Anonymous Doctor

My med student sucks and I think it's my fault.

I can't deal with him anymore. I tell him things, and he doesn't listen. It would be easier if he wasn't there. He's supposed to help ease the load on me and my intern, but mostly he just creates more work.

It's not that hard to be the med student on a team. We give you one or two patients to follow. You pre-round on them-- you come in at 7:30 or so and check on them before we do group rounds at 7:45, so you can give a two sentence report about how they're doing. You listen to the rest of rounds. You check in on your patient a few times during the day. You write a note at the end of the day, that I take a look at and then rewrite for the attending. Throughout the day, you keep alert for ways you can help, and I give you some relatively straightforward-- and, unfortunately, usually boring-- tasks to do when we need another pair of hands. You read up on whatever your patients have, so you can understand the conversations. And when there's the opportunity, I teach, or I have the intern teach-- I bring you in to watch a lumbar puncture, or I explain why we're giving this medication or that one. You ask sensible questions, or you don't. That's pretty much the role.

And, yeah, when I was a med student, there were rotations that were fine and ones that were really boring-- and I definitely didn't want to stay later than I needed to, and I didn't always know what the residents needed me to do-- but there's a baseline level of competence that I hope I had, a baseline level of "at least I'm not making their lives more difficult," that I don't think my med student this month has. At all.

And I want to give him a terrible evaluation, but I worry it's my fault for not setting expectations, and for not teaching enough. It's a one-resident/one-intern team, so there's not a lot of time to teach.

But here's the problem. He doesn't really understand that the patients I assign him are his patients, and he should feel some responsibility for getting to know them, checking in on them, and reporting back to me about how they're doing. He doesn't come in early enough to pre-round, and he doesn't seem to care-- "Oh, I didn't see him yet. You wanted me to see him today?" "I want you to see him every day. We round at 7:45. You need to come in early enough to see him beforehand, at least for a few minutes."

He doesn't read up on what the patients have, so he can't follow anything we talk about. So he doesn't have opinions, or questions, or ideas, or anything at all to say. I ask him questions and he never knows the answer-- or at least if he would realize he doesn't know the answer, and say he'd look it up, or he'd make sure to try and learn some more about it. But, nope, never. And I give him things to do, and they don't get done.

"Can you ask the nurse if she ever sent off the blood sample?"

"Sure," he says, as he continues to text on his phone.

Ten minutes later I ask him he checked with the nurse.

"Oh, not yet. Did you need me to do that soon?"

"Yes. I needed you to do it when I asked you to do it."

"Oh. Okay."

And then he does it, but doesn't bother finding me to tell me the answer, and I end up asking the nurse myself.

I asked him to run down to CT scan when the tech wasn't picking up the phone, to see if anyone was around, and when they could take our patient.

He disappears for 45 minutes, comes back with a snack.

"Can they take him?"

"Oh, the tech wasn't sure. There's a backup."

"Did he say when we could send him down?"

"No, I don't think so."

"Can you call him and see?"

"Now?"

"Yeah, now."

And at 5:00 on the dot, even if we're in the middle of running a rapid response, he's got his backpack on and he's out the door. Half the time, without writing a note on his patient.

I want to ask him-- "How do you think this is going? What are you getting out of this rotation? How can I help you get more from this / be more engaged / care a little bit?" But I don't feel terribly confident that I know how to have that conversation. Because maybe it's my own fault for not sitting down with him on the first day and being really explicit about all of this. I thought I was, but I also figured he's now four months into the year and has had other rotations already and should be slightly more used to this process than he seems to be. And maybe it's less my fault than the resident who preceded me-- the med student came on four days before I started, and I don't know what the last resident had him do. Maybe she had him do nothing, and he figured that's what this rotation is, you do nothing and everyone's fine with that. But I feel like I keep having the same conversations with him. "I need this done." "Okay." "Did you do it?" "No." And so I want to kill him.

This is why a lot of being a resident has very little to do with how much medicine you know or how good of a doctor you will be. It's about being a supervisor and a manager of people, it's about being a boss.

Maybe I'm just worried that once I tell him he needs to stop texting and stop surfing the web all day, he will start watching me, and every time I check my e-mail, or go to the bathroom, I will feel like I'm doing something wrong. And this way, I can be slightly lazy because I know he's incredibly lazy and so I'm awesome in comparison.

But it's not like I'm being lazy. I'm getting everything done, my patients are okay. It's just that in a lot of ways I still feel like the med student, and I don't necessarily want to be watched like a hawk and micro-managed. I don't want to be the resident who makes the job suck for my med student. But that only works if the med student doesn't suck. He sucks. That's all there is to it. I wish I could trade him in and get a new one.