Saturday, December 02, 2006

Walking Barefoot Uphill in the Snow....Both Ways!

I'm going to turn in to one of those crotchety old physicians that thinks that the younger generation of physicians are a bunch of slack-asses. I can just feel it already. From time to time I have a medical student on rotation for OB/GYN with me. I usually only have 2 or 3 a year, but lately, more and more have been requesting to switch rotations from some other doc to me. I am flattered, really, that the students are having such a good time in my clinic, but sometimes I come across a student that just rubs me the wrong way. Here is a list of what not to do as a student (claiming to want to go into OB/GYN):

~ show up to round at least half an hour after the physician is already there, and a full hour after the time that s/he told you to be there

~ after being late to said rounds, ask "Well, you don't want me to write notes on the patients *now*, do you?"

~ when your precepting physician asks you to pull up a newish drug on your fancy new PDA to check for interactions, do not say "Don't *you* have one of these to look things up?"

~ wander over and play with the newborn kiddo while your precepting physician is repairing a second degree, and trying to show you how to do it.

~ make up a lie about an ailing, possibly dying, relative, in order to get the full week around Thanksgiving off, rather than just being upfront, honest and asking for the time outright.

~ ask your precepting physician for the dosages of medications when writing prescriptions (after s/he has told you several different times, nevermind that you have a fancy PDA to look them up) because "It's easier to ask you than to look it up."

~ near the end of the rotation, when you are well versed in discharge instructions and discharge meds, when the precepting physician asks you to get a patient's discharge ready, do not ignore her/his request, and instead, play with one of the newborn kiddos in the nursery because "She was crying."

~ decline to watch a circ because you've "seen enough of those, already."

This is just a sampling of the smorgasbord of med student miscues during a recent rotation. It really blows my mind (long winded tirade ahead) because when *I* was a student in a large teaching institution, my butt was rounding on patients at 4 in the morning, frantically getting notes written, vitals, and labs pulled before the intern came in to round between 5 and 5 :30 am. You wouldn't dream of getting to the hospital after the intern much less the attending! All discharge orders were skeletonized (along with prescriptions) and tucked in a pocket in the front of the chart in order for more efficient discharges. If (and I do mean if) the attending ever spoke to you directly outside of lecture and asked you to do something, you better have it done before the request was cold in the air! You certainly didn't smart back. Declining to watch *any* procedure? That just didn't happen. Because of the atmosphere in the hospital in which I trained, you functioned as a Sub-I when you were a third year, and really, as a fourth year, you functioned as an intern. I realize that a small community based hospital is going to be cushier, and definitely not as much work as a large inner city hospital. The respect and interest in learning should be the same across the board though. *Sigh*

Okay, you can start reading again. I'm done ranting for now.

In other news, Mr. Whoo is sitting out in the freezing cold woods looking to shoot some poor defenseless animal, CindyLou is watching her 3rd episode of Mickey Mouse Club-house, and I am getting really good at holding my breath when opening the fridge, lest the smell of the food in there make me gag. I really don't think there is anything rotten in the fridge. Mr. Whoo can't seem to smell anything offensive, but I'm gagging just the same. I'd like to know what is going on with this pregnancy, because I'm really not digging the gagginess, but I would gladly take it if it meant that the bean was going to be ok. I have made the decision not to order any further testing on myself, and I will wait until I see a physician in University City and let them diagnose me...hopefully sometime next week. Thank you all again for your kind thoughts, wishes and prayers. You are the best, and I will keep you updated. :)


Fat Doctor said...

If you get just one of those students every five or six months, you're lucky. We have 20 new kids every six weeks in our clinic. It can be a very miserable six weeks when the "lazy and arrogant groups" come. Do you think they all get that from each other? Is it a virus?

Anonymous said...

My doc always told me gagging was a GOOD sign. Hah I didn't believe him at the time. I was extremely happy when I FINALLY got Zofran at 17 weeks! 40 pills a month that they got approved through my insurance for a $20 copay. Retail price - $1700 a month!

Hoping everything is ok.

Hey I didn't know docs can order their own labs! I know I would be neurotic and would not be able to comfortably let go. I would have to micromanage everything. Heck I am not even a dr and I still order my records to check them out. When I was pregnant, I drove my dr crazy with how are those labs, when are you sending me for a 24 hr again, don't we need to run those liver panels again? Sad I know. It will be ok and hoping your baby bean sticks.

arturo said...

