Is it possible to be consistently happy during a tough internship?

[keepinon]

I think I have a good attitude and even have some fun as an intern, but I really hate my job overall. By extension, I am starting to hate my life, which consists of my stressful job, sleeping as close to 8 hrs/night as possible, and barely finding time to eat. On my one day off I tend to catch up on sleep b/c I'm so tired. My internship program is not what I thought it would be and I work more than 80 hours most weeks (although a mentor tells me all programs play "bait & switch"). I wonder if other people feel similarly or if I am having a stronger than normal reaction to a difficult time we all must bear. More days than not I do a mental search for any other job I would prefer to do more but so far have come up dry.

I'd appreciate hearing any thoughts about others' internship experiences. I have heard my thoughts echoed by a few of my co-interns who are also dissatisfied with our program, but I'm eager to hear from others about their experience.

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[VALSALVA]

You seem to have good insight and the general "vibe" I get from your post suggests you have a good attitude.

The intern year is difficult for a lot of people. You're at the bottom of the totem pole every month. Your difficulties with finding time to eat, sleep, etc. are pretty typical, IMO and experience. During my intern year, I liked most of my colleagues, attendings, etc. but still had the same problems you did finding time for sleep, activities, etc.

Once the big holidays are over, you'll begin to count DOWN the days to July 1. That's a big psychological hurdle, I think.

I sort of smirked when I read, "sleeping as close to 8 hrs/night as possible" because for me (and many others) it was more like a goal of 5-6 hours/night. Frankly, if I slept more than 7 hours in a night during my entire residency, I felt like I was stealing something.

You'll be okay.

 

[ubcredfox]

I think I have a good attitude and even have some fun as an intern, but I really hate my job overall. By extension, I am starting to hate my life, which consists of my stressful job, sleeping as close to 8 hrs/night as possible, and barely finding time to eat. On my one day off I tend to catch up on sleep b/c I'm so tired. My internship program is not what I thought it would be and I work more than 80 hours most weeks (although a mentor tells me all programs play "bait & switch"). I wonder if other people feel similarly or if I am having a stronger than normal reaction to a difficult time we all must bear. More days than not I do a mental search for any other job I would prefer to do more but so far have come up dry.

I'd appreciate hearing any thoughts about others' internship experiences. I have heard my thoughts echoed by a few of my co-interns who are also dissatisfied with our program, but I'm eager to hear from others about their experience.

And I thought that I was the only one. I do pretty much the same thing you do every day. My hours are generally in the 90+ range per week. I have two weekends off per month only. I generally go 20 days straight without a day off, then a weekend falls. I'm due for one starting tomorrow. Feel like total hell. Exhausted and tired. I too do mental searches for jobs I'd rather do other then this one. It's hard being at the bottom, especially when the term "R1" is used pejoritavely. I may be an "R1" but I'm no re-**** (as said in The Hangover). Seems like my "colleagues" have forgotten that I have an M.D. like they do. It also seems like the only time it actually matters is when I cosign an order. Otherwise, I'm just "the resident", "the intern" or "the R1." A warm body filling a spot. Sigh. I really hope I can last it for the next few months. What a slog. Worse then third year I figure...well maybe not...but it still sucks.

 

[45408]

I'm guessing that you're not logging all of your hours then?

 

[eforest]

I'm pretty unhappy with the intern situation overall. I think it's pretty normal. At my program we're breaking hours, but there is really no way to cut down hours because the work load is too large. Also, it is socially acceptable to treat doctors badly. Nurses are viewed as noble and self sacrificing, whereas doctors are not viewed in such a positive light. And the way the hospital is set up- if a nurse or other ancillary staff feels mistreated, they have a union to complain to. We just have to grin and bear it, regardless of how inappropriately we are treated by staff. It is normal to have patients behave in an abusive manner (partially it's the patient population we're treating at this hospital). And then, when we're covering, we're expected to manage 70+ patients overnight which means that often the pager does not stop beeping.

I've notice that it's not that any one thing is bad, it's just the whole package- the lack of time off, the consecutive hours worked, poor treatment on the part of patients and staff... it is all just demoralizing.

 

[docbill]

I see how interns are treated at different hospitals and I am not looking forward to doing first year residency. It is really another year of being abused left and right. That is why it is really important to pick a place you will be happy at and not just a place that is well known for the name.

Where I did one of my IM rotations, for the most part. The staff and PD are very nice to interns and residents. They get treated with respect. The nurses at this private university affiliated hospital also treat the residents well (as long as they are nice back). The patients can be mixed. Rough and pleasant. But usually ZERO policy for abuse. The hours are great as well.

 

[BobBarker]

My intern year is fantastic. Couldn't be happier. I have lots of free time, and when on call we only do things like rapid assessments of crashing patients, run codes, intubations, and place central lines. All without an attending or sr resident looking over your shoulder. I'm doing anesthesia so I know a lot of this is specialty specific, but most anesthesia PGY1 years aren't this nice.

 

[keepinon]

I'm guessing that you're not logging all of your hours then?

