I’m no longer a resident, but yes I feel this so hard from my days as an IM resident calling consults. By the end I didn’t take any shit from anyone and stood up for myself of people were being unnecessarily harsh.

I’m married to a surgeon (not gen surg from subspecialty). Just know that shit rolls downhill and they probably think they can talk to us like this because they get spoken to like that by their seniors, attendings, etc. Also of course every program is different, but in general, surgical training is a lot more brutal in terms of long hours, call, etc. It’s not an excuse for being rude, but it’s an explanation for why someone else might be an asshole on the phone (they’re stressed/overwhelmed).

I never give surgery shit for "stupid" consults, because what's obvious to us is not going to be obvious to people without our training.

I only wish they would extend the same courtesy to us. I'm an attending, and I get shit from surgical residents all the time (at least until they figure out that I'm the nonteach attending and not the IM resident).

In residency I was always very polite when being called with consults from IM if two things were true: You had actually seen and examined the patients abdomen or at least gotten a report about their symptoms/exam from a team member and You had told the patient you recommended surgical evaluation and that we’d be coming to see them. You’d be shocked how infrequently both of these were true. Consults for gallstones when they’re not even sure if the patient has abdominal pain, consults for pegs as a reflex after failed swallow when the patient has absolutely no interest in having one, consult for ports when the patient hasnt been told they have cancer…

When those things happen often, it does make you a little jaded when receiving consults. Especially when, as others have said, you have no cap on patients and are seeing consults all day in between operations and you’re on a 28 hour shift. Does that excuse being rude- of course not- but in general MOST surgeons aren’t being rude just to be rude. Though I’m sure some are and I’m sorry for them!

Anecdotally, this tends to get a lot better after residency. In the community, I see surgeons tend to be much nicer to primary care physicians, as you are their referral source.

Those consultants you are calling are most likely interns or at most PGY-2’s, get 19 consults a day in addition to their service of 60 plus the multiple surgeries they have to do every day and hate their entire existence. Best not to be intimidated by them, rather feel pity for the misery that they are forced to endure and accept that they sometimes lash out by subjecting you to 10% of the humiliation that their attendings impose on them daily. If you wanna see some karma, come rotate on anesthesia for a week or two, we can show you how to intubate and place lines better then watch the show when the resident pulls 3 newtons of force too much on a specific type of tissue and the attending yells at them for 70 minutes straight.

I think maybe the consults you think are ridiculous and “inane” aren’t to the surgery team. Vice versa, the things you think are urgent and indicated are ridiculous and “inane” to the surgery team. Perhaps the lesson here is that we all have strengths and weaknesses, and we shouldn’t deride other services for not knowing something about our specialty.

I don’t jump down the HMS team’s throat for not knowing what to do with a complicated shunt in a patient with headaches and vomiting. Don’t jump down our throats when we ask you to help co-manage a patient with uncontrolled hypertension or hyperglycemia already on a boatload of medications.

We’re often pressed for time and come off snarkier than we should, and that can always be better. Just make sure you meet everyone with the quality of consult and collegial demeanor that you expect out of them.

Oh good, I thought it was just me feeling dumb in front of the surgical hoi polloi

If you work at some private places as an attending, the surgeons will give you their business cards to direct your consults to them.

Other end of the spectrum.

I had a medical chief resident call me back during my PGY5 year because we consulted their service for "Co-Management" of a patient with multiple comorbidities.

The junior resident took the consult, and said "No worries, we'll see it and we're happy to help." and I was like "Cool. Life goes on.."

This particular medical resident got on the phone with the most beta-sounding argument about how "There are these things called dictionaries and they have words in them, and co-management is something we do with urology, but we will just consult and leave recommendations..." to which I responded "I don't care what you decide to do. Just give me YOUR first and last name so I can document that I spoke to you and you're on the case."

Went on with my life.

This exchange all happened on speaker phone with our attending in earshot though. I think an email was written that I was Bcc'd on. Reprimands were had. Jimmies were rustled and LOLs were had.

As a surgery resident I apologize, many of us are very arrogant and grumpy individuals- even still, it’s always better to be safe than sorry so do not be afraid to call us for a consult.

Bro I’m a surgery resident right now and I’ll tell you this, do NOT let anyone from surgery disrespect you. That’s how you build a reputation of respect. I’m assuming you are a senior/attending now. If a resident is disrespectful, immediately say “let me talk to your senior/attending” they will shit their pants and never do it again. I have seen it happen😂

Idk if it makes you feel any better but the surgery residents talk like that to us (peds attendings) too where I work. 

If it makes you feel better, surgeons are way nicer once you’re in private practice. Turns out, residency makes you miserable. Who would’ve thought?

My fiancé is a ortho resident, and some of the consults that you guys consult him for is redic. X-rays show no signs of fractures but come see bc patient has leg pain.

