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I am so mad right now I want to SCREAM!

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gingerBcookie

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How do you say "no" to a boss? When an intern is off, the upperlevel resident covers for that intern and checks in on their patients and writes their notes for them. I came in to work today and my co-intern was off. I called my upper level to ask a question about one of my patients, he nicely answered and then tacked on...btw, see "DR.XX''s" patients for me today and write their notes because I don''t want to have t come in today. WTF?!!? I wish I could say my upper level covered for me, but NO, NEVER. I''ve had to drag my @ss out of bed to write ONE NOTE on days the upper level was already in the hospital but he couldn''t write that note for me. I didn''t complain because it was part of my job and he just wasn''t being "cool" like some of the other upper levels. But today he stepped over the line of "uncool" to inappropriate. Not only is it not my job to cover for the other intern. I DON''T KNOW THE PATIENT, and just can''t give the level of care someone who has followed the patient.

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AAAAAARGHHH!!!!
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I have NEVER written a bad evaluation before. NEVER. And as mad as I am right now, I don''t know if I can.

Sorry. had to vent somewhere and hubby is not here.
 

gingerBcookie

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Just re-read my post and i may sound like i''m over reacting. It''s been a lot of little things he''s done that i''ve held inside and now this tipped me over i think. I have the slow burn temper but once it ignites it can consume me. This episode today def was a flame.
 

basil

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Wow. That''s awful. What a jackass. I''ve never heard of an upper level resident doing that. It''s actually probably against ACGME rules. I would consider reporting it to your chiefs, seriously.

I just got home myself. Luckily, because it''s change of service day, both interns and the upper level were in this morning, and my upper level saw 2 of my 10 patients in order so that we could all get out faster.
 

strmrdr

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do whats best for the patient and let the chips fall where they will.
 

Skippy123

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I don''t think you are overreacting. I would be angry too.

Lazy people bug me. It sounds like people in your profession cannot do that.
 

phoenixgirl

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Hmmm, it does sound like protocol has been breached. If something were to go wrong, would the administration says, "Egads! Why wasn''t upper level resident there?" If so, then I think you should do what''s best for the patient and best for yourself -- ask somebody even higher up if this is ok first.

Sorry to hear about the lazy jerk.
 

AGBF

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Ginger,

I read this a few times. It''s not clear enough to me for me to make much of a contribution. Are you referring to an evaluation of the upper level resident you will write when this rotation is over? If so, must you wait that long? Is it possible to speak to him constructively before then? I realize he''s not an easy guy, but can you summon up your anger in order to say that he has not being very obliging in the past and that now he has added an inappropriate demand to the lack of being obliging? It would be ideal if you could tell him now, to his face, that he leaves the impression of a physician who is always ready to pass the buck on a patient, rather than one who is part of a medical team dedicated to the patient''s well-being.

Deb
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DIAMOND*QUEST

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Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I would have to agree that the most important thing of all is that the patients were seen. In your future practice, you will have to jump in on patients whom you have never laid your eyes on, and on any given day. I am sure the patients you saw were appreciative of your care and dedication. If you feel that a breech in protocol happened, by all means go up the "food chain", write your report, and be done with it. I once knew an old Neonatologist who told me, "Take care of business and move along". That bit of advice always gets me through during the most frustrating of times in all aspects of life.
 

AGBF

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Date: 12/31/2006 3:55:21 PM
Author: DIAMOND*QUEST
I would have to agree that the most important thing of all is that the patients were seen. In your future practice, you will have to jump in on patients whom you have never laid your eyes on, and on any given day. I am sure the patients you saw were appreciative of your care and dedication. If you feel that a breech in protocol happened, by all means go up the ''food chain'', write your report, and be done with it. I once knew an old Neonatologist who told me, ''Take care of business and move along''. That bit of advice always gets me through during the most frustrating of times in all aspects of life.

That sounds like superb advice. Not just for Ginger. For me. Thank you, D*Q.


Deb
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smitcompton

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Dear Intern,
I think you let your anger get in the way of an effective reply. I believe you should be direct in your approach without the hostility showing. "Oh, you mean you want me to do you a favor and cover for you?" Or, "I think that''s against the rules, isn''t it. I don''t feel right taking on patients I know nothing about." If something like that is said everything is out in the open and perhaps you won''t need to go to a higher up. I think he is used to doing this and all he needs is someone to put a nice brake on. Its harder when you''re young, but practice now because you will be taken advantage of if you don''t assert yourself. This was the time. Do it as nicely as you can but be firm.
I think you should talk to him before you to complain. Say you won''t do it next time. Just a statement.

