Is IM really like this?

[KnuxNole]

Here, we call the attending to present new admits overnight(the attending on call are on call for the faculty patients and to oversee the on call person). To me, that feels safer than waiting till the AM for the attending to here about it. Especially since I'm scared that my plan is wrong, or I miss stuff...

2nd year is gonna suck :/

---

Members don't see this ad.

 

[Instatewaiter]

They do considering they work 7 on/7 off, hence half the year.

That's a bit of a skewed way to look at it. Those shifts are usually 12 hour shifts. So in those 7 days on, they're working 84 hours or 42 hours per week. Compare that to the average dermatologist... 77% of dermatologists work 40 hours or less per week (medscape data)... It's not really that different in terms of total hours... just in raw compensation

 

[Instatewaiter]

Here, we call the attending to present new admits overnight(the attending on call are on call for the faculty patients and to oversee the on call person). To me, that feels safer than waiting till the AM for the attending to here about it. Especially since I'm scared that my plan is wrong, or I miss stuff...

2nd year is gonna suck :/

An in-house attending looking over your shoulder can stifle your learning and development as a resident.

In terms of autonomy, at very strong residencies, the residents can handle the autonomy and things go smoothly. However if the residents aren't strong, autonomy leads to some scary things happening. A balance between handholding and autonomy is difficult to find.

 

[KnuxNole]

An in-house attending looking over your shoulder can stifle your learning and development as a resident.

In terms of autonomy, at very strong residencies, the residents can handle the autonomy and things go smoothly. However if the residents aren't strong, autonomy leads to some scary things happening. A balance between handholding and autonomy is difficult to find.

That's the scary part...and the reason why I don't want to even THiNk about moonlighting, I would kill thousands of patients in urgent care with no attending help with complex cases left and right...

You are right, the balance is hard. Especially as a resident, and one who isn't smart to handle everything solo, it's helpful to have attendings to run by plans and making sure we don't kill people.

Just curious, if an attending doesn't look over my shoulder, isn't that a HUGE liability for me? That thought scares me to death. I'm sure I'm the stupidest resident imaginable...

 

[DermViser]

Hospitalists dont make big money.

Not compared to a cardiologist, no.

 

[Elisabeth Kate]

The very problem is I don't want to chill but I don't want to be short-sighted and believe that I will never ever want to chill down the road. I have to keep in mind the me of 15 years from now.

If you can handle a surgical residency, which is anything but chill, then work a few years as part of another practice, you can open up your own practice and make it as chill as you want. One of my friend's dads is a general surgeon in private practice who does nothing but hernia repairs and cholecystectomies at a surgical center in town. He hardly ever goes to the hospital unless a patient's operation needs to be done at the hospital for some reason. He works 7-3 most days and takes every weekend off.

That's the scary part...and the reason why I don't want to even THiNk about moonlighting, I would kill thousands of patients in urgent care with no attending help with complex cases left and right...

You are right, the balance is hard. Especially as a resident, and one who isn't smart to handle everything solo, it's helpful to have attendings to run by plans and making sure we don't kill people.

Just curious, if an attending doesn't look over my shoulder, isn't that a HUGE liability for me? That thought scares me to death. I'm sure I'm the stupidest resident imaginable...

This is exactly my fear as an incoming intern. I feel like I don't know anything. I still hesitate when it comes to plans for very bread and butter stuff. I can't imagine what will happen when it comes to more complicated cases I'm responsible for. I WANT the handholding.

 

[username456789]

This is exactly my fear as an incoming intern. I feel like I don't know anything. I still hesitate when it comes to plans for very bread and butter stuff. I can't imagine what will happen when it comes to more complicated cases I'm responsible for. I WANT the handholding.

You'll quickly learn early on that "looking it up" holds far more utility than just impressing an attending.

 

[DubVille]

If you can handle a surgical residency, which is anything but chill, then work a few years as part of another practice, you can open up your own practice and make it as chill as you want. One of my friend's dads is a general surgeon in private practice who does nothing but hernia repairs and cholecystectomies at a surgical center in town. He hardly ever goes to the hospital unless a patient's operation needs to be done at the hospital for some reason. He works 7-3 most days and takes every weekend off.



This is exactly my fear as an incoming intern. I feel like I don't know anything. I still hesitate when it comes to plans for very bread and butter stuff. I can't imagine what will happen when it comes to more complicated cases I'm responsible for. I WANT the handholding.

