Teams pull together. They’ve got your back. They work together towards a common goal. The term “team” is used very loosely in the medical world. The fact is there is no team in medicine — it’s just a term used to foster some semblance of cohesiveness within dysfunctional rotations. Don’t let them try and tell you otherwise.
Medical school rotations are typically made up of an attending, one or more residents, and one or more medical students. This is what is collectively called the “team” on ward medicine. If you look deeper you’ll soon realize that an accumulation of more than one body isn’t adequate to truly define a team.
The common goal on ward medicine is typically to care for patients. This is really where the teamwork both begins and ends. Unlike a football or basketball team, there is a lot going on behind the scenes in medicine to ensure that teamwork does not truly exist.
- Other students will go behind your back and attempt to show you up. This can include answering questions about your patients or bringing in journal articles when other students aren’t prepared.
- Some residents will not tell you where you need to be and then fault you for not being wherever it is that they (supposedly) wanted you to be.
- Attendings are malignant about “pimping” and some verbally abuse students and/or residents for not knowing the answers.
- You are overworked and very rarely will another person put in some extra effort to make sure you’re out on time.
- Attendings waste tremendous amounts of time. They’ll tell you that they want to round at 5 PM and then not show up until 6:30 PM. No phone calls are made to let the residents know that he is going to be late. You sit around for an hour and a half with your thumb up your ass.
- Nurses, who are sometimes considered part of the “team,” are incredibly slow about getting things done.
- As a student, you are made to complete meaningless extraneous tasks such as coming up with a presentation about some topic you’ll never use ever again. This time could be spent studying for your shelf exam.
- Most residents and attendings don’t care that you have an exam at the end of the rotation to study for. Instead, they’d rather you follow them around and waste 4 hours every day.
With just a few examples, you can see that there really is no teamwork in academic ward medicine. Here is what you actually have:
- The attending is getting paid a monthly bonus on top of his regular clinical (or academic) duties and salary to participate on the wards. Thus by nature of the situation his ward duties come second.
- The residents are there to please the attending and to do the daily “scut” work. They just want to make sure that everything is in order before rounds.
- The students are there because they were told to do so. At best they want to learn something useful to apply to their career. At worst they just want to pass the rotation and could care less if they remember anything 1 day after the shelf exam.
- In order to impress the attending, cut-throat measures on the part of students and residents will sometimes be employed. After all, they want good letters for that competitive fellowship or residency.
So in reality, you have three different individuals: Attending, resident, and student. Each wants something different. This in itself defeats the “team” in medicine.
Contrast this with a football or basketball team. The coach wants to win. The players want to win. They pull together to make it happen.
There is no team in medicine. What once might have been a team has transformed into a cut-throat competitive atmosphere where each participant has their own individual goals. Without well-defined universal objectives that apply to each participant as a whole, teamwork cannot and will not exist.
I think this point may underlie a lot of the dissatisfaction with current medcine (at least in my case). More than just a lack of common goals but an utter lack of loyalty. As I’ve found out, you’re not irreplaceble – for all their talk about collegiality, the minute things look bad they’ll throw you to the wolves. I remember reading a blog post by a former Marine turned medical student who commented that although his fellow Marines were not as well educated as his med school classmates, he never doubted for a second that they had his back. Living your entire career always looking over your shoulder and not trusting anyone, no wonder medicine grinds down so many people.
I agree. Been on rotations for a week and had to do three stupid presentations. I wish the damn attendings would just tell us stuff instead of having a “learning atmosphere” (which really means we look stuff up on wikipedia).
Also, I had a nurse today tell me to find another nurse and give her some information. Like hell I’m gonna do that. The other nurse had a damn phone clipped to her belt. I’m not your messenger boy. Learn to do your damn job.
This is a dead-on description of 3rd year. I hate most of my classmates- they are cutthroat brown-nosers. And, I’ll tell you about my day on surgery today that illustrates pretty much EVERY point you just made. It’s really amazing how well you articulated the frustration surrounding 3rd yr.
Today: I was ready at 6:15 to round, and there’s no one there for 20 minutes. I page the intern, who doesn’t respond, and I sit there for another 15 minutes until he decides to finally show up. He tells me to go print out 10 copies of signouts and stick them under some office door (scut), and then meet him back on the floor. I do so, and wait for half an hour before paging him again. The CHIEF resident answers and tells me that the intern had paged me to come down for a conference (never got the page…and the intern doesn’t know my name, so i’m thinking that I wasn’t paged). Great start to the day, right?
