How to make internship less *sucky*?!

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LanceArmstrong

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So for all of us who are hopefully going to be interns this coming year (if we don't have the misfortune of winning the lottery before then) what are some suggestions for making the intern year less sucky?

In other words what would you do your first week/month/6 months knowing what you know now as a PGY1.5 or higher?

Please don't say the following things: "stay on top of your patients" "read more" "find time for relaxation and exercise"...

-Thnx
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1. Attitude and expectations: You will work hard, possibly harder than you have ever worked before. don't be surprised or pissed off by this. Just roll with the punches, and you'll find that you can make it through any rough call night or painful rounds or difficult patient. And don't forget to have fun at work. Be goofy every once in a while (when appropriate). Joke around with the patient if they joke around with you. Make balloon people out of nitrile gloves in the team room, if that's your bag. As long as you remain professional, everything else is fair game.

2. Be nice. Even if you are legitimately upset at a nurse or a family member or a team member, it doesn't help to be rude. You CAN be really really straight-forward, but make sure you try to empathize with the other person when you do it, or you will come across as a jerk.

3. Don't be afraid to go to a chief resident or a program director if you run into problems. I'm not saying to "tattle" on everyone you disagree with, but if your team is dysfunctional, don't wait until you are 3 weeks into the rotation before telling anyone.

4. All that other stuff everyone else has said: know your patients, don't piss off the nurses, find time for exercise and leisure and family, etc... It really is important.
 
Before you go to your program director with any problems check with other residents who may have done so (you don't have to know the nature of their problem) and find out if that PD was open to the situation or just used it against you later.
 
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How about this survey: post calls days - a) take a nap and go to bed late that night or b) don't take a nap but goto bed earlier ? :idea:
 
LanceArmstrong said:
How about this survey: post calls days - a) take a nap and go to bed late that night or b) don't take a nap but goto bed earlier ? :idea:
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I have yet to stay awake postcall...I always take at least a 2hour nap.

All of the above advice is good. Schedule a vacation at the end of December or sometime in January/February to offset some of the winter blues. I didn't schedule any extra days off during the holidays like some of my fellow interns and wish that I did... I could use a day off in a big way right now.
 
One of the biggest things that made my intern year "less sucky" was establishing early that I respond to pages quickly and listen to the nurses concerns. I've kept a couple kids out pf the PICU by listening when a nurse thought that there might be a problem, and reponding quickly, and I tended to get fewer pages for minor things on my call nights.

No matter how much some people may seem to hate to admit it... nurses are a critical part of the health care team. I sure don't want to be the person cleaning up after a pooper/puker, so I do appreciate the MA, CNA or nurse who does this job, and while I can write for a med to be given or an IV started, I just don't have the time to also be the one to do it.

As for being post call... I take a 2-3 hour nap, get up and do the normal evening things, then go to bed at my normal hour. I feel less wiped out by the end of the month than if I'd stayed up and went to bed early on my post call night.
 
LanceArmstrong said:
How about this survey: post calls days - a) take a nap and go to bed late that night or b) don't take a nap but goto bed earlier ? :idea:
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wow you're tough.
For me there is no nap. Post-call I go to sleep as soon as i get home/shower, and just sleep until the next morning, sometimes waking up once or twice to go to the bathroom or eat/drink.
 
Good advice so far. Along with "be nice," I would add - don't take it personally. When you are tired and then more tired and then even MORE tired and feeling overburdened, you can get into this weird mindset where somehow the patient chooses to flip into A-fib just to torture you. Sounds kinda stupid when you write it out, but honest to God, you can start thinking paranoid when you're an intern. The nurses page you because they need something, NOT to harass you. The ER calls you to admit a patient an hour after you went to bed because that's when they knew the patient would need admission, not because they were intent on disrupting your sleep. Don't laugh! You are going to think these things and it's okay to vent, but don't let this weird paranoid thinking actually take hold in your brain because it will really bring you down.

Totally agree with taking some time off in December or January if you can. It's the Jan-Feb dark months that feel sooooooo long.

As for sleep: if I got home by 12n or 1p, I would go to bed for 2 hours, then set my alarm to get back up, have dinner, do something mindless, and then go back to bed at my regular time. If I didn't get home until after 3pm, I'd try to stay up for an hour or two, hit the sack by 5p and stay in bed til the next morning. This is based on long experience of knowing that I'm highly unlikely to be able to sleep more than 12 hours straight no matter how exhausted I am; I couldn't sleep from, say 2pm til 5am the next day.
 
