I mean say the service is 18 people. For the morning notes and rounds, you split that 9 and 9. But once the other intern signs out and goes home, now you're first-call and finishing any to-do's for all 18. I was trying to understand how that was compatible with "interns cannot be responsible for ongoing care of more than 10 people." Sounds like it's because ongoing care really just means the 6am-early afternoon part with all the documenting and frantic morning phone calls!
I’m going to make some assumptions here and say someone is upset post-call.
If I’m reading between the lines correctly and you’re frustrated with your co-intern/set up for unfinished tasks, the first step is to talk to them first (not SDN, not your senior, definitely not your attending/chief). Identify 3 examples of something that you felt they should have handled before leaving (refer to Smurfette’s explanation above) that were not handled and explain how that affects you and therefore care. If you don’t want to do that (fear of political ramifications in your program), you’re going to have to just deal with it. Alternatively, if you feel you are working much harder than your colleagues and not being recognized, that is equally frustrating but a good problem to have in the long run and the best strategy is to say nothing and let the things work themselves out. The reasons for this are numerous.
1.) In regards to your point about referencing duty hours, I feel that it’s a weak rationalization. I’m not sure if it’s written somewhere but as the intern, ongoing care
to others effectively means who presents and writes the note for the patient. To YOU it should mean what Smurfette writes above (for the sake of YOUR training). In essence, the plan on each of your patients should be finalized before leaving.
2.) The first step in anything that needs to be escalated is a 1-1 conversation with the person. If there are multiple persons involved who aren't having an issue, reflect what it is you’re doing that’s making you feel this way. You could be overdoing/working things and may benefit from pulling back to avoid burn out. If you ever need to escalate, the first thing you will be asked is if you talked to the person.
3.) Follow up items are not part of carrying a patient and trying to argue such will be perceived in poor light. A critical skill to learn as a physician is to prioritize in order to manage simultaneous tasks. You need to learn to prioritize between admissions, discharges, to-do items, etc. It’s one of the most important things to learn in training. I echo what Smurfette says above regarding what ongoing care is.
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Now if everyone feels the same you do, maybe it’s something worth bringing up at the next meeting. Most programs host chief open houses or town halls anywhere from weekly to quarterly. If it seems like this is a systemic issue, talk to a couple of people and find three recurring themes that adversely affect patient care that occur as a result of the current call system and propose an alternative. Definitely talk to a few people who you know are in good standing with the program (and not vigilantes themselves) to see if they feel the same way before doing this.
