worst comment ever!

[karenwkyk]

My preceptor in family medicine put the comment "she should slow down her speech and work on pronunciation. She also needs to not mistake nodding and smiling for understanding by patients" on the Dean's letter section.

I am from another country and didn't speak English until I moved to America 6 years ago, at the age of 20. I basically started from zero in learning English. I have been working very hard and try my best to impove my language skills. However, I am still not able to speak perfect English; it is just "normal" for a foreigner to speak with an accent.

I couldn't understand why my preceptor cannot be more considerate about my situation. I don't know why she couldn't put this comment on the NON-DEAN's letter section rather than put it on the Dean's letter Section. I just don't think that it is fair to judge me in this way.

Moreover, it is my nature to smile to the patient when they smile to me; I didn't assume that it meant the patient had full understanding. I really don't know what to do if smiling to the patient would give her such impression.

She also only give me a pass, while putting 4 or 5 on each assessment catagory (e.g.fund of knowledge) ...She is horrible; she interionally screw me up....she must be mad at me when i pointing out her mistakes. (e.g misinterpate iron overload as wilson disease etc..)

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[drfunktacular]

She also only give me a pass, while putting 4 or 5 on each assessment catagory (e.g.fund of knowledge) ...She is horrible; she interionally screw me up....she must be mad at me when i pointing out her mistakes. (e.g misinterpate iron overload as wilson disease etc..)

My $.02: If you want good evaluations, never ever ever ever ever ever do this.

 

[Ypo.]

she must be mad at me when i pointing out her mistakes. (e.g misinterpate iron overload as wilson disease etc..)

I'm sure this didn't help. An attending this morning was explaining to me this morning why "thiazides" are usually her second choice after metformin for treating newly onset type II diabetes. I asked her if she didn't mean something else, since 'thiazides' are anti-hypertensive agents. But she started to argue with me, saying that hydrochlorothiazide is not the same thing as a thiazide. I just shut my mouth rather than correct her. (I think the family of drugs she was thinking of were the thiazolidinediones?) Anyways, the point is you have to be very tactful if you decide to correct an attending and you should avoid doing it in a contradictory manner or in a way that would make it difficult for them to save face. A lot of the time it's just not worth the energy. At the end of the day I'm exhausted from tiptoeing around people's egos and getting grilled and analyzed on my own knowledge base. It's not really going to hurt the patient's care if the doctor thinks that pioglitazone is a thiazide.

I think the comment your attending left is just plain mean spirited (bet she has a chip on her shoulder against FMGs). I wouldn't worry about it too much, though. I would imagine that a residency director wouldn't pay too much attention (if any!) to one random bad comment.

 

[climbingdocs]

You know screw them. English is also my second language, although I've been speaking it longer then you have. I understand what you mean. And I too correct attending if I am sure I am right. I don't care what they think. I need to pass my rotations thats all, and if they are making dumb mistakes I don't need letter of recomendation from them anyway. I really have hard time keeping my mouth shut sometimes

It is wierd to me though that someone would still have problem with accents, especially that there are so many foreign docs.

Is her comment really going to go into Dean's letter?????

 

[diosa428]

It sucks that she wrote that, although if it HAS to go in your Dean's letter (will it definitely go in there?), it comes off as pretty mean-spirited and I'm sure residency programs will see through it. I doubt a single comment like that would get your application thrown out by residency programs (as long as the rest of your comments are good), and just come up with an explanation ahead of time as to why you feel she wrote that - just try not to get defensive and blame her or say she didn't like you b/c you corrected her, say exactly what you said here - you just began speaking English 6 years ago and are still working on your pronunciation, and you don't feel that it has interfered with your communication abilities thus far.

Also, if you're going to point out mistakes, try to do it in a less obvious way - rather than saying that your attending is wrong, try saying "oh, why isn't it wilson's disease? the pt has x,y and z that point to it" or whatever. That way, if YOU'RE really the one that's incorrect (which does happen sometimes), they can explain it to you and you don't come off looking like an idiot. And if they're the one that's wrong, they can acknowledge it without feeling like you're correcting them (or they can just tell you you're wrong anyway; if that's the situation, I'd just ignore it and move on). You can't win them all.

 

[karenwkyk]

I hope the Radiology residency director can see though this too...I really don't know how the Dean's letter work, it seems that someone would put all the comments together into a letter.
I e-mail my clerkship director about my situation, I hope that someone can help me out....I don't care about the grade, becasue I get good grade in other rotation and i am not interested in FM, I just want to get rid of this comment.....she is just a meant bitch! I even get her gift when i left! I really couldn't believe that she would come back to bite me like that.

