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Clinical Rotations: Dealing with Conflict

Created 09.01.07 by Alison Hayward, MD
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Nearly every medical student, at some point during training, will have a negative encounter with someone higher up on the ladder. One of the most difficult aspects of medical school is the vulnerability of medical students to criticism or disciplinary action due to these types of encounters. These situations can lead to the most dreaded of outcomes – a negative comment in your dean’s letter or file.

Your skills in interacting with others will be put to the test not only with patients, but also with physicians and support staff.  Oftentimes, a perceived offense to the ancillary personnel can be particularly damning, because physicians often have close relationships with these staff members.

This can also work in your favor: getting in the good graces of the rest of the staff can help secure a favorable impression on your supervisors. Remember, some attendings may be quite removed from your daily activities as a medical student. If this is the case, they may count on secondhand reports from other staff members as part of your evaluation.

With seemingly innumerable potential pitfalls, the third year clerkships in particular can be maddening. At no time are you lower on the totem pole, and sometimes it can feel like other staff members – particularly those normally at the bottom of the pecking order – revel in making you feel completely clumsy and irrelevant. It is a difficult situation to be in, but the key is to keep smiling. Being cheerful and enthusiastic, as many students who have excelled on the wards know, is usually more important than getting “pimping” questions correct. Many attendings believe in a variation of the adage, “knowledge can be taught, but personality is forever.”

Students can often be heard bitterly complaining about the subjective nature of clerkship evaluations. Since evaluations of one’s personality are necessarily subjective, and personal interactions will figure prominently in nearly any career, there is little chance that clerkship evaluations will cease to be an important factor in residency admissions. Being able to “play nice” will help you in any profession, regardless of your mastery of the facts or your physical ability to do procedures. Therefore, simply raging against the machine, while perhaps cathartic, is not the solution.

So what are your options, aside from being relentlessly pollyannaish and striving to get along well with everyone you meet? If you have an abrasive personality or commit a truly heinous act, then prayer may be your only resort. However, if you are like many medical students and have been misconstrued in something you said or did despite good intentions, you may have alternatives.

First, apologize regardless of the situation and whether you feel the complaints are justified. Not only will you hopefully improve relations with the individual, if your future career is more important to you than the flap in question, you may avoid repercussions. Attempts to defend yourself may add fuel to the fire, because you will appear to be questioning authority.

Titrate your apology to the offense: if it is minor, a simple apology will suffice, but if it is serious, a more extensive explanation may be required. In fact, the best response to a low-level negative comment (such as the type you may receive daily from a grouchy, sleep-deprived resident or attending) is usually just a cheery “all right, I see what you are saying, I will try not to let it happen again!” Although this type of response may not only feel false but may be tough to fake, mastering it will help you deal with a multitude of situations that have the potential to go on a downwards spiral. It is also often said that the best doctors are great actors.

Second, if another authority is available who you feel will be sympathetic, go to them for help. For example, if your problem is with your preceptor, but you have a kind clerkship director, make your case to that person. If you go down this road, never appear to be accusing the person who criticized you. Explain it in terms of being a misunderstanding, or propose extra credit work you could do to remedy your grade. If you come off well in this encounter, this person may leave out the offending comments or alter your grade accordingly. If this option is not feasible, or if the person you appeal to is unwilling to change their colleague’s ruling, consider giving up. Further pushing may get you into more trouble.

Finally, as a last resort, find out if your institution has an “ombudsman” or “ombudsperson”. These individuals act as student advocates in situations where students have been intimidated, harassed or otherwise wronged by faculty members. Ombudspeople are meant to serve as equalizers in the large power differential between students and attendings.

If none of the above is helpful or appropriate, consider writing a letter that you will not send stating your grievances. You will likely feel better after making your case on paper/in e-mail, but you will not risk getting yourself in deeper by appearing to accuse, blame, or inflame those who are above you.

Above all, the rule in clerkships is to try to avoid the negative encounter in the first place. Remember that you are being watched. The way you talk, the way you dress, and the way you treat patients are being minutely scrutinized. Remember that one of the most common accusations leveled against medical students is that they have acted “unprofessionally”. Avoid any language that even borders upon ‘colorful’, even if you are only in the company of colleagues. Do not make jokes with colleagues or patients on any political, religious, or personal topics, particularly about the patient’s appearance. Do not complain about a co-worker’s behavior to another staff member unless it is of crucial importance to do so.

It is also prudent to avoid giving negative feedback (about persons or activities on the rotation) in general, unless you can do so anonymously. You are not protected from repercussions otherwise. You have the rest of your career to be opinionated and blunt. As a student, stay conservative and positive. And, because expectations of students can be unrealistic, if you cannot avoid a reprimand, use the tips above to counter it.

 

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  1. Ann O. Nymous says:

    So, basically we are supposed to bend over, take it “up the chute,” smile, and say, “thank you sir, may I have another?”

    If a physician cannot have enough respect for and honesty with him/herself, and be willing to stand up for themselves and what is right, how can they be expected to do so for their patients?

