how do you guys deal with intern year especially Medicine Floors?

[RussianJoo]

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I am sure I am not the only one but I really hate the fact that we have to do an intern year outside of anesthesia. I am not just complaining because I'm struggling in fact I am one of the first interns out of the floor teams to get my work done, sign out and leave. But I just hate all this BS.

My program isn't so bad we only do 3 months of floors but it's getting harder everyday to come in to work, and I am constantly pissed off while at work. I have no clue how IM residents deal with this crap. Just recently had a pt come back to the ED whom we d/ced 1 week ago for CHF exacerbation, comes in now with SOB, edema and crackles again. I asked her if she took the meds she was prescribed on discharge, the answer "I was going to fill the scripts today, but I got short of breath while watching tv so i decided to come the ED". I just don't understand why we have to take care of these pts, it's pretty clear that they don't give a crap because they don't listen to what you tell them and now I have to waste another hour to admit her. Why can't we just say no, I am not going to treat you again, if you don't care about your health I definitely don't.

Or the fact that medicine can't refuse admissions from the ED, a few months ago I admitted a lady who's CC was I am bleeding from the incision site on my thigh where I had a Fem-Pop bypass w/ graft put in a week ago. The ED attending tells me that she tried paging Vascular but they didn't answer the page, she called the pt's PCP who happens to be on staff and he said admit to medicine and consult vascular surgery in the morning. So what I get screwed because I actually answer my pager? This was at 3am. WTF am I going to do about this as an "IM" resident, vascular rounds at like 5am she couldn't hang out in the ED for 2 more hours?


And the rounding OMG, we round for like 30-45min per pt. But these are all "great learning" opportunities. If I wanted to learn about this I'd read a book. I really don't care about most of these pts, and wish they would just get the f out of the hospital one way or another, but of course the attendings love this stuff and get pissed when I ask them if I can d/c a pt home today.

This is really bothering me so how do you guys deal with it? do you go home and get drunk everyday? are you really that compassionate and feel that every pt really means well and is good inside? Do you just have such low self esteem that you don't mind being dumped on?

Am I a bad person because I don't give a crap about my patients? I do the right things, I treat them, I go see them when the nurses ask me to, I don't endanger my pt's lives, I am observant and do everything by the book, but at the end of the day I really don't care about them.

I picked anesthesia because the pharmacology, procedures and physiology interest me, not because I want to help patients.


thanks for reading my rant any advice or words of wisdom are appreciated.

 

[lazylikeapanda]

on the bright side, your half way through intern year. You know how to treat chf exacerbation and all the bread and butter medicine problems. Once you're done with medicine floor months, you're done with it for the rest of your life. Intern year sucks so that when you start as a CA-1 you'll be more appreciative of life. As far as how to deal w/ medicine...i vented w/ my anesthesia interns and learned to stop giving a carp.

 

[proman]

1) They can always hurt you more, but they can't stop the clock.

2) Learn IM (cards, pulm and renal) as best you can this year. It will be invaluable in your future as an anesthesiologist.

 

[WholeLottaGame7]

I am sure I am not the only one but I really hate the fact that we have to do an intern year outside of anesthesia. I am not just complaining because I'm struggling in fact I am one of the first interns out of the floor teams to get my work done, sign out and leave. But I just hate all this BS.

My program isn't so bad we only do 3 months of floors but it's getting harder everyday to come in to work, and I am constantly pissed off while at work. I have no clue how IM residents deal with this crap. Just recently had a pt come back to the ED whom we d/ced 1 week ago for CHF exacerbation, comes in now with SOB, edema and crackles again. I asked her if she took the meds she was prescribed on discharge, the answer "I was going to fill the scripts today, but I got short of breath while watching tv so i decided to come the ED". I just don't understand why we have to take care of these pts, it's pretty clear that they don't give a crap because they don't listen to what you tell them and now I have to waste another hour to admit her. Why can't we just say no, I am not going to treat you again, if you don't care about your health I definitely don't.

Or the fact that medicine can't refuse admissions from the ED, a few months ago I admitted a lady who's CC was I am bleeding from the incision site on my thigh where I had a Fem-Pop bypass w/ graft put in a week ago. The ED attending tells me that she tried paging Vascular but they didn't answer the page, she called the pt's PCP who happens to be on staff and he said admit to medicine and consult vascular surgery in the morning. So what I get screwed because I actually answer my pager? This was at 3am. WTF am I going to do about this as an "IM" resident, vascular rounds at like 5am she couldn't hang out in the ED for 2 more hours?


