MD co ‘20 Residency Panic Thread

[Oedipa Maas]

I tried my best to prep for clinic the night before. Then one patient gets switched on me the next day which was fine because I had time to prep. I think things are going well with the day until it’s realized that I kinda missed something pretty basic yet really important... Feels kinda terrible

Found out I’ve been clicking the “patient is medically cleared for admission” checkbox...for patients being discharged. For the past week. It happens. #internlife

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[MerYangBey]

Found out I’ve been clicking the “patient is medically cleared for admission” checkbox...for patients being discharged. For the past week. It happens. #internlife

Haha yeah honestly I thought there would be more showing of how to do things in general. But it’s more like ask questions if you need help. Anyways hope we all survive #internlife

 

[ciestar]

This call tonight makes me regret going into medicine.

RIP

 

[HuskyMD Emeritus]

ERAS panic thread has become intern panic thread, haha.
EPIC is great once you learn to use it.

 

[ciestar]

ERAS panic thread has become intern panic thread, haha.
EPIC is great once you learn to use it.

We have a scheduled Epic downtime tonight. This is fun.

 

[ciestar]

Pagers are the devil. Ive been paged like 30 times today.

 

[Oedipa Maas]

Pagers are the devil. Ive been paged like 30 times today.

My school had used portable phones so I am completely not oriented when it comes to using my pager. Getting paged 30 times sounds like a nightmare!

 

[HowAreYaNow]

Pagers are the devil. Ive been paged like 30 times today.

I shoulda kept track yesterday. Honestly it was a lot of pages but none of them were too too bad. Lots of "can she get maalox?" And "can he get ibuprofen?" Stuff like that.

And then a handful of stupid ones where my attending on call literally took the phone from me and yelled at nursing lol.

 

[ciestar]

I shoulda kept track yesterday. Honestly it was a lot of pages but none of them were too too bad. Lots of "can she get maalox?" And "can he get ibuprofen?" Stuff like that.

And then a handful of stupid ones where my attending on call literally took the phone from me and yelled at nursing lol.

I got paged many more times after that post and had to do an admission lolol
The night was rough.

 

[ciestar]

Let me add; an admission with no EMR

 

[MerYangBey]

ERAS panic thread has become intern panic thread, haha.
EPIC is great once you learn to use it.

I think it must be the last few updates that are really annoying me. Also different hospitals have different versions of it. I just recall a time maybe a year ago where I was able to do a more seamless chart review without all the extra clicks I need to find the same info now. Idk maybe I can attempt to customize it a bit more. In my opinion it’s clunkier now than it was a year ago.

 

[MerYangBey]

Pagers are the devil. Ive been paged like 30 times today.

I wish people would use the epic chat more. Like for non urgent stuff. At my last hospital people did that and it reduced the number of pages a lot. Honestly why are pagers still a thing. Give everyone a secure phone or something. In 2020 there has to be better options

 

[Oedipa Maas]

I wish people would use the epic chat more. Like for non urgent stuff. At my last hospital people did that and it reduced the number of pages a lot. Honestly why are pagers still a thing. Give everyone a secure phone or something. In 2020 there has to be better options

The phones worked so well at the one hospital. You didn’t have to drop what you are doing to go find a landline to call. There was no learning curve - it’s a phone, you pick it up. You want to talk to someone, you call them and talk to them. No sitting around waiting for a return, tethered to the landline you gave as the page back.

 

[Giovanotto]

I wish people would use the epic chat more. Like for non urgent stuff. At my last hospital people did that and it reduced the number of pages a lot. Honestly why are pagers still a thing. Give everyone a secure phone or something. In 2020 there has to be better options

Yeah we have "volt" iphones with these portable chargers at my hospital. It's passed on from resident to resident at the beginning of a shift. Lets the nurses, pharm, consultants, etc. just text or call me directly. Most just text. Saves a bit of time me thinks, pagers are so outdated. I was technically given a pager day 1, but apparently nobody ever uses it, and I might get paged once during all of residency. Sorry to hear other places are still using them....

