lfesiam

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So, with the intern year coming to an end, I would like to pass on a list of advices. Find a system that work for you. Fellow intern, please chime in!

The faster you work, the more time you have off to actually "learn" than just pushing paperwork. Every institution is different so some of my advice may or may not work.

1) GROUP ALL TASKS TOGETHER, BUNDLE THEM UP. I.E. Pre-Round on all of your patients first. Then sit down and write all of your notes at once. Then if no stat orders are needed, carry blank order sheets, wait until the end of round to put them in (your attending will more than likely say "add this, add that, do this additional test, etc...." Then call all of your consults. Grouping tasks will save you mucho time.

2) MUST HAVE BOOK FOR THE FIRST MONTH - LANGE Instant Access Hospital Admissions: Essential Evidence-Based Orders for Common Clinical Conditions By Anil Patel. Full of pre-filled ADMISSION orders and symptoms managements that you will get paged for.
- POCKET SIZED :)

2a) MUST HAVE PENS: GEL INK 0.5mm is the perfect pen. My favorite is the zebra sarasa. Pilot G and Mitsubishi (uniball signo) are good too. You can buy bulk on amazon.


3) KNOW WHAT TASKS CAN BE DONE LATER

4) USE PRE-FILLED FORMS AND PROTOCOLS for admissions, DM sliding scales, sepsis, heparin, ETOH withdrawal etc if possible, save you time. If your hospital don't have one, make your own and xerox them.

5) WHEN YOU GET PAGE, ALWAYS ASK FOR THE VITALS FIRST.

6) KEEP A POSITIVE ATTITUDE

7) KNOW THAT THIS TOO SHALL PASS.

8) EMPATHY FOR YOUR PATIENTS - probably the hardest thing to do when if your patients are alcoholics, drug abusers, psych, ... try to put yourself in their shoes, their upbringing and life experiences.

9) CONFLICTS MANAGEMENT - read it online, know the techniques on how to resolve them... not that hard, most of the time, it requires more listening than talking :)

10) BE FLEXIBLE

11) TRY TO SCHEDULE A NORMAL OUTING Q WEEK WITH a NON-MEDICAL FIELD FRIEND OR WIFE even if you're on ICU.

12) ALL YOU REALLY NEED IS YOUR STETHOSCOPE and Pharm Ref. (IPOD TOUCH FOR ME). Throw away everything else in your white coat. Travel lite.

13) GET SOCIAL WORKERS INVOLVE FROM THE GET-GO

14) EXPECT TO BE A SECRETARY when you're on other services... learn to be an efficient/fast scutmonkey with a good attitude, life will be a lot easier.

15) PERSONALITY ADAPTABILITY TO VARIOUS HIGHER POWERS (ATTENDINGS, SENIOR RESIDENTS)... you can probably read this online, you will encounter different personalities whom you will work under, you are on the bottom of the totem pole, each personality require you to adapt your own for pleasant working environment :)

16) EAT WHEN YOU CAN

17) SLEEP/POOP WHEN YOU CAN

18) START A ROTH IRA ACCOUNT, get some good ETFs or MUTUAL FUNDS, balance it with US, Foreign, Gold/Oil, etc.... www.optionshouse.com is great, only $2.95 per stocks/ETF. use "FREE100" for 100 free trade when you open a new account.

19) KEEP A BUDGET - www.mint.com is great

20) TAKE STEP 3, get it done your PGY-1 year

21) CASE PRESENTATION/ POSTERS are awesome, get some in if you can, they are paid mini-vacations with non-clinical responsibilities.
 
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Green Chimneys

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Thanks for the advice. The book you mentioned seems like it would be very helpful. Is it pocket sized?

And Dream, I think I'm going to have to order a year's supply of lube (to be used up probably by the end of July). Can't wait.
 

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23) If you get paged about a patient, and the page is not completely ridiculous ("Doctor, the pt's HR is 52!" "Yeah, he's a young, in shape, avid runner, and that's where he's been since he was admitted this morning" *click*), GO SEE THE PATIENT!

