ever feel this way?

[nightowl]

I read a blog online, and found this post written by a pediatric resident who switched to anesthesiology.

"When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax."

My husband is planning on going into surgery partly because he feels this way too, endless paperwork and rounding, and not actually "doing" much. Just wondering everyone's thoughts on this...

---

Members don't see this ad.

 

[ZekeMD]

I read a blog online, and found this post written by a pediatric resident who switched to anesthesiology.

"When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax."

My husband is planning on going into surgery partly because he feels this way too, endless paperwork and rounding, and not actually "doing" much. Just wondering everyone's thoughts on this...

That's residency for you. But the comforting thing is that some day, you will be the attending.

 

[nightowl]

now that is a very good point.

 

[TexasRose]

I read a blog online, and found this post written by a pediatric resident who switched to anesthesiology.

"When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax."

My husband is planning on going into surgery partly because he feels this way too, endless paperwork and rounding, and not actually "doing" much. Just wondering everyone's thoughts on this...

Sounds like a crummy service to me. Certainly I've seen residents who felt that way and seen attendings treat residents that way, but not as a rule.

 

[DarthNeurology]

I read a blog online, and found this post written by a pediatric resident who switched to anesthesiology.

"When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax."

My husband is planning on going into surgery partly because he feels this way too, endless paperwork and rounding, and not actually "doing" much. Just wondering everyone's thoughts on this...

If you are entering something electronically then someone in the future can be able to easily read it. If a pediatric patient was hospitalized then you can bet that the primary care doc might like a copy of the discharge summary when they are seen in clinic after discharge, i.e. what to follow up. An enormous amount of clinical assessment and treatment occurs during any inpatient admission and they are all different, i.e. a child with meningitis, etc . . . As a resident you come up with your own plan, see what the attending does differently and you learn and identify weak spots. If this resident is *already* as competent as a pediatric attending then they should shorten the pediatric residency for him/her (sarcasm), as a resident it is your job to learn and take care of patients, obviously you are not a pediatric oncologist so you must have their input i.e. orders, and you use your brain to figure out what you don't know. It is EXACTLY for this type of resident that pimping was invented you sit down him/her and you pimp the hell out of them and they realize they don't know anything and they go study/ask good questions about their patients. EVERYTHING is facinating about pediatric inpatient care, IMHO, i.e. if this resident is bored then something is wrong, if they don't feel in control, well, they are a resident and shouldn't be power hungry. I don't know how someone can be bored on these electives as the resident is even more involved than students and I am not bored ever on rotations (unless waiting for lecutre to start), this resident just doesn't like being subservient to someone, but you always are, just focus on the patient I would say and don't think that your attending is 'using' you, after all you applied for the residency and are being paid to do work in addition to learning which students don't get.

 

[nightowl]

excellent points and I wholeheartedly agree. It could be painfully boring if you weren't interested in the subject matter, and in that case, it's probably best to switch.

 

[1998]

To be a doctor, most time, we deliver service to patients, not always about knowledge and technique.

 

[Freibi]

That's residency for you. But the comforting thing is that some day, you will be the attending.

Exactly, and that awfully soon (in a mere 3 years), unlike somebody who chooses surgery
Just imagine you were the attending: what would you do (think about that BEFORE you get the answer from your attending, and if you had something different in mind, then ask him/her your questions, that's a good way to learn!)?

 

[andyh]

I read a blog online, and found this post written by a pediatric resident who switched to anesthesiology.

"When I was a Peds resident on call for Oncology, or the NICU, or on the wards, so often I'd just feel like the human equivalent of a USB cable--just a conduit between the attending's mouth and the computer order system. I'd get in early, and then we'd round for eight hours, during which I'd write down everything that the attending was saying. Then I'd park myself in front of the computer for the next two hours, endlessly checking five million lab results and entering orders into the system. After that, I would rush around and poke my patients with sticks, trying to make sure they were all still alive so that I could park myself in front of the computer for another two hours to write a pile of worthless progress notes that no one would ever read. And inevitably, later in the evening, the attending would find me again and give me a whole list of new orders to enter, or change from the first time I entered them earlier in the morning. With the exception of examining the patients, I hardly felt like what I was doing was medical at all. I mean, accountability aside, anyone could enter orders into the computer. Anyone could copy down lab results. Anyone could sit on the phone for hours waiting for pharmacy to confirm that they received my fax."

My husband is planning on going into surgery partly because he feels this way too, endless paperwork and rounding, and not actually "doing" much. Just wondering everyone's thoughts on this...

Sounds like a tough situation to be in. While I won't start until June, here are my thoughts. I think there will be days which feel like the above. But I'm hoping that it is more like
Preround
1) Plan from me
2) Edited by senior residents if need be
Rounding
3) Response from attending / sr residents
4) Discussion with families about the plan
5) Revised plan into computer (hopefully with the help of my fellow interns we can do this on the fly)
6) See patients and update signout/progress notes

It would be nice if all my plans could skip from 1 to 4 but especially in areas like peds h/onc or the NICU/PICU, there are a lot of nuances to the same disease. Even on the general wards, I think many of us have seen a fair number of asthma or gastroenteritis pts but with high complexity pts or patients with specific histories etc..., treatment plans may be pretty different.

Was this post earlier on in the resident's experience? Perhaps for the first part of internship, this is what we will feel like. As we start to get a handle on various things, perhaps we'll feel more like the provider with support from the senior residents and faculty.

 

[Stitch]

Sounds like a tough situation to be in. While I won't start until June, here are my thoughts. I think there will be days which feel like the above. But I'm hoping that it is more like
Preround
1) Plan from me
2) Edited by senior residents if need be
Rounding
3) Response from attending / sr residents
4) Discussion with families about the plan
5) Revised plan into computer (hopefully with the help of my fellow interns we can do this on the fly)
6) See patients and update signout/progress notes

It would be nice if all my plans could skip from 1 to 4 but especially in areas like peds h/onc or the NICU/PICU, there are a lot of nuances to the same disease. Even on the general wards, I think many of us have seen a fair number of asthma or gastroenteritis pts but with high complexity pts or patients with specific histories etc..., treatment plans may be pretty different.

Was this post earlier on in the resident's experience? Perhaps for the first part of internship, this is what we will feel like. As we start to get a handle on various things, perhaps we'll feel more like the provider with support from the senior residents and faculty.

This is roughly how we work things. I expect my interns to have a plan, and to discuss it at rounds with both me and the attending. Of course the attending always gets last say, but I would always ask myself if I'd do the same thing. Eventually you do realize that there may be more than one way to do something. At present, I'm finally figuring out how I would handle things and I'm fairly confident discussing and my ideas/plan with the attending or intern. In fact I currently have an awesome intern who's just really smart and he's always offering useful thoughts, even if we don't go with them.

 

[J-Rad]

bump