    Simply taking the abuse simply encourages and perpetuates the cycle. Being older than many, I will not let staff and attendings abuse me in order to make themselves feel superior/better about themselves.

    It is NOT unprofessional to be honest, direct and defend oneself from abuse and baseless accusations.

    Regards,

    Ann

  2. Jolly B. Good says:

    I think it is important to choose one’s battles carefully. As a medical student, it appears that attitude is everything. Subjective evaluations are just that. That said, if there is a serious ethics breach, I am sure that the author would agree that it is important to stand up. But in order to protect yourself I think these rules are at least a good start. Even farm animals know to never desecrate their feeding sources.

  3. Sam says:

    I would say that students have right to stand up against what is wrong, if you just pretend you aren’t being abused and make fake statements then you are a sell-out, and make whatever attending who abused you more emboldened to attack other students. Medical students are becoming more savy, and with the internet and long-distance phone call it is a foolish attending who think that they will suffer no punishment or repercusions for an episode of abuse. I was abused and made sure that everyone knew about the sick acts that an attending forced on me, and yes he is no longer interacting with students. Attendings beware, we are also evaluating you, the days of when you could do and say whatever you want are over.

  4. Alison Hayward says:

    Hello Ann!

    Thank you for your comments. I think you may be misunderstanding a few of my points. To address your concerns:
    1. The answer to your hypothetical question is – yes, if the conflict in question is not truly abuse/harassment/inappropriate behavior on the behalf of the person in question. For example, if you made an honest mistake and forgot to see a patient on rounds, and a resident gets angry at you, then that is not a baseless accusation, and it is not ‘abuse’. You have to have a response to what they say, and the best response (in my experience/opinion) is to be positive and apologetic. A defensive response is unlikely to help you out.

    2. I am by no means advocating that any student or employee should tolerate abusive behavior. It is inappropriate and most if not all medical institutions have policies against it. If this is the case in a situation that has arisen with you, I definitely recommend making contact with the ombudsperson. Some institutions also have anonymous phone numbers you can call to report incidents like this, or committees who deal with it. If you have been mistreated, I agree, you must address that.

    My article is simply referring to the numerous situations that arise where a medical student is accused of some non-serious offense, such as ‘unprofessionalism’. This type of accusation may actually come from an attending who believes that they are trying to do the right thing by reporting a student who has behaved badly, and may have nothing to do with student abuse.

  5. Sam says:

    On a second reading I think this article is SICK, who would tell students to bear the pain of daily abuse and harassment with a smile on their face? This is written by an attending who probably was unnerved by a student who wouldn’t sit there with a smile on their face while they are verbally harassed. I don’t think the tone of this article, with explicitly states that students will face severe repercusions is correct. You should been teaching medical student how to do damage control with an abusing attending. It makes me laugh to think that the same people who want med students to take the abuse, also want to make more humanistic physicians. To all clerkship director out there: You can’t have your cake and eat it too, i.e. abuse medical students and expect to produce kind doctors. I hope that some attendings who have abused students receive a very humbling experience as a patient, i.e. made to wait a long time and told that they reason they had a heart attack is becaue they are obese and too angry. This article just makes me want to file a complaint against some of my more abusive attendings. Students need to band together and throw out these abusive attendings.

  6. E.G. says:

    I don’t agree that if a medical student didn’t have a patient’s vitals, often because they are made to do something else like a dressing change, that the deserved to be harassed. Too many attendings and residents feel that if a student didn’t something that was evently slightly wrong then they have a right to harass them the whole clerkship. There is somethin fundamentally wrong when a resident gets angry with a student and yells at them with anger. Abusive attendings and residents are delusional in that they abuse a student and then rationalize it by saying the student that they deserved it. Sort of like saying that someone who is raped somehow deserved that. And medical school administrators wonder why students are so less optimistic and more focused on lifestyle residencies like derm and radiology.

  7. Alpha says:

    Grading are important but you have to stand up for yourself. If any attending are abusive, you should file a complaint and get your lawyers when necessary.

  8. docB says:

    Ann and Sam, you are both making erroneous assumptions here and your anger is misplaced. The article is not talking about abuse. It’s talking about the options a student has if they feel they have had a negative interaction with faculty. A faculty on student abuse incident is an entirely different issue. I suggest looking at what the article actually said and not making it quite so obvious that you have axes to grind on this.

  9. E.G. says:

    docB, there is a very fine line between medical student abuse and as you put it, “a negative interaction with faculty”. Abusive comments that are racially charged, yelling, harassment and overly berrating medical students is abuse. This article gives the negative impression of instructing medical students to worry about retaliation and not to report abusive faculty. I find it amazing that some attendings feel that they can get away with yelling at medical students over trivial matters. The last paragraph is the most self-serving statement to make students feel that they will be “not protected from repercusions” I would get a lawyer and suit any attending who harasses students, or get dirt on them and release it anonymously to their patients, I guess that is what would work against these scare tactics. I know one student who filed a lawsuit against facult member and settled out of court. bottom line is get a lawyer and suit the slimmy freaks for what they are. I don’t buy the whole “tough love” malarky.