If you don't know what is going on in urgent care, send them to the ED. It happens all the time, and is usually for very basic things. Seeing the ridiculousness of those docs or NPs or PAs makes me feel pretty safe. Sadly as of now my advanced program doesn't allow moonlighting.

 

[Priapism4tooLong]

If you can handle a surgical residency, which is anything but chill, then work a few years as part of another practice, you can open up your own practice and make it as chill as you want. One of my friend's dads is a general surgeon in private practice who does nothing but hernia repairs and cholecystectomies at a surgical center in town. He hardly ever goes to the hospital unless a patient's operation needs to be done at the hospital for some reason. He works 7-3 most days and takes every weekend off.



This is exactly my fear as an incoming intern. I feel like I don't know anything. I still hesitate when it comes to plans for very bread and butter stuff. I can't imagine what will happen when it comes to more complicated cases I'm responsible for. I WANT the handholding.

When i started off they treated me as if i never went to medical school. It was really comforting, seriously don't worry.

 

[SouthernSurgeon]

An in-house attending looking over your shoulder can stifle your learning and development as a resident.

In terms of autonomy, at very strong residencies, the residents can handle the autonomy and things go smoothly. However if the residents aren't strong, autonomy leads to some scary things happening. A balance between handholding and autonomy is difficult to find.

My hospital is considered a "very strong" medicine residency. It's still scary. I think it's completely inappropriate that a second year resident with 8-10 months of inpatient experience, with such a broad scope of residency that they've only maybe spent 1-2 months in any given specialty, is independently managing complex patients without direct oversight.

 

[DermViser]

My hospital is considered a "very strong" medicine residency. It's still scary. I think it's completely inappropriate that a second year resident with 8-10 months of inpatient experience, with such a broad scope of residency that they've only maybe spent 1-2 months in any given specialty, is independently managing complex patients without direct oversight.

Could the issue be that since General Surgery is 5 years, the autonomy given is a lot slower than compared to 3 years of IM?

 

[KnuxNole]

If you don't know what is going on in urgent care, send them to the ED. It happens all the time, and is usually for very basic things. Seeing the ridiculousness of those docs or NPs or PAs makes me feel pretty safe. Sadly as of now my advanced program doesn't allow moonlighting.

I didn't know that was allowed. I thought they would get mad if I sent 80%-90% of the cases to the ED, since all the septic, STEMI, head lacs, altered mental status, respiratory failure walking into urgent care scare the **** out of me when I'm with no attending help! Plus, in the clinic, the attending catches me if I forget to ask if patient's had their vaccinations, what they take for birth control, etc. I fear that I'll forget to ask key questions, which would lead to the death of thousands of patients, also considering the high acuity of patients that come in.

Elisbaeth Kate, in intern year, you'll always have backup. Having an amazing senior works wonders. Ask, ask, ask! It's better to be cautious and ask your upper level if it's ok to do XXX, or ask what should we do now that XXX has came back positive. Also, for admits, going over the plan and presentation with them is gonna make up feel comfortable. It may seem scary, but focus on the hard work aspect. The clinical aspect will slowly but surely be gained. I felt like I literally learned nothing in medical school, and it was fine.

Also, having everything run by the attending makes care better. They are quick to tell you if you need to add something, ask certain questions to patients, or to consider different medications. In the clinic, having to run by every patient with the attending makes it more comfortable and learning improves to know what questions to ask. If there was no attending, I would literally feel like I'm killing every single patient daily. After all, residency is a protected environment for the duration of 3-5 years for a reason haha

 

[SouthernSurgeon]

Could the issue be that since General Surgery is 5 years, the autonomy given is a lot slower than compared to 3 years of IM?

Yes, certainly. But still - our chief residents, even if they are completely capable of developing a sound plan, don't do so without touching base with the attending. The medicine teams just have a totally different culture when it comes to communicating with their attendings - it almost seems like it's taboo to contact them. Transfers to ICUs, RRTs, codes - I've seen all of these happening without informing the attending, which would not happen on our service, regardless of the level of resident.

I have some nightmare stories of mismanagement by the medicine teams, including a couple that resulted in deaths. I'm sure they have similar stories of us being idiots however, to be fair, and an attending is not always a magic genie.

But I just don't think it's appropriate patient care. Same as I don't think it was appropriate patient care back in the cowboy days for general surgery residents to be doing complex operations while the attending was sitting at home. There has to be a balance of autonomy and appropriate supervision - it's not fair to the patients otherwise.