Definitely not logging all hours. This is the norm for my program as I have learned from my residents. Apparently the program admin folks contact residents who document over 80 hours and ask them if they really meant to put those hours. Then the norm is for the resident to go back and change the hours. I do not know what happens if the resident says he really worked those hours, but I also don't want to get in trouble with my program as I'd like to make it through to get to my residency.

Thanks to VALSALVA for your encouraging response. Beyond all the lifestyle factors, I also just feel like I'm responsible for too many patients to not let things fall through the cracks. I don't feel safe covering as many patients as I do, even on my own rotation team. And there are so many holes in the on-call/overnight system that I see things get missed daily. I do my best to avoid missing critical items, but I there have been times when what I've missed just as easily could have been critical as not.

Only about 9 more months to go.

 

[Law2Doc]

I think I have a good attitude and even have some fun as an intern, but I really hate my job overall. By extension, I am starting to hate my life, which consists of my stressful job, sleeping as close to 8 hrs/night as possible, and barely finding time to eat. On my one day off I tend to catch up on sleep b/c I'm so tired. My internship program is not what I thought it would be and I work more than 80 hours most weeks (although a mentor tells me all programs play "bait & switch"). I wonder if other people feel similarly or if I am having a stronger than normal reaction to a difficult time we all must bear. More days than not I do a mental search for any other job I would prefer to do more but so far have come up dry.

I'd appreciate hearing any thoughts about others' internship experiences. I have heard my thoughts echoed by a few of my co-interns who are also dissatisfied with our program, but I'm eager to hear from others about their experience.

Give it time. I think a lot of us appreciate our intern year a lot more IN RETROSPECT. In the beginning, you work long hours, seniors take the more desirable tasks/procedures, you are treated as the bottom of the food chain that you are. My experience was that the hours were long but that the program at least made an effort such that you ought to be able to leave by the 80th hour ON AVERAGE (although not necessarily every week), but that's certainly not universal, which is unfortunate. The system is rough -- you have an extremely steep learning curve to go along with long hours and sleep deprivation.

But toward the end of the year, you start to have a notion of what you are doing, how to "manage" the attendings, which seniors are helpful and which to give a wide berth to, how to collaborate with other interns so you each can get out early now and then, how to trust yourself and your decision making without running everything by someone more senior, and generally you just get a lot more efficient. At that point, you probably start enjoying yourself, because you aren't working nearly as hard as you used to, you have a much greater degree of autonomy (which also makes the seniors happy to stop the babysitting), the attendings are probably starting to regard you as "not totally useless", and you probably can get what used to be over an 80 hour week's worth of work done in closer to 70 hours. So improved efficiency, more relaxed atmosphere, and the year tends to end on a high note. So if you are in an otherwise decent locale, with good people working with you, you probably come away not hating internship as much as you perhaps do in the first few months.

Just have a good attitude about it, know things will improve, and have a thick skin and try to absorb things like a sponge, and you will do great. It gets better. And you emerge a better doctor for the experience, believe it or not.

 

[ShyRem]

Oh, lordy. I am so lucky. My program demands you log all hours and does not want you to go over 80. Yeah, lots of times you're running 74-78 hours, but never over 80. Over 80 doesn't get the intern in trouble, but the PD gets a call asking why the intern went over 80 hours. So if we're running close, we have to leave early later on. So far it hasn't happened this year.

 

[eforest]

Oh, lordy. I am so lucky. My program demands you log all hours and does not want you to go over 80. Yeah, lots of times you're running 74-78 hours, but never over 80. Over 80 doesn't get the intern in trouble, but the PD gets a call asking why the intern went over 80 hours. So if we're running close, we have to leave early later on. So far it hasn't happened this year.

My program is not particularly sadistic, but there seems to be no way to cut back so that we honor the hours requirements because of the work load to resident ratio. It's so dumb- what other profession expects people to work 30 + hours with no sleep?! We don't go over on indivudual shifts very often because we have night float, which is good.

Overall, internship is surviv-able. But I can't wait for it to be over so that I can go to my chosen specialty!

 

[95439]

I can't complain about hours, because my program's really aren't bad at all. My problem is dealing with being yelled at every single day for things that aren't my fault. Senior residents (who are far from perfect) telling you to do one thing, then getting mad at you for doing it.
Recently my notoriously abusive senior started SCREAMING at me because over a period of 1 1/2 hours, I had gone from 'efficient' to 'useless'. This was because I hadn't staffed a patient with an attending, because I'd been called to a code, then said attending had asked me to find a patient's PCP (with a generic name) on the internet, to let them know the patient had been discharged. It took 30 minutes to call 3 offices and finally get a call back from the right doctor. So I got back to the same patient I had been working on 1 1/2 hours before, when my senior resident called me, found out I hadn't finished with the pt yet, and yelled at me because the attending was supposedly mad at me that I hadn't staffed with him yet. The attending was standing right there, heard the senior yelling at me, and says he wasn't unhappy with me at all. I told my senior that, and he launched into a tirade about how disrespectful I am, and that he was going to 'give me as many patients as possible and report me to the chief resident'. I almost quit. I've done everything I can to make my senior resident's life easier since I've been working with him.
I was expecting long hours and hard work as an intern. I don't think I realized that the hardest part of this year is just being treated so poorly all the time. By everybody. I look forward to going into patient's rooms because it's the only place I won't get yelled at. I'm literally developing an ulcer and don't want to go back to work. And I had no problems with criticism or hard work as a medical student. I scored very well on every one of my rotations.