  10. Jolly B. Good says:

    I find irony in doctors-in-training suing the doctors that are training them. What then becomes of the med students who cannot afford attorney fees?
    And since this point has been raised, what recourse besides an ombudsman does a student have for addressing racial (or sexual or…) discrimination? These allegations can be difficult to prove. This might also expose the identity of the complainant (especially if the one African-American student files a racial discrimination complaint for example).

    Although I commiserate with students about the need to stand up to ‘bullying’ — the author has clarified that the article pertains to assessments and basic conduct, advice that could help if only we keep cool heads. Besides, we won’t always be med students.

  11. docB says:

    Where on earth are you getting the idea that the article is defending the use of “abusive comments that are racially charged, yelling, harassment and overly berrating medical students?” Are we even reading the same article? Are you really just waiting to feel as though you have been abused so you can sue someone? Or will you just be spreading rumors with some “dirt you dug up?” And if you are trying to injure your attendings by slandering them aren’t you engaging in abusive actions? Where is the due process and justice in that?

    Abuse should not be tolerated but I suspect your bar for what constitutes “abuse” is set pretty low.

  12. Archie says:

    This article is very confusing, it correlates with what I have heard from final year medical students that the third year is more of a political game than anything having to do with real medicine. I hope that I am able to fake the proper enthusiasm or learn to say “may I have another” when punished or whatever happens in the clinical years. I guess this is why more and more college students are looking outside of medicine to make a difference. I am surprised that the best actors make the best doctors, I guess this is why so many premeds say they want to do primary care and then go for the high-paying specialties!

  13. Melissa says:

    Everybody acknowledges that medical school hazing goes on in the third, and fourth year. This is no different than the severe types of hazing involving abuse and emotional tormentation that goes on, but is banned at colleges. The advice in this article is no different from the advice that you would receive upon entering a fraternity or even some sororities with very harsh hazing practices. The goal of surviving the hazing in both situations is to become a “higher-up” so that you can do unto to others as has unfortunately been done unto you. Smile your a** off and eventually you will be able to be “oppinionated” i.e. kick some third year booty when you are an attending. This article doesn’t really offer any other advice than that.

  14. anonymous says:

    I think it’s a good article. Students need to realize that they are still at an extremely vulnerable and fragile point in their careers and can literally gain or lose residencies with a phone call. Attendings talk, and getting labeled as a bad, rude, or argumentative student is hard to recover from. Everyone has an ego, but maintaining a low profile will never hurt you. Ideally, you’ll just be smart and tactful enough to earn respect, but you have to let the occasional megalomaniac attending or resident’s berating roll off your back and just feel sorry for them. It’s only a month long rotation at the max in most cases…

  15. Fred says:

    I don’t think that attendings who berrate students and residents are taken as seriously as more fair attendings. I knew a student who had a supposed big-wig attending write a great letter for him, and told him he would get into a certain prestigious residency, but it didn’t work out, later he found out that this attending isn’t very well regarded and he should have gotten letters from someone different. I think that medical students shouldn’t have to sell thir souls just to get a residency, and it is sad that attendings who take advantage of a “critical and vulnerable time” in a student’s career and use it to basically get away with murder. Such attendings should be exposed.

  16. Alison Hayward says:

    Hello commentors:

    Just wanted to note again for those who did not catch my first response. I do not condone abuse or harassment in any way. I would like to make that as clear as possible. I would also like to point out that people can be grouchy and crabby in this world, and you’ll have to deal with them. It doesn’t mean that they are bad people. I am sure that you get grouchy and crabby too, especially when you are working 80 hours or more per week doing stressful work. In fact, some of you sound like you are pretty stressed out right now. I understand that. I felt very stressed all the time as a student because of just these reasons.

    I agree, there is a fine line between being abused/harassed and being criticized. But I think that most reasonable people are able to understand the distinction.

    To Sam: I am not an attending, I am an intern who has been in a situation where I felt I was wrongly accused of being unprofessional, and I also had a number of friends who had variations on this experience. The article results from the lessons I learned from these experiences. I try to treat all those below me with respect. I wish that everyone would do the same. Since they don’t, I have this advice. You don’t have to take it if you don’t think it’s good advice.

    I still stand by my comment that you should only make accusations or criticize an attending through either an ombudsman or an anonymous feedback route such as a phone line or anonymous written feedback at the end of the rotation. I would like to point out that I never said it was right that students are not protected from repercussions if they make complaints, I merely stated the fact that they are not protected and thus should be careful. I think that is fair.

    I just graduated from medical school, guys! I am still going through these things on a regular basis as an intern. I feel for you. I am on your side. No need to displace your anger on me.

