u/Purple-Marzipan-7524

I usually get fantastic, eager, medical students. Even the ones that are gunners have something to offer and half way through the rotation they learn how to make my job a bit easier because they’re good at incorporating feedback.

Then there’s those students who… just don’t know how to explain it. But one thing they all have in common is that that they’re just so god damn unteachable. The other day we had a new patient with seizures and I prepped my student for the presentation for a good 30 minutes. I taught him about EEGs, showed him the spot on the MRI the seizures are coming from that correlated with the EEG. Explained to him why we’re using certain seizure meds and why we aren’t using certain other seizure meds. Went with him to show him the physical exam.

And when it came time to do the presentation he just….. flopped. Didn’t mention basic parts of the history. Didn’t even mention the MRI or EEG that we spent 10 minutes going over. It got to the point that when he finished I basically just gave the presentation all over again. And it wasn’t even a first time thing. It’s every damn day. And I’ve talked to him about it and he says sorry and just does it over again. I’ve tried practicing presentations beforehand and that doesn’t help either.

It feels like I’m teaching SpongeBob SquarePants how to drive. I try to not give him more than one patient in a day but he sees the other med student (who’s a head above him) carrying 3-4 patients so he aggressively tries to get me to give him more.

For example, a 30 year old with epilepsy has been seeing an epileptologist for several years. The patient begins to develop migraines, should their epileptologist mange their migraines?

Or suppose a 65 year old with Parkinson’s is well established with a movement specialist. The patient ends up getting a TIA. Should they follow up with their movement specialist for stroke prevention care?

At my residency program I’ve seen it go both ways. Some attendings are comfortable managing all of these things on their own. Other attendings try to look to pass on everything not related to their sub speciality onto someone else (usually resident clinic).

As a neurology resident, our field is complicated and a big part of my job is to educate patients and educate medical students. But when I’m getting consulted by another service…. a part of my job becomes educating NPs and PAs. I’ll send them a message listing out our recommendations. And then I’m hit with “why do you want….” and “why not….” and “can you educate me on….”. But when it’s a resident who’s consulting me, somehow they just follows our recommendations without asking too many questions.

I understand that consultants have to explain their rationale and explain what they’re thinking. Not a problem with that at all. But these NPs are arguing with me about giving a dose of dexamethasone to a patient failing a migraine cocktail just because he’s a diabetic, even though he’s well controlled with an A1C of 6.5. Or arguing with me about why a patient that likely has meningitis needs an LP instead of just “giving them vanc and zosyn for a week” (don’t even get me started on that one).

Again my problem isn’t about them asking questions. My problem is that I’m not here to make up for their lack of medial education and, moreover, they seem to be more interested in arguing rather than learning.

Patient is a right handed bodybuilder and can provide full resistance with both upper extremities (5/5 bil). But to me (well built male in his 20s) it’s obvious that the L is stronger than the R when I apply enough force, which is concerning since the patient is R handed. But to my attending (100ish pound woman in her 60s) he seems to be equal strength on both sides when she personally tests his muscle strength.

Anyways, turned out he did have a lacunae stroke in his L internal capsule after all.