Friend is an attending on service at an esteemed academic institution...

[VentAlarm]

i agree entirely.

all of us have worked sick.

but at the end of the day that's a bug in medicine, not a feature.

while the OP story is inappropriate on the part of the resident, there are a large group of attendings in academics who feel that they should never have to see a patient primarily again, write a note, or put in orders. the amount of stress and pain that could be alleviated if more people were willing to just practice medicine a bit would be enormous. i dealt with a situation a few years back where one of my residents had to step out of a micu call for 2.5 hours in the middle of the day to do a required residency activity (this was a one off). the micu service had absolutely no answers on how to cover this. fellow hold pager? can't do it. attending hold pager? don't even think about it. their only option was that we had to find another EM resident on one of their days off who would come to the unit, get sign out on 15 icu pts they had never met, and cover them for 2.5 hours. and that is what happened.

again, this was for 2.5 hours from noon to 2:30. the blank stares we got when we asked if the fellow could cross cover their own patients they had just rounded on.....

Ha. Yea, it’s amazing how many of my co-faculty members seem to have obligations or meetings occupying the morning when residents have conference.

I remember once all the housestaff were pulled off service for some important meeting or something. I had the division director very meekly ask me if it was going to be alright or if they needed to arrange some assistance for an afternoon without residents and fellows. I was like “dude, I’m done with rounds in half the time without housestaff - I can put in TPN and DVT prophylaxis orders on my own. The world won’t stop spinning.” Now, take away my icu pharmacist and we have a real issue.

[Random1]

Some times as a physician you have to "own" the problems. I have been in private practice for 20+ years, there is no pretending or hiding at a meeting. If I don't take care of the issue, no own else will. I could not even imagine hiring some one like this who thinks you can just turf your responsibility to someone else whenever you don't feel like working. Maybe i am old school, but just because a you have a social event it doesn't mean patients are not sick or need your help.

[jhwkr542]

I think there's a pretty clear distinction between working through a medical emergency and not wanting to round on your patients during your shift cause you have other stuff you'd rather be doing.

[Lordosis]

I think there's a pretty clear distinction between working through a medical emergency and not wanting to round on your patients during your shift cause you have other stuff you'd rather be doing.

Exactly. Some people know where to draw the line. Others do not.

[Tim]

Sure, but it has swung too far the other way. I had a resident tell me they shouldn’t have to see a social admit because it wasn’t educational. I told her she was wrong and that, believe it or not, they are paying you to do a job. She decided that we should agree to disagree.

Obviously, I think it’s wrong that women used to work in labor until the time to push, but we have gone so soft as to be embarrassing. Give a resident appropriate feedback and it’s almost certainly going to filter back to the program director as not forming an inclusive work environment. If you don’t let your residents leave at 5 with a gold star and snack, it’s abusive.

Not all residents and programs are the same.
Speaking of women and the labor thing, I don't think it would be wise to make a rule no deliveries after 5. Or is that a bridge too far?
The PD won't care. It takes more than inclusive work environment. Diversity, Equity and Inclusion. Actually, allegations are required to be thoroughly investigated.
The same friction in society exists in residencies. PD's, attendings, residents are no different. Perception counts. Is there a reason to think residencies are any different than other parts of society? I think not.

[VentAlarm]

Not all residents and programs are the same.
Speaking of women and the labor thing, I don't think it would be wise to make a rule no deliveries after 5. Or is that a bridge too far?
The PD won't care. It takes more than inclusive work environment. Diversity, Equity and Inclusion. Actually, allegations are required to be thoroughly investigated.
The same friction in society exists in residencies. PD's, attendings, residents are no different. Perception counts. Is there a reason to think residencies are any different than other parts of society? I think not.

They certainly are different. Residencies are, by definition, a part of academia which prides itself on being woke. It’s easier to navigate to most program’s diversity statements than it is to their curriculum, call schedule or philosophy on education. My university put out a statement condemning Putin. Do you think Putin cares what a random med school thinks of him? No.

On the other hand, my father in law owns a business. Do you think he carefully crafted an email about the Ukraine? No. Because he is getting paid to produce. He could serve another client in that hour.

[cards67]

And these residents turn around and complain about malignant attendings. I knew a resident who "needed" to leave everyday by 4. People are weird.

[MPMD]

Ha. Yea, it’s amazing how many of my co-faculty members seem to have obligations or meetings occupying the morning when residents have conference.

I remember once all the housestaff were pulled off service for some important meeting or something. I had the division director very meekly ask me if it was going to be alright or if they needed to arrange some assistance for an afternoon without residents and fellows. I was like “dude, I’m done with rounds in half the time without housestaff - I can put in TPN and DVT prophylaxis orders on my own. The world won’t stop spinning.” Now, take away my icu pharmacist and we have a real issue.

i've had the same experience.

remember once a resident had a family emergency mid shift and had to leave, it wasn't that busy, was trying to activate sick call. come on dude, no way. the number of things that would need to happen to this ED before i "need" a resident is extreme and not going to happen. absolute WCS i have to stay and write some notes or someone with ankle pain waits.

similar is when a resident can't get a procedure or something like that and i can, sometimes i say (in a supportive way not an arrogant one) "i'm supposed to be better than you, that's the whole point."

