Here is what I do most of the day:

1. Aquire data. (history, examination, discuss patient with nurses, ultrasound, laboratory values and so on).
2. Discuss the data with the boss.
3. Do what the boss and I agreed on in step 2. (Do more examination, initiate treatment, stop treatment, get other consults and so on.)

So far so good. I have written many posts about my part of this. How I screwed up and what I learned from it.

Now this post is about the attending. Here is how you know whether you have good attending working with you here. Possibly surprisingly to many, whether you have a good or bad attending becomes evident in step 2, not in step 3 when he gives you his magical treatment regimen.
A good attending will do the following during step 2:

1. He listens.
2. He asks questions.
3. He asks for your opinion on further workup. (He might suggest the opposite, but that’s not the point)
4. He walks to the patient and talks to him. (I actually have witnessed this. IT HAS HAPPENED!!! Far too seldom, but it did happen.)
5. He looks at the result, the X-rays etc. in the computer himself.Accordingly, bad, uninterested or inexperienced attendings will do just the opposite. Shall I draw the picture? OK, for you:
6. He doesn’t listen but tells you what to do before you even gave all of your info.
7. He doesn’t ask questions,.
8. He doesn’t ask for your suggestion.
9. He is allergic to patients.
10. He doesn’t look at any result.

So what does this help you? Maybe now you know you have a bad attending, but there is nothing you can do about it, can you?

Well, there is:

Let’s assume he is more the 6-10-kind-of-guy. He may be new in his position, he needs your feedback to be able to grow as an attending. You gotta tell him that his attending skills more or less suck! How do you bring that across without losing your job? Here are some suggestions on how to tell him:

• “I’m really impressed when you tell me your treatment regimen quite fast. But I fear that some of the information that I hadn’t been able to share with you may have been relevant for your decision process. Could I finish my presentation quickly, and you’ll give me your insights afterwards?”
• “I’d be a lot more comfortable if someone more experienced than I am -like you- could have quick look at the patient. Would you mind having a look at him with me?”
• “May I suggest something I would really like to practice my skills of working out a treatment plan and would be glad to hear your feedback on that.”
• If all fails start radiologist bashing, most attendings can agree on that:
  “The radiologists wrote in their report he is in pulmonary edema. However I’m not sure about that, what do you think…? – This would be the perfect time to open the X-ray!

Remember: The attendings especially the younger ones are just as scared of this as you are. And they are entitled to learn and grow just as you are. So they should know about their mistakes. Telling them takes some courage, but hey: You’re a doc.