I can’t believe I haven’t written about one of the most evil, most frustrating things about being a med student: the dreaded Attending Effect(tm).

The Attending Effect, by definition, is the magical, mystical powers that the presence of an attending has on your patient’s history. The mere sight of an attending will transform the words that come from your patient’s mouth from those he or she told you to a different story entirely.

You’ll get the story from your patient, “Okay, so it’s been 3 days of vomitting, but you’ve been keeping liquids down fine, and there’s no blood in your stool, or black, tarry stools.”

You go tell this fascinating story to your attending, give your assessment and plan, they agree, and you feel good–“The attending said I’m doing the right things! Yes!”

Then, you either go back with your attending to examine the patient again–or worse, your attending sees the patient without you–and the story the attending gets is totally different. Your attending tells you, “She told me it’s been a week and a half of diarrhea, sometimes bloody, and she can barely drink anything.”

The first few times this happens, your eyes bulge out, your jaw drops. You sweat, your heart races, you panic. You are convinced that the attending thinks you totally lied to him or her, or that you weren’t listened to the patient, or that you’re just a total dumbass. You quickly re-tell the story the patient gave you, and you swear you didn’t make it up. You are so totally pissed at this patient.

Once this has happened a dozen times or so, you just kind of shrug it off. You’re annoyed, wonder what the patient was thinking. But you know it’s just the Attending Effect at work, there’s nothing you can do about it, so you just adjust your assessment/plan and keep on moving. There’s more patients to see.

(Reminded of this by Flea , whose stories are totally depressing lately and really getting to me, and making me wonder “Is this really what being an attending is like?)

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