At what point can/should you defend yourself as an intern? There has to be some sort of limit to what you can be yelled at, or blamed for, right? I know we're lowest on the totem pole. I understand that, but I always thought the mark of one's character is how they treat the people below them.

 

[Law2Doc]

At what point can/should you defend yourself as an intern? ...

As soon as you are an attending, you can defend yourself. Until then, you stay quiet, and simply say "Sorry. My bad. I will fix it.". To do well, you really have to have the mindset that this is a military operation, and you are the lowest rank. It is insubordination to correct your seniors even if you are right... especially if you are right. Do what you need to to make sure the patients don't get mistreated, but aside from that, keep your mouth buttoned and daydream about how you will do things differently when you are senior.

Part of the problem is that most seniors have no experience being anyone's boss, and are finding their way, often inelegantly. The bigger part of the problem is that most seniors get yelled at for things that don't get done even if it was the intern's task, so your screw up is their screw up. &*% flows downhill, and whatever crap they are knee deep in means you are neck deep. So they get yelled at and pay it forward to you. You never can defend yourself because by definition you are the junior, so you are in the wrong. "Right" and "wrong" are driven by seniority in this system, just as they are driven by rank in the military. All you can do is offer to fix whatever folks are unhappy about, regardless of whether you think you had anything to do with it. You are everyone's whipping boy.

Part of the learning experience of intern year is learning how to work with difficult personalities. Some people never learn this, and don't do well. It's all about having a good attitude and being a team player. The better seniors will cover for underlings, and take the blame to protect their team. The worse ones (like the guy you described blaming you in front of an attending) will throw you under the bus. But either way, you have to be ready to assume blame and offer to fix things because within the program that is your role. Next year you can decide how you want to conduct yourself differently. For now, button it. Just my two cents.

 

[95439]

As soon as you are an attending, you can defend yourself. Until then, you stay quiet, and simply say "Sorry. My bad. I will fix it.". To do well, you really have to have the mindset that this is a military operation, and you are the lowest rank. It is insubordination to correct your seniors even if you are right... especially if you are right. Do what you need to to make sure the patients don't get mistreated, but aside from that, keep your mouth buttoned and daydream about how you will do things differently when you are senior.

Part of the problem is that most seniors have no experience being anyone's boss, and are finding their way, often inelegantly. The bigger part of the problem is that most seniors get yelled at for things that don't get done even if it was the intern's task, so your screw up is their screw up. &*% flows downhill, and whatever crap they are knee deep in means you are neck deep. So they get yelled at and pay it forward to you. You never can defend yourself because by definition you are the junior, so you are in the wrong. "Right" and "wrong" are driven by seniority in this system, just as they are driven by rank in the military. All you can do is offer to fix whatever folks are unhappy about, regardless of whether you think you had anything to do with it. You are everyone's whipping boy.

Part of the learning experience of intern year is learning how to work with difficult personalities. Some people never learn this, and don't do well. It's all about having a good attitude and being a team player. The better seniors will cover for underlings, and take the blame to protect their team. The worse ones (like the guy you described blaming you in front of an attending) will throw you under the bus. But either way, you have to be ready to assume blame and offer to fix things because within the program that is your role. Next year you can decide how you want to conduct yourself differently. For now, button it. Just my two cents.

I appreciate it Law2doc. After that incident, I decided to do what you said and basically keep my mouth shut, but I had another incident yesterday, and there was really nothing I could say that would stop me from being yelled at. Basically the attending told me surgery should be discharging a patient, and told me not to d/c them. My senior calls me and yells at me for not d/cing the patient. I start to d/c the patient and the attending starts yelling at me for d/cing the patient. Umm, what the hell am I supposed to do? I started telling my senior that but stopped myself when I realized it wouldn't do any good. "Yes sir may I have another please".

Let me ask you a question though, if I may. Do you think this is the proper way for physicians to be trained? Honestly, or do you think it's more of "This is how it was for me, so that's how it's going to be for you", like a child raised in an abusive household..? Because it's not even like the military, really, it's more like a frathouse 'hazing' process.

There's a senior resident who's story is well known where I am - he came into the program as a nice guy, but after an attending chose him as his "whipping boy" for his entire intern year, he became just another as*hole, carrying on the tradition of treating underlings (and patients) like ****.