 

[Priapism4tooLong]

Yes, certainly. But still - our chief residents, even if they are completely capable of developing a sound plan, don't do so without touching base with the attending. The medicine teams just have a totally different culture when it comes to communicating with their attendings - it almost seems like it's taboo to contact them. Transfers to ICUs, RRTs, codes - I've seen all of these happening without informing the attending, which would not happen on our service, regardless of the level of resident.

I have some nightmare stories of mismanagement by the medicine teams, including a couple that resulted in deaths. I'm sure they have similar stories of us being idiots however, to be fair, and an attending is not always a magic genie.

But I just don't think it's appropriate patient care. Same as I don't think it was appropriate patient care back in the cowboy days for general surgery residents to be doing complex operations while the attending was sitting at home. There has to be a balance of autonomy and appropriate supervision - it's not fair to the patients otherwise.

Some of the attendings are useless seriously

 

[DermViser]

Yes, certainly. But still - our chief residents, even if they are completely capable of developing a sound plan, don't do so without touching base with the attending. The medicine teams just have a totally different culture when it comes to communicating with their attendings - it almost seems like it's taboo to contact them. Transfers to ICUs, RRTs, codes - I've seen all of these happening without informing the attending, which would not happen on our service, regardless of the level of resident.

I have some nightmare stories of mismanagement by the medicine teams, including a couple that resulted in deaths. I'm sure they have similar stories of us being idiots however, to be fair, and an attending is not always a magic genie.

But I just don't think it's appropriate patient care. Same as I don't think it was appropriate patient care back in the cowboy days for general surgery residents to be doing complex operations while the attending was sitting at home. There has to be a balance of autonomy and appropriate supervision - it's not fair to the patients otherwise.

Oh, wow. We did these all the time. Of course, the IM attending was told AFTER the fact (i.e. so and so was transferred to the ICU for yada yada; so and so coded, yada yada.) I figured it was just part of the increasing autonomy that one gets in a categorical residency.

 

[CherryRedDracul]

Some of the attendings are useless seriously

Reminds me of this story about Dr. Royal Jelly in the "Funniesh Chief Complaints" thread.

The chief complaint isn't funny, but the attending is-

7yo boy with 1 month history of polydipsia, polyuria. Comes in because 1 day history of fever, abdominal pain, nausea/vomiting. UA shows ketones greater than the machine can read, and proteinuria; negative for WBC and leuk esterase.

Attending: This patient has UTI and gatroenteritis. I will tell the mother to wait for the UTI to go away, and then we will do a renal ultrasound [because we own an ultrasound machine].
Me: Do you think we should get a fingerstick?
Attending: HX, this is NOT how diabetes insipidus presents!

----

I'm not kidding you.

Later that day, I am fearful for the child's life so I look back through his chart to see if maybe there is something that will re-assure me he's not going to go into DKA and die.

----

Me: I see here that he was in 3 months ago and had a UA that showed 100 of glucose in the urine.
Attending: Now that's not very much... do you know what normal is!??!
Me: Um... zero.
Attending: Oh yes, well, for urine. Well our machine just does that sometimes. Especially if they just ate.


Really!!?!

Seriously, WOW.

 

[SouthernSurgeon]

Oh, wow. We did these all the time. Of course, the IM attending was told AFTER the fact (i.e. so and so was transferred to the ICU for yada yada; so and so coded, yada yada.) I figured it was just part of the increasing autonomy that one gets in a categorical residency.

I mean it's not always feasible to tell them at the exact moment **** goes down. But as soon as the patient is stable or in the ICU or whatever we call the attending. The medicine teams often won't tell the attending until the next morning.

 

[DermViser]

I mean it's not always feasible to tell them at the exact moment **** goes down. But as soon as the patient is stable or in the ICU or whatever we call the attending. The medicine teams often won't tell the attending until the next morning.

I guess they figured who cares, it's not like the attending can get them out of the ICU anyways (now that the patient is under another attending's care). That being said, the reason we told them, is just so that they don't look stupid going into a patient's room and the patient not being there.

 

[Brain Bucket]

You couldn't pay me 500K to do inpatient internal medicine, ESPECIALLY an academic-focused residency

Where do I sign up?

 

[SouthernSurgeon]

I guess they figured who cares, it's not like the attending can get them out of the ICU anyways (now that the patient is under another attending's care).

