03/11/2016    David A. Pougatsch, DPM

Dealing with an Incompetent Attending

Don’t sit there and be frustrated. Find a way to
make it an educational experience! Every program
has their share of “bad” attendings, and it’s not
just limited to podiatry. This I know first hand
from training in large level-one trauma center
and hearing complaints from all residents in all
specialties about their “bad” attendings. I put
“bad” in quotes as it is relative. These “bad”
attendings can be “good” for your education.

If you realized that these procedures are
improper or below standard of care, as you’ve
already stated in your question, then you have
learned not to utilize those techniques when you
are out on your own. Residency teaches you how to
treat patients who will present to you with a
multitude of ailments. You will also learn what
not to do, and those lessons are just as
important.

Also remember that a lot of current attendings
had different training prior to the
standardization of podiatric residency programs.
What was once the accepted treatment for a
problem might be considered below the standard of
care in 2016. As the younger generation of
attendings takes over, you will see these old
treatments cease.

Secondly, if you are ever uncomfortable from
doing a procedure or partaking in a procedure,
feel free to excuse yourself. Don’t feel
pressured to do anything an attending tells you
to do just because they tell you to do it. It’s
perfectly acceptable to question an attending
about any procedure in which your are
participating in a professional manner without
making it confrontational. This type of dialogue
can go a long way to forge a strong attending-
resident relationship.

As far as reporting... if you believe the care
provided was below the accepted standard, follow
the chain of command that is dictated within your
residency program. If you are a junior resident,
discuss the issue with your chief. If you are the
chief, discuss it with the program director. If
the attending in question is the program
director, then you will likely need to go to
department chair or the GME office. There will
always be someone willing to listen. Document the
events you have witnessed. If there is a pattern
of poor care being rendered, I assure you the
problem will be addressed.

Just remember something I tell my residents all
the time: any good attending will yell at you if
you screw up, but a great attending will bail you
out!

David A. Pougatsch, DPM, Los Angeles, CA

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