I almost want to go to her office and ask her why do you do that?

 

[Droopy Snoopy]

I hope the Radiology residency director can see though this too...I really don't know how the Dean's letter work, it seems that someone would put all the comments together into a letter.
I e-mail my clerkship director about my situation, I hope that someone can help me out....I don't care about the grade, becasue I get good grade in other rotation and i am not interested in FM, I just want to get rid of this comment.....she is just a meant bitch! I even get her gift when i left! I really couldn't believe that she would come back to bite me like that.

I almost want to go to her office and ask her why do you do that?

My school's academic affairs dean automatically removes comments outliers, as it's almost certain that even the most agreeable medical student will not get along with every single resident/attending in which they come into contact simply from a personality standpoint, much less be lucky enough not to catch an eval written by somebody in just a post-call piss of a mood. We also have the option of meeting with the attending and the dean and having a kind of appeal-type process, where the dean ultimately decides if the comments stick, and you at least learn the reasoning behind the comments. And there's no reason you can't set up a meeting with the preceptor as well.

As an aside, I've always felt it's kind of a bad idea to go around handing out gifts to your attendings. Too much like a bribe for a good eval imho, or at least have the potential to be perceived as such.

 

[karenwkyk]

I got gift for her is because she go very upset when i discuss the differences between the way that she practices medicine and what i learn from school. (like: she would order a mammogram for a 29 years old woman without any positive family history or suspicious lump, order a UA for every person, and come up wrong diagnoses for the person (like say someone has SIADH when they are on vasopressin.) I was just scared to hell that she is going to get back at me on my evaluation, that why I get her gift and hope that it can alleviate her angar.

 

[Blade28]

While I sympathize with your plight, I agree that you have to be very tactful when correcting an attending, especially in front of other physicians, residents, students or patients. Usually it's just not worth it, unless it's something critical (e.g. wrong dose of a medication, etc.).

 

[haveaniceday]

I got gift for her is because she go very upset when i discuss the differences between the way that she practices medicine and what i learn from school. (like: she would order a mammogram for a 29 years old woman without any positive family history or suspicious lump, order a UA for every person, and come up wrong diagnoses for the person (like say someone has SIADH when they are on vasopressin.) I was just scared to hell that she is going to get back at me on my evaluation, that why I get her gift and hope that it can alleviate her angar.

If she is in private practice, she can pretty much order whatever test she wants as long as the patient agrees and will pay. This is her style and somewhere along the way she incorporated this into her practice. I'm sure she has her reasons and it is definitely not your place to question them in a confrontational manner. These are her patients and perhaps she knows this 29 yo female is particularly anxious about things like breast cancer from working with her in the past and ordering a mammogram is easier than having the patient return every 3 mos with worries. Also gives the patient peace of mind. I'm a 29 yo female without a lump or family hx, but sometimes worry about stuff like this...and I know all the stats and standard of care! Sometimes you just do things for patient's peace of mind.

The art of medicine is not learned in textbooks or in lecture. It is insulting to attack your attending's "art." Also, gifts are not the way to go.

Good luck, just put it behind you and learn from this. A lot of good advice from everyone on here

 

[jocg27]

I don't know...I agree with posters saying that if this is an outlier, it is likely to be thrown out. It sounds like a good amount of schools do this, and it certainly seems like all should.

That said, to me these aren't the worst comments ever. She wasn't saying anything bad about you; she's saying that you need to be understood by your patients, and if you can't at least at minimum you need to be able to gauge on some level whether or not they understand you. This is certainly a true statement for everyone in the medical profession. Of course here on sdn we don't know the level of your accent, nor do we know the educational level or language abilities or cognitive functioning of the patients you were seeing on this rotation...but if there's a chance there were consistently misunderstandings, it would seem that this is something you need to know, and I don't see why it wouldn't be part of a family medicine evaluation, a specialty where good communication with all types of different people is kind of central to the whole idea.

I'm not talking about if she's picking on you because you have an accent or something -- that's clearly uncalled for. But the comments don't sound really mean-spirited or anything. At worst, it sounds like the evals and your interactions with the attending are saying she doesn't think you're the family medicine type; this is likely something you already knew heading into the rotation. So you passed, and it's possible the comments won't matter for your dean's letter. I don't know enough about radiology to know if passing family medicine will block you from residency programs, so someone else can speak to that I guess.

