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We discuss a Reddit post from a resident dealing with an attending who takes melatonin and Lunesta during their shared overnight calls, rendering them unavailable and leaving the resident alone to manage all patient care decisions.
We discuss various approaches to addressing this dilemma, weighing the merits of speaking with trusted senior residents versus approaching program leadership directly.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
All right, so we are back.
If you missed the last segment,we just talked about a medical
myth that Dr Nee thinks needs tobe retired.
Ie doctors ain't leaders, sostop running.
Then we talked about days thatwe don't work, especially as
locums, days that we just thinkare unacceptable.
Now we're about to talk aboutwhat Dr Nee we're about to talk
(00:24):
about what Dr Ne.
Speaker 2 (00:25):
All right, you know I be scouring Reddit, so let's
talk about an unreachableattending on call person in the
residency forum.
They want advice.
So it says hey, everyonelooking for advice and sanity
check from fellow colleagues.
I'm currently doing 24 hourin-house calls and I share these
(00:45):
shifts with an attendingphysician.
Here's the issue afterfinishing outpatient clinic
around 5 pm, this attendingroutinely takes melatonin and
lunesta to get good sleepovernight.
He goes to bed around 6 pm andbasically knocks out for 12
hours straight.
We're both still on call duringthis time, but here's where it
(01:07):
gets uncomfortable.
After taking Lunesta I don'tknow why this person is using
the trade name.
Anyway, he becomes oddlytalkative, emotionally
unfiltered and starts sharinginappropriate or personal
secrets about his life.
He laughs randomly over sharesand clearly isn't functioning
with normal inhibition.
Once asleep he is completelyunavailable, doesn't respond to
(01:29):
texts or calls.
During the night I'm leftmanaging everything, including
some higher stake decisions, andhonestly I'm not sure he'd even
be capable of handling anemergency if one came up.
Speaker 1 (01:41):
He wasn't taking Lunesta.
Speaker 2 (01:43):
Has anyone seen similar behavior in their
program?
I've asked other residents andI'm getting mixed feedback.
Some say it's just how it goes,others are more concerned.
I want to be reasonable, but Ialso don't want to be the only
one awake and responsible by theattending.
It's pharmacologically sedated.
Ooh, that's a good question.
Before you answer Dr Renee thatquestion or give advice, I want
(02:05):
you to take a guess whatspecialty you think that is,
cause I got thoughts you know.
Speaker 1 (02:09):
I am.
They take all I am In aresidency program.
Speaker 2 (02:18):
Yeah, I was going to say something like psychiatry or
something like that.
It can't be something like itis not surgery.
There's no way that's surgeryOB.
There's no way it's OB.
Speaker 1 (02:29):
Oh hell no.
Speaker 2 (02:31):
There's no way.
It's ER OB.
Speaker 1 (02:34):
That would be a career.
That's why I don't think it'shospitalized.
Speaker 2 (02:39):
I don't think it's IM , but it could be IM because
they just admit.
Speaker 1 (02:44):
Or family med.
Speaker 2 (02:48):
Family med, I'd have to say it's probably some, it's
some specialty that.
Once they said the office thingI was like, yeah, it's not like
psychiatry or ophthalmology orsomething like that family med,
family med, I think all Allright.
So they ended off by saying Iwant to be reasonable, but I
also don't want to be the onlyone awake and responsible.
(03:09):
While they're attending thispharmacologically sedated she or
he sound like they hate androll there, but anyway, has
anyone seen similar behavior intheir program?
I've asked other residents andI'm getting mixed feedback.
Speaker 1 (03:28):
Some say it's just how it goes, others are more
concerned thoughts, renee,thoughts, thoughts, thoughts,
thoughts.
Speaker 2 (03:33):
Hey yo, you want to talk about inappropriate that is
so inappropriate to take a napor to be sleeping.
No, no, no.
What's more and moreinappropriate to be sleeping and
not responding to texts, or tobe talking about your personal
life no, no, it's fine that yousleep.
Speaker 1 (03:47):
You must respond.
But it's fine if you sleep.
It is not fine that you takemelatonin and lunesta that's
what I'm saying.
Speaker 2 (03:57):
This is not that hype .
This is not a crazy typespecial.
This is what I'm telling you.
Most people who are likethey're like I.