Sure...but our assumption on the surgery side is that the attending does care, even if they can't do anything, since the patient is under their care and their outcome is that attending's responsibility.

 

[DrBowtie]

I mean it's not always feasible to tell them at the exact moment **** goes down. But as soon as the patient is stable or in the ICU or whatever we call the attending. The medicine teams often won't tell the attending until the next morning.

I think it's probably due to the lack of interventions that require attending supervision in medicine vs. surgery. The hospitalist isn't going to do the emergent broch or scope where as the general surgeon would be the one taking them for an ex lap.

 

[KnuxNole]

Sure...but our assumption on the surgery side is that the attending does care, even if they can't do anything, since the patient is under their care and their outcome is that attending's responsibility.

The same is with the medicine side too. The attending signing all of our notes is in the medical chart, so in a lawsuit, they are the ones under the fire, saying they have "agreed with the resident." Which is what freaked me out about the select few who don't read my notes/orders and say they "agree"......

For codes, it'd be nice for the attending to walk the resident through on what to do...I mean, unless a resident is expected to know how to handle everything 100% with no help!!

 

[Priapism4tooLong]

Reminds me of this story about Dr. Royal Jelly in the "Funniesh Chief Complaints" thread.



Seriously, WOW.

Where did you find that? thats total BS no way did that happen lol

edit: I know i said some attendings are useless, but no way does anyone let alone an attending miss a possible DKA and go on to confuse it with a UTI? lolll

and finger prick testing for DI? what? literally nothing in that whole story made any sense

I'm sick of you posting dumb SHI* CHERRYRED, You're never going to achieve the >1 ratio with BS LIKE THIS (jk i liked it anyway, i know how much that ratio means to you.)

 

[DermViser]

Sure...but our assumption on the surgery side is that the attending does care, even if they can't do anything, since the patient is under their care and their outcome is that attending's responsibility.

No I mean in the ICU they have a completely different attending taking care of them vs. the wards.

 

[username456789]

No I mean in the ICU they have a completely different attending taking care of them vs. the wards.

If it's a closed ICU. At my hospital we had an open ICU, so they were still our/our attendings' patients.

 

[DermViser]

If it's a closed ICU. At my hospital we had an open ICU, so they were still our/our attendings' patients.

I thought most ICUs are closed, except maybe hospitals in rural areas that have no choice and are short on staff.

 

[DubVille]

I didn't know that was allowed. I thought they would get mad if I sent 80%-90% of the cases to the ED, since all the septic, STEMI, head lacs, altered mental status, respiratory failure walking into urgent care scare the **** out of me when I'm with no attending help! Plus, in the clinic, the attending catches me if I forget to ask if patient's had their vaccinations, what they take for birth control, etc. I fear that I'll forget to ask key questions, which would lead to the death of thousands of patients, also considering the high acuity of patients that come in.

Elisbaeth Kate, in intern year, you'll always have backup. Having an amazing senior works wonders. Ask, ask, ask! It's better to be cautious and ask your upper level if it's ok to do XXX, or ask what should we do now that XXX has came back positive. Also, for admits, going over the plan and presentation with them is gonna make up feel comfortable. It may seem scary, but focus on the hard work aspect. The clinical aspect will slowly but surely be gained. I felt like I literally learned nothing in medical school, and it was fine.

Also, having everything run by the attending makes care better. They are quick to tell you if you need to add something, ask certain questions to patients, or to consider different medications. In the clinic, having to run by every patient with the attending makes it more comfortable and learning improves to know what questions to ask. If there was no attending, I would literally feel like I'm killing every single patient daily. After all, residency is a protected environment for the duration of 3-5 years for a reason haha

Fresh NP grads with no real nursing experience man the walmart clinics independently. You will be fine. All I feel like I learned this year was how to not kill people and how to recognize "sick" patients. If they aren't "sick" they will get better on their own even if my therapy is sub optimal, or not 1st line. If they are, do what you do in the hospital and "call an adult." That's what I say when sh** gets real. As far as vaccines at urgent care, save for tetanus and maybe pneumonia for oldies, it's probably not super relevant for the acute stuff. I suppose kids are a different story.
My program is hand holding in the day but nights and weekends require you to make decisions at times. Maybe I've been lucky so far, but I feel ready to moonlight even though I can't as of now. Who knows, if it became a true possibility I may change my tune.