Thanks for the advice! I will print this post so I will not forget it.

medstudentitis said...

Oh man, those med students sound like real winners. I have to say, I haven't done clerkship yet, but when I do, I hope to be a loveable student who doesn't know a whole hell of a lot but tries hard. Although I'm sure I've learned a lot in med school so far, I'm even more sure that the real learning starts when I get onto the wards. I do remember a really kind OB/Gyn who let me go to OB clinic with her one day and she let me go see patients on my own and measure them and work out dates - I thought it was awsome. I'm sure the majority of your students appreciate what you're doing for them, don't let the few losers ruin it for everyone else!

Dr. K said...

I know exactly what you are speaking about; it makes me feel so old when I start a rant to a colleague with "you know, back when *I* was a student ...".

By the way, Dr. Whoo, tag! You're it!

Maggie Rosethorn said...

Gagginess...oh how I remember that from my first pregnancy. I couldn't stand to be around cooking food and grocery shopping became a real chore, too. Good luck with the bean and I hope the gagging goes away soon!

AtYourCervix said...

What's going on with these med students? Do they not realize just what they are getting into? Or is it plain laziness? I have run across a few med students like this, they just have no desire to learn, nor do they show enthusiasm for their chosen profession. Luckily, it's only a few that I've run across that act like this. The majority are very eager to learn, and learn not only from the residents/attendings, but are very receptive to learning from the nurses as well. It shows respect for the entire team, that they want to learn from everyone.

BTW Dr Whoo, you've been tagged!! AtYourCervix

Milk and Two Sugars said...

Just wanted to say that we're still reading. We just don't have anything useful to say! I hope all is going well with the bean.

On another note, there are still some good medical students around. I know of one in Australia, for instance!

Jawndoejah said...

Had to check on you. No news is hopefully good news.


dr. whoo? said...

amy1970~ Yes, all of the quotes above are from the very same one student. Unreal.

Me? Serene? Ha, no. I just recognize in myself the tendency to over-obsess, and I know it won't do any way or the other. If anything, I believe that it is the emotional equivalent of sticking my fingers in my ears and chanting "La la la la la la!"

Thanks for the warm huggy thoughts, though. I'll take all the help I can! :)

FD~ Sometimes I wonder if it *is* contagious. 20 new kids every 2 weeks? Yipe! I wouldn't have the patience.

missgamecock~ As a general rule, nausea is a pretty good sign. However, my perception is somewhat skewed because I was sicker than a dog with CindyLou. I took Zofran every day until I was past 37 weeks just to be able to function. This time around, the nausea isn't nearly so bad, so my brain interprets that as a rather ominous sign. Thanks for the sticky thoughts!

arturo~ The best advice that I can give is to discuss the goals of the rotation with the preceptor at the beginning, be interested, be helpful, ask for feedback, and strive to meet the pre-determined goals. Oh, and don't be insolent or lazy. Simple enough, right? ;)

medstudentitis~ This was only one student, and luckily, I have found them to be the exception rather than the rule at my current institution. Not so with the students where I did my residency. They made being lazy into an art form. I know you will be a super loveable student. I can tell. :)

dr. k~ I know, it makes me feel old, too. Wah.

hi maggie~ Yeah, I have good days and bad days. Brushing my teeth really seems to set it off, but not brushing is a somewhat gross alternative! Thanks for the good luck wishes!

atyourcervix~ I agree, thankfully, that these lazy students are the exception rather than the rule. Doesn't make it any less frustrating, though. I learned (and continue to learn) a great deal of medicine from the nurses with whom I worked as a student. Most of all I learned how to actually *care* for patients from the nursing staff...a valuable lesson, indeed.

milk and two sugars~ Thanks for still reading and the good wishes, I promise I'll have more to say soon, as well! Thank goodness there are good students still out there, or the future of medicine would be quite bleak!

Hi Dawn~ Aw, thanks for checking in on me and the bean! So far, so good. Fingers crossed! :)

Tak said...

Well... I have to admit, I'd not like to watch a circ, mainly because I strongly believe it is genital mutilation (excepting cases where it is medically necessary).

However, the rest of it is out of line. How did you tolerate him/her?