Thursday, March 20, 2008

How to Piss Off An Attending

Noon conference, for those unfamiliar, is an educational endeavor where an attending physician gets to spoon-feed medical residents factoids and pearls about various medical conditions or treatments critical for their training. Usually it consists of "core" educational topics felt by their peers to be those topics necessary to prepare them for passing their National Board Examination. For attendings, these aren't the most exciting lectures to give, but they certainly serve an important purpose. For the residents, it's a chance to hear from experienced attending physicians from various departments throughout the hospital who have spent considerable time, energy and effort to organize the critical themes central to their education. The residents get to sit back, interact, and learn.

And sometimes in the dark, warm, post-prandial post-call setting, residents drift off to sleep. I'm okay with that.

But being at noontime, residents often eat lunch since their many responsibilities preclude much time to stop by the cafeteria. Not uncommonly, nice, attractive drug reps bring tantalizingly scrumptious cuisine upon which they can munch during the lecture. They, too, want to make that the budding doctors-to-be know how to give the latest dose of Drug X or Drug Y, and "here's-a-corparately-sponsored-study-we-thought-you'd-like-to-see."

So let me be perfectly blunt.

The minute residents start prioritizing their interactions with the industry drug rep over the attending's lecture, I'd suggest they consider another field...

... like marketing.



Anonymous said...

... maybe they're just that hungry? ;)

Anonymous said...

hungry for what?

Anonymous said...

I'm very sympathetic to your argument, Dr. Wes. The sad thing is that in NYC where I did my residency, my salary barely covered my rent. The hospital didn't have enough subsidized housing to go around and I got the short straw so I was left to do whatever I could to keep body and soul together - which included working TWO additional part time jobs. When I got a "free lunch" I was so grateful that I even squirreled away extra food for dinner and breakfast the next day. I know it sounds crazy - but some of us residents were in such a position of need that we were easy targets for "messaging opportunities" if food was a part of it. I don't know if your residents are in similar situations - but just wanted to point out that in some cases the food is a distractor because of actual poverty.

Doctor David said...

My institution has gone back and forth on the issue of industry-sponsored meals during such conferences. My own take is somewhere between Wes and Val. It's not reasonable to accept the food and bar the rep, but it is totally reasonable to expect the residents coming to the conference to focus on the conference, and not the rep. If the rep wants to talk up his/her product before or after the lecture... that's one thing. But to have such a conversation during the lecture is rude, disrespectful, and shouldn't be tolerated.

As an aside, when there are patient-focused conferences (M&M, some Grand Rounds), industry reps are barred from the room. If they still want to provide food, we let them and post a little sign thanking them for their generosity.

DrWes said...

I (obviously) have my own opinion about such lunches. While I can empathize with the plight of the underfunded resident, the need to have time to eat, etc., it does not excuse such behavior toward one of their colleagues. When social banter with a drug rep supercedes a scheduled educational activity by an attending, priorities are misaligned. Do the busy residents forget others might have a pressing schedule also?

Eating during these lectures is fine. Come early, pile the calories upon your plate, stuff cookies in your pocket if you must, but common courtesy would dictate that you have your butt in a chair ready to learn on time. It's the last time you'll ever have your education handed to you on a platter (pun intended) - make the most of it. Your attendings and colleagues will appreciate it.

Drug reps should to their part, too. If they ever want to have a chance at maintaining such access to the fertile medical minds of tomorrow, they'd better respect the lecturer's schedule and close their chow hall on time.

Anonymous said...

Totally agree that poverty and hunger are no excuse for disrespect. I promise that I ate very quietly and listened carefully to the lecturers - and was grateful for the time they took to spoon feed me some knowledge! Your residents are behaving in a rude manner, which is not cool.

Anonymous said...

Been a while since you were in residency eh? As pointed above, those indentured servants who live in a high expense areas are barely(or often frankly not) making ends meet.I've got an idea how about YOU talk with your residency office to get THEM to pay for lunches (and good luck with that).

re: " Do the busy residents forget others might have a pressing schedule also?"

Do you have any idea how many hours I waited for tardy attending's back in residency. The thoughtlessness of some academic attendings was astounding. Frankly obnoxious behavior that I have not ever seen (to the extent) in private practice. Give the resident's a (one minute)break. They are usually the ones up all night covering YOUR patients.

As far as spoon-feeding. As someone with a PhD and an MD. I find ALL OVER MEDICINE TRAINING SPOON FEEDING related to graduate research. You really need to get over yourself Dr. Wes and spend some time outside the ivory tower.

Anonymous said...

Residents are quite busy, and noon conference is an excellent educational opportunity. Residents should therefore be provided food during these activities. The issue is not the food, but who sponsors the meal. Many of the academic institutions simply don't have the funding to pay for their housestaff to eat lunch everyday.
With Medicare funding always at risk for being cut, it is unlikely that GME funding will increase. Until their is another source of funding either from the government, private sector, foundations, etc; institutions will continue to use the pharmaceutical industry to feed their poor and tired learners.

DHS said...

Where I work, the reps set up for lunch 15 minutes before the lecture, and everyone is expected in the lecture hall right on time. The problem with this is that if you are busy (and who isn't?) the medical students eat all the food.