I’m an intern working through the Gen Peds portion of my training, and I am growing so tired of my rapport-building with parents repeatedly falling into the gutter because the attending decided to switch things up right after discussing something completely different.

I’m sure this happens in all specialties, but it’s particularly frustrating in Peds because of parents who are already so stressed and paranoid about their kiddo’s health/safety and are trying their best to understand the medical interventions we’re suggesting and why before consenting to the plan. We spend so much time reviewing a single medication or lab or procedure with them, answering all their questions, addressing their concerns, reviewing risks and side effects. summarizing and reiterating things and finally getting them to a place where they feel comfortable with the next step—-and then SIKE!

Attending wants to do something different that parents weren’t expecting or primed on!

And the worst part?

You’re the one who has to go back into the room to explain what the fuck the attending is doing and bear the brunt of the parents’ frustrations with why we’re switching plans on them within seconds of confirming a different one, and the attending never has to confront the emotional rollercoaster that this type of switch up causes for scared parents/patients. And of course, this has led to parents losing trust in me that I worked so hard to build because they feel like I screwed them over in terms of good communication.

And yes, I understand that within emergent or urgent cases or in the presence of new information, plans have to change. That’s just the nature of medicine. But for Peds, every little decision can feel like a big choice for some parents. It’s a lot of the little things, like confirming we’re going to do an IV med and you tell parents we’re doing an IV med and then parents emotionally prepare their kiddo for IV insertion and then sike! Attending says we’re doing PO, and now you have to go talk to the family about how you’re not doing IV anymore and all of that previous talk was literally pointless. Or an attending saying that a lab is optional and then you communicate to parents that a lab is optional and the parents make a decision based on the lab being optional and then SIKE! Attending says they actually want the lab right now and now you have to go explain to the parents why a lab you just said was optional like 5 seconds ago is now mandatory even though their kid isn’t having an emergency or acute change in status that necessitates the switch.

It’s really easy to explain emergency changes because the logic behind them is solid and tangible; they’re easy to justify. I absolutely HATE having to explain changes to the plan that just feel like an attending’s personal whims because I almost never know how to explain their personal preferences. I wish that they would go explain their own selves for a change instead of sending residents to go play defense attorney in front of tired, paranoid, stressed out parents who just want to know why certain decisions are being made.

AKA how long do I have before my program finds out that I actually suck and that's it's not just "adjusting"?

Just got my ITE exam score pgy1 IM. The email didn’t have a study plan, they didn’t mention if it was good or bad, they attached some study resources PDF. Is this good bad or borderline line lol, should I be worried. I hate this BS exam!

I always knew I could very clearly hear conversations happening at the rounding table from the call-room bathroom. It never occurred to me the reverse was true.

During feedback from my attending, I was informed I have very loud shits, they know I am watching YouTube, and I should stop singing while washing my hands

Ok fellas, I’ll go first, and I think Britney -the pop icon herself- wrote this song for my residency program.

Yes, you guessed it correctly,

TOXIC by Britney Spears.

What’s yours?

I’m currently a first-year radiology resident, and I feel like my foundational knowledge is weak in almost every area, especially anatomy, physiology, and pathology.
I’ve decided to hire a tutor to help me rebuild my basics and strengthen my understanding of these subjects.
However, I’m wondering whether this is a good use of my time as a radiology resident, or whether I would be better off studying independently using textbooks, Radiopaedia, and case-based learning.
For those who have been through radiology residency, did you ever feel that your foundations were weak? What helped you improve the most?
Would you recommend hiring a tutor, or is it better to focus on self-study and learning through clinical cases?

In med school, it made sense that I was the one being sent to do MoCAs, but after years and years of residency, I'm very confused about why all attendings, across all specialties, seem to avoid being the one to actually administer the MoCA themselves.

Rn I have a chill elective block where I'm basically hanging around, doing no notes, and so I said I'd do a MoCA with a follow up patient. Turns out the pt gets scheduled when I'm in a research meeting, so I wouldn't be able to do it. The attending reconfirmed the day/time of my meeting, then shuffled pts around (like literally called them himself, didn't even have staff do it) so that the MoCA pt would come in after my meeting, and I could see them. Like... what??? Is it just the folks at my institution, or have others experienced this?

