Another incredibly good day. The chief let me leave by 3pm. Of course today I absolutely adore her.
Partly by my aggressive management (I don’t think I’m very popular with the case managers anymore; on the other hand, if they would answer their beepers sooner than noon, we could get more work done) and partly for lack of emergencies the last couple days, I’ve pared my list down to about seven or eight patients. After formal rounds today, the attending remarked in a disgusted voice, “We could just call it SNF rounds: every single patient is just waiting for skilled nursing placement.” Tomorrow we have a long case schedule, so I’m sure this will be quickly corrected.
But Sunday is my last day before vacation, so I just want to survive this week, and I don’t care if the list doubles by Monday.
Attendings are funny creatures. The purpose of their existence seems to be to frustrate the chiefs by doing old-fashioned things with little evidence to support their practice. Several of our attendings here are relatively young, and a few graduated from this program not too long ago. I can’t figure out how they changed from chiefs into attendings. At what point do you decide to start doing things because it feels better, or is more convenient, rather than because there’s evidence? (Not that there is evidence for a lot of surgical practices; but sending lap chole patients home, or using a particular method of graft implantation for hernia repairs, does have good evidence.) M&M today was curious. One of the strongest chiefs had a series of disasters to present, and essentially spent most of his time at the podium saying, “I’m not sure why we did it this way; it was attending preference.” Sometimes the preference turned out well, and sometimes not, but either way, even the chief, who is loyal and competent, had no rationale to give other than, the attending likes it this way. And somehow, the chief came out looking a little badly, because he tried to shift responsibility onto the attending, rather than standing up and giving some kind of explanation (even though it wasn’t his decision, and he probably argued against it when the choice was made). I don’t know. Most likely the attendings have just as good rationales as the chiefs do, but because we (or at least interns) spend more time with the chiefs, their side is the only one we hear. (But this seems to happen in all specialties. Medicine attendings have funny quirks that have to be humored, too.)