We're in the health profession, yet our jobs, starting from intern year, are anything but healthy. I don't know about you, but when I'm yelled at and can't do anything about it, I carry it with me and it gets dispensed at some other unfortunate soul. It's difficult to be kind to patients when you've just been torn apart for no reason. Worst of all, I'm losing passion for the field. If I can do no good why try? Trust me, I know that's terrible but it's hard to not feel that way sometimes..

 

[Law2Doc]

I appreciate it Law2doc. After that incident, I decided to do what you said and basically keep my mouth shut, but I had another incident yesterday, and there was really nothing I could say that would stop me from being yelled at. Basically the attending told me surgery should be discharging a patient, and told me not to d/c them. My senior calls me and yells at me for not d/cing the patient. I start to d/c the patient and the attending starts yelling at me for d/cing the patient. Umm, what the hell am I supposed to do? I started telling my senior that but stopped myself when I realized it wouldn't do any good. "Yes sir may I have another please".

Let me ask you a question though, if I may. Do you think this is the proper way for physicians to be trained? Honestly, or do you think it's more of "This is how it was for me, so that's how it's going to be for you", like a child raised in an abusive household..? Because it's not even like the military, really, it's more like a frathouse 'hazing' process.

There's a senior resident who's story is well known where I am - he came into the program as a nice guy, but after an attending chose him as his "whipping boy" for his entire intern year, he became just another as*hole, carrying on the tradition of treating underlings (and patients) like ****.

We're in the health profession, yet our jobs, starting from intern year, are anything but healthy. I don't know about you, but when I'm yelled at and can't do anything about it, I carry it with me and it gets dispensed at some other unfortunate soul. It's difficult to be kind to patients when you've just been torn apart for no reason. Worst of all, I'm losing passion for the field. If I can do no good why try? Trust me, I know that's terrible but it's hard to not feel that way sometimes..

You will make it through, and will realize, in retrospect that you are very well trained. Whether that is thanks to all the crap, or despite all the crap, it's hard to say. But it's more or less a system where folks come in wide eyed idealists who think they know more than they do, and they get broken down and rebuilt from the ground up, and emerge good doctors. They may also emerge a-holes, I suppose, but most people only go that route if they always somewhere in their psyche had that tendency to start with (albeit well hidden). At any rate, you learn how to work with difficult patients, difficult bosses, difficult underlings. Makes you quite skilled in some of the professional relationships you are going to be dealing with your whole career, so in this respect there is some value to the crap. You get really good at "managing" people, even those you work for, which is a very difficult skill to teach. That and the fact that you get efficient much faster where there are direct repercussions to not keeping everybody happy. Just go with it. Next year things will be different.

 

[95439]

You will make it through, and will realize, in retrospect that you are very well trained. Whether that is thanks to all the crap, or despite all the crap, it's hard to say. But it's more or less a system where folks come in wide eyed idealists who think they know more than they do, and they get broken down and rebuilt from the ground up, and emerge good doctors. They may also emerge a-holes, I suppose, but most people only go that route if they always somewhere in their psyche had that tendency to start with (albeit well hidden). At any rate, you learn how to work with difficult patients, difficult bosses, difficult underlings. Makes you quite skilled in some of the professional relationships you are going to be dealing with your whole career, so in this respect there is some value to the crap. You get really good at "managing" people, even those you work for, which is a very difficult skill to teach. That and the fact that you get efficient much faster where there are direct repercussions to not keeping everybody happy. Just go with it. Next year things will be different.

I wish I could disagree with your logic, but I really can't. Theory and reality are often two different things. While I believe I'm right, in theory, about how residency training should be. The reality is there are as*holes in every profession and I agree that I'm learning how to deal with different personalities. I'm still not necessarily sure that should be 'part of the training', but it is and I'll make an effort to deal with it. Thank you Law2doc. Is it really different next year or are you just saying that?

 

[Buzz Me]

The unhealthy part of our field (Gen Surg) is that when you're getting beat on (even if it's unfair), you're taught to just suck it up and take it.

And THAT can wear on even the kindest, gentlest residents.

 

[keepinon]

My program is not particularly sadistic, but there seems to be no way to cut back so that we honor the hours requirements because of the work load to resident ratio. It's so dumb- what other profession expects people to work 30 + hours with no sleep?! We don't go over on indivudual shifts very often because we have night float, which is good.

Overall, internship is surviv-able. But I can't wait for it to be over so that I can go to my chosen specialty!

I like your attitude! I agree that the baseline work requirements are what lead to most people going over hours. Unfortunately the workload is high b/c the census is at its highest point ever. My upper years did fewer admissions and carried fewer patients than we do as interns this year.

At my program we have night float but we must finish our work and sign out only urgent things (cardiac enzymes, H&H, etc.) to night float. Otherwise we would be dumping daytime work on people who are overloaded covering 70ish patients and doing admissions in the ER at the same time. Finishing the work takes time, and staying to dictate discharge summaries only takes longer. We are encouraged to do them from home.