And the rounding OMG, we round for like 30-45min per pt. But these are all "great learning" opportunities. If I wanted to learn about this I'd read a book. I really don't care about most of these pts, and wish they would just get the f out of the hospital one way or another, but of course the attendings love this stuff and get pissed when I ask them if I can d/c a pt home today.

This is really bothering me so how do you guys deal with it? do you go home and get drunk everyday? are you really that compassionate and feel that every pt really means well and is good inside? Do you just have such low self esteem that you don't mind being dumped on?

Am I a bad person because I don't give a crap about my patients? I do the right things, I treat them, I go see them when the nurses ask me to, I don't endanger my pt's lives, I am observant and do everything by the book, but at the end of the day I really don't care about them.

I picked anesthesia because the pharmacology, procedures and physiology interest me, not because I want to help patients.


thanks for reading my rant any advice or words of wisdom are appreciated.

I feel you, my intern brother. Secretly I think it's to ensure that we are appreciative and motivated when CA-1 rolls around.

We chose anesthesia for a reason, and I'm sure the fact that we get to control pharmacology and physiology instead of being reliant on patient compliance is a significant part of it for most people. Mad props to those physicians who are great motivators, but I certainly didn't go into medicine to be someone's life coach, which is what 95% of patients really need.

As far as crap admissions go, it's just easiest to remember that that post-op fem-pop patient's H&P will probably be the easiest one you have to write all month. I just try to learn one at least one thing from each patient; oftentimes it is something not disease-related, such as how to better communicate with faculty/staff/patients, something technical regarding equipment, or techniques for coping with frustration, such as going to my "happy place," otherwise known as July 2011.

 

[fakin' the funk]

FWIW, there's not a single day of CA-1 that I don't use in the OR something I learned during internship.

As said above, they can't stop the clock.

 

[RussianJoo]

I feel you, my intern brother. Secretly I think it's to ensure that we are appreciative and motivated when CA-1 rolls around.

We chose anesthesia for a reason, and I'm sure the fact that we get to control pharmacology and physiology instead of being reliant on patient compliance is a significant part of it for most people. Mad props to those physicians who are great motivators, but I certainly didn't go into medicine to be someone's life coach, which is what 95% of patients really need.

As far as crap admissions go, it's just easiest to remember that that post-op fem-pop patient's H&P will probably be the easiest one you have to write all month. I just try to learn one at least one thing from each patient; oftentimes it is something not disease-related, such as how to better communicate with faculty/staff/patients, something technical regarding equipment, or techniques for coping with frustration, such as going to my "happy place," otherwise known as July 2011.

well the lady was in her 80s with a laundry list full of medical problems, and of course as a medicine resident I have to address all her issues in my plan so the H&P took a while just because it was long, not because I didn't know what to put down. her only complaint was the bleeding...


I was just waiting for some surgery intern doing vascular this month to tell me that this was not "a surgical complication" like they often do about all the other post op admission pts.. I would have punched him right in the face...

 

[OB1🤙]

1) Go to your online book seller of choice.
2) Buy "The House of God" by Samuel Shem.
3) Learn its laws.

July is right around the corner. Keep your head up.

 

[GasEmDee]

1) They can always hurt you more, but they can't stop the clock.

2) Learn IM (cards, pulm and renal) as best you can this year. It will be invaluable in your future as an anesthesiologist.

Agree.

I feel your pain, RussianJoo, and your post dredged up painful memories of my internship. In retrospect, I learned a lot in that year about how to be a PHYSICIAN. It contributed a lot to making me an anesthesiologist, as opposed to just someone who anesthetizes. Remember, this year is one of the main things that genuinely differentiates you from a CRNA.

Hang in there, brother, you are halfway there!