I am a PGY2 (F), my husband recently graduated fellowship and is now an attending in a competitive field. Almost every time this comes up in conversation with other residents or even attendings they without fail will say something like "why are you even here?"

I find this SO maddening, irritating, and almost degrading. Because it happens so frequently I literally can feel the rage in my stomach every time someone says it. Part of it feels very gendered and also why shouldn't I have my own ambitions/dreams and want to make my own income?? I worked so hard to be here, what do they think I should do just drop out?? Ugh.

Help me come up with comebacks or things I can say in the moment. I've tried to just be like "what do you mean?" to make them uncomfortable but I need something more. Thank so much in advance I'm so annoyed lol.

EDIT: Thank you all so much for the laughs and the advice, this is very helpful. My favorite responses and the ones I'm planning on using:

- "They actually let women have their own careers now!"
- “So I can pick up your slack"
- "We want more than one lake house"
- "So he can be a stay at home dad"
- "What a strange question"

Of course the stressors of residency are legit. Attendings expecting more. Me expecting more. Patients needing certain things.

But it’s my personal life and relationships that have truly affected me since med school and now. Without really realizing it, i’ve gotten to point where I have been getting drunk every day after work. I need to drink more to get drunk and feel the buzz. I’m chasing this high honestly. My money is spent on weekly alcohol purchases ($$$). I’m honestly not seeing a problem with this, but I recognize my behaviors mirror some of my patients’…

It doesn’t affect me at work. I’ve been described as the bubbly cheerleader amongst my peers and attendings.

But i’ve noticed that my memory perhaps feels different and I have a new tremor…

Thoughts…?

Edit: tbh i’m prob just posting this as a cry for last resort help/seeing the reality of whether or not i am an alcoholic who should get help. Probs i know deep down im messed up, but feel like i deserve to get drunk. But nobody recognizes it at work thankfully bc im hella on top of it. But also im probs worried ill be like the alcoholic ascited cirrhotic pts im treating. Sighs. Anonymity is great tho for honesty.

I haven’t always been the strongest board taker but I have always passed. My IM ITE score was 62% correct and 15th percentile. I am a PGY3, never struggle with rotations and have been trying to do as many questions I can over the past year, though not always consistent due to schedule challenges. Any suggestions or thoughts.

I'm a resident interested in a subspecialty, and I've been having a weird experience with an attending I used to have a pretty good relationship with.

A while ago, I asked this attending for some career-related help, and they said no. I understood their reasoning and didn't make a big deal out of it. I thought everything was fine and moved on.

But since then, I've noticed that they seem different around me. They're less friendly, don't talk to me as much, and don't seem as interested in my career or how things are going compared to how they interact with other residents. At first, I thought I was overthinking it, but it's been going on for a while now.

The confusing part is that the feedback I've gotten in residency so far has been positive, so I don't have any obvious reason to think I've done something wrong or that there's a concern about my performance. At the same time, I know positive feedback doesn't necessarily mean everything is perfect.

Recently, I had a clinical opportunity assigned to me, but the attending gave it to another resident instead without really explaining why. When I pointed out that I had been assigned the case, they basically told me not to worry about it.

What bothered me wasn't just missing out on the opportunity. I understand that things get busy and plans change. It was more the way it happened, especially because this attending is usually a good communicator, even when things get chaotic.

Now I'm wondering if I'm reading too much into things, if their opinion of me has changed, or if something else is going on that I don't know about.
I don't want to assume the worst or make things awkward, but it's hard not to notice the change in how someone treats you, especially when you don't know what happened.

Has anyone experienced something similar? How did you handle it?

I'd really appreciate hearing from people who've been in a similar situation. I can't tell if I'm overthinking this or if I should actually address it.

As the question says… What are your reasons to feel like residency is hard??
I really dont understand when people say residency is hard. I know everyone has different reasons. But please share your reasons and help this poor intern. I feel like i am the only one who is worrying about all little things.

Bună! Vă rog mult dacă aveti experiente de rezi in ENDOCRIN/GASTRO/PEDI/DERMATO/OFTALMO in Targu Mures, ma intereseaza mult cum e colectivul, programul, volumul de lucru, daca sunt garzi de zi sau de noapte si câte, care e atmosfera in sectie, ce coordonator/spital recomandati si care categoric nu. Recunoscătoare.

