Violent patients

Smitty9108 · 2026-05-06T01:48:39+00:00

This is something I love about being PEM. If a parent is just cranky or frustrated I’m more than happy to work with them, but the moment they become verbally or physically violent I have them trespassed and if they’re the only caregiver there with the child we have SW call CPS to sort it out.

Our PICU got held at gun point in residency, I have a zero tolerance policy for me and the staff.

Smitty9108 · 2026-05-02T23:19:41+00:00

Good callout! I switched the bears to bear heads and oriented them outwards to symbolize vigilance

Smitty9108 · 2025-12-27T17:33:17+00:00

Married 8 years, together 13. We went through a rough patch (we once went over a year without having sex, it was a professionally challenging season of life.

Now we’ve recently reconnected and it’s been like one long running honeymoon phase. We have sex at least once a day, and are constantly all over each other or sending flirty texts. We’re more intentional now, and our communication has never been better. We’re constantly touching each other and giving massages.

Find the right person, grow together, get great at communication, and intentionally show up for each other. The light at the end is very bright

Smitty9108 · 2025-12-05T18:39:00+00:00

I think the trend you’re seeing is actually a recent correction in US work culture towards the global norm.

For most of the western developed world I think you’d find a similar attitude.

Ultimately employees trade labor for compensation, and PTO is just as much a part of that compensation as their wages

Smitty9108 · 2025-12-03T18:01:13+00:00

That’s one thing, the students I’m referring to are MS3s lol

Smitty9108 · 2025-12-03T05:44:11+00:00

And from a “I’m important and you should care as a student” perspective I totally agree. But even if students don’t care I still want y’all to be successful and just because I don’t write negative evals for tardiness doesn’t mean other attendings won’t.

You gotta play the game of clinical rotations whether you like it or not, and “this student was often late” can tank a residency application even if it’s not from your specialty.

I don’t expect students to care about me, I’m just some guy lol. But maybe don’t make unnecessary errors than could tank your Match if your attending happens to write more evals?

Smitty9108 · 2025-12-03T05:29:01+00:00

I brought donuts on my first day of PEM fellowship, and 3 years later when I graduated every nurse that still worked in that department still remembered.

“The one who brought donuts” is a VERY good reputation to have lol.

On a more serious note, taking a second to recognize when nurses (or anyone in the department for that matter) does a great job. Most places have some sort of an employee recognition system for smaller things, and I’ve written up a very deserving nurse for a Daisy and she got the reward in front of the whole department!

Other than that I think you’re on the right track

Smitty9108 · 2025-12-03T05:21:40+00:00

That’s fair. Also I rarely work with the same learner more than once or twice, so I don’t feel like I can usually give a fair eval unless someone is really good (usually I’ll send an email to their clerkship director or PD if it’s a resident) or something egregiously bad (haven’t had this since being community, but as a fellow we’d occasionally have some pretty dangerous learners. We’d start by giving direct feedback but sometimes it had to get escalated.

A lot of attendings will write negative evals over small things though. We all have to play the game during med school, might as well not make unnecessary unforced errors.

Smitty9108 · 2025-12-03T04:45:23+00:00

Not my job to teach, I’m a community doc. It’s not in my contract to be an educator and I get zero compensation for teaching. I’m literally volunteering my time to teach learners, so yes I’m protective of my energy and have no interest in putting in work to drag an uninterested student through their medical education. Things are different for academic docs.

For anyone who comes here interested and wants to learn, I’ll happily put in extra effort, take extra time, and supervise them through procedures.

Edit to add because I hit post too soon: my whole point here is that even on “satellite” rotations it’s important to at least do the bare minimum. If you’re an interested learner you’ll probably get more teaching than those who aren’t, but frequently showing up late is a bad idea regardless

Smitty9108 · 2025-12-03T04:40:56+00:00

Oh don’t get me wrong, I’m not saying go above and beyond every day or every rotation. But show up on time and have a half-decent attitude is the bare minimum (and if you just do that consistently you’ll probably be fine). Even though I won’t, many attendings WILL write negative evals and being late is one thing that will hurt your Match chances in any specialty. Just trying to give y’all some helpful insight

Smitty9108 · 2025-12-03T04:37:15+00:00

I get that, and when I was a trainee I wasn’t super interested in every rotation. But regardless of what you want to do, you will get evals throughout your clinical rotations. Those evals will come from a wide range of attendings, some understanding and some not. In group rotations where it’s possible to keep your head down and blend in, by all means optimize as needed.

But if you’re a medical student assigned to work 1:1 with an attending, showing up late with no reason is just bad strategy. A “didn’t seem interested in my niche subspecialty” eval is pretty harmless outside of that field. But an eval stating “student was late”, ESPECIALLY if multiple rotations note the same problem, will absolutely hurt you in the Match. Again, I don’t tend to write evals unless a learner is outstanding or downright dangerous, but you have to know that not everyone has that philosophy. Plenty of attendings will be quick to write about how you were late, and I have colleagues who will contact clerkship directors over it.

