Everyone's a critic

Everyone's a critic. I had a patient weaned and extubated because she was getting ready to self-extubate. I ran it past the attending, who sort of agreed, but was mixed in feeling afterwards. He wasn't critical, but I definitely got the vibe that maybe this was too soon. One of our consulting attendings wasn't quite as subtle. He upfront said to me that I had extubated too soon and would have to reintubate her. I won't go into specifics, but anyway, I was vindicated. She's doing fine and out of the ICU. The attending conceded, but the outcome's really not the question.

I'm a first year medicine resident. As such, I have NO clinical judgement. I don't have that gestalt that attendings use for diagnosis and treatment. That's the skill I'm supposed to garner from residency. Seeing as that's the case, there's just about no reason to suppose that I will make the right clinical decision. In fact, I'd bet against me on all questionable treatment decisions. Already, I've had several of my orders changed or otherwise D/C'ed because they were inappropriate or outright wrong.

The point is to learn, and some attendings are better teachers than others. One of my attendings told me that I did the wrong thing, period. And that wrong thing had the capability of jeopardizing one of my patients. I didn't get burned on it; the patient's doing fine. But he didn't get in my face about it. He showed me what to look for next time, who to talk to, what I should consider, and really who to trust.

Y'know, it's all about attitude. Some people honestly believe that criticizing and yelling is the best way to teach. I'm glad that most of these people don't go into internal medicine. Medicine's got all the passive aggressives. Like I was telling my medical student today: medicine's full of asses. All the jackasses become surgeons. All the smartasses go into internal medicine. The dumbasses? Well, someone's got to do psych I guess.

That being said, I think I should've gone into psychiatry.

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