I'm not like the other people here.
There's a personality to being a doctor-- maybe it's not even about being a doctor, a personality to being someone who's sees themselves as professionally successful, ambitious, driven, I don't know-- it's not that the other residents care more, or work harder, or are better than I am. And I'm not even sure it's that they get more fulfillment out of it or like it more than I do. It's that they're so enmeshed in the hospital, they're so completely consumed by their professional lives as residents that they don't even think about the rest of it.
Not that there's any time to have much of a life-- there isn't. But I worry about that-- I feel like I have other needs, that I can't be at the hospital 24 hours a day, that I need sleep, I need friends, I need to have other things in my head besides the work. And that my entire existence shouldn't necessarily be defined by the job. And that wanting to leave when my work is done-- being able to joke about things with my colleagues-- being a human being instead of a medical robot-- can't be a bad thing.
But that makes me different. And not in a good way.
I'm being vague, when I don't have to be. One of my residents gave me a lousy review. Most of my reviews have been really good-- surprisingly good-- especially from the attendings. Apparently I'm competent at this, even if I don't always feel like I am. The attendings like me, they trust me, my patients like me, and I haven't made any colossal mistakes (yet). Most of the residents I've worked with have been fine-- I've clicked with some more than others, of course, but they've been fine.
And yet one of them gave me a lousy review. He said I'm always working with an eye on the clock, that I push too hard to leave, that I don't seem invested in being there. He said I don't care enough-- not in exactly those words, but close. And I'm not really sure what to make of it. He's right that I work with an eye on the clock, he's right that I want to leave when I'm done-- when we're on days, it's 6AM to 7PM-- on our feet, racing around the hospital all day-- so, yeah, if none of my patients are in acute distress, I am thrilled to be done at 7PM and sign out to night float. That's what night float is there for. This resident routinely stayed until 9, 10, 11 at night-- did it hurt the patients? Of course not. Did it help them? No, not really. There's always more to do. There's always labs to follow up on, family members to talk to, notes to write. If you wait around long enough for someone to stop breathing, someone will. Or there'll be a new admission. Or something will happen that needs a doctor's attention. But we have a night float team. And I need sleep, at least sometimes, to be a decent doctor the next day, and actually help my patients.
And wanting sleep can't make me a bad person. Or at least I hope it can't.
And, see, it almost wouldn't be so bad if he gave me the lousy review but sat me down and talked to me about it. I could explain that, yeah, maybe I don't like staying for quite as many hours as he does, but I try to be efficient and get things done and help the patients, and I could apologize if I seem like I'm rushing to leave, and we could be, I don't know, civil about it. Instead, I feel like he gave me the lousy review and now he's my enemy. Every time we pass in the hall, I feel like he's giving me a dirty look.
And I walked into the ICU last night, just to say hello to the night float people over there-- and he's in there, and he wouldn't even say hello. He and a bunch of his friends were talking about nothing-- the hospital food, whatever-- and he made a point to not include me, he made a point to not be friendly. As if I've done something personally offensive to him-- as if somehow-- even if he thinks I'm a lousy resident, which I don't think I am-- this is a personal issue for him.
Maybe I am too detached. Maybe if I felt more personally invested, I would stay until midnight every night. Maybe I'm wrong for thinking the job doesn't have to consume every moment of my life, and every piece of my existence.
But even if that's true-- and I hope it's not-- why does it mean this guy has to be my enemy? I don't want an enemy. I've worked with residents who don't seem to be that great. It's unfortunate for the patients when they screw up, and it makes my life as a doctor more difficult. I don't feel like I take it as a personal affront. I don't think it means I'm less civil to them as human beings. I may not want to work with them again, but I don't hate them.
Clearly I'm letting it get to me.
Friday, June 4, 2010
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Sounds like he's threatened by you, by your different (and liberating) approach to medicine. That's why he's avoiding you -- he's probably afraid that you will confront him. He sees something in you that will take you far - perhaps farther than he has gone or is capable of going. This is the essence of professional jealousy; happens in all careers, especially those that require dedication and giving more that the usual. That's probably it: he knows you are competent and popular with the attending and he knows that something positive in you is being reinforced by this. He knows that those pats on the back from the attendings will allow you to be happy in your career. Some people are miserable by nature -- this guy sounds like one of them. Hurting people hurt other people. I think you could get back at him by giving him a big smile every time you see him. At best, he may open up a bit more; at worst, he'll be disconcerted and embarrassed enough to not bother you again.