Thanks, Annette
I count on you guys or girls. Some of you have saved my life several times. I have learned to be be direct with doctors also. It was hard but I learned, so can you.
 

gingerBcookie

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Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I was not about to let the patient suffer for my upper level being lazy. I saw the patient, acted as though there was nothing extraordinary about a doctor she''d never met coming in to talk to her and did the best I could to get her settled for the day with what I knew. The point is, my best is not going to be as good as his best because he knows the patient, I do not. I can read the past notes and history and do my best from that. So what it came down to is the patient COULD NOT receive the best care because her doctor decided he did not want to get out of bed and asked someone lower down on the food chain to do his work for him.
 

gingerBcookie

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Date: 12/31/2006 3:55:21 PM
Author: DIAMOND*QUEST

Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I would have to agree that the most important thing of all is that the patients were seen. In your future practice, you will have to jump in on patients whom you have never laid your eyes on, and on any given day. I am sure the patients you saw were appreciative of your care and dedication. If you feel that a breech in protocol happened, by all means go up the ''food chain'', write your report, and be done with it. I once knew an old Neonatologist who told me, ''Take care of business and move along''. That bit of advice always gets me through during the most frustrating of times in all aspects of life.

I did. I''m here to vent, not to find an excuse to not justify letting patient lie there without a doctor. Ans I''ve jump in and see patients all the time I don''t know. We cover the entire hospital twice a month as "float" where on any given night I have ~100 "emergency" calls on patients I don''t know. THat wasn''t why I was angry. I was angry about how I was treated and wanted to let off steam. But hey, I''m an intern, the bottom of the bucket, and I just need to bite the bullet and keep on moving so I am
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gingerBcookie

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Date: 12/31/2006 1:51:00 PM
Author: AGBF

Ginger,

I read this a few times. It''s not clear enough to me for me to make much of a contribution. Are you referring to an evaluation of the upper level resident you will write when this rotation is over? If so, must you wait that long? Is it possible to speak to him constructively before then? I realize he''s not an easy guy, but can you summon up your anger in order to say that he has not being very obliging in the past and that now he has added an inappropriate demand to the lack of being obliging? It would be ideal if you could tell him now, to his face, that he leaves the impression of a physician who is always ready to pass the buck on a patient, rather than one who is part of a medical team dedicated to the patient''s well-being.

Deb
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Fortunately my rotation is him is over in two days so my evaluation of him will be written this week. And as with all food chain type relationships its hard for me to think about leaving a bad evaluation for fear of retaliation. He is set. He has his fellowship. I, ont he other hand, depend very much on my evaluations to help get me a postion in a few years. At this point I''ve cooled down (Ihad some "retail therapy" at the Galleria
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), and I''m not sure how I will fill out his evaluation. I''ve heard of worse upper levels and part of me feels like I''m just being a Sulky Sally. I hate complaining.
 

Skippy123

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It always helps to vent. Happy New Year. I am glad you care about your patients!!!!
 

gingerBcookie

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Date: 12/31/2006 5:19:16 PM
Author: smitcompton
Dear Intern,
I think you let your anger get in the way of an effective reply. I believe you should be direct in your approach without the hostility showing. ''Oh, you mean you want me to do you a favor and cover for you?'' Or, ''I think that''s against the rules, isn''t it. I don''t feel right taking on patients I know nothing about.'' If something like that is said everything is out in the open and perhaps you won''t need to go to a higher up. I think he is used to doing this and all he needs is someone to put a nice brake on. Its harder when you''re young, but practice now because you will be taken advantage of if you don''t assert yourself. This was the time. Do it as nicely as you can but be firm.
I think you should talk to him before you to complain. Say you won''t do it next time. Just a statement.