"When you are tired and then more tired and then even MORE tired and feeling overburdened, you can get into this weird mindset where somehow the patient chooses to flip into A-fib just to torture you. "

I swear that I got into that type of thinking until I just resolved it within myself that Internship is hard and that is just how it is. If I don't get paged for 30 whole minutes on call, I know just what to do to get my next page: try to lay down for a nap...those pagers will start going off like crazy.

Sometimes I swear that their is a cameraman following me that transmits the video to nurses and soon as they see me about to attempt to take a nap, they will page me and laugh out loud.

Of course, this is all in my head. The biggest thing you can do to make internship a lot easier is what has been said before: expect it too be very tough. Expect to get paged all day and at any moment. expect to lose lots of sleep. It is easy to fall in the trap of expecting to get a full nights rest on call and having a light patient load but that is just not reality. You may luck out and get it but don't expect it.
 
would writing a lot of prn orders and (if allowed where you are) conditional orders allay some of the paging medicine. as in give tylenol for temp > 100.4 prn or colace prn constipation or perform cpr prn vfib ...lol
 
because I get cranky if i dont get my 9.5 hours of sleep :mad:
 
Cpt.Hook Hamate said:
"When you are tired and then more tired and then even MORE tired and feeling overburdened, you can get into this weird mindset where somehow the patient chooses to flip into A-fib just to torture you. "

I swear that I got into that type of thinking until I just resolved it within myself that Internship is hard and that is just how it is. If I don't get paged for 30 whole minutes on call, I know just what to do to get my next page: try to lay down for a nap...those pagers will start going off like crazy.

Sometimes I swear that their is a cameraman following me that transmits the video to nurses and soon as they see me about to attempt to take a nap, they will page me and laugh out loud.

Of course, this is all in my head. The biggest thing you can do to make internship a lot easier is what has been said before: expect it too be very tough. Expect to get paged all day and at any moment. expect to lose lots of sleep. It is easy to fall in the trap of expecting to get a full nights rest on call and having a light patient load but that is just not reality. You may luck out and get it but don't expect it.
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:laugh: Totally.

For me though, the patients choose to fall out of bed. That's a real winner right there. Watch LovelyRita go ape$hit because somehow a farking 98 year old lady who can hardly move MANAGES to farking fall out of the farking bed. Explain that. Then I gotta get up, do a farking exam and order a farking head CT and make sure I get the result. This is an enigma to me.
 
LovelyRita said:
:laugh: Totally.

For me though, the patients choose to fall out of bed. That's a real winner right there. Watch LovelyRita go ape$hit because somehow a farking 98 year old lady who can hardly move MANAGES to farking fall out of the farking bed. Explain that. Then I gotta get up, do a farking exam and order a farking head CT and make sure I get the result. This is an enigma to me.
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Yep. I can never understand the 100 yr old frail female houdini impersonator who at 2am, can manage to get out of their vest restraint and fall out of bed and bust their head wide open. Fruck what is going on on the mooon and what happened to Jimmy Hoffa! I want to know how does that frail little old lady gets out of that vest each time to wake my ass up at night.

Also, ordering PRN orders help and Xanax is a miracle drug but you will still get call from nurses like "hey, Mr. John Doe peripheral IV just came out" at 2:30am.
Restrain from yelling "well put it back in, Einstein!!!!"
 
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LanceArmstrong said:
would writing a lot of prn orders and (if allowed where you are) conditional orders allay some of the paging medicine. as in give tylenol for temp > 100.4 prn or colace prn constipation or perform cpr prn vfib ...lol
Click to expand...

I hate to break it to you, but being paged all night long is usually DESPITE writing all those good prns.

I definitely endorse the "evening rounds" concept where you go around and do chart checks, and make SURE the nurses see you and ASK them if they have any concerns that you can address. As you schlep off the floor at 11:30 pm, after solicitously asking every nurse if s/he has any other concerns, yawn hugely and express the hope that you will get some sleep. If they have seen you working hard and really looking out for patients' welfare (as well as theirs), they will really think before they page you, honest! But you can't do much about the 3am ER admission if your team is next up, or the perfectly stable post-op who falls going to the bathroom, or the person who was in a perfectly normal sinus rhythm who decides to go into A-fib with RVR.... well, there's just no end to the weird crap that comes up overnight.
 
