There are times in medical education that you feel like you can’t do anything right. Lately I’ve been feeling that a lot, as has the rest of my team. We walk on eggshells and agonize over every little decision because we just know that regardless of what decision we make, or our reasons for making it (no matter how well intentioned or researched), we will be wrong.
- Rock: I was scolded by an attending for using an antibiotic combination that he didn’t like. Hard place: I used the combo because the attending the week before had told me to.
- Rock: My attending didn’t like the way a week-old surgical incision site looked on my patient, so I was told to consult surgery. Hard Place: Surgery said it looked perfect and not to mess with it. Harder Place: My attending tells me to disregard surgery because it’s infected and needs to be explored.
- Rock: attending who specializes in pain management says use short acting opiates on patient X. Hard Place: attending who is older and higher in position in the hospital says use long acting. Meanwhile my patient hates me because their pain is uncontrolled.
- Rock: my attending expects me to know the value of every single lab that is drawn on my patients from memory at rounds. Hard Place: Freakin labs are never flippin resulted by the time rounds starts.
- Rock: my patient’s condition is well controlled on an inexpensive yet sometimes complicated medication regimen (insulin, anticoagulants, BP meds, you name it) due to cost issues. Hard place: My attending says this regimen is unacceptable (though it is both effective and evidence based) and the patient should be switched to the much more expensive, yet less complicated type that will offer the same control.
- Rock: Attending seems annoyed that I’ve called him 4 times today. Hard Place: attending is mad at rounds that I made a tiny decision without consulting him.
There have been SO many times in the course of my medical education where I’ve been scolded or ranted at over something I had absolutely no control over. I just had to smile, nod, and say, “yes sir,” and hope it didn’t affect my evaluation. I’ve learned with some attendings to not question why they choose certain drugs or make certain decisions, because they really don’t have a good evidence-based reason for it. They do it because it’s how they’ve always done it. And of course they’re right.
And I’m always wrong.