Mind the Hierarchy

Here’s a pro tip for doctors from someone with no formal medical training:

When you are a resident, regardless of what year you are, introduce yourself as such when you are greeting parents of a 26-week preemie (or any other person in the hospital). Do not say, “Hi, I’m the neonatologist,” as if you are the attending when I can clearly read the giant block letters on your name tag that spell out, “R E S I D E N T.”

Important reasons for identifying yourself as a resident, in no particular order, are:

1. If you’re not a great doctor and you introduce yourself as the neonatologist we are going to assume, at the very least, that you are a fellow or maybe even an attending. And then we will be frightened because if you’re the fellow, then who the hell is the resident and are they next to my baby and, if so, can they please step away from her right now.

2. It’s nice of patients or parents of patients to know your resident status. We will actually give you a little slack (some of us will) because we know you are in an intense three-year period pursuing specialization in your desired field of study.

3. If you say something we disagree with or want to challenge (for example, ordering up another chest X-ray), it’s important for us to know you are the resident so we can communicate to you that we want the fellow’s opinion as well or that we want the attending in on this decision.

4. In rounds, don’t forget that you are the resident. You may be high on your horse, but remember, there are nurses in this circle that have been taking care of preemies since before you were born. There’s also a hierarchy. If a fellow is challenging your idea and nurses are backing up that fellow and the attending is sitting nearby not saying anything, that should really clue you in to the fact that the attending approves of what is happening.

5. You earn your title. Attending. Fellow. Resident. Intern. Clerk. Sub-I. So let us know exactly where in this hierarchy you reside. It’ll be best for all of us.

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