Reflection on a Wednesday: To the Generation Y Learners with Love

*Disclaimer: This is a slight rant. If you are easily offended, please skip this post as I have much touchier, feelier offerings for your reading pleasure. . .

You DO realize that we can hear you, right?
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"To all the learners that we've taught before

Who traveled in and out our doors

We're glad they came along

We dedicate this song

To all the learners that we've taught before. . ."


(Remix on Julio Iglesias and Willie Rogers' "All the Girls I've Loved Before")
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I started medical school in July of 1992. Back then, we called every doctor "Dr." and were so formal and deferential that you'd think it was a military academy instead of medical school. Although the internship I started in 1996 was slightly more relaxed, we regarded every faculty member highly, and never dreamed of anything that might come across as overly familiar or presumptive--especially when it came to our attendings and their time. Now, I'm not saying that there aren't students and residents who hold their attendings in the same esteem now. . .but sometimes. . . .just sometimes, it seems like the culture today in medical education is different than it was back then. The Generation Y learners seem to have a certain chutzpah that took us some time to grow into. . . . (I'm just saying.)

Case in point:

Just about every week, I find myself in a water cooler chat with a colleague about something an intern, student or resident said that was so . . . .uhhh. . ."no-he-or-she-di'in't!". . . that it leads to more discussion. All from off day "requests" to emails about being excused early for flights to texts about getting out of teaching sessions to you name it . . .all approached with such nonchalant audacity that it, literally, blows the minds of faculty. Our water cooler conversations are almost always punctuated by an emphatic,

"I wish I WOULD have even THOUGHT to say something like that to my chief/attending/program director/senior resident! No way, no how!! I would have been torn a new you-know-what!"

::five way faculty fist bump::

The verdict: Times have changed. Learners are much more comfortable making suggestions to us that never occur to them as outlandish. I can honestly say, I have heard them all. I have been a senior resident, a chief resident, an attending, and now a residency program director--and with every year, the ante gets upped with boldness that makes me (and my colleagues all over the country) say, "Awwww, hell naww!"

Now don't get it twisted--everyone knows how much I love me some interns, residents and especially medical students. . . .so for this reason, out of sho' nuff love and nothing else, I cannot allow this to go on any further. So. . . just for all of you-- my beloved learners, here is a guide to what NOT to say to your attending, program director, chief resident or adviser, no matter how extraordinarily cool and approachable they seem.

Yes, it is 2010, but no, assuming that we do not have a life (or feelings for that matter) is NOT cool. So this is an intervention of sorts. And lucky you, I'll be as concrete as possible by providing a few examples . . . . . balancing it all with some viable alternatives. Yeah. . . . this is a love-filled intervention indeed.

Let's jump right in, shall we?

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Examples of "No-he-di'in't/No-she-di'in't" Correspondence:

What you said over an email (three days before the start of the rotation):


Dear Attending,

Hope you are well! I am looking forward to working with you next month on the wards. I am emailing you because I made a schedule request with the chief residents to be on this schedule so I wouldn't be on call over the three day Weekend. I have plans to go to Vegas for my best friend's bachelorette party, and was hoping to fly out early (around 4pm) and get that Saturday and Sunday off. I already spoke to the senior resident who said she's fine if you are. Touching base with you to make sure it's okay.

Thanks in advance!

Dr. Pria Sumptive

Let's try a better approach, shall we. . . . .(One month or more before the rotation starts)

Dear Attending,

My name is Ina Turner, and I will be rotating with you on Team X in September. I am contacting you to discuss a scheduling issue that I have considered for next month. My best friend and roommate from college and medical school is getting married this year. I have been fortunate enough to be asked to be her honor attendant, and already scheduled vacation to be able to attend her New England nuptials. She is also an intern, and she, as well as several of our mutual friends, have coordinated their schedules to meet out of town for a bachelorette celebration in her honor over the Labor Day weekend. I recognize that so early in the month and in my internship that this could be a hardship. I am respectfully asking for the consideration of being afforded two consecutive off days for my best friend's celebratory weekend. While our team is not admitting, I realize that this could potentially inconvenience others on our team, especially you. I have not yet purchased a flight, and would absolutely understand if this were not possible. The specific days are Saturday, the 4th and Sunday, the 5th. I will be post overnight call on Friday the 3rd. Thank you for your consideration and I am very much looking forward to working with you next month.