 

[MerYangBey]

Yeah we have "volt" iphones with these portable chargers at my hospital. It's passed on from resident to resident at the beginning of a shift. Lets the nurses, pharm, consultants, etc. just text or call me directly. Most just text. Saves a bit of time me thinks, pagers are so outdated. I was technically given a pager day 1, but apparently nobody ever uses it, and I might get paged once during all of residency. Sorry to hear other places are still using them....

It’s good to know what’s out there! Maybe something like that can be suggested or turned into a QI project at some point.

 

[bananafish94]

There are so many more dimensions to being a resident than I ever realized. Obviously, I knew there were a lot of notes. But I did not understand the extent of it. For every clinic patient there are like 45 tabs you have to click through just to finish the encounter. For the discharges you have to go through the whole med rec and figure out everything and get their outpatient appointments scheduled. And then there will be some issue with the pharmacy and the patient wants it to go somewhere else but the sky is falling and you can only do one thing at at time. My God. I apologize to every resident I ever judged for having an ugly note - there's just no time!

 

[HowAreYaNow]

There are so many more dimensions to being a resident than I ever realized. Obviously, I knew there were a lot of notes. But I did not understand the extent of it. For every clinic patient there are like 45 tabs you have to click through just to finish the encounter. For the discharges you have to go through the whole med rec and figure out everything and get their outpatient appointments scheduled. And then there will be some issue with the pharmacy and the patient wants it to go somewhere else but the sky is falling and you can only do one thing at at time. My God. I apologize to every resident I ever judged for having an ugly note - there's just no time!

One thing I dislike is calling family or getting any kind of collateral. Like, I can't stand it. I hate talking on the phone already and it feels so awkward.

 

[MerYangBey]

There are so many more dimensions to being a resident than I ever realized. Obviously, I knew there were a lot of notes. But I did not understand the extent of it. For every clinic patient there are like 45 tabs you have to click through just to finish the encounter. For the discharges you have to go through the whole med rec and figure out everything and get their outpatient appointments scheduled. And then there will be some issue with the pharmacy and the patient wants it to go somewhere else but the sky is falling and you can only do one thing at at time. My God. I apologize to every resident I ever judged for having an ugly note - there's just no time!

Yes this is the most accurate thing ever.

 

[Giovanotto]

Yes this is the most accurate thing ever.

It's funny because already at the end of my 4th year my notes got sloppy. As an intern someone recently gave me very good advice, nobody has ever saved a patient's life by writing a really good note. Ironically in my specialty, documenting a certain portion of the note IS very important, but nevertheless, good advice!

I can't wait to be a 3rd-4th year resident and have the interns and 2nd years be writing the bulk of notes.

 

[sharkbyte]

One thing I dislike is calling family or getting any kind of collateral. Like, I can't stand it. I hate talking on the phone already and it feels so awkward.

During my first week of intern year I was on a medicine consult team and we got consulted to help co-manage one patient. We were strongly recommending to the patient's husband that she be transferred to an LTACH facility and I sat on the phone for 45 minutes trying to convince this really skeptical husband for her to go there. This was at the end of a very rough day where I got chewed out by a chief from a different specialty for not providing recs until later in the day even though we were completely slammed with COVID admissions on top of all the consults. The husband wanted more time to think about it but it looked like he was becoming more agreeable.

Sure enough, the next day my attending instead says "oh she can just go back to her normal rehab facility, she's doing a lot better." I've never felt more like an idiot than I did during that second phone call when I had to tell the husband "What's going on my dude, just forget everything I told you yesterday, she can just go back to her normal place"

 

[MerYangBey]

So I wish we got some legitimate inbasket training. Epic doesn’t make it intuitive

 

[ciestar]

So I wish we got some legitimate inbasket training. Epic doesn’t make it intuitive

It is frustrating. I also get refill requests from the senior that graduated and im all... uhmmmmm

 

[Giovanotto]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

 

[ciestar]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

I feel like an idiot most of the time. Im also slow af with admissions. Im on a consult service this month and im slow because i suck at cardio and look up stuff constantly so i dont look dumb when presenting.

Im glad the people in my program are really great though. Ive already made a good friend with my co-intern. It helps pass the time and made our overnight calls bearable.