 

[Acherona]

Sounds like your resident is just a jerk and your attending isn't much better. i mean your resident told you you were "disrespectful"?!! Who is this guy, 1-2 yrs ahead of you in training and probably just learned last week the difference between his ***** and a hole in the wall. Actually what it sounds like is your resident is horrible at communicating with your attending about the pt plans. If this keeps going on I would start retaliating bypassing the resident and checking with the attending directly. You have to do what you need to do to get your work done and patients tucked away even if it pisses someone off. The beauty of rotations is that they only last a month and next month you will probably have a much nicer team.

The other thing is, in your first example, you really shouldn't have spent that much time looking for the PCP. It's still early in the year so you are probably still learning how to prioritize. But staffing a new pt definitely takes precedence over calling a PCP just to inform him of a discharge which is basically a courtesy. You could always do that after more pressing issues were taken care of. You could even leave it until tomorrow. If someone asks you just say you weren't able to get in touch with him today but would try again in the morning *shrug*.

 

[95439]

Sounds like your resident is just a jerk and your attending isn't much better. i mean your resident told you you were "disrespectful"?!! Who is this guy, 1-2 yrs ahead of you in training and probably just learned last week the difference between his ***** and a hole in the wall. Actually what it sounds like is your resident is horrible at communicating with your attending about the pt plans. If this keeps going on I would start retaliating bypassing the resident and checking with the attending directly. You have to do what you need to do to get your work done and patients tucked away even if it pisses someone off. The beauty of rotations is that they only last a month and next month you will probably have a much nicer team.

The other thing is, in your first example, you really shouldn't have spent that much time looking for the PCP. It's still early in the year so you are probably still learning how to prioritize. But staffing a new pt definitely takes precedence over calling a PCP just to inform him of a discharge which is basically a courtesy. You could always do that after more pressing issues were taken care of. You could even leave it until tomorrow. If someone asks you just say you weren't able to get in touch with him today but would try again in the morning *shrug*.

LOL...yup, him telling me I was 'disrespectful' was probably the nicest thing he said during his tirade. He finished it off by telling me, no joke, that I'm "Lucky that he's a nice guy". Oh man.

I agree I shouldn't have spent that long calling the PCP, but when an attending tells me to do something, I do it, no questions asked. Otherwise, you know what happens..KABOOM.

 

[gutonc]

I would posit that it's difficult (although probably not impossible) to be consistently happy for an entire year doing just about anything. Even if all you were going to do for a year was sit around the house, listen to music and smoke weed, you'd probably get pissed off about something during that year. Probably about running out of weed.

Residency doesn't have to (and shouldn't) be consistent physical and emotional brutality. But sometimes you're going to take a beating, and other times you're going to be OK.

WRT the situation you describe, both your attending and resident are being d-bags. Put your head down, do the best you can not to piss them both off and get through the month...remember that they can't stop the clock. As long as your eval doesn't say "when he wasn't busy raping babies in the NICU or killing my pets, Dr. Keepinon proved himself to be an incompetent physician" you'll be fine.

 

[revolution1980]

I would posit that it's difficult (although probably not impossible) to be consistently happy for an entire year doing just about anything. Even if all you were going to do for a year was sit around the house, listen to music and smoke weed, you'd probably get pissed off about something during that year. Probably about running out of weed.

LoL. just got home from a tough call in the MICU. this literally made me laugh out loud. i needed that.

 

[gutonc]

LoL. just got home from a tough call in the MICU. this literally made me laugh out loud. i needed that.

I used that example specifically because I had a college roommate who was like that. Did nothing but smoke weed and drink beer (and Get B's on Engineering exams that he'd study for about 2 hours before they started) and still found things to bitch about.

 

[glade]

Part of the problem is that most seniors have no experience being anyone's boss, and are finding their way, often inelegantly. The bigger part of the problem is that most seniors get yelled at for things that don't get done even if it was the intern's task, so your screw up is their screw up. &*% flows downhill, and whatever crap they are knee deep in means you are neck deep. So they get yelled at and pay it forward to you.

And therein lies the problem.

I'm quite a sucky senior, in that I yell a lot at the juniors. It's something I never wanted to do. But the problem is this whole "teamwork" concept, which I've hated from day one. When I was an intern, I'd grind it out, get all the work done, and even do the job of some of the lazy seniors who used me like a biatch. But I told myself it would all be worth it because some day I'd be the senior. Then that day came and my interns and juniors turned out to be lazy jack-offs. So the same thing happened. Now I was the senior, but I had to do all the intern stuff because my interns are for some reason incapable of doing things that they are told to do and are like "oh, you REALLY meant that I should do that?? I thought you were just thinking out loud!" And after a while, I stopped being OK with that, even though I didn't want to be the "a-hole senior." But here I am and here we are. And it's all because my interns are idiots.

P.S. I know this won't be welcomed and probably most people will hate my verbalizing the sentiment, but that's just the truth. I have months where my interns are fantastic and, although they hate doing the intern work, it gets done and I never say a word. Then there are months like this month where my juniors are essentially useless. I've never worked with people who are so devoid of thought or motivation and the only way to get them to move is to scream at them until they do. And believe me, I'd like nothing better than to let them just sit around mindlessly, except I don't plan on doing their work "for the good of the team."