Why do people always seem to fall at 6:00-6:30? right at the end of my shift.:)
 
Call really wouldn't be so bad, if it weren't for the damn pesky patients. If I could just get rid of all the patients, I really wouldn't hate it quite so much...:)

At my hospital, we interns get paged for every CT scan with contrast that is done. We have to go down to radiology and sign for the f-ing contrast, and wait to make sure the patient doesn't stop breathing. This is, to me, a form of cruel and unusual torture made up especially to make my intern year more of a living hell than it already is.

An upper level resident had a great point about this...maybe they should post an intern out on the front lawn during lunch hours in the nice weather as well. Just incase anyone gets stung by a bee and has a reaction.

I hate intern year.
 
mamadoc said:
I hate to break it to you, but being paged all night long is usually DESPITE writing all those good prns.

I definitely endorse the "evening rounds" concept where you go around and do chart checks, and make SURE the nurses see you and ASK them if they have any concerns that you can address. As you schlep off the floor at 11:30 pm, after solicitously asking every nurse if s/he has any other concerns, yawn hugely and express the hope that you will get some sleep. If they have seen you working hard and really looking out for patients' welfare (as well as theirs), they will really think before they page you, honest! But you can't do much about the 3am ER admission if your team is next up, or the perfectly stable post-op who falls going to the bathroom, or the person who was in a perfectly normal sinus rhythm who decides to go into A-fib with RVR.... well, there's just no end to the weird crap that comes up overnight.
Click to expand...

Evening rounding - easier when all the patients on one ward - now I have patients on floors 3, 5, 7, 8, 9. 10. 12. 14 and all in different wards with about a quarter mile of hallways between each...
 
hermione said:
Call really wouldn't be so bad, if it weren't for the damn pesky patients. If I could just get rid of all the patients, I really wouldn't hate it quite so much...:)

At my hospital, we interns get paged for every CT scan with contrast that is done. We have to go down to radiology and sign for the f-ing contrast, and wait to make sure the patient doesn't stop breathing. This is, to me, a form of cruel and unusual torture made up especially to make my intern year more of a living hell than it already is.

An upper level resident had a great point about this...maybe they should post an intern out on the front lawn during lunch hours in the nice weather as well. Just incase anyone gets stung by a bee and has a reaction.

I hate intern year.
Click to expand...


So in fact you have to accompany each of your pts to CT? What a beautiful use of time...
 
LanceArmstrong said:
Evening rounding - easier when all the patients on one ward - now I have patients on floors 3, 5, 7, 8, 9. 10. 12. 14 and all in different wards with about a quarter mile of hallways between each...
Click to expand...

Yeah, well, I was in a lot better shape intern year too. No idea how many miles I clocked on an average night but I'd start at the top (10th floor), work my way down then cross to the "other hospital" and do the same. There's a quarter mile just between the two buildings so my New Balance racked up some frequent flyer miles.....
 
hermione said:
Call really wouldn't be so bad, if it weren't for the damn pesky patients. If I could just get rid of all the patients, I really wouldn't hate it quite so much...:)

At my hospital, we interns get paged for every CT scan with contrast that is done. We have to go down to radiology and sign for the f-ing contrast, and wait to make sure the patient doesn't stop breathing. This is, to me, a form of cruel and unusual torture made up especially to make my intern year more of a living hell than it already is.

An upper level resident had a great point about this...maybe they should post an intern out on the front lawn during lunch hours in the nice weather as well. Just incase anyone gets stung by a bee and has a reaction.

I hate intern year.
Click to expand...


Ah yes, and this my friends, is an example of how interns are lower than **** on the totem pole.
 
Developing a good working relationship with the nurses. That is one of the biggest keys to having a better intern year. Trust me on that. Be a good intern (hard working, polite, and assertive) and your reputation will flow through the floors like you wouldn't believe.
 
Here's another question: I'm having a crappy day - I have a headache, I'm zoning out despite 10 hours sleep last night, I dont feel like doing nothing except hiding under a blanket - what do I do.
 
LanceArmstrong said:
Here's another question: I'm having a crappy day - I have a headache, I'm zoning out despite 10 hours sleep last night, I dont feel like doing nothing except hiding under a blanket - what do I do.
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Suck it up cowboy.

