Don’t Tell the Spartans

(Many of you are about to start third year and are looking forward to it with feelings of both anticipation and dread. You know that it’s going to be the real start of your medical career where you finally get to see what all the fuss is about. At the same time, despite the propaganda, you have the uneasy feeling that third year is going to blow, and blow hard, not for the least of which reasons because, after what in years to come will have seemed like a two-year vacation, you now will be working on a rigid schedule with responsibilities that you can’t casually shirk.

There are two schools of thought about clinical education for medical students. One school believes that your clinical years should be a model for residency complete with long hours, pointless abuse, and call. This is under the theory that it will toughen you up for residency where you will be further toughened up so you can be prepared for the real world where medicine is not practiced at all how it is in residency.

The other school, the Panda School, knows that abuse serves no purpose other than self-justification for the past suffering of the abuser, that you cannot condition yourself to do without sleep, and that clinical training as it is currently structured at most medical schools is actually detrimental to education. Not to mention that since you will get plenty of abuse as an intern, there is no point wearing you out now, especially since, despite what The Man says, you have no responsibility for patients.

I was referred to an interesting discussion on the Student Doctor Network about the mistreatment of medical students by residents and since we have been giving short-shrift to this topic (although Brother Hoover has it covered pretty well) I thought I’d try to address some of the common complaints that medical students have about residents and particularly interns.

I am known to be very easy on medical students, by the way, as some of my medical students who read this blog can probably attest.-PB)

1. It’s my first day on the Service, and my first day of the third year, and the intern is mad that I don’t know anything.

I don’t know of another career where the trainees are berated for not knowing their job on the first day but this is a fact of life for medical students. On the first day you won’t even know how to work the phones much less care for patients and it may take you hours to complete a simple task (such as dictating a brief note) that you will complete in thirty seconds as a resident. This is because you have nothing but jumbled facts bouncing around your brain with no experience in marshalling them into a coherent assessment and plan for your patient. You also have no idea about the logistics of the hospital, where they keep things, and who does what.
I don’t know why this is hard for some residents to understand except that medical school admission committees seem to be selecting for assholes and, although medical school is good for personal growth, these people tend to grow as assholes.

The solution? There isn’t one except the general advice that the hospital is not Thermopylae, the patients are not the Persian hordes, and you are not a Spartan who has to sacrifice himself for the greater glory of a large, bureaucratic machine that if possible, thinks less of you than it does of the residents. Pace yourself. Realize that you don’t know anything, and revel in it. Don’t apologize, and be direct in the face of worthless, spiteful criticism, especially from an intern.

I assure you that interns have very little input into your grade for the rotation and generally speaking, as most residents are decent people, we can see as easily as you which interns are socially dysfunctional. You also have to ask yourself if your grade is more important than your self-respect. If it is, then you will have to suck it up. If not then you should establish the ground rules for how you are going to be treated early. As Dr. Phil says, we teach people how to treat us. If you are firm, forceful, and fair, people will either respect you or they will be intimidated, either one of which is fine. If you are a weak, squirrely biach you are going to be treated as such.

It’s like prison. If you pick a fight with the meanest, baddest prisoner on your first day, win or lose you are going to establish some credibility. I’m not advocating beating your intern but it’s not like this guy is that far removed from you. Hell, it’s July. He’s more scared than you because he has real responsibility. So sometimes, as you learn in the joint, a brother has to shiv’ a motherfucker. Establish early on that you are not a biach and you will do fine.

2. My intern is stealing my work and getting credit for it.

One of your duties will be to see patients and write notes, especially the time-consuming Admission History and Physical. No question about it, medical students write exhaustive H & Ps. You usually have the luxury of time while your intern is perptually under the gun so his may be a little more sparse than yours. While you may turn in a copy of your luxurious History and Physical for a grade, to your intern it is nothing but meaningless paperwork, especially since for 95 percent of patients everything pertinent could be written on a small index card in thick black marker. It’s another obstacle in a day filled with obstacles. He also knows that even in the unlikely event that anybody reads the note, the only thing they are interested in is the assessment and plan and not your detailed description of the patient’s travel history since the Carter administration.

Your intern does not get credit for your History and Physical. There is no such thing as “credit” for this sort of thing. It’s done, the box is checked, and it becomes just another scrap of paper mouldering away down in medical records. I have never heard an attending say, “Hey, that was a cracker-jack History and Physical. Take the rest of the day off.”
So don’t sweat it.

3. My intern is stupid.

Have a heart. You are fresh from two years of intensive lectures and the USMLE Step 1. Your intern spent most of the last six months of fourth year playing video games and catching up on sleep. I am a PGY-2 (second year resident). I once asked a medical student a question and when he went into his pimp-defense mode I said, “Relax, I’m really asking you if you have ever heard of this condition because I sure as hell don’t remember it.

