(Have your own stories of scut? Share them with us in the comments section! And thank you for those who have already shared. Reading about other people's degradation is very normalizing.)
You should really look at doing a couple of comics from the patient angle. Like why are the gowns we are forced to wear so unsightly - I feet like Moses trying to cross the dead sea. Your a mom, you know that your breasts don't stay where they are supposed to without support.
A fellow patient and I had just come out of brain surgery and we were in ICU. We started making jokes (primarily because he was completly paranoid that the catheter would make him infertile) We got into the giggles. The nurse came to tell us that we have to be quiet, even though that rule was made to help the brain surgery patients with recovery!
Believe me, when it comes to ideas for things to write about, I could use the help...
Unfortunately, Deirdre (and others), I have far less experience being a patient than I do being a doctor, which I know makes the representation a little one-sided. Any good patient stories from the other end would be appreciated too, though!
I got roasted about this both at the end of my intern year and when I graduated:
When I was an intern, my fourth year was running late for evening board checkout on L & D (I was an OB at a busy, large academic program) with one of our more, ahem, volatile attendings when she called the main phone and had me meet her at the ER entrance and park her car for her while she ran up to board checkout. She threw the car in park and ran in as I ran out and got in the car.
She failed to tell me she drove a manual transmission and I managed to kill the car about eight times in forty feet towards the parking garage. I coasted out of the way, ran to the parking attendents booth in the garage, demanded her phone for "a hospital emergency" and called L & D for another intern to come out and help me.
And help she did. She knew how to drive a stick, but was used to American cars, not the little German VW we were trying to park and was unable to figure out how to get it in reverse. So in the Texas summer sun, while her 6'1 225 lb frame sat in the front seat, my 5'9 140 lb self pushed the car back away from the curb until she could put it in drive and we could park the car. All this took about an hour and I was supposed to be in the hospital working, my pager was exploding but I dutifully did as I was told.
Once I finally returned to L & D,smelly and sweaty, my irritated chief asked what the hell I was doing; I told her the whole story. And she and the attending loved it. Luckily she was a great upper level so I didn't mind, but it was scut, no way to argue.
On my month of transplant surgery I changed multiple wound vacs, updated every patient's electronic chart with labs, procedures, and culture results regardless of whether it was my patient. On OB I did millions of mag checks and wrote the notes.
Not bad at all, in my opinion, but there's still internal medicine.....
Yeah - ward internal medicine, home of the fifty million phone calls a days: to the lab, to various family members, to the community social worker, to the in house social worker, to the lab again (run the fuckin bloodwork already!), to countless homecare organizations, to the family doctor, to the specialists and of course don't forget the nursing home...
Not a medical-residency/internship story but as a wee intern in college, I had to align 1800+ slices of crossection(frozen section) data set because it had not yet been aligned.
*twitch* It was memorable six-weeks. I curse the person who took the photographs and didn't bother to make sure the frozen section slices were in the correct position before shooting.
Buying lunch for surgeons as a med student. This involved unscrubbing, kneeling on the OR floor and reaching under the surgeon's gown to get his wallet out of his back pocket while entire room sniggered. Closest I've ever gotten to *literally* kissing ass.
I feel really fortunate about my lack of scut experiences... The most technically "scutty" thing I was happy to do... we were running late for grand rounds, still work-rounding on all the patients. This department's grand rounds did not provide coffee or breakfast (majorly annoying!). So I was sent down with the intern to get coffee and bagels for the team so that we could all have something to much on during the talk. Since it's a really friendly team that always has breakfast together, it felt pretty natural and obvious. Don't get me wrong, I am NOT the kind of person to let something scutty happy to me. I would report those suckers to my dean ASAP. But this was okay.
Now... these stories of picking up food and not being included... that's just weird. On OB night float the med students got food vouchers just like the HOs, and when we ordered out, I was always asked for my order. One resident even bought pizza and wings for everyone on the team on her dime.
getting charts... this one time, an attending asked me for a progress note and I gave him one from my pocket which had a little crease on it and he made me find another new one. Talking about being anal!!!
I agree with the most recent anonymous. I am on my OB rotation now, and I hate it, but I think that I haven't really gotten scutted.
Everyone is fairly nice, and whenever people are ordering in, they ask me for my order, and half of the time, if residents are ordering too, they offer to buy it for me because they get paid (not enough) and I don't.
