epsilonprodigy

Physicist Enough
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Jun 17, 2009
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I'm a new intern at a very busy program where we rotate through FIVE different hospitals. This means a new EMR, new set of rules, new hospital geography every month. Compounding this with more patients than I've ever taken care of, sometimes in subspecialties I have zero experience in, I'm having huge issues keeping track of WTF is going on w/ my patients. It's fine if I admit them, but when I come on service and get sign out on someone who's been there awhile, we talk about the "active issues" while dormant ones get pushed to the back burner. Then 2 days later, I realize I have no clue why they're on antibiotics or whatever. Yeah, it's probably in the chart somewhere, but if I'm going to get minimum 4 hours of sleep a night, I have no time to look since I'm still figuring out how to work the computer, where the PACU is, etc. There are times when I'm about to walk into a patients room and have to stop to ask myself why they're even there, let alone what their crit was that day. It also doesn't help that I have terrible computer skills, so learning a new EMR is tricky for me.

I think what would help the most is a huge word document broken down by system on every patient, but again, the time. I'm not lazy, but I already end up staying until 9-10 on most nights and have to be back between 4:30 and 5. As many have said, sleep deprivation plays heavily into inefficiency and memory problems. On my current service, you get the succus kicked outta you if you glance at your paper during rounds, so I want to square this away before I switch to nights and have to actually present patients.


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Ladholyman

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The history and physical is your holy grail. Also ask your senior when you aren't sure of anything. Efficiency is everything.
 
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Psai

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God i hate when patients at like just look on the computer. You've been taking this med for 20 years and you don't know what it's called or what it's for? And you want me to do a chart review through your whole medical history filled with every subspecialty clinic, all with different emrs so I can refill it for you in the ed when I have 5 patients waiting to be seen with actual emergencies?

Same **** here bro. I don't know how my seniors keep track of everything
 
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ThoracicGuy

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I'm a new intern at a very busy program where we rotate through FIVE different hospitals. This means a new EMR, new set of rules, new hospital geography every month. Compounding this with more patients than I've ever taken care of, sometimes in subspecialties I have zero experience in, I'm having huge issues keeping track of WTF is going on w/ my patients. It's fine if I admit them, but when I come on service and get sign out on someone who's been there awhile, we talk about the "active issues" while dormant ones get pushed to the back burner. Then 2 days later, I realize I have no clue why they're on antibiotics or whatever. Yeah, it's probably in the chart somewhere, but if I'm going to get minimum 4 hours of sleep a night, I have no time to look since I'm still figuring out how to work the computer, where the PACU is, etc. There are times when I'm about to walk into a patients room and have to stop to ask myself why they're even there, let alone what their crit was that day. It also doesn't help that I have terrible computer skills, so learning a new EMR is tricky for me.

I think what would help the most is a huge word document broken down by system on every patient, but again, the time. I'm not lazy, but I already end up staying until 9-10 on most nights and have to be back between 4:30 and 5. As many have said, sleep deprivation plays heavily into inefficiency and memory problems. On my current service, you get the succus kicked outta you if you glance at your paper during rounds, so I want to square this away before I switch to nights and have to actually present patients.


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I did GS at a place that had multiple hospitals and three different computer systems in place. Yes, you have to learn a new hospital/system when you go there, but future rotations in the same place won't be so bad. You'll figure the new places out within a couple of weeks.

As for covering the subspecialities, I wouldn't expect you to know the details of them as an intern. If you have problems/questions about their patients, there will be a more senior team member you'll be able to call to get answers. That is expected as an intern.

We had documents for our patient lists that had basic details about their admission and active issues. It was up to the team to update the list for handoff to the oncall team. Then in the AM, it was up to the interns to make sure the list was current for rounds. I'm not sure why they get mad if you refer back to your paper during rounds unless you are just reading off it and not showing that you have any idea what the patient is there for. But again there should be time during the day to figure that part out.

The biggest issue I see here is your time management. I am assuming you are handing off to someone on call (night float vs oncall intern) around 6 or 7 pm each day. You need to get to the point where you are signing out on time and headed out of the hospital by then. Of course there will be days that won't happen. That's ok. Just don't make it a regular occurrence. Get home, eat, read up on things that you need to read up on, and get some sleep.
 

QofQuimica

Seriously, dude, I think you're overreacting....
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Talk to some of your seniors about what systems they use. Pick a few people who seem to have their s*** together and are approachable and friendly, and ask them for advice. Then do some trial and error using their methods until you can develop a system that works for you.