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Making Changes

I hate being blamed for something that isn’t necessarily my fault (or when it is something that is the fault of a few people all together). Unfortunately, this is a common occurrence in Medicine, especially as a junior resident. In the past, I had this compulsion to make sure people were aware of their role in the mistake or problem, because I always felt like by me being blamed, it was someone else’s way of offloading their responsibility.

A few weeks ago I commented on another blog about this exact issue. Tiffany from Surgery at Tiffany’s replied to my comment about an issue I had by saying how she really disliked when residents “argued,” (in a way). Since then I really thought about it: I thought about how it can cause more friction and perhaps even backfire on me and make me look bad. As a result? I’ve been trying harder to “accept the blame” publicly and then debrief about it personally in order to understand my role in the issue – then let the rest go.

I thought about this all again this morning, when I was about to go home after a busy night on surgery call. Yesterday afternoon, my chief resident texted me and said she was leaving early for an appointment and asked that, if I had time that afternoon or evening, if I could run up to an inpatient unit, see a patient in consult and then discuss it with her in the morning. I said “sure!” Every time I sat down to start working on this consult, my pager would go off: splenic laceration, acute appendicitis, someone pulled out their picc line, this lady hasn’t voided all day and 4 different people tried to put in her foley without success – can you come try?, Mrs. So and so’s white count went up from 14 to 20 and she says she’s in more pain, can you check the placement of that guy’s tube feed… Finally, I was done all this “urgent” stuff and it was midnight. I wasn’t going to do a “low priority” consult at midnight. I continued to deal with the night time issues in between broken moments of sleep and then this morning, I gave her the part of the consult I started and told her I didn’t get a chance to see the patient. She said, “okay” and handed it over to another resident on our team who would be there today. At the last minute she said, “why don’t we just go see this patient now and hammer it out together.”

I was given the job of looking up her pertinent medical history, imaging, and labs on the EMR while they went to see the patient. A few minutes later she came back to me saying the patient was extremely distended and wanted to look at her imaging right away. An abdominal X-ray done last night by the patient’s home service showed an extremely distended section of large bowel with nothing beyond. It was so big it looked like it could perforate at any moment. I finished the consult form and wrote orders as the chief resident made phone calls to tee her up for emergency bowl resection today. We were all very frazzled.

She told me that our staff Dr had known about this consult for some time and it sounded like a consult for a sigmoid mass. She finally asked him for the details yesterday. After getting the info from him, she texted me on her way out of the hospital. The way she phrased the text made it sound like I wasn’t a priority (we do a lot of these non-priority ward consults). So she left, the other resident on my team left after everything else was cleaned up, and I was very busy on call. The consulting service never called us to say that her clinical status had changed. The urgency of this consult was completely underestimated by everyone.

I apologized to my chief and said that if I had know. That the patient was this sick, I would have prioritized it above some of the other things I dealt with last night. Her response was, “you should always make it a point to lay eyes on a patient, even if you think it’s not important. If you had done that, you would have known.” I knew she was right. However, she obviously hadn’t laid eyes before she left because she would have been concerned and told me that it was urgent instead of asking me to do it “if I had time.”
I was about to open my mouth and say this aloud to her – that she was criticizing me for not laying eyes when she didn’t do it either… But I stopped myself. I knew that I had some responsibility in this, and she probably knew that she did too. Perhaps her comment to me was her way of reminding herself of this important tactic – she didn’t need her junior resident to point out her fault. So instead of saying what I was inclined to say, I just said “yes, I’ll do that next time.”

We never said anything else about it. We got her ready for surgery. The right people were called and there was no major harm done (that I know of, at least). As I reflected on this incident and the way I responded differently than I might have before, I realized that not being defensive was probably the best way to deal with it. I felt very good about this new change I have made.

12 thoughts on “Making Changes

  1. I have so much to learn from you. I really think this story and your new way of approaching situations at work can apply to so many areas of life. Thank you.

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    1. I agree, it can be applied in so many places! I’m glad it will get you thinking – but I do still have so much to learn too! I am humbled, though, that you feel that I have so much to teach 🙂

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    1. Thanks! It wasn’t as hard as I thought, actually. I think it’s because I had (somewhere) found the confidence to know that this whole situation was not *only* my fault. Saying it aloud wouldn’t have changed that.

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  2. You will probably never hear it out loud, but people will think higher of you and want to work with you more because of your new behavior. It is a rare quality.

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  3. This reminded me a bit of those “reflective logbooks” I had to write during placements and internship – but in a good way, of course! This is a brilliant example of how reflection is meant to be done to help improve practice.

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  4. Good for you! It’s so hard to bite your tongue sometimes but you handled this well. I couldn’t help but be reminded of those vignets from the CMPA magazine about situations like the one you described. Always cover your own ass!!!!

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