ReplyDeleteI would let you diagnose me in a hot second; if I could afford a plane ticket I would specifically, cheerfully seek you out.
ReplyDeleteDon't be too hard on yourself. A lot of working in any position above Janitor Supreme in a hospital is politics and bullshit.
I want a doctor that has enough damned sense to want to leave when quitting time rolls around - someone human like that is gonna take 10 times as much care of me than a company man just going through motions.
You are more invested by being human than any doc I've gotten. I hope you can get away with it in the long run; your patients will totally benefit.
Not to cause any arguements but where I'm from, residents work 36 hour shifts every other day with 8 hour shifts in between. In spite of that schedule, it's still rare that anyone gets out on time. Yes, even after their 36 hour duties. However, barely anyone complains at all.
ReplyDeleteI guess a huge part of it can be attributed to culture. We have been trained early on in our careers (as early as 4th year medical school) to get used to working that way. No one complains since everyone, up to the most senior resident, follows that schedule.
Basically, what we've come to accept is that it's not physiologic to be a doctor (haha!). But we entered the field knowing well enough what we signed up for, hence, we just have to suck it all up (being overworked, underpaid and with almost no social life at all). Maybe that's the kind of attitude your senior resident wants to come out of you.
I think you should just take this constructively. It probably doesn't mean that you're a bad and lousy resident but like everyone else, we all have lots of room for improvement. Residency is not just about learning about diseases and their management, but also about developing the right attitude you'll need to stay in the profession. Who knows, that resident may very well be the one to make you a better doctor in the future.
Not to cause any arguements here, but where I'm from, residents work 36 hour shifts every other day with 8 hour shifts in between. In spite of that schedule, it is still quite rare for anyone to get out on time.
ReplyDeleteI think a huge part of this can be attributed to culture. We have been trained early on in our careers (as early as 4th year medical school) to follow that type of working schedule. No one ever complains because everyone, up the most senior resident, follows it.
Basically, what we've come to accept is that it's not physiologic to be a doctor (haha!). We entered this career knowing well enough what we signed up for, hence, we just have to suck it all up (being overworked, underpaid and with an almost nonexistent social life). Maybe that is what your senior resident wants to come out of you. The evaluation of the attendings, while arguably more important (since they're the ones who have the final word on who leaves and who stays in the program), isn't as accurate an evaluation of how you are in the workplace as your fellow residents. The latter are the people you spend more time with (consultants just come and go every few minutes) and hence, could give a better assessment of yourself at work than the former could.
I think you should just take this constructively. It probably doesn't mean that you're a bad and lousy resident, but like everyone else, we all have lots of areas to improve on. Residency is not just about learning about diseases and their management, but also about developing the right attitude that you'll need in the profession. Who knows, maybe that senior resident will be the one to make you a better doctor in the future. It's all about character development ^_^
Sorry about the double post. I thought it didn't publish the first time. Just discard the first post.
ReplyDeleteIt is unsafe to work... and work... and work... while making critical decisions that make or break lives; three cheers for getting out on time!!
ReplyDeleteI have a feeling that the long shifts have become a holy cow in medicine. The Slow IT Manifesto paragraph 6 states that you should target the holy cows. Alas, there is a price to pay for doing so, and in medicine it all too often comes down to un/employment.
ReplyDeleteI mean, look at how people were ridiculed or even "frozen out" for targeting medical holy cows such as - introducing the idea of washing your hands between each patient visit, keeping the operating rooms sterile. Or, in even more modern time, some doctor got this strange idea that we might get better faster if we're happy.
And now, some doctors even think they might do better work if they are RESTED! What's next? Will someone try to persuade their peer doctors that smoking might be bad for you?
Reading this after reading your more recent posts, I can see how much you've changed in just 2 years.
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