 

[NotAMD]

your going to continue to get dumped on to some extent for the next 3.5 years
the realities of working in healthcare and the patients like u describe are sad and you are starting to realize this at this point in your training
the healthcare system is messed up on many levels wait until you get to the OR

you have to not be so vested in it..dont fight with nurses, dont disagree with attendings, just do whatever makes everybody happy unless it will kill the pt

your plan for the patient is whatever is easiest, they want to keep him, agree, keep him, they want a CT sounds good, oh yes that is an interesting article, give your recs but dont be upset when they have different ideas, who cares just do it and get them out and get home

 

[CrazyJake]

RussianJoo - Everything you've said is true and everything you're feeling couldn't be more accurate. Most of the IM patients that you'll encounter, you can't make a difference. When given the opportunity with a pt who cares, take advantage of it..but for the rest, get your crap done and move on. I like that you're not lowering your standards, play by the rules, acceptable notes, see pt's when nurses ask, etc. Despite what other specialties think, Anesthesia has some integrity in that we continually do whats right for the pt. Start implementing this standard during internship.

I approached everyday of internship as a chance to learn something toward my career in Anesthesia. I also constantly reminded myself that this was only a year and that it would be the last time I'd be doing this crap. I'd smile, laugh, happily take the next pt in the ER b/c it WILL end for you in June...for the medicine resident, they're not so lucky. That ER resident that paged you, it will only get worst for them with ER pts in the future.

CJ

 

[WholeLottaGame7]

well the lady was in her 80s with a laundry list full of medical problems, and of course as a medicine resident I have to address all her issues in my plan so the H&P took a while just because it was long, not because I didn't know what to put down. her only complaint was the bleeding...


I was just waiting for some surgery intern doing vascular this month to tell me that this was not "a surgical complication" like they often do about all the other post op admission pts.. I would have punched him right in the face...

As an aside, as an anesthesia intern I've found that my medicine notes are too short and my surgery notes are too long.

Another thing I try to remember is that the relationships we build now off-service will carry throughout residency. Even if it's only a month or two, I think it helps to "be in the trenches" with other residents, so to speak. This way we won't be just a face on the other side of the curtain, we'll be someone we can share stories about ridiculous patients/attendings/admissions/etc. A little more pertinent on the surgery side of things, but still.

 

[darkmansaad]

Avoiding social issues and medicine rounds is the reason I am in surgery. I actually enjoy going to work everyday 🙂

But cannot WAIT for July 1

 

[lfesiam]

hey bud,

hang in there, it is January, the notorious downer month of intern year,

- know that there is an end point, there is a light at the end.

when you start your CA-1 year, you will LOVE ANESTHESIA!!!! i wake up everyday this year wanting to go to work. (being able to surf at the end the day is awesome 🙂

learn as much medicine as you can now, cards/pulm/ICU are very useful.

as for patient care, try your best to find compassion & empathy (it is hard at 3am with non-compliant patients...)

most importantly, ....do no harm.

during hard times, i find that keeping a positive outlook + a hobby greatly help...

i know you probably don't have time to do anything else, + being tired 24/7....

a mandatory 15 minutes minimum of reading a fun book/ playing video games/ planing a get away vacation/ meditate/ working out/ per day do wonders in lifting the spirit....

 

[gman33]

when you start your CA-1 year, you will LOVE ANESTHESIA!!!! i wake up everyday this year wanting to go to work. (being able to surf at the end the day is awesome 🙂

Surfing every day.
Damn, I'm stuck in the NE with crappy weather.
I wish I could be out catching a few waves right now.

 

[Tukataa]

the two rules of internship are below:
1) it is always a privilege to take care of patients
2) assume no one else in the hospital is doing their job

this will get you through a career in medicine.

 

[Mman]

Looking back at my time as an intern, I am sure that I had many of these same feelings at one point or another. But as painful as it is, it's useful. I learned more about how to be a doctor in 1 year as an intern than I did in 4 years of medical school. I learned about responsibility for a patient and what that means.

I think it's also about understanding. Understanding what the patient you will be caring for in the OR will go through postoperatively. Understanding what your sugical colleagues are dealing with on their floor patients. Understanding how to effectively manage the many medical issues that sick patients have.

You will be a far better anesthesiologist having gone through a solid internship than if you didn't.

Yes, it sucks. Yes, it often seems pointless. Yes, it's something you already decided not to do with your life.

But it's already January and July will be here before you know it.

