Did I screw up?

[HollATme]

Done talking about this. Thanks for the helpful replies.

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[Rendar5]

The interns being a dick and not handling his load. Let him get himself in trouble, but don't shy away from carrying messages to him. You are part of the team and if the fellow asks you to talk to him, just do so. Let him dig his own grave.

Though I'm not sure what SE and TF is =p

 

[cpants]

Visiting student. I can't put in orders.
While in the ICU, I ask my intern a question about a possible SE a pt could be having while on a certain medication, and he/she acts all annoyed, then I attempt to tell him/her that TFs have not been started because nurse told me orders have not been put in (pt has now been 2 days w/o TFs, should have been started yesterday but wasn't), I get yelled at. So, pt has not had anything that was discussed in our plan. Intern is "too busy" with another pt.
Fellows round, they ask me if TF has started, I said no it has not and they ask me why and to tell the intern to put in the orders for it. I asked if they could tell the intern since the intern appears caught up with another pt, and the fellows told me to just tell the intern and that I should not hesitate since I'm part of the team. I end up not trying to confront the intern again because the intern starts talking about me to the other visiting student from the intern's med school and another resident (who's been in favor of me and a huge proponent of my work ethic). The resident says nothing to me, but I did not bother to confront the resident to see what was said about me or to correct the situation.
During PM check out, intern does not allow me to present pt at checkout, so fellows ask intern of status and if certain orders done, intern claims TF started which had not been. The other fellow shakes his head, makes a note on his card, and we just move on to the next pt during check-out.

I know I'm not perfect, but I am a hard worker and I try my best every time. I usually don't care about negative comments, but it's just been eating me up .. Did I screw up? If I did, how could I have handled it better?

Please don't quote this in your replies - I plan to delete this when I receive answers.

You did screw up. When the fellow told you to talk to the intern, you should have just nodded and taken care of it. The intern sounds unpleasant, but you need to deal with it to be succesful. Always be courteous and respectful. Get all your work done. Probably not the best idea to bring up rare side effects unless you think something life threatening is going on. Trust that the physicians above you are well trained, more experienced, and don't want to discuss the validity of their orders with a medical student.

 

[DrWBD]

SE=side effects
TF=tube feeds

Maybe the intern doesn't know how to write a tube feed order correctly, and is too embarrassed to admit this. Do you know how to? It usually isn't as simple as "Start Tube Feed X", especially in an ICU. You have to know which formula to start, what the initial rate and goal rate of feed should be, and what to do if there are "residuals". Usually a dietician/nutrition consult will help with most of the details and then it just becomes a matter of synthesizing the data and writing a coherent order. Easy enough once you get the hang of it but maybe not so much in the beginning.

You mentioned that you aren't allowed to "put in orders". Does that mean you can't write an order and have an intern or resident sign off on it? Or is there an electronic system that doesn't allow this? Even if the latter is true you should still learn how to do things like this for your own knowledge for when YOU are the intern. The best students I ever had were the ones who acted like interns and were proactive, not reactive. You don't need to go to medical school to bug the intern about stuff that wasn't done, that's what nurses/aides/social worker/other ancillary staff do.


~~
"SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET."
from The House of God

 

[HollATme]

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[McGillGrad]

Obviously you can't follow directions. I said not to quote me and you did. Please edit your post.

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[cpants]

Obviously you can't follow directions. I said not to quote me and you did. Please edit your post.

Anyways, it wasnt a rare SE, it was something that seemed odd from pt presentation stand-point to me and I simply approached the intern about it. I ended up simply looking it up myself and then figured I'd want to see how it plays out clinically and look at the lab values for later in the day.The lab value was fine and the pt was fine so I let it go. I tried to even talk to the intern and try to clear the air and apologize but I was scolded. Yes, I probably should've addressed the TF issue with the intern but by that time I was pretty much not wanting to deal with another scolding. Everything is EMR, yes, I don't have access to orders. I am trying my best to keep open communication with intern but it's just not working out. Usually with other interns or residents I write a note and we go over it, and I present my plan of action and whether or not it's agreed upon we discuss and the resident or intern puts in the order (or if AM rounds start soon we go over that with attending and the intern/resident puts in orders as discussed, etc).

At this point, whenever the intern doesn't know something about the pt and the primary or a consult comes to the intern and I know the answer it's deferred to me, then the intern puts in whatever they want. I just keep my interactions limited, simply telling said intern that my note is in, along with my suggested orders, then I work with another resident on one of their pts ... I still keep tabs on the original pt of course, but I just don't interact more than I have to with the intern. Oh, and I update the intern about any recommendations that a consultant or the primary made and if I was there with the pt and the intern was with another pt (I tell the intern this when the intern's not busy unless the changes need to be made STAT, at which point the intern's likely to be asked for anyway). I never get updates from the intern but I shrug it off as the intern being busy. It's just difficult because the line of communication isn't mutual.

Wanna_be_DO, I will work on learning how to put in orders, I'll just talk to one of the residents and see if I can have them run through that with me, but I'm not sure how I'd go about it consistently when my access ID doesn't have allow for me to even go in and put in orders.

I can follow directions. I chose not to. The thread becomes effectively useless to anyone who comes along later when you delete the OP. Don't waste our time. If you don't want it published for everyone's benefit, don't post. If I'm going to respond, I want the context there.

 

[OveractiveBrain]

Questioning whether your workplace ethic is sufficient, whether you "screwed up" by not being part of the team, and have this horrendous response to some one in the forum "not following your orders?"

Listen, I am usually the person who goes out of his way to write something uplifting, motivational, or share more than one side with the posters.

The intern is probably a douche. You're probably smarter than he is. But from what youve described and more from what you've DEMONSTRATED, you have a real tough time interacting with people.

Consider for a moment that the intern's dislike of you is not because of your "work ethic" because of a lack of courtesy, of human interaction, on your part. Introspect a little and consider that maybe you aren't the person you think you are, that you aren't the hard worker you believe yourself to be. Medicine is not an individual sport, its a team sport. Medicine is not about recounting every little detail you memorized but combining knowledge into the common goal of healing. I presume, because you chose to do an away, that the place you are at is a place worth going to. If that is the case, its more than likely the staff you're under know what they're doing. Yes, even the intern, 4 months in.

Introspect, my friend, introspect.

BTW, I didnt quote. I hope this pleases you...

 

[HollATme]

Thanks.