Hey everyone, it’s Medicine Mondays again and it’s nearing the end of June. Well that may not mean too much for other professions, for the medical profession everyone knows that this is when the “changeover” begins. With that said, it’s time to give a nice warm Welcome to the New Interns.

Stock Photo from: Pixabay

July 1st

Ok, so July 1 is coming up. Traditionally, that is when everyone jokes about “don’t get sick in July” at a teaching hospital. However, the truth of it is that for the month of July, every teaching hospital is going through a transition phase:

Medical students –> Interns

Interns –> Residents

Residents –> Senior Residents (or Chiefs)

Senior Residents –> Fellows/Attendings

Everyone is trying to settle into their new responsibilities.

I’ve written about them before:

How to Be a Good Intern

How to Be a Good Resident

How to Be a Good Attending (Academic Edition)

Let’s talk about being an intern a little more today.

Being an intern is like being thrown into a pool filled with quicksand. You wade into the pool and everything seems ok… for like half a second. Then you realize that you have a ton of new responsibility, significantly more than you ever had as a medical student.

However, that’s not the scary part, what is really scary is you don’t know what to do and not only that, you don’t know what to do first.

As a medical student you had a set schedule. For the first two years, you go to class, go home, study, take tests, it’s all very organized. Even as a 3rd and 4th year student, there was always some form of a schedule to follow. Your supervising intern/resident may send you home early once in awhile, but for the most part you knew where you were supposed to be.

This is completely different as an intern.

I can only speak for my time as a prelim medicine intern, however, I would imagine this feeling is pretty similar for all new interns.

There is no more schedule, other than morning rounds and lunch (which may or may not happen). I think for many that this is one of the things that medical students have difficulty adapting to. You come in to work at 6am or 7am or whenever to get your sign out from night float. You try to get a general gist of what happened to your patients in the hours you weren’t there. In your head you have a mental checklist of things you want to do for your patient before the days ends. Then you get ready for morning rounds.

After morning rounds concludes, you run around like a chicken with its head cut off trying to get things done. You want to make sure all those things on your mental checklist are done, and anything else your attending(s) added on during morning rounds gets done. This also includes doing any notes and discharge summaries.

Then, of course, there are new patients to be seen. New admits to be done. New or current patients may have new issues to come up.

You need to prioritize.

This is can difficult. You don’t want to miss anything and want to get so much done, but you need to prioritize.

Mr. Smith in 302B is discharged so I need to get his paperwork done by 11 am because his wife is picking him up at noon.

However, Mrs. Jones over in 204A is getting a cath today so I need to make sure her labs are all ok and the consent is done before she gets her cath at 10am.

Also, Mr. Kim and Mrs. Lee may be discharged today depending on their morning labs, so I need to follow those up and get the ok from the attending to discharge before 4pm.

Then, there are 9 other patients which need to have their labs and imaging followed up. Then your nurse over on 4C pages you telling you that Mr. Patel is having new chest pain…

So then, what do you do you first?

On a daily basis, you need to be able to look at your list of patients and figure out which thing needs to get done first. Then, you need to be able to handle any new issue that arises and process and prioritize it accordingly. So, you need to figure out “your method”.

As an intern, I established “my method” after about a week of being on the wards. The first week I went home late every single day. There was always something I didn’t do in time, or had put off until too late, or couldn’t finish a note, or something. I would sign out to the late person (or night float if I was late),  and then go back to finish things. For the most part this was usually my notes.

After that week, I established my method for making sure I got things done.

It wasn’t very complex.

It was just a piece of paper everyday with the initials of my patients and a checkbox for all the things I wanted done. I had a box for “note done”, “labs ordered”, “imaging”, “?discharge”, “discharged”, and “other”. If anyone else looked at my paper, they would have no idea what it meant. It would fold it twice and keep it in my coat pocket and always knew where it was. However, to me, it was my roadmap to make sure I had everything I needed to be done. I became pretty good at handling new issues that came up and judging whether these were situations that I could handle or needed help with.

My other co-interns developed their own methods for doing things. Some used note cards and others used a clipboard with a sheet for each patient. I would imagine by now that something similar exists for your smartphone. However, I think in a hurry, that pen/paper is still going to be faster, and being an intern is all about efficiency.

In the example above:

For me, I would prioritize Mr. Patel first. New chest pain is worrisome and he needs to be evaluated as soon as possible. He gets a “!” in the “other” box on my paper. I would go assess him and get an EKG and then call my senior resident. We would most likely draw troponins and have cardiology see him, or if the EKG was worrisome he may go straight to the CCU and/or get a cath.

After Mr. Patel was moved to the appropriate level of care, I could turn my attention to the rest of my patients. Mrs. Jones is next on my list. I would confirm her labs are ok (most importantly her PT/INR) and get the consent and make sure she’s all set for her cath at 10am.

After that, I would go make sure Mr. Smith is still ready to be discharged and get his paperwork ready before noon.

Then, I would go check on Mr. Kim and Mr. Lee and let them know of the plans for potential discharge, so they could get their things in order.

After that I would continue down my list of patients.

Sometimes, it’s the small things.

Being an intern is hard. You feel pulled in all directions sometimes. However, try to make sure your patients know they are important to you. I tried to make it a point to at least go say hi to all my patients before noon. Sometimes it just wasn’t possible. However, most of the time I would at the very least go say hi and let them know that I would be seeing them later.

It’s hard to imagine, but you are their doctor.

You will have patients that will only want to talk to you, even if you’re “just the intern”. Your patients will trust you (and maybe only you) because they see you everyday.

You should be proud of that.

TL;DR

Being an intern is hard.

Find your method for prioritizing things.

Remember that to every patient on your list, you are their doctor.

-Sensei

Agree? Disagree? Questions, Comments and Suggestions are welcome.

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