 

[Mman]

the two rules of internship are below:
1) it is always a privilege to take care of patients
2) assume no one else in the hospital is doing their job

this will get you through a career in medicine.

nevermind...I'm guessing you haven't updated your profile in a while since your last post was 3 years ago as a 4th year med student

 

[RussianJoo]

thanks for the support everyone.

 

[RussianJoo]

the two rules of internship are below:
1) it is always a privilege to take care of patients
2) assume no one else in the hospital is doing their job

this will get you through a career in medicine.

did your med school prof tell you this? taking care of a patient is not a privilege it's a punishment....

 

[Jeep23Guy]

As an aside, as an anesthesia intern I've found that my medicine notes are too short and my surgery notes are too long.

Another thing I try to remember is that the relationships we build now off-service will carry throughout residency. Even if it's only a month or two, I think it helps to "be in the trenches" with other residents, so to speak. This way we won't be just a face on the other side of the curtain, we'll be someone we can share stories about ridiculous patients/attendings/admissions/etc. A little more pertinent on the surgery side of things, but still.

I completely agree with all of this.

Luckily, I only had to do one month of medicine wards. I hated it. You can ask my wife...I was more cranky that month than any other.

Although...this month may be worse. On CT surgery, (as an intern) I'm the only one in the hospital taking care of their ICU. Scary...

 

[RussianJoo]

I completely agree with all of this.

Luckily, I only had to do one month of medicine wards. I hated it. You can ask my wife...I was more cranky that month than any other.

Although...this month may be worse. On CT surgery, (as an intern) I'm the only one in the hospital taking care of their ICU. Scary...

wow really? you're the only resident overnight in the CT ICU and you're an intern? That's super scary and super dangerous for the pts. at my hospital interns are never on call by themselves especially not in the ICU, in fact in the SICU or CT ICU only seniors take call.

 

[Impromptu]

You are miserable at work? I was fine at work, but miserable at home (during medicine floors), because I knew I would have to go back the next day. Driving home from work I daydreamed all the time about missing my exit and heading south to Mexico.

Our intern year is one of the best selling points to all the residents that interview at my institution. 1 month of medicine floors! 1 MICU, 2 Anesthesia ICU (fantastic for interns). 1 NICU. 1 cardiology consults. 2 ER. 1 trauma. 1 ENT. 1 ambulatory medicine at the VA. And we end with anesthesiology. It is now even better for interns, because all the services (except MICU, but you are on with a senior) have converted to a night float system.

The CA-1 year is great because I am doing what I love and what I'll actually be doing for the rest of my life. However, the feelings of burnout can continue all throughout residency, depending on the hours worked that week and a host of other factors. Our journal club article for tomorrow is the burnout article in this month's anesthesiology.

What keeps me going in the dark times are knowledge of my student loans (not a positive motivating factor, but effective nonetheless), as well as knowledge that someday I can choose the type of practice I want to work in, whether I want to burn myself out or not, and if I do choose to do the more time intensive career that I will be paid handsomely for each hour, whereas now I get paid the same no matter how much or little is heaped on my plate).

Find another resident to gripe with, but don't ever get caught up in a pity party. You can do it.

 

[WholeLottaGame7]

wow really? you're the only resident overnight in the CT ICU and you're an intern? That's super scary and super dangerous for the pts. at my hospital interns are never on call by themselves especially not in the ICU, in fact in the SICU or CT ICU only seniors take call.

We also have intern-only in-house. We do 4-6 weeks at a VA SICU, and there's no attending/upper-level in-house overnight. Granted, there's a mix of acuity (there are some old rules about post-op OSA pts staying overnight), but there's also a fair share of CABGs, big ENT cases, big GI (esophago, Whipple, etc).

Kinda scary, but the fellows/attendings are also fantastic and are more than happy to come in if the stuff starts hitting the fan.

 

[nycitygas]

When I was a PGY-1, I did a CTICU month where as the intern I was the only person in house...in an ICU filled with post-op CABGs, redos, ect.....
To say the least, it definitely put some hair on my chest. The nurses were fabulous tho, the best I've ever seen.
Even tho it was Q3, best month of intern year.

 

[Gardner]

Although...this month may be worse. On CT surgery, (as an intern) I'm the only one in the hospital taking care of their ICU. Scary...

I too am on CT Surgery (as an intern) and take solo call for our SICU and floor patients alike. That being said, most attendings would prefer I give them a ring at 2am if a patient is really getting sick.