Seeing all these comments makes me feel so much better about my program!
i'm in the middle of my third year of medical school and really haven't had to do any scut work. The worst thing I've had to do was collecting charts before we started rounds.
pretty lucky, I know. maybe it has something to do with being on the west coast? less hierarchy?
Seriously, What is Wrong with doctors (in America?) Is it a lack of respect for others who will become their colleague (and future doctors)? Maybe there's just a primitive need to help provide some retrospective amusement......
To the Anonymous poster who said that writing notes and doing wound care was scut, I ask - what do you think a med student is supposed to be doing??!!?!
When I was a 4th yr student, I did a plastics elective, and had a case w/ an HIV+ man who had AWFUL genital condyloma - we were basically removing his entire perineum and doing a skin graft. The surgeon let me do the case, but the poor 3rd yr med student had to RETRACT THE SCROTUM...
I am a 3rd year medical student and while on call one evening I scrubbed in on an emergency surgery. I cannot recall the impetus for this procedure but what ended up happening was a sub-total colectomy on an unprepped colon. Guess who had the pleasure of "opening up the specimen" in the hallway while the senior resident and attending were finishing up and clsoing the case. >_<
As a sub-i in the ICU my senior resident had me copy big blue and big red for him(and me, since I will need it eventually)...it took 2 afternoons in the anesthesia library
I don't know if anyone else had to do this but at our school the tradition on surgery seems to be that during rounds the med students and junior residents do all the writing of the notes, which is of course dictated to them by the seniors. Since everyone is in a mad dash to finish rounding so they can get down to the OR by 8, as a junior you are literally running after the senior holding a ridiculously heavy chart in one (aching) hand while trying to write down what they say with the other hand (and make sure the chart contents don't spill all over the floor). God forbid you ask them to repeat themselves because you didn't hear or because it's 6:30 as you're still waking up.
As a med students, we were expected to write all the orders and scripts as they were barked out by the seniors and then carry the chart over to them so that they could sign off. Being as surgery was my second rotation ever, I didn't know half of what they were ordering and had to ask for clarification all the time - much to everyone's great annoyance.
Day one of my 3rd year of residency was on Surgery. After orientation I was sent to the ER to manually disimpact an ostomy. I never once complained about getting people's coffee after that.
Man, I feel super lucky--I barely did any scut as a med student. The stuff I did as an internal medicine intern and resident (the endless phone calls, sending specimens to the lab, tracking down results, and so on) was just work and a natural part of the job that you get to delegate to others as you move up the chain of command. I did always resent having to fill out and fax the MRI "safety questionnaire"--I have medical degree and I'm doing the job of a unit secretary, and the MRI folks are going to ask the patient the exact same questions anyay?--but all in all I had it pretty sweet, I guess.
Karen, I don't think writing notes or changing wound vacs is truly legit scut. I think it technically stops being my job when it's not my patient and it's not contributing to my education in any way ie, I'm doing it so the interns don't have to. I didn't mind doing it, just trying to contribute my worst (and as I said, not so bad) experience so far.
I'm starting to get a little defensive about all the awful Ob/Gyn scut horror stories!! For the record, when we had the med student go get dinner/take out, we always took their order *and* paid for it.
As for me, I got the honor of manually disimpacting a couple of patients on my Internal Medicine service, hand-typed the check out list every morning and evening (complete with updated labs) for the ICU residents, and arriving at 4:30 am on my GYN ONC rotation to write notes/orders/skeletonize d/c orders on 10 + patients so that the intern could come in at 6:30, co-sign the notes, and then give me the intern scut list so s/he could go scrub the cases while I lugged patients back and forth for xrays and followed up labs. Typical med student fare, expect nothing less! :)
"Karen, I don't think writing notes or changing wound vacs is truly legit scut. I think it technically stops being my job when it's not my patient and it's not contributing to my education in any way."
If there is one thing I have learned in residency thus far (says the intern,) it is that there is very little use in trying to figure out what's "your job" and what's not. As an intern, everything is my job. As a med student, everything is your job: anything that will help the team, will allow them to spend more time teaching you. That is how you should look at it. Comparing tit for tat will only get you frustrated and miserable as you perceive that others are being unfair to you. Everyone gets treated unfairly in medical training; the key is to not let it drive you crazy.