People get upset when the comments are "Good job. Read more." At least these are concrete. Whether they're constructive or not depends, I suppose, on what actually happened during the events in dispute and whether these were real problemsor she truly was picking on you. But certainly they're concrete.

I do know it sucks to get an iffy eval, so not trying to be a jerk...just guess I thought I'd throw another opinion out there.

 

[karenwkyk]

It is not true, i didn't learn it from the book...during family medicine rotation, we also have conference with the clerkship director in a small group setting. She emphazies that it is wrong to give mammorgram to a 29 years old w/o any reasons (and the 29 years old patient is not worrying at all), becasue it will do more harm to the patient that good. A young famale's breast is a lot more dense than older woman, so the chance of false positive is very high, which will lead to more un-nessary invasive procedure, the theory go to UA too. And my clerkship director encourage us to discuss these isues with the preceptor. I hope you understand this, it call evidence based medicine, if you still haven't heard about it yet.

Also. she is not a attending, she is some random doctor ( a very old woman > 65, with tourrete syndrome, who blink her eyes, twist her neck, clear her throat every 2 seconds, I can't even look at her because she make me so dizzy) , who just moved from CA to MD, and opened her practice 3 months ago...and never takes any students from our school, I was the first one who get sent to her office.....and when my Clerkship director learned the way that she practices medicine, she flank out and wanted to send me to another office immidinately and decided not to send another student to her office again.

 

[pillowhead]

Also. she is not a attending, she is some random doctor ( a very old woman > 65, with tourrete syndrome, who blink her eyes, twist her neck, clear her throat every 2 seconds, I can't even look at her because she make me so dizzy)

you're really not helping your case here. Attacking your attending (which is any physician who has completed residency who is teaching you) for her age and her uncontrollable medical problem is extremely immature. Speaks volumes about you, not her.

 

[karenwkyk]

I don't know...I agree with posters saying that if this is an outlier, it is likely to be thrown out. It sounds like a good amount of schools do this, and it certainly seems like all should.

That said, to me these aren't the worst comments ever. She wasn't saying anything bad about you; she's saying that you need to be understood by your patients, and if you can't at least at minimum you need to be able to gauge on some level whether or not they understand you. This is certainly a true statement for everyone in the medical profession. Of course here on sdn we don't know the level of your accent, nor do we know the educational level or language abilities or cognitive functioning of the patients you were seeing on this rotation...but if there's a chance there were consistently misunderstandings, it would seem that this is something you need to know, and I don't see why it wouldn't be part of a family medicine evaluation, a specialty where good communication with all types of different people is kind of central to the whole idea.

I'm not talking about if she's picking on you because you have an accent or something -- that's clearly uncalled for. But the comments don't sound really mean-spirited or anything. At worst, it sounds like the evals and your interactions with the attending are saying she doesn't think you're the family medicine type; this is likely something you already knew heading into the rotation. So you passed, and it's possible the comments won't matter for your dean's letter. I don't know enough about radiology to know if passing family medicine will block you from residency programs, so someone else can speak to that I guess.

People get upset when the comments are "Good job. Read more." At least these are concrete. Whether they're constructive or not depends, I suppose, on what actually happened during the events in dispute and whether these were real problemsor she truly was picking on you. But certainly they're concrete.

I do know it sucks to get an iffy eval, so not trying to be a jerk...just guess I thought I'd throw another opinion out there.

Also I am pretty sure that she is picking on me, becasue I got excellent comments in multiple rotations, the neurology clerkship director even said that i am "the rock star" and my medicine attending said that I am better than the resident in front of everybody, and patients consistently telling me and my residencts that how great i am...i am going to make a wonderful doctors...and when I ask them how do you know? they just told me they have been to many doctors, they know who is good and who is bad.

 

[karenwkyk]

you're really not helping your case here. Attacking your attending (which is any physician who has completed residency who is teaching you) for her age and her uncontrollable medical problem is extremely immature. Speaks volumes about you, not her.

Do you have a problem? there are alot of incompletent doctor out there, you don't just blinkly respect to anyone who is older than you....You should use your brain and think if this person is worth it or not.....I don't know how do you get into medical school if you cann't even think critically...
My clerkship director agrees that she is not a role model for the student to learn form, that is why she never sent another student to her site anymore.

 

[drfunktacular]

Also I am pretty sure that she is picking on me, becasue I got excellent comments in multiple rotations, the neurology clerkship director even said that i am "the rock star" and my medicine attending said that I am better than the resident in front of everybody, and patients consistently telling me and my residencts that how great i am...i am going to make a wonderful doctors...and when I ask them how do you know? they just told me they have been to many doctors, they know who is good and who is bad.

