View Full Version : 25 days and counting
Whisker Barrel Cortex
05-30-2003, 09:21 AM
Just 25 more days left of the hell that is internal medicine internship! It seems like this year went by fast, but not nearly fast enough. I can't wait to start radiology for good (I got to be THE radiology resident, dictating, staffing, consulting for three months this year at my combined internship and loved it). How'd this year go for the rest of you rads interns? I think I'm gonna periodically post how many days left during this month to keep my spirits up during this month, my third month of general medicine wards in a row.
So: 25 days, 6 more hellish calls.
05-30-2003, 03:15 PM
I start a general surgery rotation Monday for my final month. 7 calls to go for me. This year hasn't been too bad and certainly has gone quick. I go right up to July 1st though so have...well for me 29 days of surgery. Although now I'll have to start reading a lot more come July 1st but will be nice to actually be doing what you want to do.
06-01-2003, 11:27 AM
Internship is a long year. I'm glad it's almost over!
As of today, I am officially done with floors. My last call was friday! I finish the year off on an elective.
Drinks on me. I'm buyin.
Radiology, here I come, baby!
06-01-2003, 06:03 PM
Ahh my 3 idols all in one place ;)... congrats for making it through alive gentlemen. I wonder if it really was like "House of God" for y'all.
I start hell year next month... 8 months of q4 call and 4 months of the cushest electives I could pick--one of which is "Medical Administration" (sounded cush so I picked it).
I trust my Radiology brethren more than I do others. Y'all must have picked up some nice pearls of wisdom/tricks of the trade this year. Do share please.
Any advise for me? Thanks!
06-02-2003, 07:58 PM
1. Write everything down. I put little open boxes and then write down tasks under each patient's name as I am being told them or as I formulate them myself. I check, check and triple check that everything is has been done, including any labs, cultures, imaging, consults and/or procedures. Be obsessive compulsive about it. You can never check too many times.
2. Call consults early. Break off rounds, if need be, to page them so that stuff gets done today. Schedule imaging tests during rounds and whatever else needs to get done. During medicine rounds (eternal rounds) there can be plenty of pontificating other the intern's patients that doesn't matter that much in the grand scheme of things. Use this time to get stuff done or fill in your notes about your own patients. Otherwise you are snoozing.
3. If you are not sure about something ask the higher ups, pgy2/3s. They've probably been through it before.
4. Keep higher ups in the loop. Run "list" (of your patients) as frequently as necessary. If there's any sign of trouble make sure pgy2/3 knows about it early.
5. Don't piss of the nurses, but learn to set limits with them. Especially if you are busy and cannot see the patient right away, unless it's an emergency. However, be nice to them, smile and compliment them.
6. Let the nurses know about your game plan and why. This especially important since sometimes you may not been able to come up and explain something to the patient within any reasonable time It can save a lot of anxiety for the patient and the nursing staff. Get to know the great nurses from the average to the dangerous.
7. *Always see the patient if the nurse calls you about it.* That includes mini hpi, current vitals, pertinent physical exam, lab and meds review. This is especially true in the middle of the night.
8. Start thinking about how you can discharge the patient from the day they are admitted. Get case workers/social workers involved early. Get the physical therapist on board from day one.
9. Some daily thoughts. what is the patient's daily weight, I/Os? When was the last bowel movement? Are they on a bowel regimine and if not why not? Can I convert anything from iv to PO? N/V/D? Pain? Fever? Does the patient still need IV fluids any more? Is my patient getting up and walking around or do they need dvt prophylaxis? Laying in bed all day? Get Incentive spirometry and PT to see them.
10. Discuss DNR/ code status early with your patients. If they agree to DNR, document it and get your attending to document it with in a reasonable amount of time (<24hrs).
11. At night spend 30 minutes writing skeleton outline progress notes on your patients and then fill in the blanks as you go on rounds.
12. Have a game plan, in terms of imaging, blood work, abx, ivf, etc ready... ie contine this or that, r/o this or that with this test(s), and start such and such medicine or this pt needs procedure x for y. Lastly, the hospital can be a dangerous place for patients. If you even think that the patient may go home "soon", stick that in your game plan. Tell your attending that I think if x and y comes back wnl, then we can discharge the patient this afternoon or tomorrow morning.
13. Even though you will try to help everyone,t you will still have patient who for whatever reason willl not make it. You have to learn to deal with the reality and limitations of medicine. This is one of the most difficult aspects of going from medical student to intern.
14. Don't expect the ER to fully work up your patient for you. Realize the limitations on ER attendings' time and other political forces that may be at work. Admitting/discharging a pt is not in your hands. Just do the admission and get on with your life. (Hit me with your best shot, fire away).
15. Some consult services will try to weasle out of seeing the patient. Don't let that happen, let them know you will be documenting the conversation (ie, that you called the consult and with whom you spoke to). The consult may not like you and your patient may not know it, but your patient should thank you for having the right people in the loop. Know why your are calling the consult and in particular what question(s)/procedure(s) you need answered/done.