Patient story of humiliation: the PACU in "America's #1 Hospital" has inadequate curtains separating the patient beds. They use safety pins to close what curtains they have (meanwhile they just spent $3 billion (with a "B") on new buildings. Standing naked in my little cubby while the surgeon marks me for a complicated procedure. I am shaking with mortification. I tell the surgeon how inadequate the privacy levels are. The PACU nurse passing by on the outside of the curtain hears me and pulls the curtains wide open exposing my mutilated naked body to the several people behind her. She had the most hideous look on her face. Like "how dare you criticize our PACU." I have a bunch more. I promise you - your worst day doing scut is nothing compared to the dehumanizing experience of being a cancer patient in a teaching hospital. To the residents you're an interesting specimen, a bunch of body parts, a checklist to get through - and don't think we don't know it.
Elizabeth: I get it, we're a team. As I've said twice now, I didn't mind doing the work. This is a normalization post - we all talk about the stuff we've done that may or may not be scut.
I don't mind the work, I don't mind helping out, I was trying to contribute.
To the cancer patient who surely has a name: of course that's worse. As an intern, I love my job, even if I work long, terrible hours that none of my friends understand, and even if I have to do some unpleasant things that are completely a part of that job. Sometimes, coping with my own stress and struggles is best done by laughing about the ridiculousness, or even complaining about other doctors/patients/process problems. And every day I get to go to work and be reminded that I am so lucky to be healthy, happy, and on this side of the equation, a fact that I recognize could change at some point. I sometimes feel guilty about this. Unfortunately, guilt is not the best coping mechanism for keeping me mentally healthy enough to do my job.
My version of scut was doing something I felt in no way helped my education and was just me being free labor. This happened more in my surgical rotations than anywhere else. Specifically, while in surgery, holding something out of the way/view of the surgeon, effectively keeping me from being able to see anything. Examples include holding a fat pad up from the head of the patient while doing a low abdominal procedure; holding something out of the way during a vag hys (again, I saw zero of the procedure). I didn't mind any of the note-taking, progress note writing, phone calls, etc, but when there was nothing educational about what I was doing, I'd get upset.
You should really look at doing a couple of comics from the patient angle. Like why are the gowns we are forced to wear so unsightly - I feet like Moses trying to cross the dead sea. Your a mom, you know that your breasts don't stay where they are supposed to without support.
ReplyDeleteA fellow patient and I had just come out of brain surgery and we were in ICU. We started making jokes (primarily because he was completly paranoid that the catheter would make him infertile) We got into the giggles. The nurse came to tell us that we have to be quiet, even though that rule was made to help the brain surgery patients with recovery!
Don't you love (and by love I mean hate with the fire of a thousand suns) when someone comes to YOUR blog... and tells you what to blog?
ReplyDeleteBelieve me, when it comes to ideas for things to write about, I could use the help...
ReplyDeleteUnfortunately, Deirdre (and others), I have far less experience being a patient than I do being a doctor, which I know makes the representation a little one-sided. Any good patient stories from the other end would be appreciated too, though!
I got roasted about this both at the end of my intern year and when I graduated:
ReplyDeleteWhen I was an intern, my fourth year was running late for evening board checkout on L & D (I was an OB at a busy, large academic program) with one of our more, ahem, volatile attendings when she called the main phone and had me meet her at the ER entrance and park her car for her while she ran up to board checkout. She threw the car in park and ran in as I ran out and got in the car.
She failed to tell me she drove a manual transmission and I managed to kill the car about eight times in forty feet towards the parking garage. I coasted out of the way, ran to the parking attendents booth in the garage, demanded her phone for "a hospital emergency" and called L & D for another intern to come out and help me.
And help she did. She knew how to drive a stick, but was used to American cars, not the little German VW we were trying to park and was unable to figure out how to get it in reverse. So in the Texas summer sun, while her 6'1 225 lb frame sat in the front seat, my 5'9 140 lb self pushed the car back away from the curb until she could put it in drive and we could park the car. All this took about an hour and I was supposed to be in the hospital working, my pager was exploding but I dutifully did as I was told.
Once I finally returned to L & D,smelly and sweaty, my irritated chief asked what the hell I was doing; I told her the whole story. And she and the attending loved it. Luckily she was a great upper level so I didn't mind, but it was scut, no way to argue.
On my month of transplant surgery I changed multiple wound vacs, updated every patient's electronic chart with labs, procedures, and culture results regardless of whether it was my patient. On OB I did millions of mag checks and wrote the notes.
ReplyDeleteNot bad at all, in my opinion, but there's still internal medicine.....
Yeah - ward internal medicine, home of the fifty million phone calls a days: to the lab, to various family members, to the community social worker, to the in house social worker, to the lab again (run the fuckin bloodwork already!), to countless homecare organizations, to the family doctor, to the specialists and of course don't forget the nursing home...