I ain't taking both.
I'm on call.
Speaker 1 (04:05):
Me.
We talked about a surgeon, aurologist, who was on cocaine
during surgery.
I mean, but he's, he'savailable though.
Anyway, if you call him heprobably do your surgery real
fast too.
Speaker 2 (04:20):
I need a Foley word.
I got you know like I need aFoley Word.
I got you know like, come on,I'm telling you, I think this, I
think this is a psych.
It's probably urology, it'sprobably psych Things, that
things, that emergencies don'thappen that often.
Speaker 1 (04:34):
That's what it is when people do in first of all.
It's inappropriate either way.
When people do inappropriatethings, they don't do it at
appropriate times Like that,don't even make no sense.
They inappropriate things, theydon't do it at appropriate
times like that don't even makeno sense.
They make no sense.
Why would it be the voice of,the voice of reason?
Here we go, go ahead.
It's like it's it's family med.
(04:54):
It's family med.
What?
What was it?
Speaker 2 (04:55):
high acuity, high acuity stuff it's not high
acuity stuff, I don't think whatdoes it say?
Speaker 1 (05:00):
what does it say?
Speaker 2 (05:03):
they finish outpatient clinic around 5 pm.
They take their Lunesta andthey take their melatonin
Melatonin.
Speaker 1 (05:10):
Right and they're left to do what.
What's the resident left to do?
Speaker 2 (05:15):
I'm left managing everything, including some
higher stake decisions, exactly.
Speaker 1 (05:18):
I'm not sure.
Speaker 2 (05:21):
Exactly.
Whatever it is, there's notmany emergencies.
Speaker 1 (05:24):
this sounds like this sounds like a, a resident who
might be handling some, like youknow, patients with multiple
comorbidities coming in withthings that might be pretty high
acuity and they they're havingto stabilize on their own like
(05:48):
uh-uh.
I mean it's just inappropriate.
Speaker 2 (05:51):
I'm potting.
I'm potting right now, but if Iwere to be a betting person,
this is not surgery, this is notOB.
This is not any of the thingsthat you would consider.
Like, yo, you need to be upBecause the attendant can sleep,
but if I call you, you need towake up.
All right, like.
Those are the things that occur, those type of specialties this
is.
I don't think this is one ofthem, but I do think on the real
(06:13):
real, you know, you got to talkto your program director.
You got to talk to your programdirector like, listen, yo, you,
we got an attending who isunreliable and, in essence,
who's not teaching Right andgranted, I'm making decisions
and I have to go rely on thetextbooks and all these
different things, or I'm justflying at the seat, or I'm just
flying on the seat of my pants.
(06:33):
This is some inappropriate like.
This should not be going on.
I'd be a little bit nervous,though, to go to my program
director at first, because I'msure they're going to be like
this person's going to be like.
So I was on call last time andI was with this resident, or
maybe every time I'm on call, Ihappen to be on this resident
(06:53):
and now I hear this complaintsand stuff.
I'd be a little bit nervous andstuff.
But you gotta talk to yourprogram director and get this
handled because this is, unlessthe person is the program
director what do you do then?
Speaker 1 (07:01):
you go to the chair.
Speaker 2 (07:02):
You have to go to the chair now you can't go to the
chair, man but, what do you do?
Speaker 1 (07:08):
if the person you can go to the chair.
Speaker 2 (07:13):
I could not go to the chair.
Rest in peace.
Rest in peace to my chairperson.
He will always, forever, be mychairperson.
I love my chairperson, butthese type of issues I could not
go to my chairperson for, no.
Speaker 1 (07:26):
So who would you have gone to?
Speaker 2 (07:28):
I don't know, but I call my residents.
My residents are alwaysavailable, even the residents
who aren't called.
They're like yo Gonzalez, yoKeyway, yo Babalolo.
Speaker 1 (07:41):
So one of the things.
Speaker 2 (07:44):
And, to be honest with you, we didn't really call
the attendings.
We call like we go to theresidents go to the residence?
Speaker 1 (07:54):
well, of course, but like when it's just you and an
attending on right, like thereyou I don't know if you had
those situations because there'sa setup I don't know if when
you went to columbus, yeah,that's, that's where yeah?
right, you have to talk to theattending right, because I I had
situations like that where it'sjust me and the attending right
, like when I went to RaritanBay, right, my mentor, dr Brugge
.
