HealthApril 29, 2020

How to navigate your new relationship with attending physicians

By: Ajibike Lapite

People often describe the hardship of residency like this: "Residents have a new job each month and a new boss each week." That is, most rotations are approximately four weeks in duration, and on most rotations, attending physicians transition after a week of service. The dynamic between first-year residents and attending physicians is different from that of medical students and these physicians.

A central component of the change in this dynamic is your change in role. As a medical student, your priority was your education. The medical team functioned to support your educational pursuits via the identification of "good" (educational and high-yield) patient cases and student-targeted teaching on rounds. As a resident, your essential role is to get things done. Your education is important but secondary.

What makes a good resident?

A good resident is hard-working, efficient, trustworthy and well-meaning. But there's more to it than that.

As you know, residents serve as in-house coverage for the patients, and there's resident coverage in the hospital 24/7. While an attending physician is present for rounds and post-rounds care, there's rarely 24/7 attending coverage in the hospital. The result? A resident serves as the eyes and ears of the attending physicians. This principle may vary depending on the specialty and institution, but generally speaking, a strong resident is one who an attending can trust to:

  • Carry out the plans from rounds.
  • Appropriately manage what arises in the attending's absence.
  • Escalate care when necessary.

As one of my attending physicians told me, "We sleep easier at night if we know we have a resident on service who is unafraid to call with a question if they have a legitimate concern."

How to rectify a strained resident-attending relationship

On the other hand, an ideal attending physician will serve as a model for medical decision-making and professionalism. But regardless of your best efforts, not every relationship with your attending physicians will be without issue.

This relationship can break down for a myriad of reasons, some personal and some professional. If you run into a situation that introduces a strain into the dynamic, here are a few ways to start to repair the relationship.

  1. Reflect. Can you identify an inciting event for the change in your relationship with your attending physician? If so, reason through it and identify areas for improvement.
  2. Ask for feedback. A feedback conversation is an opportunity to hear from your attending physician. If done well, you'll discuss your strengths and the areas that need improvement. Often, your attending will ask if you have feedback for them; this is an opportunity to mention that you noted something they did or said and worried that you hadn't met their expectations.
  3. Reach out to your upper-level. On the majority of your teams, you'll have an upper-level who will serve as the go-between for you and your attending physician. In circumstances such as these, your upper-level can be a safe individual to have an initial conversation with. Not only can they help you identify the cause of the strain (if there is one), but they can offer targeted advice to help overcome it.
  4. Stand up for yourself. Some attendings have a reputation for being challenging, and there's not much you can do in those circumstances aside from reminding yourself that it isn't personal. If they cross a boundary, it's important to advocate for yourself and discuss your concerns with program leadership. As uncomfortable and far from ideal as such escalation is, it's imperative: You deserve a safe work environment.

Now that you've matched, you'll soon be deemed a physician. You can finally write [insert name], MD. Soon after, you'll walk into the hospital on your first day of residency. You'll introduce yourself to patients and, for the first time, be their provider. And still, you'll find yourself in the new (and sometimes fraught) dynamic of the intern-attending relationship. Use these tips to keep that connection strong. And remember: The best resident-attending relationship is one in which both parties are aware that the other is committed to the best interests of the patients.

Ajibike Lapite