Not to mention that your intern is sleep deprived and under a lot of pressure. It is easy to look and sound stupid if you’re supposed to know what’s going on but don’t which is typical of most interns. It’s not that they’re stupid, it’s just that compared to their upper levels and attendings they seem that way. They’re learning too, just like you but the difference is that they count and you don’t (no offense).

On the other hand since “MD” actually stands for “Minimal Doctor,” it is quite possible that your intern is, in fact, a jibbering moron, at least by medical standards. It is inevitable that somebody is going to slip through the cracks and the “questionable admission” may very well have pulled off yet another snow-job and landed a residency position. Not to mention that there are a few specialties that are known for scraping the bottom of the barrel when it comes to the help.

If he’s a jibbering motard but otherwise a nice fellow you might consider trying to cover his ass. You don’t have to, you understand, and nobody is going fault you or even know if you don’t but good residents look out for each other and you may as well start practicing now. I know, I know. You’ll be helping a guy along who will one day be in the position to hurt patients but decent people don’t think like this. Let his State Board sort it out.

4. My intern tries to get me to do his work, especially on call.

I despise call, probably more than most people. Ever since I started publishing this blog it seems like more and more residents are coming out of the closet in this regard. Certainly when I was a medical student to say you disliked anything about medicine, not just call, was viewed with the same horror by your residents as if you had a large, greasy bowel movement in their Lucky Charms. But they’re not fooling anyone. Call blows. Nobody likes it just like nobody really likes residency training for the most part except that some tolerate it better than others.

So it would be natural for an unscruplous intern to try to either shame you or force you into doing his work for him. Just keep two things in mind. First of all, most medical schools have rules about call for medical students. At some, medical students are to be discharged at some reasonable hour of the night because, wonderous to behold, the school realizes that a medical student’s purpose is to learn, not to be a scut ox who is too tired to study. It is up to you to know the rules and grow a set of gonads about sticking to them. Don’t care for the rotation or the intern? Hey, it’s eleven o’clock buddy and I am outta’ here! All you have to lose is the respect of the intern…but…and stop me if this is obvious…he’s just an intern. His respect his worthless anyways if it comes at the price of your sleep and your health. Stay all night if you want and if you feel like you will learn something but scut work is worthless and you’re not being paid to do it.

The second thing to remember is the French Hooker Rule. No matter what they want, you can only give them what you can give them. It is not your responsibility to clear out the backlog of admissions in the Emergency Department. Most interns wouldn’t even think of giving you this task, not for the least of which reasons that you can’t do it. But sometimes a lazy and unscrupulous intern, on being paged for an admission, will send his medical student to knock out the preliminaries which involves most of the paperwork. Learning is one thing and you need to do some admissions to get the feel for it but you are not cheap labor, the intern is…or didn’t he get the memo?

And I am sick of sports metaphors. It’s not a team. If it were a team everybody would get treated better than they do. It’s more like a salt mine (I mean if we’re going to throw metaphors around). Do your assigned work diligently but don’t be patsy either.

5. My intern berates me in front of the other students.

Berate back. He’s not your mother. There is no penalty for shoving back. You are not contractually obligated to take crap from anyone. On the other hand, no need to be on a hair-trigger, either. Certainly don’t buy into the “Welcome to My Service” speech that some interns like to give. I got one of those as an intern from my twenty-something third-year resident who, among other pearls of wisdom, informed me that my family needed to come second after medicine in my order of priorities. This only sounds good to people who don’t have families, of course. The point is that the intern has different priorities and goals for the rotation than you might have. It may be his specialty and he may be really into it. You may hate the specialty and just want to get through it with the low pass.

The irony of medical school is that you are expected to take abuse from people who are only a few years ahead of you in training and whose ass you would otherwise kick if they treated you half as bad anywhere but the hospital.

29 thoughts on “Don’t Tell the Spartans

  1. This post actually takes a lot off my shoulders as far as when MS3 rolls around, thanks Panda. I’m pretty well-known by my friends & family to be extremely confrontational when provoked so I was hoping I wouldn’t be committing suicide by returning fire if treated like shit. If I can still pass the rotation, but just with a minimal pass, then I’d rather have my self-respect than a higher grade.

    If it comes up in residency interviews, I think it’d be more impressive that I stood up for myself and had some balls, and if not, I don’t think I’d want any part of that residency program anyway.

    I’ll definitely be looking very carefully as well at the rules of what MS3 students are required to do when I start third year…if I’m not required to do call then they can kiss my ass if they expect me to stick around.