Probably one of the most guilty job of internship was calling in bs consults that my attendings wanted me to call. Make sure they actully do see the pt because sometimes there is no convincing an attending that it's not necessary. Some docs just love CYA medicine. Sometimes you may be able to present a patient in such a light as to sway your attending one way or another in terms of calling the bs consult or not. It's all a matter of presentation baby.
15. Just remember to smile because this is only one year and your future is bright. Anytime someone, patient, nurse, attending yells at you, just smile at them with a big wide grin. Cause you are mentally reminding yourself where you'll be going at the end of internship year.
That cheered me up immensely whenever things got ugly. People around the hospital wonder why I smile so much, but I know why.
16. There are probably others, and I'll try to post them when I get a chance.
Whisker Barrel Cortex
06-02-2003, 08:58 PM
Wow, great advice Voxel. I agree with every single point you made.
Here are some more particular cross cover tips:
1. To supplement Potassium, give 10mEQ for each 0.1 below the desired level the potassium is. For example, if K+ is 3.5 and you want it to be 4.0, give total 50 mEQ. Works every time. Do not use this rule for renal failure patients, they will need a lot less!
2. Sleeper: The nurses will call you often requesting sleepers. First, you are not obligated to give them! Second, DO NOT give elderly (70+) patient lorazepam or benadryl for sleep. They may work sometimes, but other times it will just make them crazy (picture a naked octeganarian running down the halls).
3. Pain: Yes you should help relieve pain on call. But always know the pts clinical condiition. Respiratory suppression from too much narcs: Not good. NSAIDs for renal failure patients: Not good. Tylenol for liver patients or alcoholics: Not good.
4. Hypotension: Always find out what the patient normally runs. A BP of 80/50 on someone that is usually 95/50 is not as worrisome as in someone who usually runs 130/70.
5. Diabetes: If called on a very high accucheck (>350), always ask for a recheck or even a blood check before you give the relatively large dose of insulin required. It could save you a 4 am visit to a lethargic pt with a blood glucose of 20.
6. SOB: Always check the oxygen saturation and see the pt.
7. Diet, long term med changes, consults, family members asking to speak to you about care plan: If you are only cross covering on a patient and the nurse calls you because she wants you to do one of these, you can and most likely should refuse.
It hasn't really been that bad, but there have been some pretty bad days and weeks here and there (last week, when I initially posted this was one of the worst calls ever).
Anyway: 21 days and 5 more calls to go!
06-03-2003, 09:47 AM
Excellent advice Voxel & WBC... I'm gonna read and reread it... and apply it. Many thanks!
Whisker Barrel Cortex
06-10-2003, 08:48 PM
Just an update. 13 more days, 3 more calls. Can't wait!
06-11-2003, 04:51 AM
Hey, since you're finishing up intern year maybe you could help all of us soon to be interns. Specifically, how much of those ACLS and BLS books must be read to pass the tests at the beginning of intern year? Thanks and congrats on completing PGY1.
06-11-2003, 09:28 PM
AlexanderJ please do not try to hijack this thread about acls/bls. You have already posted a message in the General section of GME (MD/DO). You are duplicating posts in more than one forum. Please delete your current post in the radiology section. I'd delete it myself if I was a moderator, but unfortunately I am not. Anyone who wishes to give "general" advice especially for prelim/transitional year radiology residents or post their days left of internship are more than welcome to give their views in this thread.
Whisker Barrel Cortex
06-22-2003, 01:36 AM
2 more days and no more medicine calls! I will never supplement a potassium of 3.4 at 3 am ever again!
06-22-2003, 05:24 AM
I've found the best way to avoid this is to cancel all evening blood draws unless looking for something critical. Anyone ordering an evening bmp to follow up on a low potassium doesn't get my respect. I've got 2 calls left in surgery so I'm pretty jealous of you though. 8 more days for me and it is over.
06-24-2003, 06:47 PM
Yeah orders for evening lytes for noncardiac patients requiring K+ 20meq supplementation per day, who never had a magnesium level checked are painful. However, I've given patients with highoutput diarrhea who required 120meq+ per day. So they need careful monitoring. Like the diaper, it all depends. There are a lot of lame things about being an intern. I usually just grin and bear it and get the work done. A lot of the year has been team dependent. With great teams, even working extremely hard wasn't really a big deal. But with some colleagues it can be so painful.
My advice to you guys is not to let the cushier schedule lull you into complaciency. Work hard, study hard. Get to know disease processes very well. Maybe some day we will meet at RSNA.
06-29-2003, 05:00 PM
Well, it's 11:00 p.m ESt on 6/29/2003 and I'm doing my last surgery call. Will be cruising home by noon tomorrow and starting radiology which is both exciting and scary. I think it was a good year and I'm glad I've done it (makes one realize that you could actually do any of these fields of medicine). Also helped greatly for the Step 3 which is also over. I go back to being a first year again, but can't wait and I can change my signature on SDN.
06-29-2003, 05:44 PM
I would like to thank you guys for this excellent advice. I start my internship on Tuesday.