* * Anonymous Doc

Wednesday, February 2, 2011

I'm very confused by the comments that are very confused about my post yesterday.

Maybe it's different in other hospitals, but we don't stay in one place all the time. We are constantly rotating through different teams, different attendings, different patients, different nurses-- we're in clinic, we're on the floors, we're everywhere. It's not like we stay in one place and attendings rotate through. Everyone is working with new people all the time. Everyone is seeing patients all day. Everyone is in this together.

I don't get the "limited" 80 hour work week comment either. I've never heard anyone try and make an argument that most attendings work longer hours than residents. I'm not saying attendings don't work hard, but attendings-- for the most part-- are not in the hospital anywhere close to 80 hours a week. They may round in the morning with us, and may round again later in the day, but they go home. They have days off.

I worked with this attending every day for three weeks, two months ago. We were together for maybe three hours a day, two months ago, for three weeks. As one of three people on a team that he was working with. I've seen him in clinic eight or nine times since then. Including two days ago. He is someone I've had actual conversations with. He is someone I would have felt comfortable asking for a recommendation letter. I'm not even asking that he remember my name-- although I would think he would remember my name-- but to not remember anything beyond a vague recollection that I look familiar seemed pretty ridiculous to me. "Where do I know you from?" Where do you think you know me from? For three weeks, two months ago, we rounded every day, twice a day, and talked about our patients. Since then, you see me in clinic every week. For me to realize that I'm basically no different than a stranger to him is sort of disappointing.

It's interview season, and they spend an awful lot of energy trying to sell the residency program-- this one and other ones, for sure-- as a place that ends up being like your family for three years, people know each other, people work well with each other, it's a community, blah blah blah. Obviously it's all recruiting garbage and none of what anyone says to get you to take any job at all is ever anything close to reality, but I can't believe that the two comments I received on the post were trying to say that I'm crazy to think that an attending would remember who I am after working together. I give credit to the nurses-- the nurses have to remember more people than any of us, they're constantly working with a different team of attendings, residents, patients, other nurses-- and they basically remember everyone's name and who they are. Is that more a function of their job and being able to do it than for an attending, who can just bark orders at people without having a clue who they are? Maybe. But as a human being-- not as an attending, or a resident, or a nurse, or a patient-- it seems like common humanity to try not to treat the people you work with as complete strangers.

At least fake it. At least smile and pretend to be friendly and know who everyone is. Wave. I don't know. Reciprocate. I think it's posturing more than anything else. "I'm an attending, why should I lower myself to a level where I know you? Why should I know you? You're not important, you're just a resident, you're interchangeable with any other resident, you're a cog in a wheel, now go get me lab results before I forget who you are again."

I sanity-checked the idea of the post with one of my colleagues, who told me a story. An attending, one night, had to come in from home to deal with one of her patients. The resident had mismanaged the case, and the attending came in, dealt with it, and then yelled at the resident for half an hour, telling her she had no idea what she was doing, she wasn't fit to be a doctor, all sorts of stuff. Left her in tears, left her worrying she was going to be kicked out of the program. Next morning, they're rounding, the resident feels terrible about what happened, the attending comes in, gathers the team for rounds, pulls the resident aside and says to her, "I'm so relieved to have you back this morning, you've really been doing a great job. Whoever was on last night was a train wreck, I should find out who she was. But you, you're great, I'm glad to be working with you."

She didn't know how to respond. Nor would anyone. Awaiting more comments to tell me how awesome the attendings are to even let me breathe their air...


  1. I agree with you. I read those comments to the previous post and felt the sting... they definitely seemed misplaced.

    As a lowly medical student, I hope some of my attendings next year will, you know, remember me enough to write me letters. That case of the attending you ran into would make me feel like, "oh wow, I must have done such a great job for him to wipe his memory of mecompletely away after 2mo," but it's not you. Some people are just completely socially inept - and some of those people happen to be attendings.

  2. I'm confused by the comments on your other post as well. Some people like to be contrary, just for the joy of it.

    I was once on a rotation that lasted a month. At the end of the 4th week, we took our 6 person rounds into a patient's room to discuss some findings. Patient and family were very friendly, wanted to be introduced to all of us. The attending (a man who had repeatedly complimented me, told me I was doing a great job, ect ect) went around, introducing all of the residents and interns by name. And when he got to me? He paused... then said, "And....THAT....is a med student."

    So most of us understand where you are coming from.

  3. It's not just the hospital setting... Some supervisors or bosses I've worked with remember me a year or two afterwards, others seem to forget everyone's name as soon as they give their 2 wks notice.

    I think it just boils down to the type of person they are, and not the fact that they're an 'all-important attending' and you're just a 'person who happened to be in the room' for a few weeks. It's frustrating to deal with, but nothing personal. Their memory just sucks.

  4. I thought the comments to the previous post were over the top as well, but it took me a while to figure out why. I know I'm not a doctor, but I've been a manager in a customer oriented field for years.

    You have to remember your team members (who change constantly as junior levels didn't seem to last long), the customers (thousands of them), the vendors, and the bosses in order to do your job well. It seems to me that doctors should be held to the same standards as I was. Oh, and there were lots of weeks where 80+ hours of work occurred for me, so time on the job seems like a bad excuse.

  5. Anonymous here from the last post. Seems I touched a nerve and you decided to have some logorrhea, and in the process I think you missed the point quite thoroughly. I'm glad to see you have much support from your other commenters and loyal readers.

    - I am a resident somewhere, so I may as well start off by identifying myself as one.

    - I am not concerned about comparing residents to attendings. I will not argue with you the specifics as to why attendings have better pay, and frequently better hours, but many more responsibilities and less protection. Nor am I attempting to say that you're crazy to think an attending should at least attempt to remember your name.

    - I am much more concerned by your statement that patients have the lowest status in the hospital and that nobody remembers them, least of all, attendings. This seems incredibly self-aggrandizing and reeks of splitting and/or the development of a Group B personality disorder.

    - I'm glad to hear you have a few anecdotes to share about how attendings can be evil individuals with no remorse, tact, or sympathy, and an innate inability to care for patients like residents, nurses and students do.

    - You must work at a shithole of a hospital if none of your attendings remember their residents or students for "more than three minutes after the end of the rotation," as you tell it. If that is truly the case, your attendings must be at least as exhausted as you are. I can't help but wonder if your attending was running on fumes in the morning after a rough week.

    - I would like to gently remind you that you, too, will be an attending in a few short years, and then your every step and misstep will be magnified, cross-examined, perhaps even posted on the internet in somebody's anonymous blog. And in that time I imagine you, too, will still be complaining.


  6. Agree with Old MD Girl

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  8. (fixed typo)
    In college I was a firefighter paramedic. Once at a call for a small house fire I met the home owner up on his roof. I had to forcefully tell him to get off at once so I could cut a hole in his roof. We both realized we knew one another but I really couldn't remember where in that context.

    About a month later after a dental cleaning I was sitting in the chair with my mouth open and the dentist sat down next to me.

    I thought he said ahh sort of enthusiastically.. so I said "AHH" back and he said, "No I was saying Ah Ha! Your the one who cut a hole in my roof aren't you?" He told me to "relax", then turned to his assistant and asked her to get the saw.