I guess the difference with my situation is that I'm not the only one in the hospital taking care of their ICU. Here, each surgical team with the exception of trauma takes care of their own ICU patients. Still, I was pretty damn nervous that first night taking call.

 

[pgg]

wow really? you're the only resident overnight in the CT ICU and you're an intern? That's super scary and super dangerous for the pts. at my hospital interns are never on call by themselves especially not in the ICU, in fact in the SICU or CT ICU only seniors take call.

Yeah, where I did my CTSICU time it was a PGY3 or PGY4 job. The interns rounded with us but were only responsible for the floor CT patients.

Always full, very high acuity. I felt overwhelmed more than once as a CA3. Back up was the CT surgery fellow (at home). I can't imagine inflicting that place on an intern.

 

[nycitygas]

All I had was an attendings cell number and pager hah. The attendings however, were very receptive to phone calls, would rather u call about the slightest thing then not at all (thankfully).

 

[RussianJoo]

I too am on CT Surgery (as an intern) and take solo call for our SICU and floor patients alike. That being said, most attendings would prefer I give them a ring at 2am if a patient is really getting sick.

I guess the difference with my situation is that I'm not the only one in the hospital taking care of their ICU. Here, each surgical team with the exception of trauma takes care of their own ICU patients. Still, I was pretty damn nervous that first night taking call.

So you guys are unsupervised for lines and procedures that come up in the middle of the night? even if you're not certified? what about in July I am sure there were interns on that service, they did overnight solo call weeks out of med school?? that's not only sounds scary but also reckless.

 

[RussianJoo]

When I was a PGY-1, I did a CTICU month where as the intern I was the only person in house...in an ICU filled with post-op CABGs, redos, ect.....
To say the least, it definitely put some hair on my chest. The nurses were fabulous tho, the best I've ever seen.
Even tho it was Q3, best month of intern year.

Were you certified in CT tubes, and line placement already? what if a pt was crashing and needed something? you'd call the MICU fellow for help? I am sure attendings don't live across the street from the hospital.

 

[nycitygas]

In my month, when a arterial line/central line came up, I would have the general surgery consult resident come supervise me. That was their sole involvement in the unit as the ct surgeons wanted us to call them directly with questions and not "load the boat".

 

[nycitygas]

Chest tubes--> gen surg consult pgy-2 on call.

 

[RussianJoo]

In my month, when a arterial line/central line came up, I would have the general surgery consult resident come supervise me. That was their sole involvement in the unit as the ct surgeons wanted us to call them directly with questions and not "load the boat".

yeah so there was someone in house you could call for help if needed, you were only "alone" because you'd be the first person the nurses would page, but there were seniors in house with instructions to help you when you asked for it, that's not really being alone and makes more sense... you guys make it sound like you were the only doctor in the hospital.

 

[buckeye12]

did your med school prof tell you this? taking care of a patient is not a privilege it's a punishment....

Looks like this guy gets it!

If doing your job is a punishment, here's to hoping you get the boot.

 

[RussianJoo]

Looks like this guy gets it!

If doing your job is a punishment, here's to hoping you get the boot.

wait till you start taking care of some pts and the only thing keeping them hospital for a week extra are social issues, young one. I'd rather do MAC for colonoscopies all day than do IM floors.

 

[lord_jeebus]

wait till you start taking care of some pts and the only thing keeping them hospital for a week extra are social issues, young one. I'd rather do MAC for colonoscopies all day than do IM floors.

The trick is to accumulate so many of these rocks that they you can't admit any more patients.

 

[pgg]

The trick is to accumulate so many of these rocks that they you can't admit any more patients.

... and then transfer off service before any actually leave, so you don't have to do the discharge summary for a 20 week admission.

 

[Depakote]

The trick is to accumulate so many of these rocks that they you can't admit any more patients.

... and then transfer off service before any actually leave, so you don't have to do the discharge summary for a 20 week admission.

I feel like I learned something very valuable right here.

 

[WholeLottaGame7]

... and then transfer off service before any actually leave, so you don't have to do the discharge summary for a 20 week admission.

QFT.

Rocks are definitely your friend, unless they fall on you.

