Push It

I had one attending who was known to be "tough" or "mean." He grilled us on our admissions. He focused not only on our history or our presumed diagnosis, but also questioned things I usually do not consider. Why did we admit this patient? Could we have sent this patient out? As an intern, that decision is usually not up to me. For example, we admitted a patient with a blood pressure of 210/110, asymptomatic. This attending asked for specifics: describe the fundus; did you take blood pressures of both arms? But he also challenged us to justify why an asymptomatic man needed to be admitted to the hospital. He would not settle for simply a blood pressure justification, no matter how outrageous the numbers, nor would he allow us to say "the clinic and ED attendings both thought he should be admitted."

In any case, this attending at the end of the rotation told me why he does this. He thinks that attendings need to push interns and residents. Sure, we do a good job, and we take good care of patients, but to really propel ourselves forward, we need to challenge ourselves to learn more, think harder, never be complacent. It is easy, he says, after 24 hours of call to make assumptions, rely on other people's interpretations, and neglect to make our own clinical decisions, but we should resist that urge. I thought this was a very true point. When we are students, our incentive is to do well, get a good grade. But this incentive drops out when we are residents. Our main motivation is simply integrity: to do more than get through residency without hurting anyone; to learn, challenge ourselves, achieve excellence.