 

[Priapism4tooLong]

Fresh NP grads with no real nursing experience man the walmart clinics independently. You will be fine. All I feel like I learned this year was how to not kill people and how to recognize "sick" patients. If they aren't "sick" they will get better on their own even if my therapy is sub optimal, or not 1st line. If they are, do what you do in the hospital and "call an adult." That's what I say when sh** gets real. As far as vaccines at urgent care, save for tetanus and maybe pneumonia for oldies, it's probably not super relevant for the acute stuff. I suppose kids are a different story.
My program is hand holding in the day but nights and weekends require you to make decisions at times. Maybe I've been lucky so far, but I feel ready to moonlight even though I can't as of now. Who knows, if it became a true possibility I may change my tune.

are you in your intern year?.

 

[KnuxNole]

Fresh NP grads with no real nursing experience man the walmart clinics independently. You will be fine. All I feel like I learned this year was how to not kill people and how to recognize "sick" patients. If they aren't "sick" they will get better on their own even if my therapy is sub optimal, or not 1st line. If they are, do what you do in the hospital and "call an adult." That's what I say when sh** gets real. As far as vaccines at urgent care, save for tetanus and maybe pneumonia for oldies, it's probably not super relevant for the acute stuff. I suppose kids are a different story.
My program is hand holding in the day but nights and weekends require you to make decisions at times. Maybe I've been lucky so far, but I feel ready to moonlight even though I can't as of now. Who knows, if it became a true possibility I may change my tune.

Hmmm.....that is a good point. To be honest, I can see myself either going really slow with DDx, or saying "Dude, you're like sick. Go to the ED! You have SEPSIS and an MI, don't come to me!!!!". Some people joke about walmart clinics being about colds and stuff, but I am worried about all the non cold/sniffles patients. Like you said, if they look sick or unhealthy, I could "call an adult" and ship to the ED. Which, would make me feel a bit calm compared to turning in bed wondering if I killed this patient for missing a disease or giving the wrong medicine.

That is true about vaccines. I know in clinic, I got burnt for not asking about certain routine vaccinations, and the people who go to urgent care for med refills for their 10 problems, well child/well women checks at Walmart are probably the ones where preventative questions would be asked.

Hopefully, I would be fine for 3rd year moonlighting. I know people suggest it's better to start then compared to 2nd year, which makes a lot of sense. I imagine you have to have a lot of confidence and intelligence in your clinical abilities to be successful at moonlighting, and I'm the kind of guy who CLINGS on UTD/Epocrates...

 

[Instatewaiter]

My hospital is considered a "very strong" medicine residency. It's still scary. I think it's completely inappropriate that a second year resident with 8-10 months of inpatient experience, with such a broad scope of residency that they've only maybe spent 1-2 months in any given specialty, is independently managing complex patients without direct oversight.

I disagree. Intern year is about learning to know when someone is sick and when to ask for help. At a "very strong" program, like Hopkins for instance, the interns get a lot of autonomy (with appropriate oversight that they don't even realize is going on) so they know what's what second year. The outcomes during intern year are quite good.

That in turn leads to strong residents. The MICU resident is the one who runs the codes for the whole hospital.

I mean it's not always feasible to tell them at the exact moment **** goes down. But as soon as the patient is stable or in the ICU or whatever we call the attending. The medicine teams often won't tell the attending until the next morning.

I agree this is bad form. Really though, do you need to call the attending to give them an FYI that Mr. Jones PEA'ed? What's he going to do?

 

[KnuxNole]

Just out of curiosity, how do interns get THAT good to practice without that much oversight? I'd imagine people would be dying left and right if interns don't check out their plan to a superior. Are they just really, really, really smart?

I definitely have learned to ask for help(A LOT!) and i'm learning to know when someone is sick. But, I feel like I need to review EVERY plan with a senior/attending, or I freak the **** out that I missed 3-7 things. I try to be as detailed and thorough as possible, but of course, I feel like it's never enough. Even though I don't get negative feedback, I don't get ANY feedback, so I never know how I'm truly doing. Also, to run a code BY MYSELF scares the living **** out of me. ACLS Bullcrap does not count haha. In real life, there would be people screaming left and right and I can see myself freezing in my sneakers wanting to cry.

 

[Siggy]

I thought most ICUs are closed, except maybe hospitals in rural areas that have no choice and are short on staff.