 

[WholeLottaGame7]

yeah so there was someone in house you could call for help if needed, you were only "alone" because you'd be the first person the nurses would page, but there were seniors in house with instructions to help you when you asked for it, that's not really being alone and makes more sense... you guys make it sound like you were the only doctor in the hospital.

How many hospitals anywhere have only one doctor in the hospital? I maybe contacted the CCU or MICU resident once during my 6 weeks; I was much more likely to page the home resident/fellow if anything was going down. Definitely if someone needed a chest tube or central line I would page someone. Surgery resident or CT fellow would come in for a chest tube, anesthesia fellow would come in to supervise me doing a central line, a-lines I would do on my own. I actually ended up doing fewer central lines that 6 weeks than I expected since most people came from the OR lined up.

Nursing experience was also clutch. Invaluable resource.

 

[Groove]

Russ, just hang in there. You can make the experience miserable or simply bearable depending on your attitude. Intern year sucks for everyone, and medicine wards sucked big time. You should become very confident in pt management and have attained some considerable procedural competency by the end of your year, especially if you have plenty of ICU rotations. After that, you'll be in your home department. Internship for me as an EM resident was very much "in limbo" where I had little contact with my own department and was always the "non IM" guy during medicine, ICU, cards, etc.. months. It's over before you know it and amazing at how much confidence and competency 1 year can give you.

It's not wrong to feel frustrated with patients and their non-compliance or utter stupidity sometimes. It just goes to show that you prob picked the right specialty where you have brief patient contact and no continuity. That's one thing I also enjoy about EM. Medicine often times gets dumped on by virtually every specialty and it can get frustrating when you're on call and admitting patients, especially from the ED. Instead of fighting the admission, my attitude was always to just admit whatever patients I could so that I could cap soonest, but most of the time it's just as energy expensive to fight the admission versus just admitting. The unfortunate aspect is that medicine sometimes gets used as a consulting hub for the other specialties who don't want the pt on their service. Also, expect some soft admissions, it's just the nature of things. Also remember to look at things from a different perspective. I often times will get push back or stall tactics from medicine who won't want to admit the pt in the ED, after all, residents tend to see admissions as just more work, but the ED is not the place to leave patients for hours on end. ED residents have tremendous pressure to turn over the rooms to make room for all the other pt's who have been sitting out in the waiting room for 6 hours. It's often a nightmare when we have stemi's, strokes, mvc's all rolling in at the same time but nowhere to put them so we always appreciate medicine getting the pt admitted and out of the ED as soon as possible because it let's us see the next patient who might be 10x more sick than the one you just admitted.

Just be glad you're sheltered in the icu as much as you are. My first day/night as an intern, I was responsible for 20 NSICU patients and the only resident in the ICU on call. Luckily, a very experienced NP had taught me how to do a subclavian central line earlier that day. Experienced nurses are invaluable, always try to be humble and learn from them as best you can, they will often times get you through some hairy situations in the middle of the night as an intern. Always remember that there is backup SOMEWHERE in the hospital if the **** hits the fan. I can remember being on call in the SICU one night, again, only resident in the ICU as an intern and respiratory dislodged the ET tube on a beast of a guy who had been on very high PEEP all week. Sats plumetting, I'm trying to intubate, he wasn't paralyzed and puking all over the place, I'm yelling for them to page anesthesia chief or surgery chief and nobody is showing up. I yell for a 10 blade and am poised ready to do a cric and shove the ET tube in that way, imagining getting fired from residency if it failed and this guy died, when luckily both chiefs show up at the last minute and after the gas chief fails to intubate, the surgery chief does the cric. Another time I was only intern on call for CCU and ended up transferring a floor pt found in cardiorespiratory distress into the ICU and had to do the tube, central line, a-line, pressors, etc., all by myself, no time to call for backup. It's those pucker moments as an intern that really give you confidence. Again, don't be afraid to ask the nurses what to do. I'm pretty confident running codes at this point but my first code I know i probably was just standing there as an intern with a blank look on my face.

I hate rounding too, so I feel you on that point. Just remember that July is right around the corner and you'll never have to do medicine rounds again.

I am sure I am not the only one but I really hate the fact that we have to do an intern year outside of anesthesia. I am not just complaining because I'm struggling in fact I am one of the first interns out of the floor teams to get my work done, sign out and leave. But I just hate all this BS.

