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dr-cox-scrubs.jpgI can’t believe that in my second to last rotation of my fourth year of medical school that I am going to sit here ranting about what I think of as a “third year problem”. It may be one of the worst feelings in your clinical years when you get off on the wrong foot with a resident, nurse, or even worse, an Attending.

If you aren’t already in clinicals or 4th year you may not know how different it is than third year. When you are on a rotation in 4th year, you are often 1:1 with an attending in certain specialties. Normally, as a 4th year, this is a good thing: more attention, more learning, more growth. But there is that other side of the coin where as a 4th year you sometimes wish you could remain anonymously in the shadows, slipping in and out of the hospital without a trace. You’ve earned it, after all!

While we have all gotten on someone’s bad side in clinical years, I have realized it is exponentially worse as a 4th year medical student, ESPECIALLY when it feels completely unfounded. For the next 4 weeks, you will now be 1:1 with an Attending that has dismissed you as ‘just another’ lazy, unintelligent student that is just trying to pass this rotation. This tension is enough to make your existence so uncomfortable, you would rather stick a needle in your eye and swirl it around than have to spend one more minute on this service!

“Ok Leila,” you say, “Isn’t this a little bit dramatic? What could be this bad?” maybe it is dramatic, but if you have been there, you know exactly what I’m talking about. 

My Side of the Story

I recently started working with an Attending that I was so excited to impress: after all, I’m on a huge high! I am almost done with 4th year, I aced my boards, am all done with interviews, and I totally feel like “I got this”. Let’s call this Attending “Doc”.

The second day of the rotation, Doc hands me a giant paper chart, and says “you take this patient”. I have never even looked at a paper chart in my life (it’s 2016, isn’t everyone on EMR?), so this immediately threw me off a bit. When the patient is in the room, I start with my introduction, and my typical, “So what brings you in today?” The patient says she is in pain…everywhere. As I start to begin digging into her history, the Doc walks back in the room: “OK! So present this patient to me!” What. The. F*#$. “Uhhh, I, uhhhh…ummm… I don’t—uh,” I stammer. I don’t even know how old this patient is, I haven’t looked at her chart, don’t know anything about her past medical history, and I haven’t even gotten the chance to ask her about her chief complaint; it’s been 5 minutes!

Doc cuts me off and gruffly scolds me “You guys are all the same. It’s so scary. None of you know how to present a patient! You start with…” and he launches into how to present this patient.

I become defensive. “I didn’t have time to—,” I start to say before he cuts me off: “TIME?! You have to learn how to do things FAST!” Oh and the best part, he tells me “the CS exam is FAST, you are going to FAIL it if you don’t get your act together!”

Ummm…. yeah… I already have passed the CS exam… Doesn’t he know that?

“Just do her vitals,” he barks at me. Oh crap. I haven’t done manual blood pressure since like MS2… all the hospital BP machines are automatic. I mean, I know HOW to do blood pressure, but I also know that it takes me a few minutes, and right now, I’m fumbling all over the place. Damn it. This cuff won’t inflate. There is like a slow leak and I can’t tighten the knob enough to close it. Shit. Shit. Shit.

“What are you DOING!?” the Doc implores.

“I uhh… I can’t get this to inflate…uhhh,” I continue to fumble.

“Give it to me.” He grabs the cuff and starts in on me again: “These are the BASICS, you can’t just go be a heart surgeon, you have to learn the basics. You really need a lot of work!”

It doesn’t end there. For the rest of the day, nothing I said or did was right. He even got so nitpicky as to correct me when I said “patient has a past medical history of Rheumatoid Arthritis---,” he cuts me off: “PAST? PAST medical history? It’s not the PAST if she still has it! Get it together!” What the hell was he talking about? That’s how we present all patients. It just went on and on like this, all day. At one point, he even tried to give me a pep talk, at which point I pleaded, “ I really want the opportunity to show you that I am good at this.” That was the worst thing I could’ve said: “Honey, you have to learn what you don’t know, because you aren’t good at this at all.”

I. Give. Up.

Where did I go wrong?

I made excuses.

No matter how valid your excuses are, they will never be accepted. I’m sure anyone reading this story will say “wow, what a jerk” and side with me… But it doesn’t matter because at the end of the day, HE is the Attending and I am the student. The only response you ever get when you make an excuse is “I don’t want to hear your excuses!” Make it easy on yourself and just stop the excuse before it comes out of your mouth.

I got defensive.

Why does anyone ever get defensive? Pride? “I promise, I’m really much better than this”… never works. Much in the same vein as excuses, defensiveness is never well accepted. Unfortunately, even though it is only natural to defend yourself, it only ever comes across as weakness and insecurity. Wise and reasonable is the person who accepts criticism without becoming defensive. I applaud those people. I am constantly trying to be that person.

I let his words get to me.

Granted, I am an emotional person, have somewhat of an ego, and I care very much what people think about me, but if I’ve learned anything in the clinical years, it’s that ‘words can never hurt me’. They shouldn’t, at least. I can’t count how many times I’ve welled up with tears in the hospital. I’m not proud of it, but I am human that can only take so much. At the end of the day, who cares if he thinks I’m stupid and bad at what I do? I know inside that I am a hard working, compassionate medical student. Most Attendings I work with know this too! In a few months when I start residency and have a little more autonomy and respect, I will be able to show that to the people that matter. In the meantime, I need to learn to just shake it off.

So… What DO you say when everything you say is wrong?

Nothing. You say nothing.

I bet you were expecting me to have some self righteous ‘Meredith Grey” type speech that you can pull out that will not only let you off the hook, but will end with everyone erupting in a slow clap. The Attending will be impressed and he or she will say “I was wrong… you are good, Leila, well done”. Nope. There is no such speech. Life isn’t like the movies, and righteousness doesn’t always prevail.

The moral of the story is that when you are in this type of situation, the best thing you can do is be silent, polite, nod your head and at most say:

“You’re right, Doc. Thank you for the feedback.”

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Leila Javidi

Leila Javidi

Leila Javidi, MD, MPH is a graduate of Saint George's University, a Family Medicine resident at Mount Carmel Health System, and a certified consultant with MST Consulting. Although she had never before considered herself a “standardized test guru,” over the course of her first few years of medical school she developed a fool-proof study style — and crushed her exams. She loves to teach and she prides herself on her ability to motivate students to achieve their maximum potential. She is most known by her students for her sense of humor, her ‘pep talks’ and her ‘no-excuses’ study mentality.
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