It depends on the hospital... and possibly the service. At my home hospital, the IM teams have a dedicated ICU team and the gen surg has a dedicated ICU team. Neuro sx is, I guess, "open," however generally half or more of the neuro sx patients are in ICU anyways. The inpatient family medicine service (admits only patients seen in the family med clinics), on the other hand, has an open ICU.

Another teaching hospital near by (community, small, family med and traditional rotating internship) runs an open ICU, but they generally ship out anything remotely serious to county anyways.

 

[Instatewaiter]

Just out of curiosity, how do interns get THAT good to practice without that much oversight? I'd imagine people would be dying left and right if interns don't check out their plan to a superior. Are they just really, really, really smart?

For even the most autonomous of programs, there is a TON of oversight for the first three months. After that, the seniors slowly back away. Those interns who are not as strong get more oversight.

People are usually able to do more than people give them credit for. You learn more without a hand to hold.

 

[Venko]

Just out of curiosity, how do interns get THAT good to practice without that much oversight? I'd imagine people would be dying left and right if interns don't check out their plan to a superior. Are they just really, really, really smart?

I definitely have learned to ask for help(A LOT!) and i'm learning to know when someone is sick. But, I feel like I need to review EVERY plan with a senior/attending, or I freak the **** out that I missed 3-7 things. I try to be as detailed and thorough as possible, but of course, I feel like it's never enough. Even though I don't get negative feedback, I don't get ANY feedback, so I never know how I'm truly doing. Also, to run a code BY MYSELF scares the living **** out of me. ACLS Bullcrap does not count haha. In real life, there would be people screaming left and right and I can see myself freezing in my sneakers wanting to cry.

In my experience,

1. Very few patients get admitted without passing through an ED first. ED patients are usually seen and staffed by attendings.

2. Many teaching hospitals have sub specialty services which are not intern run that care for most of the complex or really ill patients.

3. There are increasing numbers of nursing or interdisciplinary safety programs like rapid response teams, code teams, difficult airway teams, even behavioral dyscontrol teams...

4. Residents don't realize usually the degree to which attendings and seniors watch over what they are doing; this is either actively by chart monitoring or passively by talking with nurses, techs etc. also, most of the experienced nurses will call us to discuss care plans that seem even the least bit out of the ordinary.

5. Online resources are very easy to access compared with previous library trips of our predecessors. Journals are available within minutes, online texts and even emedicine are really at the interns fingertips.

6. Pharmacists are increasingly checking and cross checking every order placed. This helps prevent allergic reactions, and cross reactions as well as catch dosing mishaps.

7. Also increasing use of EMR systems allow rapid access to and improved compliance with standard hospital protocols. For example potassium replacement or heparin dose adjustments are somewhat automated now. Even admission orders which formerly were handwritten using the ADCVANDISMAL acronym are now check boxed or electronic with reminders and triggers to prevent oversights or errors.

 

[SouthernSurgeon]

I agree this is bad form. Really though, do you need to call the attending to give them an FYI that Mr. Jones PEA'ed? What's he going to do?

It's not about what the attending is going to "do". It's about the fact that it's the attending's patient. Their name is the one on the chart. They are the ones who will get named in any malpractice suit. Our attendings sure as **** want to know if their patient codes, so I have a very hard time reconciling the fact that the medicine attendings apparently don't.

I disagree. Intern year is about learning to know when someone is sick and when to ask for help. At a "very strong" program, like Hopkins for instance, the interns get a lot of autonomy (with appropriate oversight that they don't even realize is going on) so they know what's what second year. The outcomes during intern year are quite good.

And I disagree with you. We have a saying that the most dangerous resident in the hospital is the PGY2 - they know just enough to think they know everything, and don't know when to recognize their limits.

As I said, this is a cultural difference and I obviously don't expect to change anyone's minds. Part of me just finds it bizarre that the medicine attendings seem so detached from their patients. I think it is an inappropriate lack of supervision and that the patients deserve better.

 

[DermViser]

It's not about what the attending is going to "do". It's about the fact that it's the attending's patient. Their name is the one on the chart. They are the ones who will get named in any malpractice suit. Our attendings sure as **** want to know if their patient codes, so I have a very hard time reconciling the fact that the medicine attendings apparently don't.



And I disagree with you. We have a saying that the most dangerous resident in the hospital is the PGY2 - they know just enough to think they know everything, and don't know when to recognize their limits.