ReplyDeleteNot a medical-residency/internship story but as a wee intern in college, I had to align 1800+ slices of crossection(frozen section) data set because it had not yet been aligned.
ReplyDelete*twitch* It was memorable six-weeks. I curse the person who took the photographs and didn't bother to make sure the frozen section slices were in the correct position before shooting.
Buying lunch for surgeons as a med student. This involved unscrubbing, kneeling on the OR floor and reaching under the surgeon's gown to get his wallet out of his back pocket while entire room sniggered. Closest I've ever gotten to *literally* kissing ass.
ReplyDeleteI feel really fortunate about my lack of scut experiences... The most technically "scutty" thing I was happy to do... we were running late for grand rounds, still work-rounding on all the patients. This department's grand rounds did not provide coffee or breakfast (majorly annoying!). So I was sent down with the intern to get coffee and bagels for the team so that we could all have something to much on during the talk. Since it's a really friendly team that always has breakfast together, it felt pretty natural and obvious. Don't get me wrong, I am NOT the kind of person to let something scutty happy to me. I would report those suckers to my dean ASAP. But this was okay.
ReplyDeleteNow... these stories of picking up food and not being included... that's just weird. On OB night float the med students got food vouchers just like the HOs, and when we ordered out, I was always asked for my order. One resident even bought pizza and wings for everyone on the team on her dime.
getting charts... this one time, an attending asked me for a progress note and I gave him one from my pocket which had a little crease on it and he made me find another new one. Talking about being anal!!!
ReplyDeleteI agree with the most recent anonymous. I am on my OB rotation now, and I hate it, but I think that I haven't really gotten scutted.
ReplyDeleteEveryone is fairly nice, and whenever people are ordering in, they ask me for my order, and half of the time, if residents are ordering too, they offer to buy it for me because they get paid (not enough) and I don't.
Seeing all these comments makes me feel so much better about my program!
i'm in the middle of my third year of medical school and really haven't had to do any scut work. The worst thing I've had to do was collecting charts before we started rounds.
ReplyDeletepretty lucky, I know. maybe it has something to do with being on the west coast? less hierarchy?
Seriously, What is Wrong with doctors (in America?) Is it a lack of respect for others who will become their colleague (and future doctors)? Maybe there's just a primitive need to help provide some retrospective amusement......
ReplyDeleteTo the Anonymous poster who said that writing notes and doing wound care was scut, I ask - what do you think a med student is supposed to be doing??!!?!
ReplyDeleteWhen I was a 4th yr student, I did a plastics elective, and had a case w/ an HIV+ man who had AWFUL genital condyloma - we were basically removing his entire perineum and doing a skin graft. The surgeon let me do the case, but the poor 3rd yr med student had to RETRACT THE SCROTUM...
I am a 3rd year medical student and while on call one evening I scrubbed in on an emergency surgery. I cannot recall the impetus for this procedure but what ended up happening was a sub-total colectomy on an unprepped colon. Guess who had the pleasure of "opening up the specimen" in the hallway while the senior resident and attending were finishing up and clsoing the case. >_<
ReplyDeleteAs a sub-i in the ICU my senior resident had me copy big blue and big red for him(and me, since I will need it eventually)...it took 2 afternoons in the anesthesia library
ReplyDeleteI fixed the fan of the air conditioning on an attending's car.
ReplyDeleteI don't know if anyone else had to do this but at our school the tradition on surgery seems to be that during rounds the med students and junior residents do all the writing of the notes, which is of course dictated to them by the seniors. Since everyone is in a mad dash to finish rounding so they can get down to the OR by 8, as a junior you are literally running after the senior holding a ridiculously heavy chart in one (aching) hand while trying to write down what they say with the other hand (and make sure the chart contents don't spill all over the floor). God forbid you ask them to repeat themselves because you didn't hear or because it's 6:30 as you're still waking up.
ReplyDeleteAs a med students, we were expected to write all the orders and scripts as they were barked out by the seniors and then carry the chart over to them so that they could sign off. Being as surgery was my second rotation ever, I didn't know half of what they were ordering and had to ask for clarification all the time - much to everyone's great annoyance.
Day one of my 3rd year of residency was on Surgery. After orientation I was sent to the ER to manually disimpact an ostomy. I never once complained about getting people's coffee after that.