I don't think you are helping your case...

 

[karenwkyk]

you're really not helping your case here. Attacking your attending (which is any physician who has completed residency who is teaching you) for her age and her uncontrollable medical problem is extremely immature. Speaks volumes about you, not her.

I don't think you are helping your case...

the fact is I did well in everything else except family medicine....if I really have a problem they wouldn't give me great comment and a excellent grade...it just prove that nobody else think that i have a communication problem except the family medicine preceptor, whom i have an argument with.
I just don't know why nobody think my speech has a problem except her if the problem is true.....anyway i am just being stupid to post a thread on SDN, because people people on SDN like to attack other people...no matter what you post, someone is going to attack you ....even you post the earth is round, someone is going to argue with you that the earth is actually square.

 

[domer621]

she must be mad at me when i pointing out her mistakes. (e.g misinterpate iron overload as wilson disease etc..)

Yep, she taught you a good lesson for the wards.

 

[smq123]

Do you have a problem? there are alot of incompletent doctor out there, you don't just blinkly respect to anyone who is older than you....You should use your brain and think if this person is worth it or not.....I don't know how do you get into medical school if you cann't even think critically...

How do you survive medical school if you're not willing to swallow a little pride?

You don't want to just "blinkly respect" (?) anyone who is older than you, no matter how incompetent they are - obviously. No one wants to do this. But it's THIRD YEAR of MEDICAL SCHOOL. You'll have to kiss up to incompetent people ALL THE TIME when you're an intern. So learn how to do it well now, and save yourself the trouble later.

Christ, you got a "Pass" on Family Med. Calm down - who cares? If you're not going to go into family med, then the answer is: no one.

 

[drfunktacular]

the fact is I did well in everything else except family medicine....if I really have a problem they wouldn't give me great comment and a excellent grade...it just prove that nobody else think that i have a communication problem except the family medicine preceptor, whom i have an argument with.
I just don't know why nobody think my speech has a problem except her if the problem is true.....anyway i am just being stupid to post a thread on SDN, because people people on SDN like to attack other people...no matter what you post, someone is going to attack you ....even you post the earth is round, someone is going to argue with you that the earth is actually square.

I don't think anyone is saying you weren't judged unfairly by your preceptor; that much is apparent. Unfortunately, that's what life is like, especially life in medicine.

The problem with what you keep saying is that it makes you sound just as petty and vindictive as your preceptor... who you are criticizing for being petty. That kind of attitude is not likely to win you any friends with your superiors or your peers. Thus it will earn you unfavorable evaluations. Thus it will not help your clinical grades.

Some people are just jerks. The sooner you learn to "grin and bear it" and move on to other things with a good attitude, the better and happier you'll be in medicine.

 

[Ypo.]

It must be really annoying for an attending to have a third year medical student following them around and constantly pointing out their mistakes (or what they think are mistakes).

 

[chrisisinnocent]

It must be really annoying for an attending to have a third year medical student following them around and constantly pointing out their mistakes (or what they think are mistakes).

From what she described those are mistakes she pointed out.
To the OP: part of your learning experience is to see things that you would not do as a physician. You can almost learn more by seeing things done wrong. At the same time you need to consider your place in medical hierarchy: whether you like it or not your job is not to correct the attending even if she is wrong. You need to learn your place and what is appropriate. I am also very intolerant of incompetence but instead of being a knowitall I just file it away in my brain learn from it and keep my mouth shut. For the sake of your grades you should do the same.

 

[getunconcsious]

Even if it does compromise care a bit, I think I'd let the patient take the hit, especially if it's something small like not putting a diabetic on ACEI. I would say something directly ef and only if I was convinced that the patient was in imminent danger of death. In other cases, I think I'd say something to the nurse or intern or someone else in order to pass the buck and avoid confronting the attending (or in many cases chief resident, since they also evaluate people) directly myself.

In my opinion, it is imperative that you secure the best possible evaluation at ALL costs. Note that I said ALL costs, not except in the cases where it would compromise patient outcomes, not except in the cases where you 'know you are right', etc. This process is all subjective and we MUST get good evals. No one will remember if you corrected an attending's error and thus it resulted in better patient care. What they will notice is that said attending wrote that you don't know how to defer to authority and are outspoken and insubordinate. If you want to do well, you've gotta just suck up your personality (and in many cases your morals), sell your soul to the devil, and run around being 150% fake all day, every day. It isn't pleasant but you have to look out for #1 and think in the long term.