Oftentimes I was on with herright, so it's like there was
(08:18):
nobody else to go to.
But you know, yeah, I mean.
So here's one other thing youcould do.
Now, this really really, reallydepends on how, like, what is
the culture of your residencyand what is the relationships
(08:40):
that the residents have with theattendings, because sometimes,
like, the hierarchy gets alittle blurred depending on you
know the hierarchy.
Like you understand what I'msaying, the hierarchy gets a
little bit blurred, like as youget more senior.
You know what I mean.
Do you know what I mean?
(09:02):
Right, where you were now as asenior resident, you're like,
all right, I'm going to justtalk to my attendant, like my
colleague now, because I'm done.
I've been in this three, four,five years.
I just we're not going throughthis, no more.
You might, might, if you canidentify a senior resident who
(09:25):
is cool with this person, tellthat senior resident hey, yo,
your boy or your girl istripping.
They're taking lunestamelatonin.
I'm trying to figure out.
Speaker 2 (09:40):
How do they know this , though?
How do they know that they're?
Speaker 1 (09:42):
they're speaking inappropriate stuff.
Probably when they do wake up,they're like I took a melatonin
and a lunesta.
They're probably admitting itright right out because it's
inappropriate and they'rethey're being inappropriate,
they're talking about theirpersonal life.
They're talking about so it's.
I mean, it would be no smallfeat to say like they probably
(10:04):
told them that they were takingLunesta and melatonin.
So I remember this one time.
I remember this one time I wason call.
I was on call, actually, at oneof our satellite hospitals and
I don't know what happened, butat the satellite hospital there
(10:28):
wasn't anything going on.
So I was like wooo, whoo, I getto sleep.
When I tell you, I was tiredthat day.
I was so tired but nothing camein, thankfully.
And I wake up right in time forsign out.
And when I wake up I look at myphone and I'm like look at my
(10:58):
phone.
And I'm like but there's athree minute conversation here
with one of my junior residentsfrom our main hospital, but I
don't remember talking toanybody.
I was like I don't remembertalking to anybody.
So I call her and I'm like yo,did you call me last night?
She's like yeah, I'm like didwe speak?
She's like yeah, I'm like whatdid we talk about?
(11:21):
She's like yeah, I had thispatient who was in preterm labor
and I was asking you what Ishould do, cause I guess she
didn't like the, she didn't likethe senior who was on call at
the main hospital, like she justdidn't trust his judgment.
And she was like, yeah, so Icalled you, so I asked you what
(11:42):
to do, and I'm like, what did Itell you to do?
Speaker 2 (11:45):
She's like you told me to drink soup.
Make sure you put some bread inthat mug and stuff scoop it up.
Speaker 1 (11:52):
She's like you told me procardia, start her on mag,
whatever the hell.
I told her um antibiotics ifshe was ruptured.
I can't even remember the wholestory, but essentially it was
the right management and I waslike, hey yo.
Speaker 2 (12:11):
So is this doctor?
Is this attending?
What do you call it?
Intoxicated Does?
Speaker 1 (12:18):
this count as intoxicated?
Yes, under the influence atleast.
Yes, yes.
Speaker 2 (12:25):
I think, I would do.
I probably would do a seniorresident.
I talked to a senior residentabout it.
I might even find anotherattending that maybe I have a
better relationship with.
Speaker 1 (12:38):
Yeah, like yo, you gotta talk to your boy, you know
, like yeah right, you knowright um program director?
Speaker 2 (12:47):
yeah, because, there's a fear of retaliation.
Would you be nervous aboutretaliation?
Because I know you, you, you,nothing bothers you at all.
I know you're gonna try.
I would say I just want to knowis there, would there ever be
any like thought process in yourmind?
Like yo, this person couldfigure out who's like
complaining about them andthere's a little fear of
retaliation it depends on whothe person is.
Speaker 1 (13:09):
Yeah, depending on who the person is.
Yeah, depending on who theperson is.
I think that there aredefinitely I mean, I could think
off the top of my head certainattendings who I think, yeah,
would come after me because Iput that out there, absolutely.