As I said, this is a cultural difference and I obviously don't expect to change anyone's minds. Part of me just finds it bizarre that the medicine attendings seem so detached from their patients. I think it is an inappropriate lack of supervision and that the patients deserve better.

One thing I noticed on rotations is that Surgery attendings are so much more "attached" to their patients than Internal Medicine doctors are, when it comes to doing everything for their patient. n=1, I know.

 

[SouthernSurgeon]

One thing I noticed on rotations is that Surgery attendings are so much more "attached" to their patients than Internal Medicine doctors are, when it comes to doing everything for their patient. n=1, I know.

I definitely think they are . Were I the philosophical type, I'd say it's because the act of performing a major operation on the patient creates that relationship. You feel more responsibility for what happens to them since it is all either a direct or indirect consequence of what you did to them in the first place.

 

[DermViser]

I definitely think they are . Were I the philosophical type, I'd say it's because the act of performing a major operation on the patient creates that relationship. You feel more responsibility for what happens to them since it is all either a direct or indirect consequence of what you did to them in the first place.

Exactly. As medical students, we couldn't understand why surgeons seemed to be so hard to let go when it came to the patient vs. when we rotated on Internal Medicine, it's like the culture completely changed. Much easier to understand now, although I'm sure it can wreak havoc on surgeons' lives both mentally and physically.

I think this is where surgeons have real beef with the "not my patient" and shift-work mentality. Esp. when you're cross-cover, you couldn't get away with that on Surgery, that you might be able to get away with in IM.

 

[jturkel]

why is this thread so long? i dont want to read it. what's the big deal?

 

[DermViser]

why is this thread so long? i dont want to read it. what's the big deal?

He he. I think you'll LOL at the numerous contortions and convolutions that took place.

 

[jturkel]

He he. I think you'll LOL at the numerous contortions and convolutions that took place.

i skimmed 2 pages. i'm done reading it. no specialty is perfect. everyone encounters difficult patients. everyone has different interests. you cant go into a field b/c of the pay b/c that changes so much. do what you like and hope you dont get sued and dont get screwed over by the ACA or whatever u wanna call it

fwiw, i do like im. i know it's not competitive, but the top prgrams are still as competitive as other specialties that are overall very competitive. do i want to do IM? no i plan on specializing b/c i think IM has it's limitations and i like being more hands on (i wanna do GI) and find certain pathologies more interesting.

and i didn't really read this last page either...but i've seen surgeon's and IM docs alike "own" their own patients and fight for them and their care. this is everyone's n=1

 

[DermViser]

i skimmed 2 pages. i'm done reading it. no specialty is perfect. everyone encounters difficult patients. everyone has different interests. you cant go into a field b/c of the pay b/c that changes so much. do what you like and hope you dont get sued and dont get screwed over by the ACA or whatever u wanna call it

fwiw, i do like im. i know it's not competitive, but the top prgrams are still as competitive as other specialties that are overall very competitive. do i want to do IM? no i plan on specializing b/c i think IM has it's limitations and i like being more hands on (i wanna do GI) and find certain pathologies more interesting.

and i didn't really read this last page either...but i've seen surgeon's and IM docs alike "own" their own patients and fight for them and their care. this is everyone's n=1

It was more talking about GENERAL IM vs. IM subspecializing. IM residency is a means to an end for most AMGs. GI and Cards are popular for good reason (the salary is more the cherry on sundae, but not the reason they are popular, IMHO). GI and Cards are very action oriented, hence their popularity among AMGs who pursue IM training. I think OP's experience is in a General Medicine setting. Something I wouldn't wish on my worst enemy.

 

[jturkel]

It was more talking about GENERAL IM vs. IM subspecializing. IM residency is a means to an end for most AMGs. GI and Cards are popular for good reason (the salary is more the cherry on sundae, but not the reason they are popular, IMHO). GI and Cards are very action oriented, hence their popularity among AMGs who pursue IM training. I think OP's experience is in a General Medicine setting. Something I wouldn't wish on my worst enemy.

agreed

 

[DermViser]

agreed

Oh, and congratulations on matching into IM. I really hope you do get that GI fellowship. Might want to PM @IM2GI for more info.

 

[jturkel]

Oh, and congratulations on matching into IM. I really hope you do get that GI fellowship. Might want to PM @IM2GI for more info.

thx. i'll take all the good wishes i can get. ....GI is hard to get into for sure