Just my .02. It's November, 4 rotations down, and nothing but glowing comments thus far even on rotations where I hated the people, the patients, the subject matter, etc. It's all about acting convincingly.

 

[Ypo.]

In my opinion, it is imperative that you secure the best possible evaluation at ALL costs. Note that I said ALL costs, not except in the cases where it would compromise patient outcomes, not except in the cases where you 'know you are right', etc.


If you want to do well, you've gotta just suck up your personality (and in many cases your morals), sell your soul to the devil, and run around being 150% fake all day, every day. It isn't pleasant but you have to look out for #1 and think in the long term.

Seriously? Dang, dude. Some things are just not worth selling out for. I would say that better advice is to learn how to advocate for patient care tactfully, without damaging egos.

 

[LadyWolverine]

Yeah...I'm confused. The OP claims to be an MS3, but posted on a thread from this summer that she was deciding between Georgetown and Drexel.

Also, I find it ironic that the OP states that he/she is:

.....just being stupid to post a thread on SDN, because people people on SDN like to attack other people...no matter what you post, someone is going to attack you....

Especially after he/she was the one who started posting inflammatory comments in response to other people's genuine answers:

I hope you understand this, it call evidence based medicine, if you still haven't heard about it yet.

Do you have a problem? there are alot of incompletent doctor out there, you don't just blinkly respect to anyone who is older than you....You should use your brain and think if this person is worth it or not.....I don't know how do you get into medical school if you cann't even think critically...

Troll or no troll, I'm happy that karenwkyk isn't in my class. I don't think we'd get along very well.

 

[drfunktacular]

Troll or no troll, I'm happy that karenwkyk isn't in my class. I don't think we'd get along very well.

OTM

 

[Myempire1]

-

 

[Doowai]

she must be mad at me when i pointing out her mistakes. (e.g misinterpate iron overload as wilson disease etc..)

Yes, a violation of the "never be more holy than Jesus" principle. Sometimes painfully learned, such as when the white belt Jujitsu student points out the black belt instructor tied their belt wrong. A similar situation is never be more holy than the Pope when you are just a Bishop - i.e never point out an error (directly) made by an intern when you are MS4, never point out an error of a PGY2 when you are an intern, etc.

 

[Droopy Snoopy]

Yeah...I'm confused. The OP claims to be an MS3, but posted on a thread from this summer that she was deciding between Georgetown and Drexel.

Yep, she goes from posting those annoying this school vs. that school threads in June to posting her 257/99 Step I score in July to now posting the belligerent comments as was quoted above. Nice to know I was giving a good 5 minutes of my time typing out a helpful response to a troll. OP you've been reported, now just do us all a favor and go kill yourself.

OTM = ???, on the money?

 

[drfunktacular]

OTM = ???, on the money?

OTM...

 

[Chuckwalla]

Long story short, you spited her. This is her way of striking back. It doesn't matter if your critiques were justified or not.

It is hard to enough for people to suck up being criticized by people above them, having someone below them do it makes them blow their top. Not only that they have the power to take it out on you.

If your preceptor says jump, you say "how high?" Don't question her. Life is a game, you have to play by the rules, it doesn't matter what you think is right.

 

[Final]

Even if it does compromise care a bit, I think I'd let the patient take the hit, especially if it's something small like not putting a diabetic on ACEI. I would say something directly ef and only if I was convinced that the patient was in imminent danger of death. In other cases, I think I'd say something to the nurse or intern or someone else in order to pass the buck and avoid confronting the attending (or in many cases chief resident, since they also evaluate people) directly myself.

In my opinion, it is imperative that you secure the best possible evaluation at ALL costs. Note that I said ALL costs, not except in the cases where it would compromise patient outcomes, not except in the cases where you 'know you are right', etc. This process is all subjective and we MUST get good evals. No one will remember if you corrected an attending's error and thus it resulted in better patient care. What they will notice is that said attending wrote that you don't know how to defer to authority and are outspoken and insubordinate. If you want to do well, you've gotta just suck up your personality (and in many cases your morals), sell your soul to the devil, and run around being 150% fake all day, every day. It isn't pleasant but you have to look out for #1 and think in the long term.

Just my .02. It's November, 4 rotations down, and nothing but glowing comments thus far even on rotations where I hated the people, the patients, the subject matter, etc. It's all about acting convincingly.

i hate people such as yourself. they make med school so unpleasant.