  2. “sometimes a brother has to shiv’a motherfucker.” Classic.

    But the African American “brother”, don’t you think that’s too ethnic?

  3. Justin, first of all I doubt Panda means it to be derogatory in any way.

    Secondly, correct me if I’m wrong, but I doubt he cares much about being PC. That is part of why we read his blog remember?

  4. I’ve actually never had a bad intern – in as much as they’ve never treated me poorly. I have had, though, some that were obviously questionable admits. Not knowing where the liver is in relation to the stomach? I know you’re stressed, but damn man!

  5. Great read. Choosing to be somewhere and having to be somewhere is such a big difference for med students. When I was doing OB I think I would have rather spent the entire time at Abu Garab prison than have to do another H&P for them or step into a 98 degree room with the sweet smell of amniotic fluid wafting about.
    We have 5-6 med students per month gunning for Ortho and we let them know up from their job was not to be scutted out. However those that jumped in and did paperwork and helped out would have a better shot for an ortho spot. What a difference between choosing and being forced.

  6. 1. Do what you’re told
    2. Lay low

    FWIW I liked 3rd year much better than the first two. Yes there’s scut and sleep deprivation, but at least you’re finally learning something worthwhile.

  7. I am not advocating, again, going throught third year on hair-trigger looking for a fight. And the number one rule of medical training is to never lose your cool or get mad at anybody for any reason.

    But it is perfectly acceptable to say, “Make your own copies,” or “Get your own coffee, I ain’t yer’ bitch” which is what I had to say once (once) to an asshole of a resident who confused me with his valet.

    I was so surprised to be asked to get somebody coffee, as a matter of fact, that I had to have him repeat it. I don’t think I look like a little gopher bitch and I certainly don’t act like one. I think he confused my good humor and respect for lack of a spine.

    And no, I didn’t care if he was “busy” and getting him coffee would help him out. Fuck him. Nobody is ever so busy that they can’t take the elevator down a few floors to get a cup of coffee.

    Man. Don’t get me started because I will never shut up about this topic and the way I’ve seen medical students (and residents) fold like cheap suits in the presence of people who don’t deserve the dread.

  8. Any thoughts on picking up dinner for the “team”?

    I liked it, in fact getting outside of the hospital for an hour or so was usually the best part of the call night.

  9. I’m about to to start my internship in 9 weeks and I feel completely dumb. I dont remember anything I learned on the boards, I dont know any “medicine” and I am completely slow and disorganized and have no social skills whatsoever. Moreover I am not trembling in anticipation at the thought of internship just looking forward to a 3-year long grind, burdened by overly too much responsibility and a complete inability to enjoy my life. Why o why did I ever go into medicine training: 1) challenge 2) “prestige” 3) money 4) parents. Why didnt I ever learn to enjoy things I like instead of doing what other people want me to do?

  10. Valid points and a good post.
    I would emphasize to medical students to not be confrontational or risk your reputation preceding you for a long time.
    Never ever try to show up fellow students, interns, residents etc- this is just massive tool behavior.
    Interns will not know much more and a good possibility less than you for reasons Panda detailed. They will, however, know logistics and pearls of how to functionally work in a hospital and focus on that educational value

  11. Dr Who,

    If you are not joking I truly suggest that you quit and do something else besides medicine. If you feel this way now you will be on a psychiatric hold if you havn’t successfully killed yourself 3 months into your internship.

    Your reasons:
    1. Yes,true. So is crawling across Texas
    2. Huh?
    3. Where? And fast disappearing.
    4. What the ****!

  12. I can’t believe someone actually had a problem with the inclusion of “brother” with “shiv a motherfucker.” That was definitely among the top-ten Pandaisms.

    But yeah, Panda, good stuff to read and remember a while from now when I’m going through it… and I think Dr. Who’s comment is, well, scary.

  13. Apaprently I am the only one that went into medicine for the 4 reasons above. All of my classmates went into medicine to “help people” while for me it was just 1) challenge, 2) prestige 3) money 4) parents and actually 5) to show off and 6) because I know I am a bad salesman / banker. I guess everyone else will be changing the world and making it a better place to live, while poor old me would be just facing the daily grind, taking it one step at a time. P.S. Jerry thank you for your suggesting to kill myself … I’l look into it.

  14. P.S. I love Don Imus he’s the bomb, too bad my other idol Howard Stern doesnt like him…

  15. I repeat, sometimes a brother has got to shiv a motherfucker. I’m not proud of it but there it is.

    When it’s your time to shiv a motherfucker…well…then you’ll understand.