Thanks, Annette
I count on you guys or girls. Some of you have saved my life several times. I have learned to be be direct with doctors also. It was hard but I learned, so can you.
WHen he aksed me over the phone, I was sitting with a few other residents, both interns and upper levels. When he asked me to do this I paused (I was a bit shocked) and repeated slowly back to him, "You mean you want me to write Dr. XX''s note FOR YOU?!" Everyone''s jaws around me dropped. My upperlevel sheepishly said yeah, i don''t want to have to come in today for just that (his job btw) yaddi yaddi yaddi. When I got off the phone, one of the other upper level asked me, "Did we hear right, is he asking you to write your co-interns not for him? That''s inapprpriate, you need to put that in you evaluation." Everyone kept muttering, that''s just not right, that''s just not right.

Being direct to someone about a negative subject is hard when your future partially depends on that person''s evaluation of you. I have an excellent record and fear sullying it with retalitory remarks from someone upset.

I''m very glad you are direct with your doctors, it''s the best for your health when they know as much as possible. This is a different type of dynamic that isn''t as straightforward unfortunately.
 

strmrdr

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Date: 12/31/2006 6:38:07 PM
Author: gingerBcookie

Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I was not about to let the patient suffer for my upper level being lazy. I saw the patient, acted as though there was nothing extraordinary about a doctor she''d never met coming in to talk to her and did the best I could to get her settled for the day with what I knew. The point is, my best is not going to be as good as his best because he knows the patient, I do not. I can read the past notes and history and do my best from that. So what it came down to is the patient COULD NOT receive the best care because her doctor decided he did not want to get out of bed and asked someone lower down on the food chain to do his work for him.
wooo
thats not what i meant at all.
and just getting out of the hopital i know how it sucks for the patient to have a different doc each day like I did cuz the lung docs were rotating in and out of Christmas vacation.
What i am/was trying to say is do what needs to be done and dont feel bad about getting someone who deserves it in trouble.
 

gingerBcookie

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Basil - Thanks for the support. I can''t wait for switch day. Your resident sounds great, That;s the kind of resident I''ve been used to working with. One that works as a teeam and remebers how much it sucks to be an intern and gives you a helping hand here and there so that you have some semblance of a normal life!
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Skippy - yep, can''t stand work laziness. not saying i''m perfect, I''m accused of being lazy all the time AT HOME. But my job is muy job and when I''m working, I do my job and feel others should too and it really irks when my work is held up because someone else won''t do THEIR job. And Happy New Year to you too!

phoenixgirl - if something happened to the patient it wuld be the upperlevels @ss on the line. ultimately ALL of the patients are his responsibility. I think I may speak to my chief about this "anonymously" without mentioning ANY names (even the upper levels) and see how they feel. may be i really am overreacting (bad day? pms?) sigh. i hate drama. i just want to live my life, do my job, come home to my family. why can''t everyone else do the same? (emphasis on do THEIR job)
 

gingerBcookie

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Date: 12/31/2006 7:10:26 PM
Author: strmrdr

Date: 12/31/2006 6:38:07 PM
Author: gingerBcookie


Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I was not about to let the patient suffer for my upper level being lazy. I saw the patient, acted as though there was nothing extraordinary about a doctor she''d never met coming in to talk to her and did the best I could to get her settled for the day with what I knew. The point is, my best is not going to be as good as his best because he knows the patient, I do not. I can read the past notes and history and do my best from that. So what it came down to is the patient COULD NOT receive the best care because her doctor decided he did not want to get out of bed and asked someone lower down on the food chain to do his work for him.
wooo
thats not what i meant at all.
and just getting out of the hopital i know how it sucks for the patient to have a different doc each day like I did cuz the lung docs were rotating in and out of Christmas vacation.
What i am/was trying to say is do what needs to be done and dont feel bad about getting someone who deserves it in trouble.
ok i understand now
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. i know, it does suck to have a million docs switching in and out and never knowing whos who at at ime you''re feeling vulnerable. sorry i''m feeling alittle sensitive. I hope you''re feeling better!
 

Skippy123

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ginger,
are you a nurse or a doctor? Just curious.
 

gingerBcookie

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Date: 12/31/2006 7:23:48 PM
Author: Skippy123
ginger,
are you a nurse or a doctor? Just curious.
a doctor
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AGBF

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Date: 12/31/2006 6:49:26 PM
Author: gingerBcookie
Date: 12/31/2006 1:51:00 PM

Author: AGBF

Are you referring to an evaluation of the upper level resident you will write when this rotation is over? If so, must you wait that long?

