Get sent, as a surgery consult, to see a patient who really needs a derm – and/or psychiatry – consult. I really hate it when people consult us without calling to give some idea of why they thought we would have anything whatsoever to contribute to the management. (At least when we consult cardiology without calling, there’s usually a wacky EKG to explain what’s wanted; although I try to call, myself.) I especially love it when the admission H&P states, “Patient was seen by Surgeon X’s resident, who said he doubted there was much to be done, and patient was instructed to follow up as an outpatient. Now that the patient is being readmitted two weeks later, before that followup appointment, we will consult Surgeon X again.” If you would give us a call before placing the official consult, we could point out, with one look, at one slice of the CT scan, that ayurveda and acupuncture are statistically more likely to do this patient good than surgery is. Then you wouldn’t have to torture the night float service with having to work your patient up, in between admitting from the ER, handling traumas, and juggling disasters in the ICU. I also love it when the surgery team sees the patient and writes up a complete consult note with recommendations, before medicine has even an intern’s note on the chart. It’s so easy to figure out what on earth the primary team’s plan is, that way.

Spend 50 minutes on the phone with tech support trying to figure out why your internet service shuts down as soon as you get to an interesting webpage. Their final diagnosis: turn off X vital service; the internet now works; hang up with them, turn X back on, the internet still works. What was that about?

Why are there a dozen more interesting pages on the trauma beeper now that it’s none of my business to look at them?

Decide to be a really good resident and go to conference, even thought not technically required to be there. It’s a very boring topic, and I only stay awake because one of the other residents (required to attend) is sitting there shaking his head at my foolhardiness in coming.

With that kind of a track record today, I don’t think I’ll get good results from trying to study for Step 3 right now. There, that was easy to avoid.