I'm having a crappy day - I haven't eaten since dinner last night, I'm zoning out despite 1h of sleep last night and I'm on my 14th straight day of work w/o a day off including 3 overnights and I feel like doing nothing except putting pillows over the heads of either half my patients or my case managers (the latter would be less work and more effective in the long run).

Instead, I do my attending rounds, write all my post-call notes, follow-up on a bunch of labs and consults so my on-call colleague doesn't have to and get out the door at 29 hours on the dot.

And then I go get a beer and a nap.

Sometimes you just have to roll with it. The days I describe (which suck) will make the days you describe (which also suck) seem less painful. And then, 12 months later, you'll be done.

For the record, this is all much more tolerable w/ supportive staff and senior residents which I've been fortunate enough to have so far this year so YMMV.
 
I highly recommend making your own little round around 11:30 pm (after nursing shifts change). You really look like you care about patients and you save youself a lot of pages later in the evening.

Even if you have patient all over the map, it is still doable. I usually just call the nurses to get updates.
 
Totally agree!
1.IF doing ICU rotation, round on your patients at night, somewhere around midnight; it's easy 'cause they all are in the same place. If you are on call for the floors, well, at least go see and/or talk over the phone to the nurses taking care of the sickest pts that you got on the sign out. You'll prevent a lot of pages later in the night, especially the stupid ones.
2.Relationship with nurses IS KEY! Treat them right, show them that you care about their patients and about them; ie. don't order an enema unless it's really necessary, for example. Answer back their pages asap.
3.My night float strategy which I think was very effective (but don't think I could pull off for more than 2 weeks): not only have a mindset that you will be working hard all night long, but also that you won't sleep. I decided I was not going to sleep last time I did night float; pros: always alert; able to answer pages immediately which nurses appreciate a lot; when paged at 3 am, my mind was fully awake and could solve problems immediately usually (compared to be woken up and not even knowing who the hell the nurse is talking about or what you want to do with a certain drug or something); not really minding being called to the ER at 4 am 'cause they are not really waking you up. Cons: for however long your nightfloat is, you pretty much don't have a life because in order to be able to not sleep at night, you must sleep all day long.
In my book it's worth it, because at my program we do 5 weeks of night float, 2 weeks, 2 weeks and 1 week so it is doable and worth it.
For those of us current interns, less than 6 months to go, YES!!!
 
euroboy98 said:
Totally agree!
1.IF doing ICU rotation, round on your patients at night, somewhere around midnight; it's easy 'cause they all are in the same place. If you are on call for the floors, well, at least go see and/or talk over the phone to the nurses taking care of the sickest pts that you got on the sign out. You'll prevent a lot of pages later in the night, especially the stupid ones.
2.Relationship with nurses IS KEY! Treat them right, show them that you care about their patients and about them; ie. don't order an enema unless it's really necessary, for example. Answer back their pages asap.
3.My night float strategy which I think was very effective (but don't think I could pull off for more than 2 weeks): not only have a mindset that you will be working hard all night long, but also that you won't sleep. I decided I was not going to sleep last time I did night float; pros: always alert; able to answer pages immediately which nurses appreciate a lot; when paged at 3 am, my mind was fully awake and could solve problems immediately usually (compared to be woken up and not even knowing who the hell the nurse is talking about or what you want to do with a certain drug or something); not really minding being called to the ER at 4 am 'cause they are not really waking you up. Cons: for however long your nightfloat is, you pretty much don't have a life because in order to be able to not sleep at night, you must sleep all day long.
In my book it's worth it, because at my program we do 5 weeks of night float, 2 weeks, 2 weeks and 1 week so it is doable and worth it.
For those of us current interns, less than 6 months to go, YES!!!
Click to expand...

I have to agree with this whole heartedly. Although its tough to do when things get slow around 2-3 am. I don't nap on 12 hr day shifts, so I shouldn't need to nap on 12 hr nights. But somehow I have a tough time convincing my mind and body of this fact. Night float is coming up again, and I'm really going to try to go this route. We'll see how it goes.
 
mamadoc said:
I definitely endorse the "evening rounds" concept where you go around and do chart checks, and make SURE the nurses see you and ASK them if they have any concerns that you can address.

If they have seen you working hard and really looking out for patients' welfare (as well as theirs), they will really think before they page you, honest!
Click to expand...

