(Many of you are about to start third year and are looking forward to it with feelings of both anticipation and dread. You know that it’s going to be the real start of your medical career where you finally get to see what all the fuss is about. At the same time, despite the propaganda, you have the uneasy feeling that third year is going to blow, and blow hard, not for the least of which reasons because, after what in years to come will have seemed like a two-year vacation, you now will be working on a rigid schedule with responsibilities that you can’t casually shirk.
There are two schools of thought about clinical education for medical students. One school believes that your clinical years should be a model for residency complete with long hours, pointless abuse, and call. This is under the theory that it will toughen you up for residency where you will be further toughened up so you can be prepared for the real world where medicine is not practiced at all how it is in residency.
The other school, the Panda School, knows that abuse serves no purpose other than self-justification for the past suffering of the abuser, that you cannot condition yourself to do without sleep, and that clinical training as it is currently structured at most medical schools is actually detrimental to education. Not to mention that since you will get plenty of abuse as an intern, there is no point wearing you out now, especially since, despite what The Man says, you have no responsibility for patients.
I was referred to an interesting discussion on the Student Doctor Network about the mistreatment of medical students by residents and since we have been giving short-shrift to this topic (although Brother Hoover has it covered pretty well) I thought I’d try to address some of the common complaints that medical students have about residents and particularly interns.
I am known to be very easy on medical students, by the way, as some of my medical students who read this blog can probably attest.-PB)
1. It’s my first day on the Service, and my first day of the third year, and the intern is mad that I don’t know anything.
I don’t know of another career where the trainees are berated for not knowing their job on the first day but this is a fact of life for medical students. On the first day you won’t even know how to work the phones much less care for patients and it may take you hours to complete a simple task (such as dictating a brief note) that you will complete in thirty seconds as a resident. This is because you have nothing but jumbled facts bouncing around your brain with no experience in marshalling them into a coherent assessment and plan for your patient. You also have no idea about the logistics of the hospital, where they keep things, and who does what.
I don’t know why this is hard for some residents to understand except that medical school admission committees seem to be selecting for assholes and, although medical school is good for personal growth, these people tend to grow as assholes.
The solution? There isn’t one except the general advice that the hospital is not Thermopylae, the patients are not the Persian hordes, and you are not a Spartan who has to sacrifice himself for the greater glory of a large, bureaucratic machine that if possible, thinks less of you than it does of the residents. Pace yourself. Realize that you don’t know anything, and revel in it. Don’t apologize, and be direct in the face of worthless, spiteful criticism, especially from an intern.
I assure you that interns have very little input into your grade for the rotation and generally speaking, as most residents are decent people, we can see as easily as you which interns are socially dysfunctional. You also have to ask yourself if your grade is more important than your self-respect. If it is, then you will have to suck it up. If not then you should establish the ground rules for how you are going to be treated early. As Dr. Phil says, we teach people how to treat us. If you are firm, forceful, and fair, people will either respect you or they will be intimidated, either one of which is fine. If you are a weak, squirrely biach you are going to be treated as such.
It’s like prison. If you pick a fight with the meanest, baddest prisoner on your first day, win or lose you are going to establish some credibility. I’m not advocating beating your intern but it’s not like this guy is that far removed from you. Hell, it’s July. He’s more scared than you because he has real responsibility. So sometimes, as you learn in the joint, a brother has to shiv’ a motherfucker. Establish early on that you are not a biach and you will do fine.
2. My intern is stealing my work and getting credit for it.
One of your duties will be to see patients and write notes, especially the time-consuming Admission History and Physical. No question about it, medical students write exhaustive H & Ps. You usually have the luxury of time while your intern is perptually under the gun so his may be a little more sparse than yours. While you may turn in a copy of your luxurious History and Physical for a grade, to your intern it is nothing but meaningless paperwork, especially since for 95 percent of patients everything pertinent could be written on a small index card in thick black marker. It’s another obstacle in a day filled with obstacles. He also knows that even in the unlikely event that anybody reads the note, the only thing they are interested in is the assessment and plan and not your detailed description of the patient’s travel history since the Carter administration.
Your intern does not get credit for your History and Physical. There is no such thing as “credit” for this sort of thing. It’s done, the box is checked, and it becomes just another scrap of paper mouldering away down in medical records. I have never heard an attending say, “Hey, that was a cracker-jack History and Physical. Take the rest of the day off.”