And then there's others who Ithink, you know, would just be
like man, I was, I'm just reallytired and I got to do X, y and
(13:30):
Z and blah, blah, blah, but youknow, and then say you know,
like, no, you're right, Ishouldn't have, I shouldn't have
done that.
Speaker 2 (13:36):
But more than likely, though, if someone is doing
this like you're not the onlyresident that is seeing this
type of behavior.
Correct Nurses have seen thisbehavior Correct.
Other you know patients mayhave seen this behavior and more
than likely you're just one ofmany who's going to say
something.
It's just that you know this isthe first time that you've had
to stand up and say something oryou feel like you have to stay.
Speaker 1 (13:58):
Yeah, yeah.
Speaker 2 (14:00):
But remember it's all about.
This is part of advocacy.
You're advocating for yourself,Would you?
Speaker 1 (14:05):
tell.
Speaker 2 (14:05):
Who me.
In your program specifically,it depends.
Speaker 1 (14:12):
In your program specifically, it depends.
Speaker 2 (14:12):
In your program?
Yeah, because, like, the stuffthat I was dealing with is
really high acuity, right.
Like that stuff, like I can'tadmit someone without their
input.
I can't really like if it'sminor things like someone's
potassium or you know somethingelse.
Speaker 1 (14:30):
Yeah, but that's things you don't call in
attending for.
So anything that attending forpotassium at night, you think
ortho?
Speaker 2 (14:38):
does that?
This might be ortho.
This might be orthopedicsurgery it could be ortho,
because you know they'll be like, which I think they'd be like,
they'll be like.
Speaker 1 (14:49):
And Seth, I'll see him in the morning.
Speaker 2 (14:52):
Yeah, man, Okay, I would so for me if I needed.
Like I just remember my program, If I called my attending, it
was always for something thatwas like major.
Speaker 1 (15:03):
Yeah.
Speaker 2 (15:04):
So if it was something that I could not get
in contact with my attending forand I needed to get them in,
get in contact with them, it's aproblem, right?
This is someone I may have tocrack someone's chest.
This is someone that I may haveto take to the op, or someone
who may need an operating room.
This is someone who may need togo back on on pressers.
Like I remember, at my program,we weren't allowed to just put
people back on pressers withoutletting the attending know,
(15:26):
because they didn't want to comein the next morning and be like
yo.
So first of all, why is?
this person on pressers?
Why didn't you let me know?
And then what did you do aboutit?
You know.
Speaker 1 (15:38):
Right.
Speaker 2 (15:39):
So those are things that like were big deals, right?
And if you're admittingsomething like, you damn sure
can't admit someone to thesurgery service without letting
your attending know.
Are you crazy?
Speaker 1 (15:47):
Yeah, you know, I mean, yeah, I think in my
program I definitely would havetold I mean we could more freely
admit people.
Um, we could more freely admitpeople on, especially on labor
and delivery.
You know, patient comes in,she's eight centimeters, you
(16:09):
know.
Or patient comes actuallypatient goes in, she's five,
let's say five centimeters,because eight centimeters, you
know.
Or patient comes actuallypatient comes in, she's five,
let's say five centimetersbecause eight centimeters.
Eventually you want to let themknow hey, she's going to
deliver, but like she comes in,she's five centimeters and she
just kind of chugging along butyou might not know, you're
attending until this boils downto the leadership thing you're
talking about.
Speaker 2 (16:27):
This boils down to leadership again, like right,
like you're gonna have to learnhow to have some difficult
conversations.
You know these difficult heylook, these difficult
conversations, they start withyou.
You know, like they don't start, I think sometimes people say
like it's gonna be real cleancut and it's gonna be like
should we discharge someone ornot?
It doesn't start like that,guys.
No, it actually starts withsomething that's related with
(16:48):
you, like how you're beingtreated or what you see at your
job or what you see at yourschool, and you either see bad
behavior or something's gonnacome back and get you, or you
feel like somebody's gonna comeback and retaliate you what
you're gonna do.
That's how it starts.
Speaker 1 (17:01):
So I don't know that's a very interesting
situation, but good luck towhoever that is.
Hopefully, hopefully, they toldsomebody Thoughts and prayers,
thoughts and prayers.
Thoughts and prayers.
Speaker 2 (17:19):
Peas and peas, Peas and peas.
All right, y'all Listen.