 

[95439]

"But I told myself it would all be worth it because some day I'd be the senior."

This sounds like the family background of a serial killer. So you were treated poorly as an intern, but what got you through was "Some day I'll be the one treating people poorly"..? Awesome.

I'm anything but lazy. I've had 'Acting Interns' both months I've been on wards (AI = 4th year med students who can't write orders or take overnight call at the hospital I'm at). So I've done double the work of most interns, while sparing my senior as much as possible. The reason I was so shocked by his yelling at me was I've done EVERYTHING I can to make his life as easy as possible. I actually caught my senior lying to me about seeing patients too. I told him one of my patients was having more hematemesis, and before I could continue he says "I saw it...that's not blood...". Well, according to 2 nurses and myself, red, thick vomit = blood. I described my senior to my patient and asked if she had seen him that morning, and she had no idea who I was talking about. And she was there for abdominal pain, was completely oriented, was not on a ridiculous amount of pain meds, and knew the names of 2 other doctors who had seen her that morning. So not only is he not doing his job, he's messing with my ability to do a good job.

Anyway, I understand your point that sometimes you have to get your point across if people aren't doing their jobs. I'll do the same thing as a senior as well. But please don't use the "I was treated poorly so I'll do the same thing when I have a chance" mentality.

 

[Winged Scapula]

"But I told myself it would all be worth it because some day I'd be the senior."

This sounds like the family background of a serial killer. So you were treated poorly as an intern, but what got you through was "Some day I'll be the one treating people poorly"..? Awesome.
Anyway, I understand your point that sometimes you have to get your point across if people aren't doing their jobs. I'll do the same thing as a senior as well. But please don't use the "I was treated poorly so I'll do the same thing when I have a chance" mentality.

I think his point was that "I'll do all this work now because someday I'll be the senior and someone else will be doing the work and I just get to operate" ie, the hard work will pay off in the end. But in his case it hasn't since he's doing the work of the senior and the juniors. What he finds now is that he spends all day in the OR and then comes out to find his interns haven't done the work they were supposed to, so now he has to do it.

I don't think he was implying that he was looking forward to being a senior so he could payback the abuse he was given.

 

[Buzz Me]

That's how I interpreted the post as well.

Not that he was seeking revenge a la the abused freshman fraternity pledge who secretly vows to a hardass when he's an upperclassman.

 

[cartoondoc]

I think everyone is unhappy as an intern. I think if I had realized everyone was as unhappy as I was, I would have been happier.

As for getting yelled at by seniors, that's what cruel resident stories are all about:

http://doccartoon.blogspot.com/search/label/cruel resident stories/

 

[glade]

Hey, if I was looking foward to be an a-hole senior, you think I'd feel badly about it? I was looking forward to just having to deal with managing the team. Instead, I'm forced to review every single thing my interns do and call THEM to tell them updates on the patients and then try to casually mention "maybe you'd want to do this now." It's like they just stand there. You know what's REALLY irritating? If I do everything, they just accept it. Last week, I was rounding, putting in orders, calling other teams to notify them of stuff, and following up tests. The interns just sat around talking in the call room. And then, at the end of the day, they're like "wow, this is a pretty easy rotation!" That's when I lost it and went ape-**** on them and was screaming at them. And I sort of felt badly because it was like I was abusing some handicapped kid. Seriously, they didn't even GET why I was upset. It was like "hey, why are you yelling, everything got done today, right?" Yeah, because I did it, not you. Freakin' every day I drag myself home exhausted and the interns are all bright and chipper and relaxed and that pisses me off even more.

This week I crushed the interns. Literally crushed their asses. Any little thing I could find that I didn't like or was missing, it would be a five minute ream-out festival that was no-holds barred. I insulted them, their families, their clothes, anything I could think of. And by the end of the week they were a LITTLE better and also in PTSD and scared of their shadows. So unfortunately that's how it has to be done.

 

[keepinon]

I have never been yelled at by a senior or an attending in my program or at my medical school. Most people I encounter in my program are nice to me. Just lucky so far?

I have recently realized that my peers are at least as unhappy as I am at times. Some are a lot unhappier. For some reason this has surprised me, and I find I'd rather not join the whine-fests because they make me feel really bad about my schedule and my program.

At least I can take satisfaction in doing my job as well as I can.

 

[Law2Doc]

...
At least I can take satisfaction in doing my job as well as I can.

I think most people feel like they are trying to do their job as well as they can. Many get told they are useless even when they are doing their best. It's hard to take much satisfaction out of that. It's all part of a process whereby juniors get broken down and remodeled. The attendings keep the seniors feet in the fire until things get done the way they think is best, and the seniors do the same to the juniors, albeit sometimes more brutally. You have a situation where you have interns that don't know much and though they may be doing the best they can, the room for improvement is infinite, and you have seniors who have never been anyone's boss before who are now feeling the heat directly from the attendings, and want the interns to be more useful so they can be freed up for other tasks, rather than picking up the spare of all the intern tasks. So it makes for a bit of aggravation all the way around.