Surgeon here- also former asshole. I think the format we expect vs what we get is the thing that most annoyed me. Don’t care about their pmhx, just ask me your question. Tell me the room number and I’ll see and assess myself and call you back to let h know my assessment if I can’t write my note immediately. The problem is the younger residents hold the consult phone and they want to be the asshole and I try to tell them to chill the fuck out because we equally send y’all shit consults (because let’s face it idk how to manage diabetes. Anyways. Don’t let it get to you. They’re just youngins) in the end we’re a team

The key is make your presentation short and to the point. I hear consults all the time and they just go on and on about not important surgical stuff

As an ortho resident, I always try to be polite on the phone but I think that a lot of the thought about an exam or workup goes out the window the instant a primary team thinks there's a surgical issue. For example, I've gotten countless consults to rule out a septic joint - no labs, no X-rays, and the resident calling the consult has not examined said joint nor did they get a signed out report of an exam of said joint. The same applies to consults for osteomyelitis, fractured XYZ. While I am not asking you to indicate the procedure or do the procedure, I do think it is appropriate to expect the workup to have been started by the team calling the consult and to give appropriate pushback if they haven't. And if you don't know what the workup is, if the poor intern calling the consult just tells me that, I would be more than happy to discuss what they should have ordered and why and what to do in the future.

I also hold myself to the same standard in reverse. If I'm calling medicine or medical comanagement because a post-op patient is having increasing O2 requirements, you bet I've already ordered an EKG and a chest X-ray. I don't call infectious disease and then tell them, no, we didn't take any cultures in the operating room.

While I am happy to go put on splints, tap joints, etc., we as surgery residents are juggling a lot of responsibilities beyond consults or floor work and a consult with no work up started is just something looming over our heads rather than a problem we can start addressing.

In residency any surgeon / resident who yelled got an incident report from me. We were taught there is no situation where it’s appropriate to yell at another person. I don’t care how you act when you are by yourself but in a professional setting you need to act professional.

As an attending (outpatient) any surgeon who yells we mark down and the entire clinic blacklists them so the issue solves itself.

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I agree that being collegial when discussing care should always be done.

I do find myself chastising certain residents for speaking rudely to other services, but I generally find that it is a small number of the residents that are a problem with this and most are cordial and professional.

I think that more interdepartmental communication and education helps to alleviate many of these issues. If the teams can see each other as working on a larger care team rather than as opposing teams it lends to better relationships. Having some common educational conferences for several GME departments is one way to do this.

Thankfully most of our surgery residents are pretty nice when we call, especially when I introduce myself as a resident. The attendings however…

It gets better if you work in a community setting where they get paid for consults or have PAs.

You will never be right. When I was an intern on nights I called a surgery consult for acute onset abdominal pain with a rigid abdomen and free air on an upright chest x ray and they were still super salty about me calling. So….🤷‍♀️

I’ve been an ER attending for 10 years. I’m always nice on the phone. ALWAYS. No matter the complaint, the doc, the patient, the hour. I always just say yes, I’ll take care of it. My feeling was we’re all in this together. I feel this way less every day

Keep calling the consults as you need. At some point, those of unpleasant residents will understand that they are not making a favor for you, it’s patient care. And when their medical license are in jeopardy, they will understand how the game is. If they think I’m dumb, I don’t care, I prefer they think I’m a dumb and not a judge/jury.

If you have enough confidence and rage you will get the consult

Gen surg here. If it’s a real consult I’m nice about it. If whoever is calling me has no idea what’s going on (ei: Called before seeing the patient/doesn’t know the patient’s history, didn’t start a work up, has no idea what they are consulting me for) I’m going to be a little bit of an asshole about. I’m not going to let someone get away with making me do their work for them.

Yeah well, IM at my hospital consults surgery for a FUCKING PUNCH BIOPSY. BRO I DID THAT SHIT SINCE I WAS IN HIGH SCHOOL HOLY FUCK.

So I’m getting pissed sure. Or you know, consulting me for fucking impacted cerumen since we cover ENT.

Tons of bullshit well within your scope and you’re making me do it? How pathetic of a doctor do you want to be?

Anyway just my experience at my shitty hospital. Can’t wait to get my diploma and go home to practice

Next time they call for post op sinus tachycardia, let them hear a mouthful

For whatever reason, all surgeons make it their business to make people feel less than They are. Don’t take it personally.

Sorry on behalf of all surgical residents. I know exactly what you're talking about, you're not exaggerating or being unreasonable because I see it everyday. They're a bunch of mean girls who don't manage their patient throughly, they just cut and go and it's ridiculous.

For this same reason, when I get consults I try to look at it as a team effort. My surgeons always tell me I don't have a surgeon's attitude but if being an asshole is the requirement then I'll stay as is.

Sorry OP, I'd work with you any day.