  17. Alison Hayward says:

    to Archie:
    Yes, the final years of medical school are sort of a ‘political game’ – just like any other job. Business, law, academia: many career paths have the same hierarchy that you have to fight your way up. So there are many reasons why people are not choosing medicine these days, but I don’t know if this is one of them. As I say in the article, you usually have to be nice and easy to get along with to make your supervisors happy. I didn’t think this idea was as controversial as it seems to be – I guess some people have difficulty being nice to others? :-)

    To E.G.: As I said, I do think medical students should worry about retaliation – they are vulnerable to it! I doubt that in most situations getting a lawyer and suing an attending is appropriate. We are talking about instances where a medical student has made a mistake, or been perceived as rude or offensive to a patient or co-worker. How can you sue someone because they think you are offensive? And I think your comparison to not reporting a rape is completely out of line with what I am saying, in fact, that is rather offensive to me – though I hope you won’t sue me for saying so.

    By the way, I am not necessarily saying in every situation here that the student is innocent! Though I would like to believe it is true, I know we do not always do the right things or say the things we mean. So… these are also some ways to try to fix it if you do something dumb, though I’m sure that would never happen to anyone here…. :-)

  18. FancyDoc says:

    I think there are some good points in this article, it is always good to be on the defense, i.e. don’t make jokes or laugh at inappropriate jokes that residents or students make. There are alot of attendings who will get into personal issues with students. This is in large part due to a lack of training amoung newer attendings about how to criticize, how to educate students, and what to do in certain situations. While it is often said that medical students can get in alot of trouble which will follow them forever, there are new rules to play by. Specifically, LCME requires that situations of abuse be investigated, I would suggest that you make an open complaint immediately, so that a certain attending can then give you a bad grade when they realize that you are going to file a formal complaint. This had and will happen. You ARE protected from retaliation, at least at my institution, once you make a complaint of abuse, and basically anything that faculty member says about you will be questioned from that point on. Believe it or not but many lawyers will take on a case of workplace abuse for medical students and medical schools do quietly settle out of court, similar for inappropriate in inaccurate or downright falsified statements in the Dean’s Letter. I would not suggest planning on making an anonymous comment at the end of the rotation, although this may help future students, it is unlikely to help you. Make a journal of everything that happens, this can be used in court. Regardless of how bad a day a resident or even an attending is having, if they are “crabby” with students this will catch up with them and their career in academic medicine will be short-lived.

  19. EG says:

    I have been in the clinical environment a while, I have seen occassionally students be “rude” to each other or to a resident or attending, usually it got a weird look, I would guess it might impact their grade, but I don’t know for sure as I have rarely seen this. Most medical students have made it through so many hoops already that we know not to be blatantly rude. Having said that, I have seen many attendings act quite rude, to both patients, residents and students, what usually happens is that people don’t want to work with them. Your article is excellent *prophylactic* measures, i.e. smile, try to avoid fights, the best war is the one that you avoid. However, once an attendings has declared war on you, i.e. I am going to destroy this student, then you need to give negotiation a try at least once, i.e. volunteer to come in later, etc . . . if that fails then go to the complaint committee, and resolve it quickly, this will make you feel better, and it will help your situation. Obviously, we all fear attendings and residents too in terms of what damage they can do to us. However, once it occurs you need to file a formal complaint as soon as possible. Studies show that medical students perception of medical student abuse is pretty much on the mark, and we don’t exaggerate. You should worry about your reputation before something happens, but if an attending goes as far to put in writng and give you a bad grade, then you have to realistically ask yourself if this was unfair, and then file a complaint. I think that alot of these remarks from attendings are without base, but I don’t know the real story witout numbers. You mention the real world in terms of negotiating and working with people. In the real world, doctors do nasty things to each other, steal patients, force others out of business, and do a multitude of unethical things. Once an attendings start making negative comments you need to either 1. Change what was wrong, or 2. Take appropriate action, which includes legal maneuvers, i.e. getting lawyer to write a letter even if you don’t file a lawsuit, having a lawyer write a letter goes a long way. In the real world doctors i.e. attendings interact with lawyers all the time to defend themselves, there is nothing shameful or overeacting if a student does this, in the long run it is worth the cost. Thankful this is changing.

  20. surgery.nightmare says:

    Thank you for opening up this discussion Allison. I understand that as an intern there are tips to be given about how to get through a rotation with crabby attendings.

    But what I would like to know is what organization can we report abuse to outside of our schools? I did report serious abuse to my school and they retaliated against me, put me on “conduct probation” and said if I have problems with another attending they will kick me out. Thankfully, all of the rest of my evals have been great, and I am keeping copies of everything.

    Where do I go from here? What outside agency serves medical students? This is not the first time a medical staff person harrassed me, when I was a unit secretary a female nurse was harrassing me. I reported her to human resources and she never bothered me again. How funny that as a unit secretary I had more protection than as a medical student.