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Fortunately my rotation is him is over in two days so my evaluation of him will be written this week. And as with all food chain type relationships its hard for me to think about leaving a bad evaluation for fear of retaliation. He is set. He has his fellowship. I, ont he other hand, depend very much on my evaluations to help get me a postion in a few years. At this point I've cooled down (Ihad some 'retail therapy' at the Galleria
9.gif
), and I'm not sure how I will fill out his evaluation. I've heard of worse upper levels and part of me feels like I'm just being a Sulky Sally. I hate complaining.


Given the situation, Ginger, I would keep my mouth shut. Don't burn your bridges. What this guy did is not so heinous that it is worth putting your own career in jeopardy. I was in a similar situation as a social work intern. My (very wise) father kept me from doing anything retaliatory toward my difficult field instructor that might come back to bite me in the derriere one day. Even after I got my final (excellent) grades, he reminded me that someday I would be looking for a job! Think of the big picture. If this man were harming a patient, it would be different; if he is just lazy with his interns, move on and don't let him bog you down.

We are all with you, however!!!!!

Major hugs,
Deb
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strmrdr

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Date: 12/31/2006 7:14:36 PM
Author: gingerBcookie

Date: 12/31/2006 7:10:26 PM
Author: strmrdr


Date: 12/31/2006 6:38:07 PM
Author: gingerBcookie



Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I was not about to let the patient suffer for my upper level being lazy. I saw the patient, acted as though there was nothing extraordinary about a doctor she''d never met coming in to talk to her and did the best I could to get her settled for the day with what I knew. The point is, my best is not going to be as good as his best because he knows the patient, I do not. I can read the past notes and history and do my best from that. So what it came down to is the patient COULD NOT receive the best care because her doctor decided he did not want to get out of bed and asked someone lower down on the food chain to do his work for him.
wooo
thats not what i meant at all.
and just getting out of the hopital i know how it sucks for the patient to have a different doc each day like I did cuz the lung docs were rotating in and out of Christmas vacation.
What i am/was trying to say is do what needs to be done and dont feel bad about getting someone who deserves it in trouble.
ok i understand now
1.gif
. i know, it does suck to have a million docs switching in and out and never knowing whos who at at ime you''re feeling vulnerable. sorry i''m feeling alittle sensitive. I hope you''re feeling better!
1.gif

im not the clearest when im on vicodin.
overall im doing very much better :}
arthritis and asthma is acting up today cuz of the damp weather. 50 degrees and 90% humidity on the last day of the year is hell.
 

HOUMedGal

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What a lazy jerk! He was totally abusing his upper-level priveleges. I certainly won''t ask who it was, but I could take a few guesses after having just finished my three months Medicine a few weeks ago. :) You are justified in feeling upset, because that was just plain laziness and abusing his authority over you. And kudos to you for handling it professionally. There''s no reason why you can''t put it in your eval in a very professional, respectful way....I don''t think anyone would fault you for putting it in your eval in a thoughtful, non-bridge-burning way.
 

strmrdr

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Date: 1/1/2007 1:41:03 PM
Author: HOUMedGal
What a lazy jerk! He was totally abusing his upper-level priveleges. I certainly won''t ask who it was, but I could take a few guesses after having just finished my three months Medicine a few weeks ago. :) You are justified in feeling upset, because that was just plain laziness and abusing his authority over you. And kudos to you for handling it professionally. There''s no reason why you can''t put it in your eval in a very professional, respectful way....I don''t think anyone would fault you for putting it in your eval in a thoughtful, non-bridge-burning way.
agree, want to bet he has got by with it before because someone was afraid to say anything?
 

lawmax

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This stuff is unfortunately part of life almost everywhere! As an intern, you will take a certain amount of garbage. Just know that internship and residency will come to an end! Once you are independent or a partner in a group, you will be treated as a "colleague" and people will treat you equally. I''d write a neutral evaluation on this one. It won''t do any good to write something negative in this case. Pick your battles and know that arrogance runs rampant everywhere. Where I work, it comes from the teacher assistants toward the therapists, ie, the high school grads make life miserable for the ones with master''s degrees and phds! It''s nuts!!!! The ego is based on fear for them just as much as it is for the chief resident, the head of the hospital, the managing partner, the CEO, the President....:)

Some people are more adept at handling power issues and knowing how to disarm the one abusing his/her power. Sometimes, the best thing to do is to take it for a bit (but never take it personally) and in other cases, leave the position and go elsewhere. So far in your case, things appear minor, so that''s great. If you were being put in a position with severe liability, that would be different.

