I hate it when interns _____.

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ewokka

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Time (free) is running out for those of us who recently graduated and we will soon start new. I've seen multiple posts about what incoming interns should read/practice so that they wont be behind when they start. Some even want to be ahead of the curve. Most responses go something like, "drink beer and travel." Because we wont get to do this anymore. I have done this so now what else?

Rather than make a list of things an incoming intern should do before July 1; how about you all list things that grind your gears when interns do them after July 1.

Thanks
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ewokka said:
Time (free) is running out for those of us who recently graduated and we will soon start new. I've seen multiple posts about what incoming interns should read/practice so that they wont be behind when they start. Some even want to be ahead of the curve. Most responses go something like, "drink beer and travel." Because we wont get to do this anymore. I have done this so now what else?

Rather than make a list of things an incoming intern should do before July 1; how about you all list things that grind your gears when interns do them after July 1.

Thanks
Click to expand...
Lie.

Everything else is expected as part of the new intern process.

-d
 
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...pretend to know something they don't.

Medicine isn't a fake it till you make it field, so don't try it. I don't know if it's a pride thing or what that leaves some interns unable to admit that they lack knowledge in a particular area, but it's a practice that has been laughable at best and dangerous at worst for me to deal with as a clinician.
 
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Mad Jack said:
...pretend to know something they don't.

Medicine isn't a fake it till you make it field, so don't try it. I don't know if it's a pride thing or what that leaves some interns unable to admit that they lack knowledge in a particular area, but it's a practice that has been laughable at best and dangerous at worst for me to deal with as a clinician.
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I had an attending this year on my cards rotation commend me on my "honesty in regards to my ignorance." Hahah. Still honored the rotation because he said I improved so much!
 
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...don't listen to the concerns of the nurses. Yes, you made it through medical school, and we commend you for that. I'm not saying you need to ask the nurse to tell you what the plan of care should be, or that there aren't a lot of nurses out there who really do have attitude problems and think that they know more than they do. But if they are saying that something you want to do is concerning to them, just pause. Grant them the benefit of the doubt, and ask someone more senior for advice on how/whether to proceed. Probably, you will have been right all along, but

Also, listen for subtle cues. SDN thinks that all nurses want to eat all interns for dessert (after devouring their own young, of course.) But seriously, some of us really do want to help you, and will try to do so respectfully. Some won't tear into you to tell you they think you are doing something boneheaded... they will just hint. "Wow. That is a very conservative dose..." They are counting on you to pick up the cue and reconsider. There is a double bind, where if they don't speak up, then they are risking the patient and helping you fail, but if they do, some doctors will take offense. So, the game of "Gee, Doc, are you sure about that?" goes on.

Cultivate cooperative relationships of mutual respect with the nurses and your intern year and beyond will be a much smoother ride.
 
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Promethean said:
...don't listen to the concerns of the nurses. Yes, you made it through medical school, and we commend you for that. I'm not saying you need to ask the nurse to tell you what the plan of care should be, or that there aren't a lot of nurses out there who really do have attitude problems and think that they know more than they do. But if they are saying that something you want to do is concerning to them, just pause. Grant them the benefit of the doubt, and ask someone more senior for advice on how/whether to proceed. Probably, you will have been right all along, but

Also, listen for subtle cues. SDN thinks that all nurses want to eat all interns for dessert (after devouring their own young, of course.) But seriously, some of us really do want to help you, and will try to do so respectfully. Some won't tear into you to tell you they think you are doing something boneheaded... they will just hint. "Wow. That is a very conservative dose..." They are counting on you to pick up the cue and reconsider. There is a double bind, where if they don't speak up, then they are risking the patient and helping you fail, but if they do, some doctors will take offense. So, the game of "Gee, Doc, are you sure about that?" goes on.

Cultivate cooperative relationships of mutual respect with the nurses and your intern year and beyond will be a much smoother ride.
Click to expand...

And on the same note don't blindly agree to whatever the nurse asks. I have had them suggest things that would literally kill my patient.

At the end of the day you should be open to any input from anyone (nurse, respiratory therapist, family member, etc.) they probably spend more time with the patient and know them better than you...but you need to do your due diligence and try to evaluate them at bedside yourself.
 
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link2swim06 said:
And on the same note don't blindly agree to whatever the nurse asks. I have had them suggest things that would literally kill my patient.

At the end of the day you should be open to any input from anyone (nurse, respiratory therapist, family member, etc.) they probably spend more time with the patient and know them better than you...but you need to do your due diligence and try to evaluate them at bedside yourself.
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:claps:

Truth.

When I was a noobie nurse, I called docs a few times to come look at perfectly normal and expected post-operative conditions. They weren't perfectly normal to me, then. If they had just gone with my assessment and ordered treatment, we would have been doing the patient a disservice. I'm sure it was inconvenient to have to come explain that there wasn't really a problem, but it wasn't futile. I learned what really deserved a call and what didn't. A couple minutes of patient explanation saved a dozen other similar situations.

Collaboration works in everyone's best interests.
 
