Agraphia Medical Tragicomedy


Constructive Criticism

Let me talk briefly about oral case presentations. Over the years a fairly concise format has evolved so that a large volume of information about a patient can be delivered in a very short amount of time. This format is essential to the workings of a team†, because without the standardization, you forget things. Important things. Like the lab results that came back last night, or the drug that your patient reacted to this morning. I love well-formatted case presentations.

We got to evaluate our Pediatrics Clerkship today. Normally when I evaluate other people, I give them highest marks all the way down the line, because that's just the kind of stand-up guy I am. Y'see, I believe in people.

However, we had one attending on service that routinely interrupted everyone to tell us we didn't know how to present, and rolled her eyes while anyone was talking. On top of that, she distinctly gave me the impression that she had no idea what she was doing. We rounded on 12 kids for 3 hours every morning, and they were the most disorganized, chaotic rounds I've seen all year. People interrupted, took phone calls, looked up lab results... nothing was ever accomplished.

Now, it's very difficult to go through 7 years of medical training and still be incompetent, but somehow this woman pulled it off. I have no doubt that someday she'll kill a kid. She probably already has. We'll put it this way; she was wrong about almost every diagnosis for the past 3 weeks. My interns knew more than her.

So I gave her some pointers on my feedback evaluation. I sincerely hope she reads it, because I included comments like "totally inappropriate during rounds" and "failed to practice evidence-based medicine" and "was incapable of running a service". I also included "did not feel this way about other doctors I have worked with".

Constructive criticism's a bitch, ain't it?

† I'm not saying that you can't shorten things up when a patient is well known to a team... but usually the initial presentation is fairly formal.

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  1. I’d do the same thing. If I were a doctor, that is. Or even where I am, with people playing their bossy roles, while they have absolutely no idea about they are doing.

    PS: I noticed that you rarely reply to comments here, when there is something that needs to be replied.
    PPS: I suggest adding a comments subscription plugin to your blog. Makes it easy to follow comments. Thanks!

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