Once you get better at this, you can find some enjoyment and satisfaction in it. Until then, it's kind of a pressure cooker situation. You gotta push through and emerge better for it. And then perhaps not do the same to your interns next year. As I said, in retrospect, internship was a positive learning experience. But while in the thick of it, it was hard to overlook some of the negatives.

 

[glade]

The problem is that it's not good enough to do "your best." You have to do the job. Because if you don't someone else has to do it for you.

 

[IMdocT]

i've never been yelled at in med school or internship so far. on floors i'm only averaging about 75 per week. it's not bad but i'm still feeling the same way about going home with not much time to do anything else except to eat, sleep and catch up on errands. not interacting much with anyone outside of work. did get yelled at patients and patients' families though. i've also lost some weight and i was pretty skinny to start with. cross covers are hard sometimes. never stop paging and once you start calling one nurse back another one pages you. there's a time when it gets quiet just before the AM team comes in but by that time i start dozing off while i try to finish up H&P's and cross cover notes.

 

[Substance]

And therein lies the problem.

I'm quite a sucky senior, in that I yell a lot at the juniors. It's something I never wanted to do. But the problem is this whole "teamwork" concept, which I've hated from day one. When I was an intern, I'd grind it out, get all the work done, and even do the job of some of the lazy seniors who used me like a biatch. But I told myself it would all be worth it because some day I'd be the senior. Then that day came and my interns and juniors turned out to be lazy jack-offs. So the same thing happened. Now I was the senior, but I had to do all the intern stuff because my interns are for some reason incapable of doing things that they are told to do and are like "oh, you REALLY meant that I should do that?? I thought you were just thinking out loud!" And after a while, I stopped being OK with that, even though I didn't want to be the "a-hole senior." But here I am and here we are. And it's all because my interns are idiots.

P.S. I know this won't be welcomed and probably most people will hate my verbalizing the sentiment, but that's just the truth. I have months where my interns are fantastic and, although they hate doing the intern work, it gets done and I never say a word. Then there are months like this month where my juniors are essentially useless. I've never worked with people who are so devoid of thought or motivation and the only way to get them to move is to scream at them until they do. And believe me, I'd like nothing better than to let them just sit around mindlessly, except I don't plan on doing their work "for the good of the team."

Have you expressed appreciation to interns who are competent and effective? In my experience as a resident I've found that subordinates are far more willing to work even harder if they know you appreciate their work.

 

[glade]

Not really, I haven't. But I sort of don't get why I should. It's a job. I expect you to do your job. I mean, I understand the difference between rewarding good behavior versus punishing bad behavior, I'm just not sure what the application is at a job. This isn't kindergarten. I'm sort of thinking that after something like 20+ years of school people understand their responsibilities. Apparently not, but that's what I thought.

 

[Law2Doc]

Not really, I haven't. But I sort of don't get why I should. It's a job. I expect you to do your job. I mean, I understand the difference between rewarding good behavior versus punishing bad behavior, I'm just not sure what the application is at a job. This isn't kindergarten. I'm sort of thinking that after something like 20+ years of school people understand their responsibilities. Apparently not, but that's what I thought.

Actually the concepts of rewarding good behavior/punishing bad do not stem from child rearing as much as from business. Folks have been given bonuses and promotions and other positive acknowledgements for doing well, and getting fired/demoted/censured for poor performance since free markets began.

 

[dilated]

This week I crushed the interns. Literally crushed their asses. Any little thing I could find that I didn't like or was missing, it would be a five minute ream-out festival that was no-holds barred. I insulted them, their families, their clothes, anything I could think of. And by the end of the week they were a LITTLE better and also in PTSD and scared of their shadows. So unfortunately that's how it has to be done.

I will presume this is a hefty dose of internet tough guy syndrome. At least at the places I've been, any senior resident who spent substantial time insulting his intern's families every day would find himself either in the program director's office being "relieved of duty"... or rendered unconscious by one of the meathead ex-lineman ortho interns.

 

[Mr. Freeze]

More importantly than praising good "behavior", when these interns first came on service, was there a proper inprocessing whereby they were instructed on the duties for which they would be held accountable? I am a generally proactive person, but every rotation has it's quirks. I have on more than one occasion said, "Now why would I know to do/not do [insert whatever esoteric regional/hospital/rotation-specific task you can think of]?" Am I going to have less of a need for direction as the year and residency progress? Of course.

But, when it is YOUR job to guide and let juniors know what THEIR job is, getting pissed at someone for not doing it when you haven't done so reflects on you, not them.

 

[glade]

I will presume this is a hefty dose of internet tough guy syndrome. At least at the places I've been, any senior resident who spent substantial time insulting his intern's families every day would find himself either in the program director's office being "relieved of duty"... or rendered unconscious by one of the meathead ex-lineman ortho interns.

a) I didn't say "a substantial time." I'm a busy guy and don't have a lot of time to waste on reaming people out.

b) You don't sound like you're in Surgery, which means you're irrelevant to me.

c) If any Ortho interns tried to attack me, I'd just be like "OK, dude, you can hit me in the head if you want" and watch him look confused as he tried to figure out where that was.

