Things you do as PGY1 intern that make attendant's or resident's job easier or more difficult?

[bronzigu]

As an intern, you are obviously going to make mistakes and then try to learn from them. Trying to be proactive - what are things that you do that can either make the job of the program director, attending physician or your supervising resident easier (so to try doing more or learning about) or harder (so to try to avoid)?

I'm mostly interested in things that they expect you to do and, if you don't do them, they have to enhance, redo or worst case do some corrective actions. Also mostly interested about things that they care about themselves. E.g. if you "hurt" yourself by not asking questions that you need answers to, you will lose as you won't learn (might come handy when you actually start working alone), but then again your supervisors might not care about that (to take a cynical stance here - I assume most of them are not like that, but let's play Devil's advocate for this discussion).

For example, say you did half of the necessary physical. Is that good? No. Is that somewhat acceptable coming from an intern? Maybe. Would the resident in your team be pissed off or just tell you "go do this", "do this the next time" or something along those lines?

If you are OK giving some real examples that you went through personally, I'd appreciate that greatly! I really don't have a good idea about what might be good or bad and most importantly why (and how much) would your supervisors care, examples should help that a great deal.

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[Crayola227]

Try reading most of the threads already up.

Try reading as much of my history in any threads that seem related to resident misery.

I'll write a better response tomorrow.

 

[Crayola227]

whoa reread this

never acceptable for a resident to do half a physical for Chrissakes always do enough for:
1) patient safety
2) billable note

Also, the more of an exam you do, the less of an exam your uppers will do counting on the fact that you did it, since it is your f*ing job to do it. So really, this is safety and saving your uppers work. Are they supposed to repeat all of your exam? I dunno probably but never seems to happen that way when I watch them. Of all the BS you do, even an half-assed PE doesn't take that long and should be the least of your trimmed corners.

1) Get your notes done as fast as humanly possible - the attending does care when they are done, they have to get them signed and they are not interested in doing that at 8 pm at night. Plus if the note isn't signed the attending starts getting pages from the nurses wondering what the plan is. Which brings me to the next point:

2) Dealing with all work and pages in such a way to head off anyone paging your senior or attending. There are a few ways to do this. Your goal is to answer every page within 5 min, sooner if you can. Some pages you will not need to call the nurse back, like if they want an order for APAP or something, the "answer" is if you Rx it in the next 5 min and they see it in EHR. If it takes you longer to get that order in you might want to call cuz then they might not see it/think you overlooked it, and if you're lucky in that case they re-page you rather than go above you. If your senior or attending starts getting APAP pages your ass is grass. Otherwise I call back even if it's to say I'm going to have to shelve it for a mad min. Anything to keep pages from going above me. Also, if every page leads to a call back, sometimes nurses page you less because then they have to answer the phone, and you get a rep for being responsive, so win-win.

3) Having comfort/protocol driven orders (like already having saline drops for dry eye, etc ordered, just be sure you're checking the MAR for PRNs to be sure you're not missing patient complaints that might be clues) already written helps with the paging thing too, also being mindful of the fluff orders like PT/OT, nicotine cessation consult, SW consults, whatever, having those in

4) Know how to order lytes day 1

5) The moment you can after matching, try to become the master of your EHR. The minute you can start making templates, customizing the tabs, etc. If you actually master the EHR to where you are helping the ATTENDING and SENIOR find **** you have a done a good thing my friend.

6) Have the Sanford guide to abx and have your abx plans down pat, your notes and your rounding sheet should make it VERY easy for someone to look in your recorded note and to ask you what day of abx they are on and what the expected endpoint is, this can clear up lots of confusion. Ditto for anything that is usually a course, like steroids, etc

7) You are basically the walking EHR for your patients. Sure, the numbers are in the computer, but you should be able to regurgitate them to your senior or attending faster than they can click it out of the EHR or you are not saving them time, and ultimately saving them time is what your job is really about

8) Keeping track of to-dos, especially longitudinal ones and ones that are related to d/c

9) Keeping up with test results that trickle in (the genetic test you sent off 4 days ago that has resulted but everyone forgot about cuz that was 4 days ago)

10) Every single patient should have the most amazing and complete bowel prep ppx already written in, I can't tell you how many days of hospitalization and delayed d/cs that can avoid. Most important issue second only to the patient's primary problems.

TLDR
PE
notes
pager
regurg numbers
to dos
patients pooping
anything that saves uppers time
is your job

 

[MasterStroke]

What about how to make your senior's job more difficult?

 

[Crayola227]

What about how to make your senior's job more difficult?

Wait, what?
Did I read that right?

You can make their life more difficult by not doing most of the above timely
not answering pages fast enough so they get paged instead
not passing on critical value pages to them or other critical pieces of info, especially if you wait to drop it on them in front of the attending,
being too specific on plan/dispo to family members so then they have to contradict you leading to upset
not keeping track of what day in a course of meds a patient is on your notes forcing them to count in the MAR especially on your day off
not starting d/c summaries and keeping up on them
not doing good exams
calling crap consults and giving the fellow/attending a poor presentation getting them yelled at for it
ordering expensive tests/imaging without running it by them first so they can get the angry call from radiology or your attending
not making sure NPO orders are in for the night so patient can't have a procedure the next day
not holding anticoagulants as above
not keeping a good list of to do's so the little things that should be your job get missed, like you didn't put in that PT order and so they can't be dc'd to the nursing home that required that eval first
work hour violations, they will be taken to task for not getting you out on time

I'm sure there's more