Incoming Interns: What are you worried about?

[jonquille]

I wanted to ask people who are going to be starting their internship this July what they are apprehensive about - giving bad news, code status discussions, etc, whatever. I'm trying to get a broad sense of what people are thinking of when starting internship because we're trying to put together a "curriculum" of sorts for incoming interns - I have my personal experience from this past year and the experiences of my friends, but believe it or not, your perspective changes so much between July and the end of internship, it's hard to remember clearly what your fears/concerns were as you were starting doctoring!

Thanks for your thoughts...

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[georgia9999]

Fear of being ******ed. Many of us haven't had real "medicine" months in over 6 months. Scares the poo out of me.

 

[Medical123]

Though I feel as if I have a fairly strong knowledge base, I fear making a mistake that harms a patient and not living up to the expectations of my program.

I had a nightmare where I was placing a central line and gave the patient a pneumothorax! Actually, that did happen to one of the residents on my Medicine AI last year and it scared the pee out of me!

 

[tibor75]

I had a nightmare where I was placing a central line and gave the patient a pneumothorax! Actually, that did happen to one of the residents on my Medicine AI last year and it scared the pee out of me!

If you do enough of them, this will happen.

I am long past internship and beginning of fellowship, and will be an attending come July, but the same thing has scared me at each step - being exposed as a fool out of my league. I always worry I will "mess up" and harm/kill a patient right off the bat. Frankly, I know that eventually I'll make a mistake and somebody will be harmed by it. But I'd rather make that mistake 6 months in so that people will say, "Well, he's not an idiot, he did well for 6 months, these things happen"

 

[Rocky2007]

I'm most worried about being in a situation where a patient is 'crashing' and needing to make quick decisions. Bipap, cpap, nonrebreather? - I have absolutely no idea. And then getting an unintelligible EKG...ugh. I think this is what scares me the most...when a patient is going 'downhill'...it would be good to have an algorithm to follow. It seems like most other things you can think through and talk it over w/ your senior. Oh yeah...I also have no idea how to put in lines IJs etc.

 

[tum]

my main concern is killing someone. as in, that is not the situation i would like to be in.

 

[2ndyear]

I'm most worried about being in a situation where a patient is 'crashing' and needing to make quick decisions. Bipap, cpap, nonrebreather? - I have absolutely no idea. And then getting an unintelligible EKG...ugh. I think this is what scares me the most...when a patient is going 'downhill'...it would be good to have an algorithm to follow. It seems like most other things you can think through and talk it over w/ your senior. Oh yeah...I also have no idea how to put in lines IJs etc.

You'll usually have access to an upper level in some form, so don't worry too much. One algorithim that has helped me is "call your resident, call the attending, call the family". Got that one from the ICU intern survival guide. As an anesthesia resident I go to lots of resp. distress calls. My advice is get an ABG early and act on it. No one will ever fault you for intubating someone at night that is going downhill, but nothing looks worse on morning rounds than the patient that sat on a NRB all night with a PCO2 of 60.

 

[carrigallen]

My recurring nightmare is:
Giving a medication for something routine while on-call at night, then:
Patient gets some disasterous side-effect (like a stroke, fatal arrthymia or status epilepticus),
and I get reamed out about it for months..

For example, "didn't you KNOW to check aed levels? didn't you see her ALLERGIES? didn't you know NEVER to give this medication in the presence of THIS? (insert random contraindication here). didn't you KNOW that a dig-loaded 90 yr old with an EF of 15% would code if you gave her "X" medication?

I guess this is why it is always smart to call the resident.

 

[Samir Desai]

I remember feeling the same way when I started internship. It is scary. I tell my new interns that they shouldn't feel like their alone. If you find yourself over your head, don't hesitate to contact your resident or attending.

As far as emergencies, I truly didn't feel comfortable until I finished my ICU rotation. Fortunately, for me, that was relatively early in the year. There was a world of difference between my comfort level pre-ICU and post-ICU.

As far as medication errors, you all know how common these are. I believe one of the keys is to be systematic. With every medication order you write, consider the following:

Is the patient allergic to this medication?
Does the patient have any contraindications to this medication?
Is the medication teratogenic?
Will this medication interact with any of the patient's other medications?
Does the does need to be adjsuted for renal dysfunction (including dialysis), liver dysfunction, weight, or age?
Have I spelled the medication correctly?
Have I avoided the use of abbreviations?
Is the dosage, route of administation, and dosing schedule correct?
Did I date and time the medication order?
Have I signed and printed my name along with my beeper number?
Is my handwriting legible?
Does it need to be administered as soon as possible? If so, have I conveyed this to the nurse?