We're going to go into our nextsegment where we're going to
make a little comment on afamily medicine resident who
actually wrote back to us afterwe gave them advice on the
previous episode.
So catch you on the nextsegment.
All right, so we are back.
If you missed the last segment,we just talked about a medical
myth that Dr Nee thinks needs tobe retired.
Ie doctors ain't leaders, sostop running.
Then we talked about days thatwe don't work, especially as
locums, days that we just thinkare unacceptable.
Now we're about to talk aboutwhat Dr Nee we're about to talk
(00:24):
about what Dr Ne.
Speaker 2 (00:25):
All right, you know I be scouring Reddit, so let's
talk about an unreachableattending on call person in the
residency forum.
They want advice.
So it says hey, everyonelooking for advice and sanity
check from fellow colleagues.
I'm currently doing 24 hourin-house calls and I share these
(00:45):
shifts with an attendingphysician.
Here's the issue afterfinishing outpatient clinic
around 5 pm, this attendingroutinely takes melatonin and
lunesta to get good sleepovernight.
He goes to bed around 6 pm andbasically knocks out for 12
hours straight.
We're both still on call duringthis time, but here's where it
(01:07):
gets uncomfortable.
After taking Lunesta I don'tknow why this person is using
the trade name.
Anyway, he becomes oddlytalkative, emotionally
unfiltered and starts sharinginappropriate or personal
secrets about his life.
He laughs randomly over sharesand clearly isn't functioning
with normal inhibition.
Once asleep he is completelyunavailable, doesn't respond to
(01:29):
texts or calls.
During the night I'm leftmanaging everything, including
some higher stake decisions, andhonestly I'm not sure he'd even
be capable of handling anemergency if one came up.
Speaker 1 (01:41):
He wasn't taking Lunesta.
Speaker 2 (01:43):
Has anyone seen similar behavior in their
program?
I've asked other residents andI'm getting mixed feedback.
Some say it's just how it goes,others are more concerned.
I want to be reasonable, but Ialso don't want to be the only
one awake and responsible by theattending.
It's pharmacologically sedated.
Ooh, that's a good question.
Before you answer Dr Renee thatquestion or give advice, I want
(02:05):
you to take a guess whatspecialty you think that is,
cause I got thoughts you know.
Speaker 1 (02:09):
I am.
They take all I am In aresidency program.
Speaker 2 (02:18):
Yeah, I was going to say something like psychiatry or
something like that.
It can't be something like itis not surgery.
There's no way that's surgeryOB.
There's no way it's OB.
Speaker 1 (02:29):
Oh hell no.
Speaker 2 (02:31):
There's no way.
It's ER OB.
Speaker 1 (02:34):
That would be a career.
That's why I don't think it'shospitalized.
Speaker 2 (02:39):
I don't think it's IM , but it could be IM because
they just admit.
Speaker 1 (02:44):
Or family med.
Speaker 2 (02:48):
Family med, I'd have to say it's probably some, it's
some specialty that.
Once they said the office thingI was like, yeah, it's not like
psychiatry or ophthalmology orsomething like that family med,
family med, I think all Allright.
So they ended off by saying Iwant to be reasonable, but I
also don't want to be the onlyone awake and responsible.
(03:09):
While they're attending thispharmacologically sedated she or
he sound like they hate androll there, but anyway, has
anyone seen similar behavior intheir program?
I've asked other residents andI'm getting mixed feedback.
Speaker 1 (03:28):
Some say it's just how it goes, others are more
concerned thoughts, renee,thoughts, thoughts, thoughts,
thoughts.
Speaker 2 (03:33):
Hey yo, you want to talk about inappropriate that is
so inappropriate to take a napor to be sleeping.
No, no, no.
What's more and moreinappropriate to be sleeping and
not responding to texts, or tobe talking about your personal
life no, no, it's fine that yousleep.
Speaker 1 (03:47):
You must respond.
But it's fine if you sleep.
It is not fine that you takemelatonin and lunesta that's
what I'm saying.
Speaker 2 (03:57):
This is not that hype .
This is not a crazy typespecial.
This is what I'm telling you.
Most people who are likethey're like I.
I ain't taking both.
I'm on call.
Speaker 1 (04:05):
Me.
We talked about a surgeon, aurologist, who was on cocaine
during surgery.
