A Note for Interns and Residents: A New Law and Advice on Its Circumvention

A NOTE FOR INTERNS AND RESIDENTS: A NEW LAW AND ADVICE ON ITS CIRCUMVENTION ROBERTJ. JOYNT* There are a number of immutable laws which have been proposed, dealing with scientific, social, and organizational problems. The most famous of these is Murphy's Law, but hundreds of similar ones have sprung from this. However, there is one important situation (indeed, one's very livelihood may depend on it) which has not been treated. A long experience as a house officer, and a much longer one observing house officers, has allowed me not only to state the law, but to suggest ways to circumvent its consequences. While I claim no particular priority in formulating this patent truism, if future generations wish to credit me with the appropriate eponym I will not demur as, thus far, no sign, disease, or maneuver has been so designated. It is said—for good reason, but perhaps the CAT scan may change this—that every neurologist when he dies is buried in a posterior fossa with a subdural membrane as a shroud. But to die without an eponym and miss the hagiography of neurologic saints would make one feel it had all been for nought. Now for the law: No matter how well you have examined your patients, the attending physician or surgeon will always want to see the one you didn't have time to get around to. I don't need to emphasize the implications of this. If it has not happened to you, it will. Can it be dealt with? Yes, and here are the means, in ascending degrees of duplicity. 1. The early-bird-makes-you-feel-like-a-worm technique. This employs the hoary, but successful, battle plan that the best defense is a good offense. When the attending asks you about that patient he admitted yesterday, the one you haven't seen, you reply that he was all right when you saw him at 5:30 this morning. This immediately gives you an edge over the ?Professor and chairman, Department of Neurology, University of Rochester, Rochester , New York 14642.© 1981 by The University of Chicago. All rights reserved 003 1-5982/82/2501-0243$01 .00 144 I RobertJ.Joynt ¦ NoteforInterns and Residents attending who was in the arms of Morpheus or a similar name at the time. Occasionally, however, you will get a quick attending who will shoot back, "Yes, wasn't the sunrise nice at that time, I wasjust on my fourteenth mile of my usual 15-milejog." If this happens you have to go on to the next ploy. 2.Theflattery-will-get-you-everywhere stratagem. Having failed with No. 1, you immediately shoot back, "I certainly enjoyed your paper on the disease that patient X has." In many instances this will break the attending up completely, and he will be putty in your hands for the rest of rounds. But again, a smart one may reply, "Yes, I know it was the definitive paper on that subject but I wasn't satisfied with it." Immediately you respond with a putdown like, "I guess that's why the New EnglandJournal ofMedicine didn't accept it." This will put you back in the ballgame. Obviously, if the attending hasn't written a paper on that subject this stratagem has to be abandoned and you can go on to No. 3. 3.The I-have-read-about-this-in-a-more-obscure-journal-than-you-have approach . This can lead to an escalating or de-escalating series ofexchanges which can take up several minutes and distract the attending's attention from the unexamined patient. Don't start too obscurely, as you want to test his mettle. For example, lead offwith, "I read about this condition in the FrenchJournal ofRespiratory Disease." He may counter with a Spanish Archives ofRheumatology; you riposte with a Czechosbvakian Bulletinfrom the Ministry ofHealth on Silicosis. In most instances you have defeated him at that point, but an unusually resilient attending will come on with a Bulletin of the Chinese Workers' Health Committee on PsoriasL·. I have seen grown residents cry at this point. Usually, it doesn't go that far, and only once did I witness...