  21. plethora says:

    I admit to being particular blunt before medical school, and it was HARD to tame my tendencies toward “keeping it real.” After a tangle with some of my faculty members, I realized that the ability to tell people what they want to hear-despite being somewhat manipulative-can be an EXTREMELY VALUABLE SKILL to have. You can avoid trouble by staying within your own sphere of truth while controlling how others perceive you. I used to fight the idea of having to resort to this sort of mindset, but it has helped with evaluations and getting along with colleagues. In many ways, it can be quite amusing to think that I lived my life all this time without fully understanding how powerful perception can be–and how suprisingly easy it is to train oneself to evoke an image that remains in one’s own favor more often than not.

  22. Ann says:

    I reported serious abuse to my school too, and they became mad that I would bring up a well known problem with a certain abusive attending and basically had to be pushed to investigate it. I seriously regret not getting a lawyer to help with this. If you get a lawyer, the school will get serious, sometimes all it takes is the lawyer to talk to the schools lawyers. People who are actual administrators in medical schools are very slimy and will do all sorts of things to pester a student who brings up abuse. The only protection you can get is a lawyer, who can then identify other sources of support and legal action. Work-place harassment is a crime, whether it is done to students or to an office secretary. Medical schools feel that they can treat their own students worse than people who are paid to be there, ironic since students pay such high tuitions. It is a cruel awakening when a the get a slap of reality in the face by realizing what they are doing is illegal.

  23. surgery.nightmare says:

    What I am concerneed about is state licensing.

    There is a section on the application that states:

    “Were any incident reports regarding this student ever filed by instructors?”

    and

    “Was this student every placed on probation?”

    That means that out of my 24 rotations, one bad preceptor can ruin my chances of getting licensed.

    I think a more pertinent article to write would be called “When to get a lawyer for medical students”, or “How to document everything.”

  24. Anon says:

    Medical school is alot different from college or regular jobs I had in research or in hospitals. It is hard on the nerves working with attendings who feel they have the right to say and do anything to students, you will feel infantalized, and made to feel pretty bad about yourself, maybe even several times a day.

  25. Craig says:

    Ok. There was a lot of good advice in this article, much of which can be boiled down to medical students needing to be able to play nice in the sandbox. I also agree that during times of criticsm or conflict, it is probably a good idea to think in terms of long term strategy instead of short term battle plans or damage control. Like an earlier poster alluded to, the ability to control one’s image independently from one’s thought processes and plans is a powerfull tool. In other words, try not to wear your emotions on your sleeve, because it really is a political world.

    That being said, I also think that the overall tone of the original article might have been a little heavy in emphasizing the importance of always trying to defuse situations by apologizing and more or less prostrating one’s self in the face of criticism or other negative circumstances. Of course, I want to disclose that I have yet to experience clinical clerkships, so perhaps I will learn to think differently when that time comes. I definitely agree that somtimes swallowing your pride and smiling to get past a situation is the smart move. However, it seems to me that we should also be encouraged to develop more of a backbone and have the courage to address issues directly and in a mature and productive way, when such an approach is appropriate of course. I suspect that many higher-ups will appreciate someone that can maturely handle conflict without cowering. Confidence in defending one’s self can be just as important as a willingness to overlook things and try to smooth things over. Anyway, I am finding this discussion very helpfull. Thanks!

  26. Bilsnikey says:

    Don’t want to work within the heirarchy of medicine? Try being your own boss. Quit medical school and start your own company. Other avenues – a lot of fields require the knowledge of MDs, finance is an example. A lot of people out there have to realize that they have the freedom to change their lives if they do not like the process of becoming an “attending”.
    For those who want to stick with medicine, the people who have the most fun and also preserve themselves the best are the ones who are nice to everyone despite how they are being treated.
    One final point. In medicine and in life in general, taking care of our fellow people is one our most important endeavours, however hurting other fellow people in the process is hypocrisy.

  27. Bobby says:

    I can’t even take this article seriously. Poor ideas and poorly written.

  28. law2em says:

    I understand what the author is trying to say. Treading carefully is never a bad idea but it is lot easier to say and do. What does it mean to be conservative?

    As a new third year student, I have already seen situations where it is difficult to strike that balance between being an advocate for our patients and coming off as questioning the attendings/resident/intern’s treatment plan. Some attendings absolutely love it when we have a prepared assessment and plan or when we ask about the rationale for the attendings’ plan. Others seem to interpret it as an attack on their professional skills. This is especially true if the preceptor is more quiet than the student (i.e., the student has a more outgoing personality).

    So much of the evaluation process is subjective. It seems to come down to whether you are liked by a given preceptor or not. Sometimes this may mean whether you are more like them in personality. That is very hard to change- if you are outgoing to become more meek or vice versa. Your actual knowledgebase and skills may factor in to a lesser or greater degree depending on that preceptor and what they value.

    I know that this has been the most frustrating aspect of medicine to date for me. My previous career had a uniform standard of excellence. We could all agree that a brief was superb. Mediocre and good might have various standards but excellent was truly excellent.

    Good luck all. Let’s just remember to practice what we preach when we are the residents and attendings and we are grading students.