I mean, but he's, he'savailable though.
Anyway, if you call him heprobably do your surgery real
fast too.
Speaker 2 (04:20):
I need a Foley word.
I got you know like I need aFoley Word.
I got you know like, come on,I'm telling you, I think this, I
think this is a psych.
It's probably urology, it'sprobably psych Things, that
things, that emergencies don'thappen that often.
Speaker 1 (04:34):
That's what it is when people do in first of all.
It's inappropriate either way.
When people do inappropriatethings, they don't do it at
appropriate times Like that,don't even make no sense.
They inappropriate things, theydon't do it at appropriate
times like that don't even makeno sense.
They make no sense.
Why would it be the voice of,the voice of reason?
Here we go, go ahead.
It's like it's it's family med.
(04:54):
It's family med.
What?
What was it?
Speaker 2 (04:55):
high acuity, high acuity stuff it's not high
acuity stuff, I don't think whatdoes it say?
Speaker 1 (05:00):
what does it say?
Speaker 2 (05:03):
they finish outpatient clinic around 5 pm.
They take their Lunesta andthey take their melatonin
Melatonin.
Speaker 1 (05:10):
Right and they're left to do what.
What's the resident left to do?
Speaker 2 (05:15):
I'm left managing everything, including some
higher stake decisions, exactly.
Speaker 1 (05:18):
I'm not sure.
Speaker 2 (05:21):
Exactly.
Whatever it is, there's notmany emergencies.
Speaker 1 (05:24):
this sounds like this sounds like a, a resident who
might be handling some, like youknow, patients with multiple
comorbidities coming in withthings that might be pretty high
acuity and they they're havingto stabilize on their own like
(05:48):
uh-uh.
I mean it's just inappropriate.
Speaker 2 (05:51):
I'm potting.
I'm potting right now, but if Iwere to be a betting person,
this is not surgery, this is notOB.
This is not any of the thingsthat you would consider.
Like, yo, you need to be upBecause the attendant can sleep,
but if I call you, you need towake up.
All right, like.
Those are the things that occur, those type of specialties this
is.
I don't think this is one ofthem, but I do think on the real
(06:13):
real, you know, you got to talkto your program director.
You got to talk to your programdirector like, listen, yo, you,
we got an attending who isunreliable and, in essence,
who's not teaching Right andgranted, I'm making decisions
and I have to go rely on thetextbooks and all these
different things, or I'm justflying at the seat, or I'm just
flying on the seat of my pants.
(06:33):
This is some inappropriate like.
This should not be going on.
I'd be a little bit nervous,though, to go to my program
director at first, because I'msure they're going to be like
this person's going to be like.
So I was on call last time andI was with this resident, or
maybe every time I'm on call, Ihappen to be on this resident
(06:53):
and now I hear this complaintsand stuff.
I'd be a little bit nervous andstuff.
But you gotta talk to yourprogram director and get this
handled because this is, unlessthe person is the program
director what do you do then?
Speaker 1 (07:01):
you go to the chair.
Speaker 2 (07:02):
You have to go to the chair now you can't go to the
chair, man but, what do you do?
Speaker 1 (07:08):
if the person you can go to the chair.
Speaker 2 (07:13):
I could not go to the chair.
Rest in peace.
Rest in peace to my chairperson.
He will always, forever, be mychairperson.
I love my chairperson, butthese type of issues I could not
go to my chairperson for, no.
Speaker 1 (07:26):
So who would you have gone to?
Speaker 2 (07:28):
I don't know, but I call my residents.
My residents are alwaysavailable, even the residents
who aren't called.
They're like yo Gonzalez, yoKeyway, yo Babalolo.
Speaker 1 (07:41):
So one of the things.
Speaker 2 (07:44):
And, to be honest with you, we didn't really call
the attendings.
We call like we go to theresidents go to the residence?
Speaker 1 (07:54):
well, of course, but like when it's just you and an
attending on right, like thereyou I don't know if you had
those situations because there'sa setup I don't know if when
you went to columbus, yeah,that's, that's where yeah?
right, you have to talk to theattending right, because I I had
situations like that where it'sjust me and the attending right
, like when I went to RaritanBay, right, my mentor, dr Brugge
.
Oftentimes I was on with herright, so it's like there was
(08:18):
nobody else to go to.