I agree with this one. I did it every night of night float when possible. It wasn't before long that they just kept a pile of minor things waiting for when I got around to them. And one night when the pager system went down and I didn't get paged for an hour, they knew it wasn't me being an arse and I still got to everyone no problem. And we had ppl on 7 floors with 2 units on each.

Oh, don't forget your please and thank you's.

And no matter how crazy your day/night is, the poor nurse who is paging you doesn't know it so answering a page all pissy doesn't help. Always be nice and let them know if you'll be a while with a brief reason why. I can be dropping the f bomb left and right, get paged, and i'll still be sweet as pie to the person on the phone.

And make your signouts as if you're not coming back. It makes everyone's life easier - esp NF. And don't sign out a really sick pt or a stinkin' blood draw.
 
All of your advice is great. But I want to know is about that first month or two. Coming off of no work for 2 months, I am scared. Yeah, I'll admit it. I DON'T want to be incompetent. I DON'T want to kill anyone. I DON'T want to feel alone.

ANY reading or pertinent things to know for THIS part. Or were you all scared?

thanx
 
I was terrified.

One important thing...

Don't pretend to know more than you do. As one attending here says.."The ink is still wet on your diploma"...nobody expects you to be an expert. Don't be afraid to say "I'll get right back to you" on a call from the floor, etc. Better to ask and be sure than to try to guess and be wrong.
 
RuNnR said:
All of your advice is great. But I want to know is about that first month or two. Coming off of no work for 2 months, I am scared. Yeah, I'll admit it. I DON'T want to be incompetent. I DON'T want to kill anyone. I DON'T want to feel alone.

ANY reading or pertinent things to know for THIS part. Or were you all scared?

thanx
Click to expand...

Hey, I hope you are scared, that means that you are thinking. I was scared my first week of hospitalist service, 34 hours strait, and the only doc in the hospital. My first night, I got a page about a patient, and was asked what I wanted to do.......do.....call someone else (not an option) well I stalled, I said that I would be right down to see the patient, when in fact I was thumbing my Internal med pocket book and my PDA for a better answer than "take two asprin and call someone else in the morning" while I was walking to the nurses station. After doing this a couple of times, you start to see patterns, and you start developing a rhythm.

A couple of, what I thought were no brainers, but one of the interns did this (not me)
1. DO NOT Change orders of the attending, unless it is life or limb
2. DO NOT change orders of consultants, unless it is life or limb
3. Value nurse input, and opinion, but do your own research on patients, nurses know a great deal, but it is your butt, and they are not thinking about the same issues as you are, they are thinking about patient comfort and overall well being, you have to look at the long term and risk benifit issues
4. Trust your gut, if you think things are not right, keep looking for the cause of your gut feeling. As you get more experience your gut will kick in the minute you see a patient.
5. Be an adult, admit when you are wrong, and admit when you need help
6. You are being watched, this may sound paranoid, but act like an adult, from the minute you turn into the parking lot til you leave the parking lot to go home. You never know who your patient knows, or who is walking around the corner, as sad as this sounds, impressions can make or break you. If you get a reputation as a jerk, it will be an uphill fight to change that, and if you get a reputation as a caring, dedicated doc, you will get more slack (not fair, but true)

I hope this helped, if not it at least helped me hone my typing skills. It is ok to be nervous....I suggest anyone who goes into PG-1 year should read "House of God" before you start. Fiction, but has some real universal truths, and will help you get some perspective (it is easy reading and funny)
 
Stable said:
Hey, I hope you are scared, that means that you are thinking. I was scared my first week of hospitalist service, 34 hours strait, and the only doc in the hospital. My first night, I got a page about a patient, and was asked what I wanted to do.......do.....call someone else (not an option) well I stalled, I said that I would be right down to see the patient, when in fact I was thumbing my Internal med pocket book and my PDA for a better answer than "take two asprin and call someone else in the morning" while I was walking to the nurses station. After doing this a couple of times, you start to see patterns, and you start developing a rhythm.