Anyway, I am in the freaking OR for 3 cases ALL day– the last case was a very obstructed pt (due to tumor mets to the sigmoid), and the dumb CRNA decided to decompress the pt as we were closing up the stoma. There was nasty stinky crap EVERYWHERE (I never thought it was possible to be completely filled with stool, but I unfortunately was proven wrong), and I had to help mop it all up. It was so bad that the CRNA, scrubtech, and nurses were fleeing out of the room, so there was just the fellow, chief resident, and the hapless MS III (yours truly) stuck there. And I left at 9 freaking PM. It all starts again at 5:30 AM tomorrow. God help me.
And can you believe at one point in the start of the rotation i was actually considering surgery?!
In my not so humble opinion, when this is the case, something bad has gone wrong in the team. That’s one thing I try to teach medical students and residents is that the goal is patient care, period, and that undercutting anybody or not working as a team will get you a bad evaluation, at least from me. It always comes down to us versus them, it’s just a matter of appropriately adjusting your definition of us and them.
I think that one thing that helps with the team mentality is longer rotation lengths. Some programs do clinical rotations as short as 2 weeks, and I think in that case, once you get a team functioning, the rotation’s over. As a resident, we did 6 week rotations, and that actually worked well with respect to teamwork.
I think that teams can work well in medicine, when they have appropriate leadership. I think that inappropriate leadership is all too often a problem, but that doesn’t mean that the team concept is broken, it just means that some (perhaps many) people don’t know how to lead.
For what it’s worth, our attendings don’t get paid extra for their clinical duties. It’s part of their jobs.
we it is unfortunate that you perception of team and each person’s role was effected by some bad experiences. typical teams on the orthopaedic service consist of may be a medical student, but more commonly a 1-2junior residents, a 1-3 senior level residents, and multiple attendings. the ultimate goal for our service is patient care, i know that is something people say is a cop out, but it is true. the work is distributed base on what needs to be done and level of experience. the “team” works best when everyone pulls their weight. team falls apart when people slack.
i personally do not get money from the university for “teaching” med studs or residents. residents do not kiss up because it’s not needed. do a got job and you’ll be fine, slack and we see it. i can’t stand when med studs follow me like a puppy dog, we stress going home when they are not key or it is not teaching worthy case. in clinic that provide only more work for me, so i would rather not have them not see patients by themselves. as for rounding, i prefer to round myself with my nurse, i hate the big crowed of people walking into the rooms. pimping, i am a bold face question asker, if you are in a case and read all the bold print before the case, your pretty safe. question asking (pimping), for me, helps me to assess how to adjust my teaching and to evaluate the practical knowledge base.
finally, as MWWAK said, we (attendings) in my practice get zero reward for educational efforts. so giving an impromptu clinic lecture, med stud, or resident lecture pays me none.
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I’m not even in the clinic yet and I feel like teamwork in medicine doesn’t really exist. People may seem cordial but they’ll screw you when the opportunity presents itself.
The team concept in medicine is horseshit unless you’re the attending and you’re the boss. Then the word “team” is used to try to rally support for your absolute monarchy.
As a 4th year student I did everything I could to make 3rd years look good…even if they were gunners. Besides, slacking during 4th year naturally makes the 3rd years look good. So I was truly a team player.
When and if I complete residency, and when and if I am ever teaching, I will NEVER pimp and NEVER treat people poorly, and if I do I will apologize. Too many insane Type-A hardasses in academic medicine that need to learn the Golden Rule. You are a professional, and if you cannot juggle excellent patient care with treating residents and students with the utmost respect, you don’t need to be in medicine. Change the damn status quo.
Ward rounds seem so pointless when you are a 3rd-year medical student, don’t they?
I remember a couple of years back, a friend of mine proposed a toast, “To friends forever!”
Whereupon another guy replied, quick as light, “We may be friends now, but after we graduate, we’ll be rivals.”
I remember thinking it was nasty then. I still think it’s nasty now. I’m just old enough now to know that just because you think something is nasty, it doesn’t mean that it doesn’t happen.
Very accurate. Refreshing to see an actual account of how things are. So frustrating to hear the bullshit mission statements, and lies that the Dean for Student Affairs tell us. This is the real deal. Thank you for putting an honest account out here!
I think this article is the one that did it. After almost a year of saying I would probably be a doctor, I have decided not to go to medical school. Being part of a hierarchy of shit slinging isn’t me. Thank you for telling me before it was too late. I think I’ll be a pastry chef instead
Pop, congrats! Just do what you love. Keep it simple and you’ll enjoy life.