My program has these "My Mistake" presentations, where interns present to each other at our monthly meeting situations in which they made some error in patient care. The majority of them could have been remedied by simply seeing the patient when paged about them. Sure, it may seem easy to just order up some ativan for the agitated patient, but maybe he's agitated because he now has a pneumo from the chest tube that was pulled earlier today. If there is any doubt, whatsoever, in your mind that it is anything other than a bull**** page, just go ahead and see the patient.
 

lfesiam

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24) Don't abuse the medical students. Let them go "STUDY" instead of making them do useless work. And do teach ;) :thumbup:
 

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The Mass General Int Med Handbook is another gem to have in your pocket... lots of concise material, a fair amount of it referenced to key studies. :thumbup::thumbup:
 

neutro

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24) Don't abuse the medical students. Let them go "STUDY" instead of making them do useless work. And do teach ;) :thumbup:
this is why i picked anesthesia over surgery - people like you, and my anesthesia attendings who actually gave two ****s about me while i stood besides them and looked at the monitor and tried to learn those funky wave patterns like a nOOb...as opposed to that general surgeon who couldnt hold the camera himself but expected perfection from me in showing him the inguinal region through the camera...
 

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23) If you get paged about a patient, and the page is not completely ridiculous ("Doctor, the pt's HR is 52!" "Yeah, he's a young, in shape, avid runner, and that's where he's been since he was admitted this morning" *click*), GO SEE THE PATIENT!
:thumbup::thumbup::thumbup::thumbup:
 

lfesiam

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25) WORK ON THE RUN - i.e. while attending is rounding, don't stand there and look pretty, use the time to write discharge orders and other paperworks, by the time round ends, you got most of your post-round work already done.

26) DICTATE THE MOMENT YOU FINISH YOUR NOTE - will save you lots of headaches.

27) IPOD TOUCH/ IPHONE - a must during the boring rounds, great for pimp guarding via Dr. GOOGLE.

28) ALWAYS HAVE AN ON CALL BAG READY - toothbrush, mini toothpaste, deodarizorsss'', razor for shaving, extra pair of scrubs/t-shirt/socks/boxer, 2 bottles of water, a granola bar, extra strength tylenol is great for the POSTCALL-I-STILL-HAVE-TO-ROUND-TILL-2PM headaches.
 
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RussianJoo

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awesome advice keep it coming...

any tips on organization? also any tips on what can be excluded form a student progress note vs. a resident's note? i felt like it took me way too long to write the notes and they would be way too long and the resident would write a half page not in under 5min, mine would over a page and would take a good 15min, is it just practice and after about 100 of them i'll get faster?

thanks again these are great!
 

lfesiam

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awesome advice keep it coming...

any tips on organization? also any tips on what can be excluded form a student progress note vs. a resident's note? i felt like it took me way too long to write the notes and they would be way too long and the resident would write a half page not in under 5min, mine would over a page and would take a good 15min, is it just practice and after about 100 of them i'll get faster?

thanks again these are great!
29) MAX OUT ON YOUR ABBREVIATIONS AND GREEK SYMBOLS/VOCAB IN NOTEWRITING - should not take you more than 5 minutes per note (even the longest one), comes with practice. it starts with using the right pen i.e. gel ink will speed up your writing due to less friction at paper contact point. As for SOAP. S = can be simply "Ø acute Δ ". Know your preset minimal "normal physical exam" writing i.e. AAOx3, NTND BS+ SOFT, RRR ØM/R/G, CTAB Øwheezing, Ø E/E/C etc etc etc...... If you have a long last name, get a name stamp (if not provided already by your program) and once again bundle the "stamping" task, stamp all orders/notes at once. Have prestamped RX scripts in your pocket if needed.

30) HAVE CONSULT/ACCESS NUMBERS ON SPEED DIAL ON YOUR CELL PHONE - you can call during rounds. Time is money :)

31) BEFRIEND THE CONSULTANTS, SOCIAL WORKERS, PHARMACISTS, EVEN THE HOSPITAL's OPERATOR etc, ...was able to get cell phone numbers, Provide faster response time...instead of waiting/wasting your time for them to call you back.
 
