No prescription phentermine….

1. My medical school had a written policy that all medical students, regardless of the rotation site, were to be off for Labor Day. I was less than surprised to find that the chief resident on my medicine rotation scheduled me to be on call with her on Labor Day. After all, the unwritten rule was that since residents have a lot of say on student evaluations, if the residents did anything unfair, students would simply complain amongst themselves and say nothing. But I had already made plans for Labor Day (mostly to finish residency applications) so I wasn’t about to give up that time. I told her that a memo had gone out indicating that we have that day off, and she was quite insistent that it did not apply since this was an away rotation. She told me I’d be there with her on call on Labor Day. As far as I was concerned, it would be zero in July in Miami before I’d spend an unpaid holiday playing misery loves company with her. Giving her a look that expressed that sentiment (I’ve been told that I speak paragraphs without ever opening my mouth), I informed her that no, I would NOT be there with her on Labor Day, because we have it off regardless of whether it was an away rotation. I told her I’d bring her a copy of the memo the following day. I did but she wouldn’t look at it, insisting it didn’t apply to me. The suck-up med student on the rotation with me piped up to say that he’d be there if she needed him; he didn’t care about having the day off. I made a call to the dean’s office to double-check that the memo was still in effect; they said it was. I didn’t go to medical school to be a medical student. I went to complete a residency so that I could spend a career as a physician. For months I had planned on having that one block of time on Labor Day to tie up loose ends on my ERAS stuff, and I’ll be darned if I was going to let her attempt at a power trip interfere with time off that I was promised. It seems that the dean’s office got a little concerned by my phone call. The dean’s office called the clerkship director at the away site, who in turn had a little conversation with the chief resident. The resentment coming from her was unmistakable as she told me that I would indeed not be on call with her on Labor Day. She was positively fuming. I’m sure she wanted to make the rest of the rotation miserable for me. However, I was a good student. I did my work, had good rapport with the other residents, as well as the attendings and patients, and (perhaps importantly) another resident on the team voiced surprise but support that I stood up to the bully. The attendings liked my work and gave me good marks. I know there is always a power dynamic at work that has to be considered when you’re the student, but there will be less bullying when you develop a backbone and stand up for yourself.

2.During residency, I encountered a bully on a surgery rotation. ACGME says that the rotation has to give you an average of one day off per week. I knew the surgery program abused its residents and most of them did not get this time off, but I didn’t plan to be shortchanged. So when the chief resident gave us our schedules which (of course) were missing any indication of when our time off would occur, I brought it to his attention. The other residents just about gasped. Did I care that he was gonna get mad? Nope. Not at all. I knew the ACGME policy and it was going to be enforced whether he liked it or not. I would work hard every day I was there, but I was going to have my recovery time too. That was not negotiable.

So I asked him if he planned to indicate when our days off would be, or if he’d like us to discuss among ourselves and do that part of the scheduling ourselves. The poor surgery residents looked like they were about to have a heart attack because the chief started huffing and puffing, and he told me that Saturdays would be my day off because I could leave right after rounds. I told him that if I had to come in for rounds, then it wasn’t a day off. A day off is a day when I don’t have to be there at all. A day with just rounds is a short day, but that’s not a day off. I wanted to know when my four days off would be (yes, I was that blunt because I asked nicely at first and it got me nowhere). Suffice it to say that I got my four days (guess he didn’t want me to complain to the ACGME) but only because I put my foot down about it.

3.Perhaps the most ridiculous (and most dangerous) bullying incident occurred when I was a third year med student. Sleep deprivation, stress, and exposure to God knows what germs combined to give me an episode of pneumonia complicated by an asthma attack. It was so bad that the physician who treated me wanted to admit me because my pulse ox kept dropping, even after a reasonable period of treatment and observation. I didn’t want to get admitted because I just didn’t want to be in the hospital. Despite my continuing symptoms and low pulse ox, they were kind and let me leave without making me sign out AMA.(If you leave AMA, insurance doesn’t pay for your care.) But they wrote in BIG letters on my discharge papers to stay home until further notice. I can’t blame them for writing that. After repeated nebs, steroids, supplementary oxygen, etc. I still couldn’t walk five feet without getting really short of breath and desatting to about 92%. For a nonsmoking woman in her 20’s with no other medical history, that’s not so good. I was out for five days. When I came back, I was on a whole slew of medicines; some had to be taken every 4 hours, some every 6 hours, and some every 8 hours. The FIRST day I was back, the resident wanted me to do overnight call. (Anticipating this, the doctor who cleared me to come back to the rotation had already written a note saying that I was not to take overnight call for another 2-3 days.) I informed the resident of this, who got kind of mad but he didn’t (couldn’t) push the issue. He did, however, get mad again when I pulled him aside and mentioned that, while I knew the timing wouldn’t be exact, I had several different meds I needed to take throughout the day. I wouldn’t just take off without saying anything, but I needed him to be aware that my doctors hadn’t given me prescriptions that were taken only once or twice a day. He snorted and looked like I had done something to displease him. Lo and behold, I knew he’d do his best to make sure I’d end up retracting on a long case. No problem. I decided I’d retract, wait for an obvious lull in things, and then mention that I needed to step out for a minute to take the meds. He acted like he couldn’t believe I had the gall to do this when I politely made my request. I scrubbed out, took my meds, came back re-scrubbed, and continued retracting like nothing happened. Afterwards, he made a snide remark about my leaving to take the meds and made a comment about whether it was really “necessary”. I thought about a cousin of mine who died of an asthma exacerbation and thought it would be really stupid to risk a relapse (or even death) just to keep this knucklehead happy. So I told him it was very necessary because I liked being able to breathe, and the meds helped keep the symptoms under control. He didn’t say anything stupid to me for the rest of the day. Actually, he had very little to say to me the rest of the rotation. I didn’t care; I wasnt there to make friends with him or to lick his boots. I did my time and went on to the next rotation.

I ended up in emergency medicine. I enjoy the days that I take care of somebody who needed my help. I don’t enjoy the politics of medicine so much, but I’m not ready to totally leave medicine. I could easily see myself working on a secondary career in something else, though, just in case medicine becomes intolerable. I don’t bully students or residents, and I don’t tolerate people around me doing it either. I encourage them to stand up for themselves, because nobody else is going to do it. Many are afraid to speak up, but I remind them that they are the only ones who will advocate for their interests.

I have already given up 5 yrs up my life for studying medicine, even though I dont regret it, its attitudes like what Howard mentions that makes me sick! The PATIENT should be honored that I spent over 10 yrs of my life to help his miserable self, not the other way around. Treatment is a choice, they can always eat herbs at home and not see a doctor. Go Howard Go!