 

[MerYangBey]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

Yeah...Most everyone has been great. Except the clinic environment has been weird. I think partially due to social distancing. Like our computers are all spaced out and you’re assigned a computer. It’s awkward trying to get any help.
So my own clinic has been the biggest struggle so far.

 

[sharkbyte]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

Been feeling the exact same way. First couple weeks were super rough - was on a team that had to handle both medicine consults + primary COVID admissions in an area hit really hard by COVID. Hit 80+ hours both weeks. It kind of sucks when you have to work super long hours and take care of a bunch of tasks throughout the day but everything is super new and unfamiliar. Plus I didn't really connect super well with the attending so I felt pretty miserable...thankfully I'm on a lighter elective now, but those two weeks took a lot out of me..

 

[Oedipa Maas]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

Definitely don’t feel like a doctor yet. There is so much I don’t know. I recommended a med the other day and the attending casually went “hmmm that’s probably not going to work because of (detailed biochem explanation of the receptor sites and meds the patient is already on)” and I think my jaw hit the floor realizing all that I had technically learned throughout school but had yet to synthesize in that way. So I’ve been trying to spend more time with pharm stuff on my own since then. I’m presently pretending that step 3 doesn’t exist and am really enjoying self-directed learning. I love my co-interns but have a lot of guilt about socializing because of the pandemic so I’ve been more of a loner than I want to be. I’m enjoying work but my circadian rhythms are so screwed up they don’t know what’s hit them but at least I’m doing a better job about exercising than I was in med school. I’m on a rotation where I get weekends off so this part feels like “wow I’ve made it” but the back end of intern year is going to be so rough so I’ll get what’s coming to me but maybe by then I won’t be making dumb EHR mistakes and having pharmacy call me to let me know I botched an order and then also the reorder?? I hope?

 

[tunicaexterna]

Residency has been rough so far. And I don't mean the hours, I mean the continued feeling of being utterly incompetent. When do you actually start feeling like a doctor? I'm starting to realize how much i dislike the culture of medicine, and that's not something you can really pick up until its too late.

How is everyone else doing?

I have been feeling the exact same way. I wonder when i will feel less stupid lol

 

[ciestar]

I have been feeling the exact same way. I wonder when i will feel less stupid lol

A lot of people seem to say around the six month mark they start feeling better lol

such a long way to go

 

[ciestar]

Now that i finally started getting the hang of Epic.. my two months of rotations at another hospital started... and they use god awful Cerner

 

[Oedipa Maas]

Now that i finally started getting the hang of Epic.. my two months of rotations at another hospital started... and they use god awful Cerner

My main gripe with Cerner is that everything is so hard on the eyes. Is there no way to make the notes easy to read? Or the menus? The formatting is obnoxious.

 

[ciestar]

My main gripe with Cerner is that everything is so hard on the eyes. Is there no way to make the notes easy to read? Or the menus? The formatting is obnoxious.

YES! The formatting is terrible. It really makes a note hard to read. And stuff is so hard to find sometimes. Epic is more organized and user friendly when it comes to actually looking for stuff.

That and for whatever reason, i cannot open two charts at once and it is legit the most obnoxious thing.

 

[Oedipa Maas]

YES! The formatting is terrible. It really makes a note hard to read. And stuff is so hard to find sometimes. Epic is more organized and user friendly when it comes to actually looking for stuff.

That and for whatever reason, i cannot open two charts at once and it is legit the most obnoxious thing.

Yes!!!! Sometimes I just want to copy some phrasing from another note I just wrote or just quickly move between two patients.

 

[ciestar]

Yes!!!! Sometimes I just want to copy some phrasing from another note I just wrote or just quickly move between two patients.

It’s so annoying. I just copy the note into word and then delete it after. I cant just close every time i need to look up something.

 

[ciestar]

I left early today and took advantage of the rum and tequila at my disposal #unprofessional

 

[MerYangBey]

I left early today and took advantage of the rum and tequila at my disposal #unprofessional

I approve of your time management skills. #goals

 

[ciestar]

I approve of your time management skills. #goals

My schedule got messed up lol i wish it was that simple hahah

 

[MerYangBey]

Failed a quiz for the rotation. Not sure how that happened. I was pretty sure of my answers. Praying it was some technical glitch but also possible I just failed I guess. what a way to ruin a Saturday.

