attendings wasn't the only complaint (staying late to finish notes, the fast pace of the office, and lack of time to study because they were working hard were all also mentioned). The rest of those aren't bad things to my way of thinking, in fact I often feel guilty on slow days because my students end up just sitting around sometimes.

Also, most students aren't in a position to know what is and is not a waste of time. I can look back at 3rd year and there are things that I thought were pointless at the time and now realize they were actually pretty valuable.

 

[Meerkatology]

That's not true. Let me dispell this myth for everyone reading -- as an attending, you get to choose your job. I am in complete control of what I do and how much I work as are my friends in FM, IM, and gen surg. My surgeon friend is doing outpatient hernia repairs because he wants to be home with his family at decent hours. My IM friend is practicing in the same community where we did med school rotations and his work load is about 15 patients a day with half day a week of admin time. This whole "you have to work like a dog" mentality is purely false. You work like a dog because you choose to work like a dog, either because you like it, you like the money, or because you want to tell others you did.

absolutely this.

i work as a nocturnist averaging 2 admits a shift i probably make less than most people in my specialty but hell it makes me happy to have so much free time to spend with family and on computer games

 

[Free411]

Did you read the OP at all? The scribing for other attendings wasn't the only complaint (staying late to finish notes, the fast pace of the office, and lack of time to study because they were working hard were all also mentioned). The rest of those aren't bad things to my way of thinking, in fact I often feel guilty on slow days because my students end up just sitting around sometimes.

Also, most students aren't in a position to know what is and is not a waste of time. I can look back at 3rd year and there are things that I thought were pointless at the time and now realize they were actually pretty valuable.

"I know it's good to see patients/learn but at this point the practice is using me as free labor with this policy that anytime any doctor is in house, I must be their scribe-aren't people paid to do that, in gap year jobs? "

I didn't take it that the OP was complaining about working hard. I took it that he/she was forced to work hard at something that may be providing diminishing returns.

I'm sorry but while writing notes is a good skill, it's pretty easy to learn and making a student stay late to the point that they become effectively a scribe is a waste of time. I once had an attending who told me he didn't care about me writing notes on my FM rotation and just wanted me seeing as many patients as possible and working on coming up with a system for developing a broad DDX. On that particular rotation, I stayed later than what was advertised to me by my peers, but I was immensely grateful for the experience.

Fair enough. I'm not arguing against that. You're 100% right that students don't always know what's best for them. But I think many times you don't have have to be an attending to sniff out a crappy educational experience. Everyone who has done a 3rd year knows how quickly an experience can devolve into one of diminishing returns but be justified by those with power. Don't piss on my head and tell me it's raining basically.

 

[BigPikachu]

How we teach students on inpatient wards is different to how we teach student in outpatient clinics.

On inpatient wards, we usually have about 10 to 20 patients to see on a moring ward round (7 am to 11 am). The Intern or Resident is usually the one pushing the Computer-On-Wheels (COW) around and documenting the consultation. Occasionally the Intern or Resident may delegate the typing to the Student, but I usually find it's better that the Interns or Residents do them because they are paid to do that job and ironically it's more work that you have to proof read and double check what the Student has written; and funnily enough, I still occasionally have to check what notes Interns and Residents are writing on my behalf. I find it more useful that the Students watch how I talk and examine the patient, and moreover, as I point out interesting findings and key points to take away from each patient's case and get them to come back to review the patient themselves to present and discuss the case with me later that day. After ward rounds, if there are interesting procedures to be done, I usually supervise the Students (or Intern or Resident) with a procedure (e.g. Lumbar Puncture or Asicties Tap or Joint Aspirate, etc.). Then for the rest of the day I find it useful the Students hang out with the Intern and Residents to do ward jobs and get the hang of the hospital since that will be their job in a few years. I try to encourage my Interns and Residents not to use the Students as slave monkeys, but at the same time, do get them to gain some experience with doing consults, writing referrals and discharge summaries, and doing simple procedures like cannulas and catheters so that when they're Interns it's a lot easier for them then. If it's a slow day and nothing's happening, the Resident can dismiss the Students to go home or study in the library.

In outpatient clinics or private rooms, we usually see about 30 to 50 patients a day (11 am to 5 pm); so as you can see there's a high turnover of patients. I usually have one Student hang out with me, and the other Student with the Senior Resident or other Attending on with me in the clinic. I prefer to do all the documentation since medicolegally it's my consultation (and again, so I don't have to double my work by proofreading everything). I encourage Students to lead the consultation if they wish (and if the patient is happy for them to) and I just sit and observe and provide teaching through feedback and takeover the consult with the patient at the end. Again, we do minor procedures together; I find most students like to have their go at closed reductions, plastering, suturing and draining abscesses. If it's a boring day, and there's just all cold and flus, I just let them go home or go to the hospital library to study, and I'll call them back if there's anything worthwhile.

Most of my Students are happy with this arrangement. Unless any of you have any further suggestions?

 

[Free411]

How we teach students on inpatient wards is different to how we teach student in outpatient clinics.

On inpatient wards, we usually have about 10 to 20 patients to see on a moring ward round (7 am to 11 am). The Intern or Resident is usually the one pushing the Computer-On-Wheels (COW) around and documenting the consultation. Occasionally the Intern or Resident may delegate the typing to the Student, but I usually find it's better that the Interns or Residents do them because they are paid to do that job and ironically it's more work that you have to proof read and double check what the Student has written; and funnily enough, I still occasionally have to check what notes Interns and Residents are writing on my behalf. I find it more useful that the Students watch how I talk and examine the patient, and moreover, as I point out interesting findings and key points to take away from each patient's case and get them to come back to review the patient themselves to present and discuss the case with me later that day. After ward rounds, if there are interesting procedures to be done, I usually supervise the Students (or Intern or Resident) with a procedure (e.g. Lumbar Puncture or Asicties Tap or Joint Aspirate, etc.). Then for the rest of the day I find it useful the Students hang out with the Intern and Residents to do ward jobs and get the hang of the hospital since that will be their job in a few years. I try to encourage my Interns and Residents not to use the Students as slave monkeys, but at the same time, do get them to gain some experience with doing consults, writing referrals and discharge summaries, and doing simple procedures like cannulas and catheters so that when they're Interns it's a lot easier for them then. If it's a slow day and nothing's happening, the Resident can dismiss the Students to go home or study in the library.

In outpatient clinics or private rooms, we usually see about 30 to 50 patients a day (11 am to 5 pm); so as you can see there's a high turnover of patients. I usually have one Student hang out with me, and the other Student with the Senior Resident or other Attending on with me in the clinic. I prefer to do all the documentation since medicolegally it's my consultation (and again, so I don't have to double my work by proofreading everything). I encourage Students to lead the consultation if they wish (and if the patient is happy for them to) and I just sit and observe and provide teaching through feedback and takeover the consult with the patient at the end. Again, we do minor procedures together; I find most students like to have their go at closed reductions, plastering, suturing and draining abscesses. If it's a boring day, and there's just all cold and flus, I just let them go home or go to the hospital library to study, and I'll call them back if there's anything worthwhile.

Most of my Students are happy with this arrangement. Unless any of you have any further suggestions?

You are a dream attending.

 

[ortnakas]

I didn’t feel bad for OP for the hours or for having to do all the notes.

I started to feel bad when it started to sound like he/she was acting as a scribe for non-teaching attendings.

I do feel bad OP is being used as unpaid labor for a literature review with zero credit.