A couple of, what I thought were no brainers, but one of the interns did this (not me)
1. DO NOT Change orders of the attending, unless it is life or limb
2. DO NOT change orders of consultants, unless it is life or limb
3. Value nurse input, and opinion, but do your own research on patients, nurses know a great deal, but it is your butt, and they are not thinking about the same issues as you are, they are thinking about patient comfort and overall well being, you have to look at the long term and risk benifit issues
4. Trust your gut, if you think things are not right, keep looking for the cause of your gut feeling. As you get more experience your gut will kick in the minute you see a patient.
5. Be an adult, admit when you are wrong, and admit when you need help
6. You are being watched, this may sound paranoid, but act like an adult, from the minute you turn into the parking lot til you leave the parking lot to go home. You never know who your patient knows, or who is walking around the corner, as sad as this sounds, impressions can make or break you. If you get a reputation as a jerk, it will be an uphill fight to change that, and if you get a reputation as a caring, dedicated doc, you will get more slack (not fair, but true)

I hope this helped, if not it at least helped me hone my typing skills. It is ok to be nervous....I suggest anyone who goes into PG-1 year should read "House of God" before you start. Fiction, but has some real universal truths, and will help you get some perspective (it is easy reading and funny)
Click to expand...




Here's another thing that again bit me in the butt today (and im not even in residency yet) - Don't trust the nursing or triage (in ED) VITAL SIGNs, had an nursing home patient with AMS in the ED the triage VS are: 140/80 80 12 97F. When I see her 20 minutes later its 90/55 130 20 and 101!
 
yeah, I have read the HOuse of God. I actually read it 2 years before I went to medical school. Loved it. So, I see. I am a nice, easy to get along with person so I'm worried about getting any shady rep.

And I am humble and know I am human/don't know everything.

Ill have my maxwells, blue medicine pocketbook, and what PDAs do yall suggest........oh and the attendings info............

So i guess what got me all upset was an incident we had at our VA. I was not there but heard about it. Intern first day oncall. Came late to orientation so not sure what he missed, but he sure as hell didn't come to work with his head. nurse calls him and says patient now has a fever. he tells her very rudely to give him tylenol and he'll check it in the morning. patient dies. oh, damn skippy, he was nuetropenic.

My dad's a doctor and he told/tells me to "ALWAYS see the patient." Coming from this philosophy, this case is obvious to me. THAT resident is a lazy incompetent ass. BUT I'm sure there are cases - hard ones. THAT's what I'm scared about.

THANKS so much for the advice! It's all printed out ready to go!
 
In terms of the first weeks:

1. Ask nurses and thank them for help, then armed with your and their opinion, ask a senior
2. SEE THE PATIENT
3. If something looks funny, repeat it if it won't hurt the patient (ie bp is 250/130 in an obese male - get a manual BP while you're walking down to see pt - 1/2 of the time in the obese the auto bp was totally off comp to manual)
4. If you have downtime, something's going to go wrong (murphy's law) so plan for disaster. If you think a pt MIGHT go home, have the discharge paperwork as done as possible so when it's time to send someone home, the guy with a temp won't hold up the other guy's discharge. I basically had the d/c stuff 1/2 written with the admission if I knew what was wrong with them...
 
RuNnR said:
All of your advice is great. But I want to know is about that first month or two. Coming off of no work for 2 months, I am scared. Yeah, I'll admit it. I DON'T want to be incompetent. I DON'T want to kill anyone. I DON'T want to feel alone.

ANY reading or pertinent things to know for THIS part. Or were you all scared?

thanx
Click to expand...

as an intern you are so on your own. Do NOT trust what anyone signs out to you....always see things with your own eyes (lab, radiology results, etc). Get as many clear answers as you can on your own because if someone forgets to sign out some important details to you, guess who gets in trouble when something doesn't happen? You!

Internship suuuuuuucks. :scared:
 
LovelyRita said:
as an intern you are so on your own. Do NOT trust what anyone signs out to you....always see things with your own eyes (lab, radiology results, etc). Get as many clear answers as you can on your own because if someone forgets to sign out some important details to you, guess who gets in trouble when something doesn't happen? You!

Internship suuuuuuucks. :scared:
Click to expand...

Clarification: Internship MOST places suck..there are a few well kept secrets out there..and they are the perfect combination of the needed experience transitioning from med student to young doctor to CUSH plush world of good food, sweet physician lounges, hot nurses, etc.. hehe (j/k about the nurses):laugh:
 
I have one tip for reducing superfluous calls. When you are called to see a patient, respond gladly and ask that, while you are on the way, the person that called you obtain __blank__ (fresh vitals, doppler pulses, obscure supplies or anything you can think of). You want to be known as the intern who responds promptly and always sees patient when called, but really puts the WE in team. After a while the calls like "Mr Smith is written as NPO. Do you still mean that?" will stop in favor of some chart research and critical thinking. Good luck.
 
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