But you know, yeah, I mean.
So here's one other thing youcould do.
Now, this really really, reallydepends on how, like, what is
the culture of your residencyand what is the relationships
(08:40):
that the residents have with theattendings, because sometimes,
like, the hierarchy gets alittle blurred depending on you
know the hierarchy.
Like you understand what I'msaying, the hierarchy gets a
little bit blurred, like as youget more senior.
You know what I mean.
Do you know what I mean?
(09:02):
Right, where you were now as asenior resident, you're like,
all right, I'm going to justtalk to my attendant, like my
colleague now, because I'm done.
I've been in this three, four,five years.
I just we're not going throughthis, no more.
You might, might, if you canidentify a senior resident who
(09:25):
is cool with this person, tellthat senior resident hey, yo,
your boy or your girl istripping.
They're taking lunestamelatonin.
I'm trying to figure out.
Speaker 2 (09:40):
How do they know this , though?
How do they know that they're?
Speaker 1 (09:42):
they're speaking inappropriate stuff.
Probably when they do wake up,they're like I took a melatonin
and a lunesta.
They're probably admitting itright right out because it's
inappropriate and they'rethey're being inappropriate,
they're talking about theirpersonal life.
They're talking about so it's.
I mean, it would be no smallfeat to say like they probably
(10:04):
told them that they were takingLunesta and melatonin.
So I remember this one time.
I remember this one time I wason call.
I was on call, actually, at oneof our satellite hospitals and
I don't know what happened, butat the satellite hospital there
(10:28):
wasn't anything going on.
So I was like wooo, whoo, I getto sleep.
When I tell you, I was tiredthat day.
I was so tired but nothing camein, thankfully.
And I wake up right in time forsign out.
And when I wake up I look at myphone and I'm like look at my
(10:58):
phone.
And I'm like but there's athree minute conversation here
with one of my junior residentsfrom our main hospital, but I
don't remember talking toanybody.
I was like I don't remembertalking to anybody.
So I call her and I'm like yo,did you call me last night?
She's like yeah, I'm like didwe speak?
She's like yeah, I'm like whatdid we talk about?
(11:21):
She's like yeah, I had thispatient who was in preterm labor
and I was asking you what Ishould do, cause I guess she
didn't like the, she didn't likethe senior who was on call at
the main hospital, like she justdidn't trust his judgment.
And she was like, yeah, so Icalled you, so I asked you what
(11:42):
to do, and I'm like, what did Itell you to do?
Speaker 2 (11:45):
She's like you told me to drink soup.
Make sure you put some bread inthat mug and stuff scoop it up.
Speaker 1 (11:52):
She's like you told me procardia, start her on mag,
whatever the hell.
I told her um antibiotics ifshe was ruptured.
I can't even remember the wholestory, but essentially it was
the right management and I waslike, hey yo.
Speaker 2 (12:11):
So is this doctor?
Is this attending?
What do you call it?
Intoxicated Does?
Speaker 1 (12:18):
this count as intoxicated?
Yes, under the influence atleast.
Yes, yes.
Speaker 2 (12:25):
I think, I would do.
I probably would do a seniorresident.
I talked to a senior residentabout it.
I might even find anotherattending that maybe I have a
better relationship with.
Speaker 1 (12:38):
Yeah, like yo, you gotta talk to your boy, you know
, like yeah right, you knowright um program director?
Speaker 2 (12:47):
yeah, because, there's a fear of retaliation.
Would you be nervous aboutretaliation?
Because I know you, you, you,nothing bothers you at all.
I know you're gonna try.
I would say I just want to knowis there, would there ever be
any like thought process in yourmind?
Like yo, this person couldfigure out who's like
complaining about them andthere's a little fear of
retaliation it depends on whothe person is.
Speaker 1 (13:09):
Yeah, depending on who the person is.
Yeah, depending on who theperson is.
I think that there aredefinitely I mean, I could think
off the top of my head certainattendings who I think, yeah,
would come after me because Iput that out there, absolutely.
And then there's others who Ithink, you know, would just be
like man, I was, I'm just reallytired and I got to do X, y and
(13:30):
Z and blah, blah, blah, but youknow, and then say you know,
like, no, you're right, Ishouldn't have, I shouldn't have
done that.
