Poor Role Models

He was cocky and arrogant. The kind of attending every medical student feared. I heard the rumors before his arrival. But I was hoping that reality was less harsh then word of mouth. I had only one week left in my Internal Medicine rotation. So far, I received glowing reviews from my residents and attendings. Seven more days and I would clinch the sacred "honors" grade that I needed to be eligible for the top residency programs. A "pass" would just about eliminate all the highly competitive options.

It was the beginning of my third year of medical school and I had chosen general medicine as my first rotation. I was already signed up for the early subinterniship like many of the other students who were entering the field.

As he walked into the resident's room for the first time, I waited cautiously. He scanned our faces briefly before flopping in a chair beside us. There was no formal introduction. No exchanging of names or titles. He nodded at the third year resident and spoke to no one particular.

So what do you got for me?

*

The rest of the week went similarly. He spoke only to the residents and barely looked in the direction of the students. His condescending demeanor dripped with sarcasm and contempt.

Occasionally he accompanied the team to the bedside. He rarely asked the patient questions or spoke to them directly. His statements were curse and robotic.

Unfortunately, he was brilliant. He was able to pick apart a patient presentation and pull out the relevant facts with ease. His skills were adroit. There was no doubt his presence was highly valued by the university. He spent ninety percent of his time in the lab. Likely some administrator relegated his minute clinical duties to the VA to minimize his ability to do harm.

*

On the last day of the rotation he walked into the lounge with a smirk on his face. He would return in the afternoon to watch each student perform a blind history and physical.

My resident scrambled to find an appropriate patient. He looked for someone who could tell a good story, and had a problem befitting a third year medical students fund of knowledge and abilities.

The attending returned later that day and we walked quietly to the patients room. To our surprise, when we entered, the room was empty. She had gone for a stress test.

Looking mildly annoyed, he asked the head nurse for another suitable patient to examine. She, of course, not realizing the purpose of the interview chose a complex medical patient with a rare disease. She thought it would be a good learning experience.

*


The interview was a disaster. The patient was demented and confused. His self described pneumonia was, in reality, a pulmonary embolism. He also had empty sella syndrome.

I absolutely flopped. And to add injury to insult, after I finished the attending performed a superb history and physical and elicited everything I missed.

He later sat me down and berated me for half an hour. He was disappointed in my abilities. That morning he had been ready to give me honors, but now...
*

My final grade for internal medicine was "pass".

Although I aced many other rotations as well as my subinternship, I would not be offered interviews at many of the top residency programs that I applied for.

Years later, as I look back on the experience, I realize that that hour changed my life.

I would never have been motivated to become the teacher that I am today

if I hadn't started with such a poor role model.