Q: Now that I'm *officially* well into my intern year, I realize that some of our EM attendings are not interested in teaching (or otherwise interacting) with interns. As an intern, I'm offended. Is this acceptable behavior, and how should I handle it?
A: You're right, the attendings should be willing to work with ALL of their OWN residents (interns included). Its one thing to shun rotating residents/intern/students, but *your own* should be taken care of.
There are two different ways to look at this to help explain why SOME (i.e. not me, LOL) attendings avoid students/interns. The first way is to try and see their point of view.
Imagine you’re an attending:
When you go to work, you feel exposed (legally) because the residents are a liability. They don’t always know what to look for, what to tell you about, and how to treat the problem. Even if you, yourself, get up and go see/talk to the patient, you may miss something in your short interaction. And there are LOTS of patients. Actually, you feel overwhelmed at times because you’re responsible for the actions of others, although you don’t know what they’re doing/hearing/seeing. You have to ‘trust’ them…and that’s hard to do. And, you are just one person, and to have 2-4 people ‘presenting’ cases to you for 8-12 hours is just too hard. You can’t think, you don’t know who’s sick…and you can’t physically see everyone and do everything yourself.
And it’s even *worse* when an intern is working. BECAUSE they *really* don’t know what to look for, ask about, check or test for. And when they present to you, the story is often unclear, and you’re left sorta confused. The differential is too broad when the intern presents, and you either have to go see the patient yourself, or ask lots of detailed questions to the intern to get a better story. If the intern didn’t ask the important questions, you either have to send them back to get a better history and physical, OR you order tons of tests/studies to compensate.
Example:
10 month old baby is brought in my mom with a fever to 102.9 x 1 week. Intern presents it as a viral syndrome. Great, discharge, right? BUT they didn’t notice the dehydration and lethargy. They didn’t comment on the petechial rash. So, as an attending you can either:
1) get up and see the patient yourself as if he’s your own (this isn’t very practical if you have more than a couple of residents/interns to supervise or else the flow of the department will be very slow)
2) have the intern order more tests and studies to support the ultimate dispo (which isn’t really teaching, and isn’t really proper EM)
3) you can have a senior resident see the patient, and ‘advise’ the intern. That way, the likelihood of missing meningitis is lower if the senior resident signed off on the intern’s work.
Of the 3 – it’s easier to have the senior resident involved. Also, it’s logical because it allows the senior resident to see more, do more, supervise a bit, and begin managing an entire department. And as attending, you’re there just as back-up for the senior resident. It’s easier to teach the intern if the obvious nuances of the case have been discussed with the senior (at least from July – December). And it frees the attending up to work with the senior and students as well.
The attendings look forward to working with certain residents, just as much as residents like particular attendings. Typically attendings like residents who are confident, do appropriate work-ups, then come to them with their own thoughts about what’s going on, and what to do about it. Then the attending can talk to the resident as an educational ‘coach’ and (almost) colleague about the case. This is fun for attending.
Being stressed out about missing something because an unreliable resident (whether it’s because they’re ‘new’ or just ‘suck’) is telling you half-truths and cannot think for themselves…is miserable.
***
The second way to try and understand what’s going on is to realize that this has nothing to do with you, and everything to do with their own issues:
Imagine you’re an attending…and you’re a bit bitter about your job (for whatever reason). Really, you don’t want to work shifts, you’d rather get credit for shifts worked, while NOT doing any shifts. BUT, you’re not quite *important* enough for the department to allow you to engage in other scholarly activities…and since they NEED attendings to work shifts, you get more than your “fair share” (for your rank and experience), in your opinion. But you can’t quit, because you need your benefits and paycheck too bad. So you make due.
There are two types of doctors (those who actually are comfortable with themselves, their knowledge, and love to share and can readily admit when they are unsure of something....and there are those who pretend to know *everything* and don't want to answer questions because they feel threatened by the resident who's actively reading, and who, on any given day, may be better-read on a particular topic than the attending).
So let's say I'm the second type of attending -
I don't want to 'expose' myself as interns don't know much about 'the way things work' and instead of just 'going with it' they'll ask:
"why? why? why do we use this drug instead of that drug? why can't we just do the procedure this way like Rivers said? Tintinali's new edition said that we shouldn't use this study, that the new ultrasound technique is better..."
Whereas a senior would be more apt to 'just go with it' as per current local ED culture. And if the senior asks questions, it's more appropriate for the attending to follow-up their question with a 'reading assignment' to be presented the next shift. So the residents ‘learn’ to not ask questions.
So, in short: either this is their way of hiding the fact that they don’t know something….OR they’re acting out because they don’t want to be in the position they’re in….
Either way nothing to do with you.
Next year...maybe say something if you're still so inclined (maybe). It's not worth the risk right now. If you're black-listed, you will have a horrible residency experience. Lots of former residents can attest to this fact.
drug factory maybe? We know how automated the processes are but putting bottles in boxes for shipping maybe? It would depend on the factory. When you watch the video you can see where that could make sense. Baxter is the name of the Robot. 
off a conveyor belt, so long as they don't weigh more than five to 10 pounds. 
We already have black box warnings and a ton of warnings on side effect we hear already. In addition with data as such available they are looking to potentially avoid some of these areas if possible during drug development. In addition to such data bases of information it is also interesting to see what is being done with stem cells to also speed up the process of creating new drugs with again finding adverse reactions with cells being studied and using sequencing technologies together. 
You can read the entire article at the link but I thought this was interesting to see some of the history on how the highly successful VA system came about. The company is in the data base business and functions quite well outside the US with many clients. In addition the CEO/founder Phillip Ragon also has a foundation to where they made a $100 million dollar contribution to Massachusetts General Hospital and you can read about their research work relative to the HIV virus below. 
widely used in the health-care market space,” said Lynne Dunbrack, program director of connected health strategies at market research company IDC Health Insights, in a phone call from its Framingham, Massachusetts, headquarters. “Their customers continually praise them for their development team and their support staff.” 
Congressmen are not rich, just one huge batch of them are. The article states he was treated for bi-polar mental illness and shoot I think 3/4 of the folks in DC have some huge bi-polar tendencies, and whenever I see all the filibusters, that pops into my head. The house is listed for $2.5 million so I assume it’s good sized house. He hopes to return to work soon and perhaps he can make a case for medical bills when he returns to work on the problems and issues. 
, and why shouldn’t drug companies as we pay more here and somewhat subsidize others, but he stated in their own home country of Germany that the generic competition was becoming a much issue there. It’s a bit of a catch 22 as many can’t afford the more expensive drugs who need them and then the corporation says they need the money for R and D, so I guess we go back to the NIH for more funding again. Even big corporations are not so much worried about credit ratings being at the absolute top and I guess with plenty of cash the company doesn’t have to worry. 