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Jeep23Guy

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One of my buddies did a few things that really saved him time.
He got a blank note sheet and wrote out all of the "categories" and stuff for his note (including blank lab symbols). He then made copies and just put the pt sticker or name & MR on the top.
He would also grab the D/C paperwork out of the chart when the pt was admitted and keep it in his pocket...that way, whenever the pt needed to be d/c'd, he could fill out the paperwork wherever he was.
This guy had laziness down...this next suggestion makes things easy, but it's different at various hospitals. The senior resident was always required to write a detailed admit note along with the dictated intern H&P. He would wait to dictate so he could read the senior note. I'm not suggesting this, but it makes it easier and then the 2 notes won't be different at all.
 

RussianJoo

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29) MAX OUT ON YOUR ABBREVIATIONS AND GREEK SYMBOLS/VOCAB IN NOTEWRITING - should not take you more than 5 minutes per note (even the longest one), comes with practice. it starts with using the right pen i.e. gel ink will speed up your writing due to less friction at paper contact point. As for SOAP. S = can be simply "Ø acute Δ ". Know your preset minimal "normal physical exam" writing i.e. AAOx3, NTND BS+ SOFT, RRR ØM/R/G, CTAB Øwheezing, Ø E/E/C etc etc etc...... If you have a long last name, get a name stamp (if not provided already by your program) and once again bundle the "stamping" task, stamp all orders/notes at once. Have prestamped RX scripts in your pocket if needed.

30) HAVE CONSULT/ACCESS NUMBERS ON SPEED DIAL ON YOUR CELL PHONE - you can call during rounds. Time is money :)

31) BEFRIEND THE CONSULTANTS, SOCIAL WORKERS, PHARMACISTS, EVEN THE HOSPITAL's OPERATOR etc, ...was able to get cell phone numbers, Provide faster response time...instead of waiting/wasting your time for them to call you back.
thanks.. what's E/E/C?
 

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26) DICTATE THE MOMENT YOU FINISH YOUR NOTE - will save you lots of headaches.
Sorry...I have a stupid question regarding the above.

What do you mean by dictate when you finish your note? Is this specific for paper chart system (i.e., when you finish hand writing your note, then you have to dictate so that the chart can go into computer)??
 

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As always, Ifesiam, thanks so much for the great advice.

I hope I can be as committed to teaching in residency as you.:thumbup:
 

lfesiam

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Probably no egophony / E? / crackles...??

hehe, for me it is no edema/erythema/cyanosis on the extremities.

make sure you get a list of "APPROVED" abbreviations from the coding department or they will haunt you with phone calls/pages.
 

lfesiam

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Sorry...I have a stupid question regarding the above.

What do you mean by dictate when you finish your note? Is this specific for paper chart system (i.e., when you finish hand writing your note, then you have to dictate so that the chart can go into computer)??
some hospitals with paper charting systems will require you to dictate:H&P, DISCHARGE SUMMARIES...

that is why I love ANESTHESIOLOGY, no dictation!!! + minimal paperwork!!!! + more action.
 
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lfesiam

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32) GRAB STICKERS FIRST BEFORE STARTING ANY WORK UP- atleast 3 stickers when you are about to work up a patient. You will use them for H&P, giving one to senior residents, chasing patients labs/location, stickers are mucho importante.
 

gclax30

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27) IPOD TOUCH/ IPHONE - a must during the boring rounds, great for pimp guarding via Dr. GOOGLE.

Any suggestions on the clutch apps/programs to have on your iPhone or i-whatever-you-have for intern year?


...yep...the Match Day euphoria has definitely warn off... now I'm just crapping my pants...
 

guitarguy09

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Any suggestions on the clutch apps/programs to have on your iPhone or i-whatever-you-have for intern year?