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Intern year is long and fatiguing but being a good intern is simple. Don't lie, don't whine, play nice in the sand box, and do what you can to make life easier for the people around you. Barring going a standard deviation or two in either direction, no one really cares how much you know or how good you are at procedures. They just care whether you make work more pleasant or less pleasant...
 
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Daiphon said:
Lie.

Everything else is expected as part of the new intern process.

-d
Click to expand...

What do people lie about? I see this advice all the time so it must be an issue and there must be some pressure to lie about things in internship but I can't quite figure out what.
 
less for EM, more for IM or occasional off service rotators, but I hate it when interns try to explain to me (the attending) why a patient doesn't need to be admitted (sort of falls under the category of pretend to know more than they actually know)...
 
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Thought Crime Spree said:
What do people lie about? I see this advice all the time so it must be an issue and there must be some pressure to lie about things in internship but I can't quite figure out what.
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Lie that things were done when they were not, making up answers on the spot that were to questions that were never asked (any history of cancer? - intern answers "no" when real answer is "I didn't ask... but I'll run and ask when we're done talking.") That's probably the most common. It's rare in my experience that it's malicious, and almost always out of ignorance and the concern of "looking bad".
 
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ccfccp said:
Lie that things were done when they were not, making up answers on the spot that were to questions that were never asked (any history of cancer? - intern answers "no" when real answer is "I didn't ask... but I'll run and ask when we're done talking.") That's probably the most common. It's rare in my experience that it's malicious, and almost always out of ignorance and the concern of "looking bad".
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Yep. About sums it up. You won't look bad with an "I dunno" - but you will look really bad if you're caught in a lie.

Would also add that telling me the "patient refused" rectal/pelvic/LP/whatever when really you didn't want to do it is gonna get caught and busted when I talk with the patient.

-d
 
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Daiphon said:
Lie.

Everything else is expected as part of the new intern process.

-d
Click to expand...

I'm a resident and use the honesty is the best policy approach...but I once heard a resident jokingly tell an attending who was preaching about not lying "Don't be an ass hole and then I won't be forced to lie to you." Thought it was funny. There's no excuse for dishonesty, but some staff give a lot of motivation to lie.
 
I hate it when interns...





...blow up the bathroom and don't spray air freshener. Not cool. Really. Not. Cool.
 
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... don't know how to get ahold of their senior resident or attending so I can actually get useful answers out of someone.
 
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Doctor Bob said:
... exercise independent thought.
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I know we're joking to an extent, but when I was a med student I witnessed a PD yelling at his interns to not think, just do what he tells them to do.
 
ccfccp said:
Lie that things were done when they were not, making up answers on the spot that were to questions that were never asked (any history of cancer? - intern answers "no" when real answer is "I didn't ask... but I'll run and ask when we're done talking.") That's probably the most common. It's rare in my experience that it's malicious, and almost always out of ignorance and the concern of "looking bad".
Click to expand...

This is when you learn how to answer specific questions with specific answers. "The patient didn't state a history of cancer when I asked about medical history, but I did not specifically ask about cancer" both saves face and answers the question.
 
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Act cynical, burned out, or have a bad attitude. It takes a couple of years to earn being a little dismissive of patients or experienced providers.
 
Minimizing and blowing off patient concerns. Also telling me the reflexes were normal when pt had gigantic boots on that intern never removed. And not checking feet (especially on diabetics with just about any complaint).
 
In all seriousness: as an intern and resident you're judged on 2 things:

1-How hard you work

2-How well you get along with others.

Nail those two. Everything else that gets in the way of those two will be negatives. Book smarts matter the least.
 
SouthernSurgeon said:
Yup. It's usually panicked confabulation when put on the spot.

The problem is that it's really easy to default to the negative. Was there K elevated? Nope. Do they have any history of cancer? Nope.

The seasoned confabulator knows the default odds pretty well and gets away with it a lot.

I've found a fun way to test them on their confabulation skills is to ask them dichotomous questions that don't have a yes/no response (e.g. "Is the patient black or white?") Any hesitation to answer it lets you know a lot.



Someone said this a while ago in the surgery forum. It seems like a lot of residents ultimately fall into two camps.

Camp A is that every patient complaint is BS. Their belly pain is just gas pain or reflux. Every consultant is stupid and the patient clearly has nothing wrong with them.

Camp B is that every patient complaint is a sign of impending death. Their belly pain is really peritonitis. Every consultant is stupid and the patient is clearly dying without intervention.

Obviously neither camp is good, but the former tends to minimize and look for excuses NOT to do something.
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"I didn't ask if they are black or white."
 
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Mentioned before but I'll reiterate. Don't lie. Don't try to come up with an answer if you don't know. If you didn't ask the CP patient if they have leg swelling/recent travel/hx of DVT/PE, say you didn't ask but you'll make sure to do so. If the attending asks you what the patient's I&Os for the past 24 hours have been and you don't know, say you don't know or don't remember but you'll look it up. You'd be surprised how often they know the answer before asking your the question.
 
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Read some intern survival guides
 
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