An Intensivist Walks Into a Bar

Dr. Shah continues to progress through fellowship appropriately and has now completed her second month in the cardiothoracic ICU. While she has proved herself as a capable clinician, Dr. Shah still struggles with the culture of our critical care unit, which is deterring her further development as a member of our team.

Dr. Shah is adept at basic ultrasound, independent completion of procedures, and articulation of management goals for our niche post-surgical population. But I have noticed that when conversations turn to a lighter topic, like sports, she seems to actively avoid participation and instead continues to address patient care. For example, while discussing last night’s game on multidisciplinary transplant rounds (Go Chiefs!), Dr. Shah opted to put in routine orders for our patients and then began reviewing landmark trials. When asked if she had a favorite NFL team (an opportunity for her to participate), she replied that she “didn’t have one.” 

After I provided her with feedback regarding my concerns, Dr. Shah stated she has never had interest in football or any other sport and spends her free time on activities like running, yoga, and reading. During that conversation, she also expressed frustration with what she felt was a “lack of cooperation” on the part of the staff during rounds. Per her account, she experienced multiple dismissive, passive aggressive responses to her suggestions for patient management by nursing staff, interns, PAs/NPs, and some attendings. She reports scoffing, eye-rolling, full-on ignoring, and purposeful mispronouncement of her name despite polite correction, which she claims I was present for, but I might have been on my phone. 

The difference in treatment, she says, was especially noticeable when directly comparing responses to our star junior resident. While I acknowledge he has less clinical experience than her, this junior resident is a particularly charismatic young doctor, who has rotated through the CTICU previously and has built strong relationships with everyone. He has invited the department to many a happy hour and game-day hang, and even helps organize the yearly staff fantasy football draft. He and I have played pickleball together on many occasions, so I can speak to his charm and natural talent for critical care.

I advised Dr. Shah that part of her job as a fellow is to embrace the unit ideals, and that by going out of her way to understand our ICU’s culture and priorities, she may earn similar respect. While she seemed upset at the suggestion, I hope Dr. Shah was able to take some time to reflect on my words and potentially Google some season highlights. She could consider reaching out to the junior resident for a round of pickleball and a drink to pick his brain. If she finds it difficult to appreciate the intricacies of the sport and sheer greatness of Patrick Mahomes, Dr. Shah could also choose one to develop an interest in Taylor Swift and Travis Kelce’s relationship, which would at least be somewhat adjacent and acceptable enough. Given the resources at her disposal, Dr. Shah, with dedication, could become a respected member of the ICU team.