 

[dilated]

a) I didn't say "a substantial time." I'm a busy guy and don't have a lot of time to waste on reaming people out.

b) You don't sound like you're in Surgery, which means you're irrelevant to me.

c) If any Ortho interns tried to attack me, I'd just be like "OK, dude, you can hit me in the head if you want" and watch him look confused as he tried to figure out where that was.

Re b: I'm in a surgical subspecialty where we're not miserable and the residents are friends instead of having a workplace consisting of some sort of Nietzsche-ian struggle to survive. Sorry about your gen surg existence, bro. It sounds totally fulfilling and educational though. And I'm sure it will all be worth it for the golden existence awaiting at the end . . .

 

[glade]

I bet you're in Ortho, where you get along great because you guys all have a high dedication to not taking care of patients.

 

[Acherona]

I bet you're in Ortho, where you get along great because you guys all have a high dedication to not taking care of patients.

lol this is getting good

 

[Dejavu]

My intern year is fantastic. Couldn't be happier. I have lots of free time, and when on call we only do things like rapid assessments of crashing patients, run codes, intubations, and place central lines. All without an attending or sr resident looking over your shoulder. I'm doing anesthesia so I know a lot of this is specialty specific, but most anesthesia PGY1 years aren't this nice.

I concur with the last line. I spent four years in the Marine Corps and, including boot camp, I would rather do those 4 yrs over again than do my internship year again. To this day I like to just sit and listen to the rain, because I never once heard it rain during my internship. I was in the hospital too much to hear it.

 

[jbcarlso]

Have you expressed appreciation to interns who are competent and effective? In my experience as a resident I've found that subordinates are far more willing to work even harder if they know you appreciate their work.

As a fellow 'tern who busts my ass handling floor scut and the rest of it.

This.

A thousand times, this.

I've never been yelled at. It's been made clear that I need to step up my game, but never to the point of being yelled at.

There's nothing a senior can do to motivate a genuinely motivated, capable 'tern than mention in passing, "you're good, man. I hope you keep it up."

That kind of comment from a senior or especially a chief who the 'tern respects will make a 'tern break their back for that senior.

On the flip side, I'm older than most of my PGY3s and some of my PGY5s. I've worked in the real world, and I'm not easily intimidated. I take care of my **** because I've had jobs I hate, and I'm not so burned out that I neglect patient safety. That said, I'll be the first to admit that I don't know the answer to some question and to move questions up the chain of command. I don't know if I'm just lucky or humble enough to admit that I know what I don't know. Either way, internship blows ass, but it's far better now than it used to be: "Oh, I get to go home Sunday from 18:00 to 23:59? WOOOOOOOOOOT" Things could always be worse.

Yelling at someone like me is a great way to motivate me to write someone up for unprofessional behavior. And it is unprofessional. And yelling just makes someone look like a kid throwing a tantrum. Why yell? To intimidate? I'm sorry, but unless you're threatening genuine violence against me I'd just see it as comical, shake my head and walk away. 1 bad eval vs 2-3 positive faculty evals each month so far should off-set it.

I have no problem staying late, coming early, working long hours, calling anyone and everyone trying to get patients taken care of and making anything a senior says come to pass.

But treat me with respect. That's all I ask. So far it hasn't been an issue.

Best,
jb

 

[jbcarlso]

a) I didn't say "a substantial time." I'm a busy guy and don't have a lot of time to waste on reaming people out.

b) You don't sound like you're in Surgery, which means you're irrelevant to me.

c) If any Ortho interns tried to attack me, I'd just be like "OK, dude, you can hit me in the head if you want" and watch him look confused as he tried to figure out where that was.

So even tho this guy has been banned for trolling, I'll bite. While the ortho guys are kinda meatheads by the end of their training by stereotype, intern year I would think that the AOA 240+ step I kids would generally be considered at least fairly book smart and that they might JUST know where the "head" was?

Just saying...

 

[yohimbine1]

I think I have a good attitude and even have some fun as an intern, but I really hate my job overall. By extension, I am starting to hate my life, which consists of my stressful job, sleeping as close to 8 hrs/night as possible, and barely finding time to eat. On my one day off I tend to catch up on sleep b/c I'm so tired. My internship program is not what I thought it would be and I work more than 80 hours most weeks (although a mentor tells me all programs play "bait & switch"). I wonder if other people feel similarly or if I am having a stronger than normal reaction to a difficult time we all must bear. More days than not I do a mental search for any other job I would prefer to do more but so far have come up dry.

I'd appreciate hearing any thoughts about others' internship experiences. I have heard my thoughts echoed by a few of my co-interns who are also dissatisfied with our program, but I'm eager to hear from others about their experience.

No. Intern year sucks. Match into a good specialty so it's only one year. Suggest rads

*consistently happy no. intermittently happy yes