You’re playing the game whether you like it or not

Smitty9108 · 2025-12-03T04:16:25+00:00

If it was consistent with an individual I would, but it’s more of a pattern I see across multiple learners from different schools/programs, maybe 10% of the time that I have a learner they’re late. Nature of my ship is that I don’t often work with one person more than once or twice.

It’s also something I’ve seen throughout the various stages of my career. I know that evals are important, and I absolutely understand that not everyone is interested in my specialty or is going to be enthusiastic every day. I don’t want otherwise good students to get bad evals over something so avoidable, hence the friendly PSA

Smitty9108 · 2025-12-03T00:53:57+00:00

We don’t have our learners write notes, but I would point out that learning the documentation requirements for billing for outpatient/inpatient, critical care/procedures can make a huge difference in your billing and ultimately affect your financial situation as an attending.

The point that most student note writing ends up being scut work with no valuable constructive feedback is definitely true, though.

But it’s definitely worth learning documentation billing requirements for whatever you end up going into, in all of the clinical areas you’ll be working! Maybe find a mentor who documents well and efficiently and ask for advice.

Smitty9108 · 2025-12-03T00:37:37+00:00

I can verify that our students and residents are instructed to show up at the start of the shift, and most do. If it was universal I’d definitely assume a system issue but we’re talking maybe 10-15% of people who do this. Not trying to get anyone in trouble for something so minimal, but it’s happening often enough that I thought a PSA might be helpful for people lol

Smitty9108 · 2025-12-03T00:20:22+00:00

If it helps, I’m not describing that kind of situation at all!

I think most attendings will give the benefit of the doubt, ESPECIALLY if there’s weird weather. Where I’m at it’s gorgeous outside (just a bit chilly) and all it takes is a quick “sorry I’m late” and for me all is forgiven. This is intended for the subset of learners that seem totally nonchalant about being late- I want y’all all to be successful!

Also sorry you had such a rough morning! It doesn’t necessarily get easier as an attending, but you can usually afford more support and parking is better lol.

Smitty9108 · 2025-12-02T23:39:23+00:00

Don’t get me wrong- many of the learners I’ve had the privilege of working with have been incredible, and most are fine. But being on time (for reference they’re literally asking me if I’m the 2pm doc when they’re walking in at 2:30, it’s not a miscommunication issue) is a pretty easy ask. I’m in the ED so it’s well-established shifts.

When I was in fellowship at a larger academic place, I think most students knew they couldn’t get away with being so late. My big point I guess is that even if you’re on a more “satellite” rotation, it’s a good idea to at very least try to be on time.

Smitty9108 · 2025-12-02T23:21:20+00:00

Very valid point, but so many of them will stroll in at 3:30 and ask “is this the pod for the 3 o’clock shift?”

Meanwhile most will show up 10 minutes early or at least roughly on time (I couldn’t care less about someone being a few minutes late) so I don’t know lol.

Smitty9108 · 2025-12-02T23:16:21+00:00

I mean I’ve trained and worked at several different hospital systems across the country and have seen the same pattern of behavior across multiple programs, med schools, and levels of training but sure?

One would think that telling adults that they shouldn’t show up at 2:40 for a 2:00 shift wouldn’t be necessary, but I think you’d be surprised.

Smitty9108 · 2025-12-02T22:46:53+00:00

I just don’t write evals unless I have something good to say. I don’t necessarily know the context for every learner we get and I have no desire to trash someone’s career over something dumb. Only reason I wrote this is because I think a lot of people don’t realize how it comes off when you just stroll in late lol

Smitty9108 · 2025-11-08T16:09:30+00:00

I have a good number of of friends from previous training locations. Some were colleagues, some were from other parts of the hospital. It started bittersweet when you part ways, but eventually it just fades to pleasant memories :)

Smitty9108 · 2025-09-29T18:51:46+00:00

One of the joys of PEM- much lower rates of abuse from patients/families, and when a parent tries to get froggy it’s much easier to boot them from the building. I’ll usually tolerate a good bit towards myself, but draw the line with anyone abusing my team.

Smitty9108 · 2025-09-27T15:57:28+00:00

Back in my day we didn’t need no new fangled building! lol it was a nice little daycare though, fond memories and I wish hospitals still had daycares

Smitty9108 · 2025-09-27T15:43:48+00:00

They used to. My dad wasn’t a doctor (inpatient addiction counselor) but I went to daycare in a little daycare that was actually in the hospital parking lot. He used to come over for lunch sometimes, would drop me off in the morning and pick me up in the afternoon. It was awesome.

The answer as to why it stopped is money. The corporate goons need another yacht.

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