Taking it On The Chin

All the time.

This is part of the secret curriculum of residency.

You will spend time being adequately prepared, thinking ahead, being conscientious, and doing all the right things, only to have somebody or some thing undo all of your work and make you look like a thoughtless and incompetent dipshit in front of the people you need to impress.

They will chew you out or be visibly disappointed, and the painful but most practical course of action will be to keep your mouth shut and take the scolding…

Someone really smart I knew told me that as much as it stings, the best response to any criticism from your superiors in residency is “understood, I will do better/fix it”. Nobody can argue with that response because you arent making excuses.

Life isn’t fair, and medical education is very very very not fair.

If you ever get to the point when this is just too much to bear then in a case like this you just email the case manager. You should be able to look them up on your hospital's sytem.

"Hey I just wanted to clarify what you said earlier about Ms. Johnson when you, myself, Attending GutlessCuck, and my senior resident TakeItDeep were discussing her case. In regards to my treatment of her documented delirium you "cannot believe that I would ruin your work by doing such a stupid thing." In regards to the SNF placement despite our concerns about her mental status you "barely had them believing that she was sane enough to go there but now you'll never be able to make them believe it again." ETC. Did you have any further ideas about how we could have handled that situation safely for this patient in a different manner?

Just use the phrases as closely as possible to exact quotes that you remember.

People don't like to see their own shit in writing, documented for future usage to their superiors.

"Keep your mouth shut" is good advice for residents, but the other staff won't follow that rule. Use this power when needed. It's safest when you're like halfway through residency or more since by that point it's more hassle to boot you than to keep you, even if the PD gets pissy about this strategy.

I used to be way too invested in getting people discharged. Then I realized that this is how it goes. Discharge plans change, patients get sicker unexpectedly, specialists change their mind on inpatient plans. In our current environment where LOS is such a focus, any deviation from the initial admission plan likely will prolong LOS. But here’s the thing, that’s not your problem. Your job is take care of the patient. That means delivering the right care in the right setting. If something can be safely done as an outpatient, great! But if not, and the patient has to stay, resulting in a change is discharge plan, then that’s how it has to be. Care management can cry all they want, but you’re the doctor and you have an obligation by the patient and by your medical license to provide good medical care. Once I started focusing on this, and completely detached myself from being invested in case managements plans, inpatient medicine got a lot easier.

Some malicious care managers know they can bully residents because we’re learning. But the underlying secret is, care management can’t discharge a patient, only a physician can. And if the patient has a justified medical need to remain inpatient, or does not have a safe discharge plan, you’re not discharging that patient and no one can do jack about it.

Lol you’re an intern, but you’ll learn.

The consulting service needs to be accountable for their actions. Who gives a shit if Dr. Boomer MD, Cardiologist gets pissy because he has to own up to delaying a discharge over a potentially dumb reason? What’s he gonna do? Refuse your consults? Stop rounding on your patients?

When you “take it on the chin” for the cardiologist all that tells him is that you’re gonna cover for him more. And to be honest, if case management doesn’t let him know about discharge plans he might not even know he delayed discharge. There have been times we have been set to discharge someone but they still needed some work up done by the specialist so we just let them know abs be like “hey, can this be done outpatient? He’s medically stable and good to go.” The answer is usually yes.

I once was called out by an attending for being "aN hOUr LaTE tO cLINiC!". Clinic started at noon. Mandatory resident lectures ended 10 minutes late that day at 12:10. It takes 20 minutes to walk from lecture hall to designated resident parking lot. It takes 30 minutes to drive from the parking lot to the clinic building. Hmm what's 10 + 20 + 30? Oh right, 60 fucking minutes. I skipped lunch and he had the nerve to bitch about me being late. I guess next time I should get the lifeflight team to drop me off at clinic so I'm only 20 minutes late.

All the time

Yeah all the damn time. Just had an RN tonight who still has yet to check a blood sugar on a patient that I asked for.

It is really annoying. I kept getting a comment from this fat dumb CRNA the other day and said something back, and the attending jumped on me for it. I was off service so it didn’t really matter but man we get no respect

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:( yep.

Fuck that service the the case manager go after them. If you keep taking it you’ll become burnt out faster than the rest of us

I was with you until you used the term cuck.