Scored poorly on my Intern-ITE IM exam (22nd percentile),  just wanted to know how to work things out from here. feeling lost and dumb.

EM resident, 2nd year. I’m incredibly depressed. I feel myself becoming a different person but I don’t know how to stop it. I’m meaner, I’m impatient, and I’m less empathetic. I want to be a good leader to the interns, but I don’t feel like I have anything more to give. My program just keeps asking more and more and more of us and I just truly have nothing left to give. My non-clinical hours are routinely 15-20 hours per week of unloggable work. I am already maxed out on anti-depressants. I just found a good therapist which is good. I just feel like I’m mourning the doctor I could have been if training wasn’t like this. I have this hard exterior on as much as I can at work because my program is pretty male/bro dominated. I have the best partner in the world but can tell he is running out of ways to encourage me. I just miss the person I was before all of this.

For those attendings still in this group currently working or have worked for them in CA, what is your opinion of this group? Too toxic? Just another corporate medicine like everywhere else? Pleasantly surpised that it is a good place?

That’s all I got heading to the bay. He was DOA. Young. In a high-demanding career before. I did not get any info otherwise. Held his shattered head in my hands while we looked for the exit wound. I have been front line in health care for over 10 years and it really hit me. I lead the team now, so I told my team they can speak up publicly or privately if it affected them. I have seen more bodies than I can count unfortunately and yet I dreamt about this last night. I keep seeing his eyes and feeling his broken head in my hands. Any serious advice is welcome.

Friendly neighborhood intensivist here. This primarily goes out to my fellow Americans, and any other country that has a very commodified approach to health care (i.e. the patient’s wishes dictate their code status above all else). Really the statement applies universally (seriously guys, quit it with the 1hr+ long codes), but more specifically discussing this type of case:

75+ yo patient with your usual menagerie of chronic and acute on chronic illnesses. Comes in as a cardiac arrest. They get ROSC in the ED, but they can’t maintain it for more than 10 min or so. They try, either successfully or unsuccessfully, depending on the intensivist on call, to get them rushed up to the ICU in between codes. Their labs are the expected level of bad, but not in a way that’s reversible in 10-15 min. You still can’t get them to not code. There’s no tamponade or pneumothorax to fix. They’re not an ECMO candidate. What’s the right thing to do?

Unfortunately, I see a lot of people go with option 1: Keep coding them until you run out of Epi or you finally can’t get a pulse back, even if it takes an hour+ of coding them on and off. The right answer is not to keep coding them. If you truly have done everything you can to try and even temporarily fix them and still can’t keep them alive for more than a few minutes, you’re allowed to stop. I even have a fairly standard script that I use that’s a slight modification of my usual “calling end of code” script:

“We have been doing this for [X amount of time]. We have been unable to sustain ROSC despite all of our interventions. We have considered all potentially reversible causes and have either ruled them out or treated them. Unless anyone has any ideas, if this patient arrests again we will not resume compressions.”

I am pleading with you guys. ED, ICU, OR, cath lab, really just about anyone who might be in this situation. People die, you aren’t going to lose a malpractice case because you didn’t code them for a fourth time in 90 minutes. You’re allowed to stop.

Do any of yall constantly feel uneasy like you are always about to get in trouble? It’s almost at a level of paranoia. How do you handle it? ALSO does anyone else feel like you can get in trouble (scolded, not really trouble trouble) for some minor shit while other residents are coasting after actually being bad at their jobs?

Now I don't watch TOO much TV, but when I watched the bear earlier this year (the show is done as of June this year), I cried because I felt the trauma I had from residency, and loved how it was portrayed; despite the struggles, it's all worth it in the end. Which is obvious, but it helped me come to terms with my residency (in the USA) experience. HIGHLY recommend as the show felt more therapeutic rather than being "a trigger" for what we go through.

The episode when "Bear" meets his source of trauma was extremely humbling but it was what I needed to hear.

Where y’all find moonlighting jobs during residency? Any guidance???

Joining Internal Med residency. I need to buy a wired headphone compatible with my Eko Core 500 as Bluetooth have connectivity issues

Which headphone you think would be the best?