...yep...the Match Day euphoria has definitely warn off... now I'm just crapping my pants...
I would definitely download epocrates and skyscape. Also a med calculator like mediquations or medcalc can be useful and save you time (calculating FENa, etc). I also like medscape because there is a news section and you can select anesthesiology as a specialty to display related news. I also have pepid, works nicely as a toxicology reference when needed. I'm blanking on others but I'll repost if they come back to me.
 

vaibh

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have heard of blue book what is that ??
and what rotations to expect ?
 

lfesiam

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I would definitely download epocrates and skyscape. Also a med calculator like mediquations or medcalc can be useful and save you time (calculating FENa, etc). I also like medscape because there is a news section and you can select anesthesiology as a specialty to display related news. I also have pepid, works nicely as a toxicology reference when needed. I'm blanking on others but I'll repost if they come back to me.
yep, FENA is your friend. unless they are on a diuretic like lasix, then get the FEUrea. hehehehe.

33) SOME PATIENTS ACTUALLY GET BETTER FASTER WITH THE LEAST INTERVENTIONS (in most cases, sepsis/acute MI don't count :) ) - this is from my own observations, i think we are actually doing more harm than necessary...be mindful of this before ordering invasive testing or starting them on a bunch of meds...always think a step ahead...what are you going to do with the results.....

34) ALWAYS CHECK THE ALLERGY LIST before starting meds

35) LEARN TO THIN YOUR LIST EARLY, HOME IS NOT ALWAYS THE FINAL DESTINATION, THINK OF OTHER PLACES = SKILLED NURSING, INPATIENT REHABS, LONG TERM ACUTE UNITS, OTHER TYPE OF REHABS. WRITE FOR THESE PLACEMENTS EVAL ORDERS EARLY! HAVING A THIN LIST = shorter rounds, happier attending, happier senior residents, more teaching. I personally think that the longer the patient is in the hospital, the higher the M&M risks.
 
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lfesiam

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36) NEVER TAKE IT ON YOURSELF. DON'T GO IN WITH THE MENTALITY OF I'M GOING TO BE "SAVING EVERYONE' LIVES"...sometime you will not be able to. and DEATH ITSELF to some patients is AN ESCAPE TO THE CURRENT SUFFERING. BRING ME TO THE NEXT TIP...

37) CHECK IF PATIENTS HAVE A DNR/DNI (do not resusitate/do not intubate) and advance directives...THIS IS MUCHO IMPORTANT ESPECIALLY IN THE ICU...
CONSULT PALLIATIVE CARE OR HOSPITAL CLERGY IF NEEDED...

38) TURFIN' PATIENTS AND PREVENTING 'BOUNCE BACK' is an ART. Check your program rules on this.
 

lfesiam

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39) IF YOU DON'T KNOW THE ANSWER TO A QUESTION BY A SUPERIOR or PATIENT , JUST SAY "I DON'T KNOW BUT I WILL FIND OUT" instead of continuously guessing and BSing the answer.

40) DON'T UNDERESTIMATE THE POWER OF HOLDING A "FAMILY MEETING" FOR PATIENTS WITH DIFFICULT FAMILY MEMBERS.

41) FOR IV DRUG ABUSER WHO SOMEHOW GOT ADMITTED FOR A QUICK FIX, THE QUICKEST WAY TO GET THEM OUT = don't give IV pain meds + keep them NPO. They will magically leave AMA (against medical advice) the next day.

42) IF YOU PLAN ON DOING A PROCEDURE THE NEXT DAY (especially MI work up) REMEMBER TO KEEP PATIENTS NPO AFTER MIDNIGHT! Important on sunday admissions. Now, if you are admitting on a friday, let the patient eat.

43) BE MINDFUL OF PREGNANCY IN WOMAN OF AGE BEFORE STARTING MEDS especially ABX!

44) RELATIVELY EASY ADMISSIONS AND DISCHARGE = DKA, ETOH withdrawal/intoxication, Chest pain rule out MI (unless it's a ruptured aorta), Cellulitis, Drug OD.

45) IF PATIENT IS ALTERED = easy H&P for you. can write "unable to obtain" in ROS/FH/PSH/PMH/SH etc...