ReplyDeleteMan, I feel super lucky--I barely did any scut as a med student. The stuff I did as an internal medicine intern and resident (the endless phone calls, sending specimens to the lab, tracking down results, and so on) was just work and a natural part of the job that you get to delegate to others as you move up the chain of command. I did always resent having to fill out and fax the MRI "safety questionnaire"--I have medical degree and I'm doing the job of a unit secretary, and the MRI folks are going to ask the patient the exact same questions anyay?--but all in all I had it pretty sweet, I guess.
ReplyDeleteKaren, I don't think writing notes or changing wound vacs is truly legit scut. I think it technically stops being my job when it's not my patient and it's not contributing to my education in any way ie, I'm doing it so the interns don't have to. I didn't mind doing it, just trying to contribute my worst (and as I said, not so bad) experience so far.
ReplyDeleteI'm starting to get a little defensive about all the awful Ob/Gyn scut horror stories!! For the record, when we had the med student go get dinner/take out, we always took their order *and* paid for it.
ReplyDeleteAs for me, I got the honor of manually disimpacting a couple of patients on my Internal Medicine service, hand-typed the check out list every morning and evening (complete with updated labs) for the ICU residents, and arriving at 4:30 am on my GYN ONC rotation to write notes/orders/skeletonize d/c orders on 10 + patients so that the intern could come in at 6:30, co-sign the notes, and then give me the intern scut list so s/he could go scrub the cases while I lugged patients back and forth for xrays and followed up labs. Typical med student fare, expect nothing less! :)
"Karen, I don't think writing notes or changing wound vacs is truly legit scut. I think it technically stops being my job when it's not my patient and it's not contributing to my education in any way."
ReplyDeleteIf there is one thing I have learned in residency thus far (says the intern,) it is that there is very little use in trying to figure out what's "your job" and what's not. As an intern, everything is my job. As a med student, everything is your job: anything that will help the team, will allow them to spend more time teaching you. That is how you should look at it. Comparing tit for tat will only get you frustrated and miserable as you perceive that others are being unfair to you. Everyone gets treated unfairly in medical training; the key is to not let it drive you crazy.
Hmm, I wish the "Scut work" of millions of phone calls had actually stopped with residency... not so much.
ReplyDeletePatient story of humiliation: the PACU in "America's #1 Hospital" has inadequate curtains separating the patient beds. They use safety pins to close what curtains they have (meanwhile they just spent $3 billion (with a "B") on new buildings. Standing naked in my little cubby while the surgeon marks me for a complicated procedure. I am shaking with mortification. I tell the surgeon how inadequate the privacy levels are. The PACU nurse passing by on the outside of the curtain hears me and pulls the curtains wide open exposing my mutilated naked body to the several people behind her. She had the most hideous look on her face. Like "how dare you criticize our PACU." I have a bunch more. I promise you - your worst day doing scut is nothing compared to the dehumanizing experience of being a cancer patient in a teaching hospital. To the residents you're an interesting specimen, a bunch of body parts, a checklist to get through - and don't think we don't know it.
ReplyDeleteElizabeth: I get it, we're a team. As I've said twice now, I didn't mind doing the work. This is a normalization post - we all talk about the stuff we've done that may or may not be scut.
ReplyDeleteI don't mind the work, I don't mind helping out, I was trying to contribute.
fin.
To the cancer patient who surely has a name: of course that's worse. As an intern, I love my job, even if I work long, terrible hours that none of my friends understand, and even if I have to do some unpleasant things that are completely a part of that job. Sometimes, coping with my own stress and struggles is best done by laughing about the ridiculousness, or even complaining about other doctors/patients/process problems. And every day I get to go to work and be reminded that I am so lucky to be healthy, happy, and on this side of the equation, a fact that I recognize could change at some point. I sometimes feel guilty about this. Unfortunately, guilt is not the best coping mechanism for keeping me mentally healthy enough to do my job.
ReplyDeleteMy version of scut was doing something I felt in no way helped my education and was just me being free labor. This happened more in my surgical rotations than anywhere else. Specifically, while in surgery, holding something out of the way/view of the surgeon, effectively keeping me from being able to see anything. Examples include holding a fat pad up from the head of the patient while doing a low abdominal procedure; holding something out of the way during a vag hys (again, I saw zero of the procedure). I didn't mind any of the note-taking, progress note writing, phone calls, etc, but when there was nothing educational about what I was doing, I'd get upset.
ReplyDeleteMy very first day as a MSIII I was assigned to fax invitations to a conference in Hawaii to the attending surgeon's golf buddies.
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