Speaker 2 (13:36):
But more than likely, though, if someone is doing
this like you're not the onlyresident that is seeing this
type of behavior.
Correct Nurses have seen thisbehavior Correct.
Other you know patients mayhave seen this behavior and more
than likely you're just one ofmany who's going to say
something.
It's just that you know this isthe first time that you've had
to stand up and say something oryou feel like you have to stay.
Speaker 1 (13:58):
Yeah, yeah.
Speaker 2 (14:00):
But remember it's all about.
This is part of advocacy.
You're advocating for yourself,Would you?
Speaker 1 (14:05):
tell.
Speaker 2 (14:05):
Who me.
In your program specifically,it depends.
Speaker 1 (14:12):
In your program specifically, it depends.
Speaker 2 (14:12):
In your program?
Yeah, because, like, the stuffthat I was dealing with is
really high acuity, right.
Like that stuff, like I can'tadmit someone without their
input.
I can't really like if it'sminor things like someone's
potassium or you know somethingelse.
Speaker 1 (14:30):
Yeah, but that's things you don't call in
attending for.
So anything that attending forpotassium at night, you think
ortho?
Speaker 2 (14:38):
does that?
This might be ortho.
This might be orthopedicsurgery it could be ortho,
because you know they'll be like, which I think they'd be like,
they'll be like.
Speaker 1 (14:49):
And Seth, I'll see him in the morning.
Speaker 2 (14:52):
Yeah, man, Okay, I would so for me if I needed.
Like I just remember my program, If I called my attending, it
was always for something thatwas like major.
Speaker 1 (15:03):
Yeah.
Speaker 2 (15:04):
So if it was something that I could not get
in contact with my attending forand I needed to get them in,
get in contact with them, it's aproblem, right?
This is someone I may have tocrack someone's chest.
This is someone that I may haveto take to the op, or someone
who may need an operating room.
This is someone who may need togo back on on pressers.
Like I remember, at my program,we weren't allowed to just put
people back on pressers withoutletting the attending know,
(15:26):
because they didn't want to comein the next morning and be like
yo.
So first of all, why is?
this person on pressers?
Why didn't you let me know?
And then what did you do aboutit?
You know.
Speaker 1 (15:38):
Right.
Speaker 2 (15:39):
So those are things that like were big deals, right?
And if you're admittingsomething like, you damn sure
can't admit someone to thesurgery service without letting
your attending know.
Are you crazy?
Speaker 1 (15:47):
Yeah, you know, I mean, yeah, I think in my
program I definitely would havetold I mean we could more freely
admit people.
Um, we could more freely admitpeople on, especially on labor
and delivery.
You know, patient comes in,she's eight centimeters, you
(16:09):
know.
Or patient comes actuallypatient goes in, she's five,
let's say five centimeters,because eight centimeters, you
know.
Or patient comes actuallypatient comes in, she's five,
let's say five centimetersbecause eight centimeters.
Eventually you want to let themknow hey, she's going to
deliver, but like she comes in,she's five centimeters and she
just kind of chugging along butyou might not know, you're
attending until this boils downto the leadership thing you're
talking about.
Speaker 2 (16:27):
This boils down to leadership again, like right,
like you're gonna have to learnhow to have some difficult
conversations.
You know these difficult heylook, these difficult
conversations, they start withyou.
You know, like they don't start, I think sometimes people say
like it's gonna be real cleancut and it's gonna be like
should we discharge someone ornot?
It doesn't start like that,guys.
No, it actually starts withsomething that's related with
(16:48):
you, like how you're beingtreated or what you see at your
job or what you see at yourschool, and you either see bad
behavior or something's gonnacome back and get you, or you
feel like somebody's gonna comeback and retaliate you what
you're gonna do.
That's how it starts.
Speaker 1 (17:01):
So I don't know that's a very interesting
situation, but good luck towhoever that is.
Hopefully, hopefully, they toldsomebody Thoughts and prayers,
thoughts and prayers.
Thoughts and prayers.
Speaker 2 (17:19):
Peas and peas, Peas and peas.
All right, y'all Listen.
We're going to go into our nextsegment where we're going to
make a little comment on afamily medicine resident who
actually wrote back to us afterwe gave them advice on the
previous episode.
So catch you on the nextsegment.
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