My program isn't so bad we only do 3 months of floors but it's getting harder everyday to come in to work, and I am constantly pissed off while at work. I have no clue how IM residents deal with this crap. Just recently had a pt come back to the ED whom we d/ced 1 week ago for CHF exacerbation, comes in now with SOB, edema and crackles again. I asked her if she took the meds she was prescribed on discharge, the answer "I was going to fill the scripts today, but I got short of breath while watching tv so i decided to come the ED". I just don't understand why we have to take care of these pts, it's pretty clear that they don't give a crap because they don't listen to what you tell them and now I have to waste another hour to admit her. Why can't we just say no, I am not going to treat you again, if you don't care about your health I definitely don't.

Or the fact that medicine can't refuse admissions from the ED, a few months ago I admitted a lady who's CC was I am bleeding from the incision site on my thigh where I had a Fem-Pop bypass w/ graft put in a week ago. The ED attending tells me that she tried paging Vascular but they didn't answer the page, she called the pt's PCP who happens to be on staff and he said admit to medicine and consult vascular surgery in the morning. So what I get screwed because I actually answer my pager? This was at 3am. WTF am I going to do about this as an "IM" resident, vascular rounds at like 5am she couldn't hang out in the ED for 2 more hours?


And the rounding OMG, we round for like 30-45min per pt. But these are all "great learning" opportunities. If I wanted to learn about this I'd read a book. I really don't care about most of these pts, and wish they would just get the f out of the hospital one way or another, but of course the attendings love this stuff and get pissed when I ask them if I can d/c a pt home today.

This is really bothering me so how do you guys deal with it? do you go home and get drunk everyday? are you really that compassionate and feel that every pt really means well and is good inside? Do you just have such low self esteem that you don't mind being dumped on?

Am I a bad person because I don't give a crap about my patients? I do the right things, I treat them, I go see them when the nurses ask me to, I don't endanger my pt's lives, I am observant and do everything by the book, but at the end of the day I really don't care about them.

I picked anesthesia because the pharmacology, procedures and physiology interest me, not because I want to help patients.


thanks for reading my rant any advice or words of wisdom are appreciated.

 

[Frank Rizzo]

Russian...

Everyone feels this way... Wasn't that long ago for me:

http://forums.studentdoctor.net/showthread.php?t=218524

 

[cfdavid]

hey bud,

hang in there, it is January, the notorious downer month of intern year,

- know that there is an end point, there is a light at the end.

when you start your CA-1 year, you will LOVE ANESTHESIA!!!! i wake up everyday this year wanting to go to work. (being able to surf at the end the day is awesome 🙂

learn as much medicine as you can now, cards/pulm/ICU are very useful.

as for patient care, try your best to find compassion & empathy (it is hard at 3am with non-compliant patients...)

most importantly, ....do no harm.

during hard times, i find that keeping a positive outlook + a hobby greatly help...

i know you probably don't have time to do anything else, + being tired 24/7....

a mandatory 15 minutes minimum of reading a fun book/ playing video games/ planing a get away vacation/ meditate/ working out/ per day do wonders in lifting the spirit....

Great posts people. I find myself also facing some intern year blues....

I can't complain as our base year is very reasonable in terms of hours and call, but it IS a challenge at times. Let's face it, we went into anesthesiology for specific reasons.

I just keep reminding myself that all of these rotations (like others have attested) WILL be relavent to future practice in anesthesiology.

For us, we start anes in June, so I'm counting down the months. Keep the faith fellow interns!

 

[Ronin2258]

I had medicine rotations in medical school that made me swear off of them for internship options. I had no problem taking care of patients. It was the endless rounding, the lectures that were copied and pasted from a book onto the powerpoint slides in font so small that you can't read them. I was more on your line in doing what I could to get the patient well enough to get out of the hospital.

Now, I know I had to self study pulm and cards (though we had 1:1 sessions with EKG reads in our ED rotation.) Got a good dose of medicine and surgical ICU.

Do you have to work clinic in your intern year? That is what gets me. I am doing locums house calls/prime care where I see the patients noncompliant, despite my best song and dance to convince them otherwise. Glad to see the ones that are compliant, but seeing people just waste away because they have pills on their table that they aren't using is gut-wrenching.

It definitely makes me look forward to July.