 

[ciestar]

Failed a quiz for the rotation. Not sure how that happened. I was pretty sure of my answers. Praying it was some technical glitch but also possible I just failed I guess. what a way to ruin a Saturday.

A quiz for what?!?

 

[MerYangBey]

A quiz for what?!?

It’s a medicine specialty quiz. I’m shook because I thought I knew the answers. So I don’t know what happened there.

 

[CougarMD]

As an intern someone recently gave me very good advice, nobody has ever saved a patient's life by writing a really good note.

As the person giving them a bunch of drugs when they go to the OR unexpectedly in the middle of the night...I’m gonna disagree with this one

Whether you know it or not, other specialties rely heavily on an admission H&P.

We appreciate you, I promise ❤️

 

[MerYangBey]

Switched to an inpatient service for a couple weeks. It’s so much more my thing. Long hours but it’s the first time I’ve actually felt like a doctor.

 

[ciestar]

Switched to an inpatient service for a couple weeks. It’s so much more my thing. Long hours but it’s the first time I’ve actually felt like a doctor.

I hate inpatient medicine.

I still dont feel like a doctor. I am on newborn right now and i feel like im mostly doing clerical work. 9 hour days and i spend like an hour with babies and their families. I love attending deliveries though. (I still question if i would have been better suited for OB..)

 

[MerYangBey]

I hate inpatient medicine.

I still dont feel like a doctor. I am on newborn right now and i feel like im mostly doing clerical work. 9 hour days and i spend like an hour with babies and their families. I love attending deliveries though. (I still question if i would have been better suited for OB..)

I think with inpatient medicine the people who you work with can really make or break the rotation.
What do you do with the other hours lol? Notes?

 

[ciestar]

I think with inpatient medicine the people who you work with can really make or break the rotation.
What do you do with the other hours lol? Notes?

Notes all day long. Admissions, progress, discharges. The census turns over basically daily (babies lol).

It also depends on the day. Some days im super efficient and get stuff done early. Some days, i have to juggle sick babies and other stuff. Like having to do a NICU transfer and attend deliveries.

 

[MerYangBey]

Notes all day long. Admissions, progress, discharges. The census turns over basically daily (babies lol).

It also depends on the day. Some days im super efficient and get stuff done early. Some days, i have to juggle sick babies and other stuff. Like having to do a NICU transfer and attend deliveries.

Oh I see.So glad I don’t have to deal with babies lol. But hopefully they don’t have too much of a medical hx. The med recs on discharge are kinda ridiculous sometimes. People gotta stop putting older people on so many meds.I have the urge to discontinue so much.

 

[ciestar]

Oh I see.So glad I don’t have to deal with babies lol. But hopefully they don’t have too much of a medical hx. The med recs on discharge are kinda ridiculous sometimes. People gotta stop putting older people on so many meds.I have the urge to discontinue so much.

Majority of the time they’re perfectly healthy and theyre in an out. I love babies honestly. Im doing well on this rotation and i get to hold babies whenever i want lol

 

[Oedipa Maas]

Oh I see.So glad I don’t have to deal with babies lol. But hopefully they don’t have too much of a medical hx. The med recs on discharge are kinda ridiculous sometimes. People gotta stop putting older people on so many meds.I have the urge to discontinue so much.

Still in psych emergency services. The polypharmacy that comes through is UNREAL. I get so upset for these patients. Obviously depression is awful but ECT is also an option instead of trying to hit every possible receptor.

 

[MerYangBey]

Still in psych emergency services. The polypharmacy that comes through is UNREAL. I get so upset for these patients. Obviously depression is awful but ECT is also an option instead of trying to hit every possible receptor.

Also a lot of (older) patients have no idea what they’re actually taking. So I can’t imagine what it’s like when they’re at home with 25 prescriptions. With half of them being anticholinergic.

 

[Matthew9Thirtyfive]

Still in psych emergency services. The polypharmacy that comes through is UNREAL. I get so upset for these patients. Obviously depression is awful but ECT is also an option instead of trying to hit every possible receptor.

I think ECT has a bad rep. A lot of people think of One Flew Over the ****oos Nest when they think of ECT and want no part of that.