  29. Alison Hayward says:

    Hello law2em:

    Discussion of assessments and plans was not really what I was alluding to with this article, as a new third year medical student you are expected to have an assessment and plan but I do not think you should be worried if they do not agree with the resident/attendings. The important thing is that you gave it rational thought. You have barely any experience with clinical care- if you could come up with the same plan as the attending, you wouldn’t be paying for med school! Remember to phrase your recommendations in the A/P as “Consider medication X for condition Y” or “Consider imaging study X for indication Y”, then end with “Will discuss with Attending X/Team” – this shows thoughtfulness but yet is not phrased in the imperative. (i.e. cannot be misinterpreted by a nurse/other medical professional as “The Plan”)

    Craig: Thanks for your comments. I agree, if you think that actions/comments are inappropriate, if you have the guts, address it directly – just be as constructive/impersonal as possible. Some attendings just may be set in their ways, but it is worth a shot. The apology approach, as I mentioned before, applies more to situations where you may have actually done something wrong in someone’s opinion (or at least appeared to do something wrong by someone’s misperception/misunderstanding of a situation).

    Bobby: sorry you didn’t like the article, you are welcome to make counterarguments if you disagree with what I say. That is the benefit of this discussion space.
    :-) Alison

  30. Alison Hayward says:

    Surgery.nightmare: I can’t speak for all states but I can tell you in my state there were no questions on the licensing application about that. They just asked if you had been put on probation for any reason and then request you to explain. Once I was on academic probation so I had to provide that information, but it did not mean that I could not be licensed. I think in terms of outside organizations your best hope is with a lawyer with this level of an issue, I have not dealt with any issues on a legal level so perhaps others here can advise you more if you have specific questions on that.

    plethora: Did you ever see the ‘Chappelle’s Show’ skit about “when keeping it real goes wrong?” Your comment reminded me of that and made me laugh out loud.

  31. plethora says:

    Alison Hayward: Yes, as a matter of fact; however, I have to clarify that I used that phrase before it was on the show. Nonetheless, the ‘Chappelle’s Show’ got me through last winter–it is one of the few shows that elicits a laugh out of me.
    Recently, another epiphany I have had about life in general is that my “ghetto insight” and somewhat circuitous path into medicine has been useful with patient/ancillary healthcare worker rapport among various socioeconomic classes outside the realm of the typical bubble to which most medical students are accustomed.
    Sometimes I think that most of my fellow students don’t “get me,” but then I am reminded as to why this paradigm is a blessing in disguise and also an advantage.
    –I “keep it real” by staying true to myself and doing what is necessary to achieve greater ends without infringing upon the basic liberties of others….No baseball bat applied to perpetrators’ cars will be necessary.

  32. Anonymous says:

    I am a resident and had a student say on rounds that they had 8 hours of sleep the night before when being on call. Than the student told me she had to leave at noon that day because she was post call.

    No one yelled. No one really said anything and she went home. Its not always as malignant as people think.

  33. Anonymous says:

    When I was in Medical School during a third year rotation, a male attending was examining an attractive female patient. This attending had a thing for photographing his patients in the nude. Then he’d cut the pictures up, put all the heads on different bodies, and post them in his office! He instructed me to talk to the woman and “convince her that having her picture taken is necessary to monitor her progress”. When I asked if this was true, the attending replied, “Hell, no! I just want to see if she shaves her c&*t!”. When I refused his order, he told me, “OK, but you’ll never match in anything next year!”. His words were truly prophetic. I sent out over two hundred applications to Internal Medicine, Family Medicine, and Pediatrics programs, never receiving so much as a reply from any of them.
    When I related my problem to the Dean of Student Affairs at my school, the only thing she had to say was, “If an attending tells you he wants to f#@k you, your brother and your sister while your parents watch, you should reply, ‘Where do you want me to make the hotel reservations and what do you want room service to bring for breakfast the next morning?'”
    Medical students are utterly at the mercy of school faculty. While a student is hardly ever expelled outright, the same result can be achieved by making it impossible for the student to find postgraduate training. Either way, the result is the same. You’ve wasted your time and money for no real objective. Any prospective medical student needs to consider if he or she has the stomach to eat s#(t if forced to do so by attendings on clinical rotations. I have an MD, from a mid-ranked US medical school, but my career as a physician ended before it begun.