Hang in there!

lawmax
 

gingerBcookie

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after thinking it over, i''ve decided to not burn bridges, esp since he''s still in the program and i may still have to work with him. i usually give glowing evals as everyone i''ve worked with have been great. i''ll likely go neutral-ish with vague comments instead of top marks and detailed comments on why the resident was great. i know it seems i''m selling out and being a wimp but its really scary to think of putting my career in jeopardy over what in the big picture is a minor mishap.
 

diamondfan

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That burns me up, because you want to be your most effective and someone else passing the buck and being lazy does not help anyone. Interns are overworked as it is, and while sometimes you will have to step in unprepared and go for it, this is not one of the times it needed to occur. You do not want to be taken advantage of, yet you have to walk a fine line, which is tough when you are worn out and frustrated. Even when you are in the right, it can still stink! Sorry this happened to you...
 

DIAMOND*QUEST

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Date: 12/31/2006 6:43:55 PM
Author: gingerBcookie

Date: 12/31/2006 3:55:21 PM
Author: DIAMOND*QUEST


Date: 12/31/2006 12:43:42 PM
Author: strmrdr
do whats best for the patient and let the chips fall where they will.
I would have to agree that the most important thing of all is that the patients were seen. In your future practice, you will have to jump in on patients whom you have never laid your eyes on, and on any given day. I am sure the patients you saw were appreciative of your care and dedication. If you feel that a breech in protocol happened, by all means go up the ''food chain'', write your report, and be done with it. I once knew an old Neonatologist who told me, ''Take care of business and move along''. That bit of advice always gets me through during the most frustrating of times in all aspects of life.

I did. I''m here to vent, not to find an excuse to not justify letting patient lie there without a doctor. Ans I''ve jump in and see patients all the time I don''t know. We cover the entire hospital twice a month as ''float'' where on any given night I have ~100 ''emergency'' calls on patients I don''t know. THat wasn''t why I was angry. I was angry about how I was treated and wanted to let off steam. But hey, I''m an intern, the bottom of the bucket, and I just need to bite the bullet and keep on moving so I am
5.gif
GBC- I hope that my response didn''t imply that you were looking for an excuse. I do see how you were angry and I just wanted to say a few words that may help. I personally don''t think interns are the bottom of the bucket although at times it feels like your in a bottomless pit! The "head games" are pretty dreadful at times. Hang in there.
19.gif
By the way, what type of medicine will you be practicing in the future?
 

gingerBcookie

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Date: 1/2/2007 1:54:20 PM
Author: DIAMOND*QUEST

Date: 12/31/2006 6:43:55 PM
Author: gingerBcookie



I did. I''m here to vent, not to find an excuse to not justify letting patient lie there without a doctor. Ans I''ve jump in and see patients all the time I don''t know. We cover the entire hospital twice a month as ''float'' where on any given night I have ~100 ''emergency'' calls on patients I don''t know. THat wasn''t why I was angry. I was angry about how I was treated and wanted to let off steam. But hey, I''m an intern, the bottom of the bucket, and I just need to bite the bullet and keep on moving so I am
5.gif
GBC- I hope that my response didn''t imply that you were looking for an excuse. I do see how you were angry and I just wanted to say a few words that may help. I personally don''t think interns are the bottom of the bucket although at times it feels like your in a bottomless pit! The ''head games'' are pretty dreadful at times. Hang in there.
19.gif
By the way, what type of medicine will you be practicing in the future?
thansk for the kind words D*Q...i appreciate the support! It'' ok that interns (or intards as are loving upper levels occ call us
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) are down there...everyone had to start somehwere and I don''t mind starting at the bottom! the head games are pretty annoying...part of the reason that i''m discouraged from going academic...hate the politics part of it all. i honestly just want to do my job, care for my patients, and go home and live my quiet simple life. not looking for fame or fortune. well, that''s a lie, some fortune would be nice! at this point i''m still planning to pursue heme/onc. i''m doing my onc rotation this month so we''ll see if i still like it at the end!
 

iluvchoc

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19
Yikes, I wouldn''t want your senior resident. Just because they are higher up doesn''t mean they should shirk from their responsibilities. Hang in there!
 
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