So don’t sweat it.
3. My intern is stupid.
Have a heart. You are fresh from two years of intensive lectures and the USMLE Step 1. Your intern spent most of the last six months of fourth year playing video games and catching up on sleep. I am a PGY-2 (second year resident). I once asked a medical student a question and when he went into his pimp-defense mode I said, “Relax, I’m really asking you if you have ever heard of this condition because I sure as hell don’t remember it.
Not to mention that your intern is sleep deprived and under a lot of pressure. It is easy to look and sound stupid if you’re supposed to know what’s going on but don’t which is typical of most interns. It’s not that they’re stupid, it’s just that compared to their upper levels and attendings they seem that way. They’re learning too, just like you but the difference is that they count and you don’t (no offense).
On the other hand since “MD” actually stands for “Minimal Doctor,” it is quite possible that your intern is, in fact, a jibbering moron, at least by medical standards. It is inevitable that somebody is going to slip through the cracks and the “questionable admission” may very well have pulled off yet another snow-job and landed a residency position. Not to mention that there are a few specialties that are known for scraping the bottom of the barrel when it comes to the help.
If he’s a jibbering motard but otherwise a nice fellow you might consider trying to cover his ass. You don’t have to, you understand, and nobody is going fault you or even know if you don’t but good residents look out for each other and you may as well start practicing now. I know, I know. You’ll be helping a guy along who will one day be in the position to hurt patients but decent people don’t think like this. Let his State Board sort it out.
4. My intern tries to get me to do his work, especially on call.
I despise call, probably more than most people. Ever since I started publishing this blog it seems like more and more residents are coming out of the closet in this regard. Certainly when I was a medical student to say you disliked anything about medicine, not just call, was viewed with the same horror by your residents as if you had a large, greasy bowel movement in their Lucky Charms. But they’re not fooling anyone. Call blows. Nobody likes it just like nobody really likes residency training for the most part except that some tolerate it better than others.
So it would be natural for an unscruplous intern to try to either shame you or force you into doing his work for him. Just keep two things in mind. First of all, most medical schools have rules about call for medical students. At some, medical students are to be discharged at some reasonable hour of the night because, wonderous to behold, the school realizes that a medical student’s purpose is to learn, not to be a scut ox who is too tired to study. It is up to you to know the rules and grow a set of gonads about sticking to them. Don’t care for the rotation or the intern? Hey, it’s eleven o’clock buddy and I am outta’ here! All you have to lose is the respect of the intern…but…and stop me if this is obvious…he’s just an intern. His respect his worthless anyways if it comes at the price of your sleep and your health. Stay all night if you want and if you feel like you will learn something but scut work is worthless and you’re not being paid to do it.
The second thing to remember is the French Hooker Rule. No matter what they want, you can only give them what you can give them. It is not your responsibility to clear out the backlog of admissions in the Emergency Department. Most interns wouldn’t even think of giving you this task, not for the least of which reasons that you can’t do it. But sometimes a lazy and unscrupulous intern, on being paged for an admission, will send his medical student to knock out the preliminaries which involves most of the paperwork. Learning is one thing and you need to do some admissions to get the feel for it but you are not cheap labor, the intern is…or didn’t he get the memo?
And I am sick of sports metaphors. It’s not a team. If it were a team everybody would get treated better than they do. It’s more like a salt mine (I mean if we’re going to throw metaphors around). Do your assigned work diligently but don’t be patsy either.
5. My intern berates me in front of the other students.
Berate back. He’s not your mother. There is no penalty for shoving back. You are not contractually obligated to take crap from anyone. On the other hand, no need to be on a hair-trigger, either. Certainly don’t buy into the “Welcome to My Service” speech that some interns like to give. I got one of those as an intern from my twenty-something third-year resident who, among other pearls of wisdom, informed me that my family needed to come second after medicine in my order of priorities. This only sounds good to people who don’t have families, of course. The point is that the intern has different priorities and goals for the rotation than you might have. It may be his specialty and he may be really into it. You may hate the specialty and just want to get through it with the low pass.
The irony of medical school is that you are expected to take abuse from people who are only a few years ahead of you in training and whose ass you would otherwise kick if they treated you half as bad anywhere but the hospital.
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