  34. aNONymous resident says:

    I think that this article is a bunch of B.S. also. I have my own experience. I honestly do not even know where to begin. I started off as being one of the best students at county hospital. I was the student that the residents and attendings loved having on their service. It all began on my internal medicine rotation. My intern there was a med school graduate of the 1998 class of another school (in other words, he did not match for about 3-4 years after graduating). He was very behind on his knowledge of medicine, and our team was strongly encouraged to help him out. He began to rely on us to do everything for him. Our team of students thought that we were just helping out the team. We soon began to realize that he was not seeing any of the patients at all. He would simply copy our notes. Even scarier, we began to realize that one of our main attendings never even saw our patients either. That in effect meant that we as medical students, 2 months into our 3rd year, were taking care of ICU patients all by ourselves. At one point I was the sole health care provider for 5 ICU patients, because my team felt I was the only one strong enough to handle that responsibility. Even q3 for our long 36 hour long calls, I would spend almost all moments when I was awake reading up on my patients to try to save their lives. We were all scared; and our team members were constantly having emotional breakdowns. None of us wanted to say anything for fear of repercussions. The residents had hour restrictions, we did not. We were working more hours than they were. I was often at the hospital post call till 4-5 pm after being up all night trying to call consults/finishing discharge summaries. Our team had a mortality rate 5 times higher than any other team ever has had. The DME took the two chief residents off of their current rotation to supervise our team to punish us for being “bad students”. We were made to work brutal hours and constantly blamed for poor patient outcomes. The chief residents were about to leave our service since they had “figured out what was really wrong.” They were eager to get back to their easy rotations. They thought the only problem was simply poor medical students. We were abused daily not only with hour restrictions, but repeatedly yelled out daily. We were each personally told how incompetent and lazy we were, when we were running the entire service. I reached a point where I had to make a decision. I saw several patients die due to lack of proper care. After the first patient death, I reported what was going on to the chief residents. They refused to acknowledge or believe that this was happening. I then went to the DME who also refused to do anything. I knew at that point that there was no turning back. The residents told me repeatedly that we do not “rat” on each other. “We always act as a team.” I became a doctor to help my patients. Yes, I knew then that I wanted a competitive specialty, but I had to remember why I went to medical school. I could not watch another patient die the way I saw these patients die. The other students in my team chose to not say anything. One student even lied to the DME saying that I was the problem in exchange for a pass with honors. Gotta love Karma…he went unmatched. The problem intern promised me a pass with honors (what I always dreamed of) in exchange for my silence. I chose to not stay silent. I went to the school. It opened an investigation which subsequently that led to this intern being fired. This entire incident completely changed my life. Rumors began to fly after I left this hospital on my own volition. Many people said that I was kicked out. The residents who I was once friends with could not support my decision to go over their heads to the school. Even more, they did not like seeing one of their own getting fired. I was told repeatedly that I would never attain a competitive residency, and that they would do everything in their power to destroy my dream. These residents tried to fail me in my clinical rotations. They went out of their way to tell all my past, present, and future clinical preceptors their side of the story. When you look at my transcript, you have to realize that every single pass with honors that I received after IM was fought for. I made sure that every single person who wrote me a letter of recommendation knew my side of the story. I had several preceptors tell me that this hospital DME, and other school administrators spoke negatively of me before I started the rotation, and they wanted me to know that they did not believe a word he said after meeting me. After the residents tried to fail me I had no choice but to go to admin. The words “copies of medical records” and “attorney” made them change their mind. I cut a deal with the school that I would not talk about what happened in exchange for them clearing my IM grade to a pass. They felt this incident would be an embarrassment to the school (rightfully so). They knew that I had copies to prove everything I am telling you about right now. I made a point of letting them know that I went to medical records. I almost thought they had ruined me. My spirit was completely broken. I questioned my decision to go to this school, and even being a future physician. I received so many residency rejections when I applied for a competitive specialty. The other guys in my class who are applying for the same specialty sent me a nasty email stating that the residencies knew what had happened. I have quickly learned that the medical world is a small one. When I refused to tell inquiring students my side of the story, they told me that I am an embarrassment to the profession. I was keeping my side of the deal, even though the school was making no attempt to keep their side of the deal. This further propelled me to do everything I could to match. Though many people disagree with my decision, I know that I chose my patients over my career. I know it was the right decision. It has definitely made me a stronger person. It did affect my ability to match. Others with lower scores/grades/numbers matched at the more competitive programs. I was told that my P in surgery and medicine affected their decisions to rank others higher. However, I still matched at one of my top choices, and am pleased with where I ended up. I was diagnosed with PTSD after this, and there are many days where this incident comes back in flashbacks. I am sharing my story to tell you that, you should still do the right thing. Even if it means giving a little of yourself. Medical education has since changed at this hospital. Just how much? There have been fewer deaths since I left this hospital, maybe that is all that should matter.

  35. Anonymous says:

    Right on Ann!

  36. Alison Hayward says:

    What a story- I am sorry you had to go through all that. It really is incredible what you hear about some hospitals and doctors. I would like to hope that things like that do not happen frequently at other institutions.

    I do know though that one attending at my alma mater was known for sabotaging students’ careers – i.e. calling all the programs and ensuring that the student went unmatched. I believe this really does happen, but I also believe it is an ‘old school ‘practice that is hopefully dying out. In the meantime, you have to be the judge of what is worth crossing an attending over. In the case I am referring to, it was for simple things like failing to answer exam questions using his special algorithm for the answer (i.e. even if the answer was right, he would fail you if you didn’t phrase it his way). To me, this is a case where you grit your teeth and just do it his way, knowing that once you get out of med school, you could care less about this doctor and his theories of learning. Your case, of course, is completely different.