  16. i’m sorry I was busy saying a prayer for all the people I am about to kill of “shiv” in my internship…

  17. When I was in high school, we’d box in between two-a-days. There was this guy that nobody wanted to fight, the baddest guy in the yard, if you will. The fact that he is now doing time for attempted murder and felony drug charges only adds to the legend of our intense but short relationship in the locker room. Which was great for my little brother, who NEVER got in a fight, on account of his vicarious participation in my ass-beating. In short, the other guy thought we were “sparring”, and I apparently missed the memo and have always heard, “If thou striketh the king, strike not to wound.” So I did.

    Dr. Bear, with the more long-lasting effects of being That Guy, how do you weigh how high on the totem pole to assert your place in the pack, with such a propensity for such things to back-fire and result in more than just a bloody nose and a fat lip?

  18. You guys are making it too complicated. Just act normally like you would with anybody. Don’t kiss ass, don’t be obsequious, don’t laugh at a joke if it’s not funny and if you are asked for your opinion (“Say, Student Doctor Smith, what specialty are you interested in?”) give your opinion without altering it to please anybody.

    But be polite and good-humored all of the time. Laugh at the motherfucker who is talking down to you. Insult him back if he insults you.

    And, unless you are wrong or have made a mistake, never back down and never apologize.

  19. However…The only “C” I have ever received on any one of my rotations is when I acted like Administrator said above. The fresh attending (who was only 4 years ahead of me in my medical school) commented that I “appeared disinterested in rounds” and “has mentally checked out”…

  20. I found your blog through “Shrink Rap” ( You have an interesting place here.

    On the subject of mistreatment of medical students, residents, interns, (and fellows!), I would like to add that one reasonable approach that has worked well for me is pretending like you’re being perfectly reasonable when you try to work within the rules. Such as, “I came in at 4am yesterday and I was on call last night, and now it’s 10am, so according to the rules, I think I have to go home.” (24+6 rule). It doesn’t work well when you’re a fellow (they call it being unprofessional. I would beg to differ, especially when being asked to do completely meaningless tasks post call that could be done (probably better) by a trained monkey), but it might go over ok from a medical student. Play the “They told me I had to follow the rules” card. 🙂

  21. wonderful post and nice rules for the students. i personaly feel that the med studs should kiss my hand when they walk in my OR and maybe bring me a gift (ha ha ha, i crack myself up) ok that was only funny in my own head. anyway, i think for all involved basic courtesy rules should apply, “do unto others as you would have them do unto you.” how quickly people forget how it was for them when they were in the shoes of those they teach.

    one thing i will say for the med students the residents and attendings are human (i know this may be new); therefore, they are as flawed as the next person. There is a bit of politicing in the 3rd year, it is not always about how much you know. (i hated this about the 3rd year)

    work hard and try to be a part of the “team”

    and that’s all i got to say ’bout that

  22. Panda…words to live by. Another double-tough entry. Third year starts in two months…and I’m not exactly looking forward to it. I’m mainly interested in Rads and Path anyway, so if I have to take shit from patients *and* interns, things could get ugly. Of course, to land in Radiology, I need at least some kind of subjective approval of my “higher-ups”, so that kinda sucks.

  23. How do interns respond when you’re aggressive back to them? I’ve thought that if I tell a resident on the first day, “If this is the way you’re going to behave, we’re going to have problems during this rotation,” I’d be setting myself up for a bad relationship down the line.

  24. As an MS4 now, I would’ve loved this sort of advice 2 years ago. In general, I laid low for the first day or so to feel out my residents and attending, then opened up a bit more. I like to crack jokes, but I won’t with a tight=laced team. The point being, try to fit in a little bit, especially if you want to go into that specialty, because it’s always nice to have contacts. On the other hand, don’t let anyone run you down to avoid burning bridges (‘cos they won’t have any respect for you anyway). Like my surgery resident who kept calling me “Psych” for a full week; when he asked what I thought of a CT, I finally said “Angela”, and reminded him that no, I never did say it was ok to call me that.

  25. How do interns respond if you are firm?

    Look, medical students who become interns, with apologies, are not exactly known to be tough hombres, the meanest dudes on the block and in any other career they would hardly inspire anything close to the dread in which they are held by other medical students.

    We are all, most of us at least, geeks to one degree or another.

  26. Wish I’d read this a few days ago before I spent 10 hours doing admissions in the ER while on call (and the rest of the night following around a standard intern who didn’t have the courtesy to send me to the call room as I watched/helped him finish paperwork & page attending physicians).

    I will never again finish help one intern to finish his work and then be told to spend the rest of the night helping a second intern dig himself out of his backed up admissions pile. I’m a hard worker and definitely played the intern’s bitch during that hellish call night.

    Thanks for helping me to learn this lesson early.

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