[F0017S0]

Sure, but it has swung too far the other way. I had a resident tell me they shouldn’t have to see a social admit because it wasn’t educational. I told her she was wrong and that, believe it or not, they are paying you to do a job. She decided that we should agree to disagree.

Obviously, I think it’s wrong that women used to work in labor until the time to push, but we have gone so soft as to be embarrassing. Give a resident appropriate feedback and it’s almost certainly going to filter back to the program director as not forming an inclusive work environment. If you don’t let your residents leave at 5 with a gold star and snack, it’s abusive.

Hahah, I liked the “gold star and a snack”. Same thing when I taught my undergrads during my PhD. Made me lower the boom even harder…

[MaxPower]

i agree entirely.

all of us have worked sick.

but at the end of the day that's a bug in medicine, not a feature.

while the OP story is inappropriate on the part of the resident, there are a large group of attendings in academics who feel that they should never have to see a patient primarily again, write a note, or put in orders. the amount of stress and pain that could be alleviated if more people were willing to just practice medicine a bit would be enormous. i dealt with a situation a few years back where one of my residents had to step out of a micu call for 2.5 hours in the middle of the day to do a required residency activity (this was a one off). the micu service had absolutely no answers on how to cover this. fellow hold pager? can't do it. attending hold pager? don't even think about it. their only option was that we had to find another EM resident on one of their days off who would come to the unit, get sign out on 15 icu pts they had never met, and cover them for 2.5 hours. and that is what happened.

again, this was for 2.5 hours from noon to 2:30. the blank stares we got when we asked if the fellow could cross cover their own patients they had just rounded on.....

As I’m sure all of you did, we took our in-training exam one Saturday morning each year. It always fell to the junior residents to cover call the night before OITE, so one of us was always burned to take the exam since we had been up all night. We suggested that maybe one of the attendings cover the pager from like 11 pm to 7 am, one night per year, so that we could sleep. Of course the answer was “no.” But then guess who got upset when the resident on call the night before didn’t do great on their test?

The program director did hold the pager during the test at least, but he never did anything except write down the consults and give the list to whoever was on call the Saturday of the test. Let’s just say I took my time taking the test the time I was on call during OITE.

[Bellescamp]

I was curious where hospitalists learned that behavior; it's apparently part of training.

I always find it amazing that there is a doc on call for admissions from 5 am to 4 pm and one on from 5 pm to 4 am but nobody on for two hours each day. Imagine if the ER itself ran that way. I get that nobody likes staying late (especially after a 12) but work out a system that makes sure the job is done. Such as the leaving doc putting in holding orders and the oncoming doc starting with that patient on the floor or something. What you get on one end you give back on the other. I feel like my group is only one in the hospital that understands this and works with each other to make sure the job is done.

20+ years as a hospitalist in multiple different systems
this would never fly anywhere I worked
that group needs to change its culture, it’s an outlier in my experience

[resident_1]

As I’m sure all of you did, we took our in-training exam one Saturday morning each year. It always fell to the junior residents to cover call the night before OITE, so one of us was always burned to take the exam since we had been up all night. We suggested that maybe one of the attendings cover the pager from like 11 pm to 7 am, one night per year, so that we could sleep. Of course the answer was “no.” But then guess who got upset when the resident on call the night before didn’t do great on their test?

The program director did hold the pager during the test at least, but he never did anything except write down the consults and give the list to whoever was on call the Saturday of the test. Let’s just say I took my time taking the test the time I was on call during OITE.

Yes, unfortunately its exploitation and being taken advantage of.
Its like being chained to assembly line where you are cleaning fish or say sorting rotten fruit, and can't take a break.

All under umbrella of academia who are jumping out of their pants about their care for peoples rights and fighting injustices in our country.

Its what happens when you as a worker have no rights.

[ACN]

As I’m sure all of you did, we took our in-training exam one Saturday morning each year. It always fell to the junior residents to cover call the night before OITE, so one of us was always burned to take the exam since we had been up all night. We suggested that maybe one of the attendings cover the pager from like 11 pm to 7 am, one night per year, so that we could sleep. Of course the answer was “no.” But then guess who got upset when the resident on call the night before didn’t do great on their test?

The program director did hold the pager during the test at least, but he never did anything except write down the consults and give the list to whoever was on call the Saturday of the test. Let’s just say I took my time taking the test the time I was on call during OITE.

Our attendings took call the night before and the day of. But basically, we did all the consults once the test was over. Our program didn't use the OITE as anything significant, basically, do better than the prior year.

[AR]

He negotiated(wtf?) that the resident put in the orders. His read on the situation was that the resident thought this was punishment for the ask.(Your work is your punishment, wtf?).

It's a Mad World(Gary Jules for the 'lennials, Tears for Fear for X)

I feel like I'm almost as annoyed at your friend as I am at the resident.