    In a case where the health and lives of patients (or you) are being impacted by the behavior of others, I certainly believe the ethical thing to do is report the behavior any way that you can and do your best not to support unethical behaviors of others.

  37. Ron Bacon says:

    I got blackballed in my third year of medical school for complaining about being the only hispanic in the medical school class. I was basically a whistleblower. My rotations were a disaster and I was expelled from the school. Most of the residents stuck together like glue to get me dismissed. I called the dean one night while I was on call and miserable and said that I wanted to quit. He yelled at me on the phone and said that he always has this problem with minorities. He demanded that I continue with my rotations. Two months later, I got a phone call from him saying I had been dismissed. My advice to everyone is be careful but always stand up for what you believe in. I see myself as retired from medicine now. I have two children and a lot of free time to spend with them. My new job is nowhere near as demanding as a medical career. The amount of hazing in my new job is non-existent and the pay is very good. I still have to be nice to people but people at work are very nice and nowhere near as mean as the residents and attendings were to me. Of course, some employees still brown-nose here and there but it is not like in medical school where your life depended on it. One resident confided in me during a night on-call that female medical students used to get undressed on his bed during on-call nights to try to get a good grade. To me, that was losing all your morals and decency for a chance at “success.” If you are going to make it in life, make sure you still have your character and integrity when you reach the top. Good luck to all of you. May God bless you all! -

  38. Enraged says:

    Ron Bacon,

    What’s your email? I too got blackballed and was disliked for being a minority, esp. on rotation. Even worse, I was expelled just 6 months before graduation.

  39. Jon says:

    As a med student, I would have to say that, for the most part, attendings, nurses, interns, and other staff I come into contact with are decent human beings. It is rare that I have had issue with any staff members. In those cases where I have had problems, it is usually simply a minor issue and a result of someone’s moodiness. In such cases, I simply smile and let it go.

    I don’t think the author intends anyone to tolerate truly abusive behavior. I don’t know where some of you go to school, but where I do, virtually all of my preceptors are nice people who take pride in educating me. Perhaps it is because I am a 40 year old male student with a family, and many of my preceptors are younger than me. All I can say is that many of them tell me they remember med school and certainly the last thing they enjoy doing is making it a painful for students.

    I will say I did have one surgery preceptor who was a bit of an a**hole and thought he was God’s gift to the world. I just tried to do my best, kept my head low, and held my breath until the month was over. Personally, I don’t get why people like him even become educators, because I got nothing from that rotation.

  40. Vasca says:

    I also agree that a lot of people have associated the article about getting into an administrative issue with someone above you with real abuse.

    Over 90% of the staff I’ve been with are nice people, you just have to be polite and show some degree of interest. I’m generally hardworking, but there’s been times I’ve done dumb things that now that I look back make me want to laugh but at least I sucked it up and didn’t bitch about it. In one rotation which I didn’t like too much, the residents showed me a newspaper saying if I was bored I could take a look. Well, it had a few good articles and there I was reading the newspaper while a patient was present. It annoyed the doctors, but I just let the issue slide and no problems later.

    As a student, yes, you have the right to complain if a doctor sexually harassed you or was very disrespective of your religious beliefs (however I’m pretty tolerant of that and just let it slide because the country I live in is religious homogenous); but you must choose your battles.

    Have other students told you “X” doctor is a jerk or at the best a punctuality freak and kicks you out if you arrive late? Has the doctor told you he’s like that? If you arrive late and it wasn’t something out of your control, don’t bitch about it, lose the class, remember to be there early the next time asking for permission to enter (I had a teacher who demanded you to ask permission the next time you showed up if he kicked you out or else he’d never let you back in for several weeks) issue solved.

    You’re a student, I recieved good advice from some nice resdients and teachers: you don’t exist. It’s good and bad. Good, because if you screw up on a procedure the top-cat doctors don’t put you into problems, it’s the residents that were supposed to watch you that get into trouble. The consequences of not showing up aren’t as serious as the interns and residents either. But bad in the sense that people can push you around at their free will (buying a coke for someone is up on the list) and be abusive (in the best of cases, overly strict on the dressing code).

    But you won’t be a student forever, pick your battles. If it’s something that is serious, give it a shot (not my experience fortunately, but I’ve known female classmates that were sexually harassed and complained to my university and they couldn’t care less about it and told them to suck it up because the doctor that harassed them was a top-cat and an “intouchable”).

    Think something’s wrong wit that? So sorry, you’re a student and you don’t exist. You can start demanding once you become an intern (and even then good luck because you’re at the bottom pit of the pecking order and chances are nobody will care). Don’t like that? Medicine might not be the career for you.

    Fortunately most of the younger generations of doctors are all cool with students because they don’t want to repeat the abusive behavior they lived through when they were students. When I become an intern, I’ll try not to ignore the students and be cool with ‘em if they are cool.

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