* * Anonymous Doc

Tuesday, December 14, 2010

I did it. Not well, but I did it. I pulled my medical student aside after rounds, and I told him we need to talk. I told him I wanted to do some mid-month feedback, just check in and see how things are going.

"Oh, they're going great. Thanks."

"No, I want to actually sit down and talk. How do you feel like this is going so far? Are you learning? Are you feeling like a part of the team?"

"Oh, definitely. I think you're great. I talk to some of my friends, and their residents seem really terrible. They're making them stay late, they're giving them all sorts of stupid stuff to do, they're really torturing them. I feel like I got really lucky, and you've been really cool about not keeping me late and staring over my shoulder the whole day."

"Yeah. Great. I appreciate that. Because, you know, I'm just a few months into residency and I'm still learning how to manage the interns and the med students, and it's not always the easiest thing. I don't know that I did a great job of setting expectations at the beginning of the month, and really laying out what everyone's role on the team is."

"No, no, it seems like the interns really like you."

"Yeah, thanks, but that's not-- look, I think there are things you've been really good at. On an interpersonal level, everyone likes you. You're friendly, the patients seem to like you, the attendings haven't said anything negative-- I think sometimes there's a problem with med students who come in and think they have all the answers, and try to show off in front of the patients or the attendings, and that can be frustrating and really hurt the team. And you absolutely haven't done that, and I think that's definitely something you should be really happy about."

"Thanks. You know, I know I'm still a student, and I'm still learning."

"Yeah, exactly. But I think, along the same lines, I think you are probably more competent than you give yourself credit for, and you can take on more responsibility than you let yourself. [I really wanted to make 'you are lazy' sound as positive as I could.] The one big thing I would say you need to work on is taking ownership of your patients, and not just waiting for me to give you things to do, but to be proactive about figuring out what needs to be done, and doing it on your own."

"Yeah, I didn't want to get in the way or anything..."

"And I think that's part of where I failed to set the right expectations. As a med student, you're not just helping out-- you're an actual part of the team. And so you should be the expert on your patients. That means getting in early to pre-round on them every day so you can report to the rest of us--"

"Yeah, I keep meaning to, but I feel like I've been confused about what time rounds are."


"Yeah, but they haven't been that early every day--"

"No, you haven't been on time every day. But every day we start rounds at 7:30. Every day."

"Okay, I'll try to remember."

"It's about more than trying to remember, and it's about more than rounds. Like yesterday, when I asked you about the latest lab work, and you told me you didn't know if the patient had his blood drawn at all. It should be your job to check and make sure that happens, and then follow up to get the results, and then report those results back to me. It's not enough to wait for me to ask, and then tell me you don't know. You need to actually make sure it gets done, and then take the next step and make sure you are an expert in whatever's going on with your patient."

"So you want me to, like, and I don't mean this in a bad way-- you want me to do your work for you on my one patient."

"No, that's what I'm saying-- it's not my work. It's our work, as a team. You're part of the team. This is your patient. You're not just shadowing us. This is your patient. You should be responsible for your patient."

"But I'm just a student. I didn't want to get in the way."

"You're not getting in the way. And you're not making decisions on your own, or left to do anything you're not capable of. My job is to be here to help, when you need help. But you should be the one asking me, not the other way around. I want to be able to trust that you know that patient as well as I do, and you've taken the history, you've checked in on him, you're following up on the tests, you're monitoring what's going on. And then you're reporting back so we can all talk about treatment."

"That makes it seem like I'm the resident."

"No. That's the role of the student. You're training to be the resident, which you will be, in not that many months."

"So you want me to not just ask you what to do, and hope you say nothing so I can leave, or whatever?"

"Yeah. That's what I want."


"Yeah. That's what I need from you."

"Starting tomorrow?"

"No, starting now."



  1. :P Making "you're lazy" sound "positive" is hard work, eh?

  2. Well done. I hope he follows through.

  3. He sounds like he's not looking forward to being a doctor. He will have to, like, actually know the patients' names.

  4. Whoa... you don't need any advice from me on how to be careful and phrase serious issues seriously. Maybe I got the wrong impression from the fact that the shorter, punchier conversations are easier to blog. Nice people skills. (I'm sure he won't change in an instant or anything, but you did your part perfect.) And taking the time to plan an approach on this when you've got so much else going on is very respectful of you.

  5. You did well. And in at most a week I'd sit him down again and discuss what's going well and what (if anything) isn't. It will be good for both of you in the long run.

    Practicing Doctors need good (or excellent) management skills, and I've had several who are clueless. One can't manage to refill a simple prescription for thyroid meds without a week of lead-time, another has an office that's so chaotic even arriving an hour early I wouldn't actually get to see her until 1-2 hours after my appointment time, and then she was yelling at her staff about other patients half of our appointment.

    But your student also needs to know how he's doing. And if he's not getting the hang of it, it might be a good idea as his current boss to discuss how much harder it's going to be as a resident. That he should seriously think about whether this is really what he wants to do with his life.

    As a medical professional you both hold your patients lives in your hands. It's a tough job, but not making someone suffer because of an error or misplaced paperwork or... is important.

  6. Wow, you did a great job. He sounds utterly clueless.

  7. Well done. I hope this student turned it around. Perhaps it was just a confidence issue.

    The feedback skill - especially tough feedback - is invaluable and will stand you in good stead your whole career....any career...in ANY field: medicine, business, law, construction.....art!