Very best,

Intern

That's what I'm talking about! Okay, maybe it was a bit longwinded, but it was definitely unassuming and respectful. (You would SO get that weekend off if I received this correspondence! Again, I'm just sayin'.)

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What you said. . . .

Text message:

Hope u don't mind but gonna pass on our special session this afternoon. Long day for me in the hosp and feel a migraine comin on. BTW feel pretty up to snuff on stuff ur covering. Hit me back if an issue --thnx. Holla--

Noah Di-int, Medical Student

What about this approach instead. . . . . .

Good afternoon, Dr. Attending. I am concerned that I am feeling a migraine coming on. Do you have a moment to call me to discuss our session this afternoon? Thank you, Noah D. Medical Student

Isn't that better? Was that so hard? (Even if I say no and make you come anyway, at least you won't get the hairy eyeball when you arrive.) By the way, note that not everyone is cool with the text message. If you do get the green light to text, I might suggest avoiding "text speak:" e.g.

"OMG Dr. M! LOL ur blog is awsme! TTYL!"

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What you emailed the Chief Residents or Program Directors. . . .

Dear Program Director/Chief Resident,

I was counting my shifts on the ER schedule and noticed that I have one more shift than everyone else. John got ten shifts and Jasmine got ten shifts, too. I have 11 which is not fair. I also noticed that I did not get a full weekend off, which doesn't allow me to make any kind of plans such as travel, etc. While I do not celebrate Christmas, I am kind of annoyed that I got picked as the one to work during that time. I just don't think this is fair and hoped you could step in. Also, is it normal to have two calls that fall one on a Friday and another on a Saturday? Jasmine did get one Sunday, but she didn't get a Friday which does not seem fair. You can tell me if I'm being irrational.

Wine E. Resident

Try this approach. . . .an invitation to talk--not an email about this (which almost always sounds whiny.)

Dear Chief/Program Director,

Would you be available to meet with me soon? I wanted to discuss a couple of concerns about my schedule with you and hoped I could get on your schedule. I am at Grady all this month, and am available whenever you are open. Thank you for your consideration.

Resident, Pager 12345

So simple, yet so effective. Ya dig?

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See? It isn't really that hard.

Here are the take home points:

• Assume nothing.
• Our time away from work is just as valuable to us as yours is to you.
• If you just started your residency or medical school, factor that into your requests.
  
• Sometimes you just can't go.
  
• Do NOT buy plane tickets before speaking with the attending. Don't do it.
  
• When you have a request, make it formally and make it EARLY.
• You are NOT entitled to your request unless there are special circumstances.
• Why? Because this is what you signed up for.
  
• THINK about what you are sending and to WHOM you are sending it.
• We work harder than you realize on teaching students and residents. It is hurtful when that is not considered.
  
• Just because our response doesn't sound like we want to go off on you, doesn't mean that we aren't going off about what you said/did/assumed/requested in our heads/to our spouses/at the water cooler.
• Formality gets you further than overly familiar assumptions.
• You signed up for this.
• To quote my friend and fellow Grady doctor, Ira Schwartz, M.D.--"This ain't college."
• 
  

On a serious note, medicine involves sacrifice. Be smart before you speak and ask yourself if what you want is actually realistic and appropriate for the timing, rotation, and even your profession. If the answer is no, let it go. Know that we work hard to strictly adhere to duty hours rules, off day regulations and all measures designed to protect you from burn-out, stress, and not having a life during training like we experienced. Despite those measures, medical school and residency involve work. They also involve missing out on a couple of things sometimes. It is our job to help you achieve work/life balance through it all--but you must know that the word "work" is a part of the equation, too.

Capisce?

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For the record, I am 100% serious, and hope that the medical students and residents out there who run across this take it as such. Feel free to save a med student and forward this to a friend. . . .

~ With nothing but love and hopes for your very best future, Dr. M ***

**Students, Interns and Residents that I saved today:

You can thank me with Target giftcards, red wine, or key lime pie. :)

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