46) BEFORE WRITING AN H&P CHECK IN THE EMR IF PATIENT GOT OLD RECORDS, will save you lots of time in the FH/PSH/PMH/SH section (COPY/PASTE) + look for tests recently done so you don't have to repeat them!

47) TAKE STEP 3 DURING AN ELECTIVE OR CLINIC MONTH, CHECK YOUR PROGRAM POLICY ON GRANTING YOU "EDUCATIONAL LEAVE" FOR THE ACTUAL TEST DATE, SO THEY DON'T DEDUCT YOUR VACATION TIME. Then schedule on weekdays, ideally Monday-Tuesday (2 days exam), so you can use your weekend for last minute brush up without wasting them to take your exam. START THE PROCESS EARLY DUDES, FROM THE MOMENT YOU REGISTER, IT'LL TAKE AT LEAST 2 WEEKS BEFORE YOU CAN SCHEDULE, i.e. sending them a notarized form with your picture

48) FEBRUARY AND MARCH ARE NOTORIOUS FOR SERIOUS BURNT OUT/ LOW MORALE MONTHS DURING INTERN YEAR. SCHEDULE EASY ELECTIVES DURING THESE MONTHS OR A WEEK OF VACATION.

49) TRY YOUR BEST NOT TO JOKE IN PUBLIC, THINGS CAN BE TAKEN OUT OF CONTEXT AND HAUNT YOU LATER. DO JOKE/ HAVE FUN WITH YOUR FELLOW INTERNS BUT BE-WARY OF THOSE AROUND YOU.

50) GHOST MINI HEADPHONES - are great when want to be left alone but can't due to certain situation i.e. sharing a call room, try to rest but co-workers trying to engage you in conversations. you can just put the headphone on without even turning on any devices. works like a charm.
 
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51) Always get a good family contact number and slap it on the H&P. This will be key when trying to get consent or for asking questions later on.

52) If patients get all their meds from the same pharmacy, call there instead of trying to track down their PCP/clinic. Really easy if this is at walgreens, cvs, rite aid, etc since at least one of their branches is open 24-hours for the most part. Being on hold is a major time waster, as is having to wait until the next day.

53) If there is any chance for a blood transfusion down the road, get the consent during the H&P if you can. There will usually be family members around at this point.

54) Program your pager into your speed dial so you can covertly page yourself to get out of family meetings, long rounds, noon conference, etc.
 

fakin' the funk

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My take on internship so far:

a) hydration is key
b) frequent toothbrushing and a splash of water on the face does wonders to keep you going on call nights
c) keep thinking, keep reading, and keep questioning clinical decisions that seem pat, that seem inconsistent with the available evidence, or are of the "that's what we do here" variety.
d) Most importantly, your role as a physician, and particularly one in training: doctors take histories, perform physical exams, develop differential diagnoses, order appropriate tests and diagnostics, revise differential diagnoses, and MOST IMPORTANTLY, prescribe treatments that will either benefit the patient's LENGTH or QUALITY of life. It's easy to lose sight of this during internship!
 

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Keep a little sheet of paper to record useful extension and phone #s on. I don't like to keep em on my cell phone because it reminds me of work when I look through it. Many attendings want you to pay attention in rounds, don't call consults or whatever during that time unless you know it's ok.

And I wholeheartedly agree with fakin's advice on toothbrushing.
 
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lfesiam

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Keep a little sheet of paper to record useful extension and phone #s on. I don't like to keep em on my cell phone because it reminds me of work when I look through it. Many attendings want you to pay attention in rounds, don't call consults or whatever during that time unless you know it's ok.

And I wholeheartedly agree with fakin's advice on toothbrushing.
Agreed with UTKB, WORKING DURING ROUNDS is a attending and program dependent factor. :) along with the atmosphere and relationship between the upper levels and the lowly interns.

Some attendings/senior residents does relaxed table round + bring you breakfast and pick which patients to see on the bedside while seeing some on their own..........

............while others will see every patients with you and require you to come in to pre-pre-pre-pre-round with the seniors in the wee-hours.

You will also meet both residents and attendings whose PERSONAL LIFE itself is MEDICINE..... Adapt your work and time to fit such an individual.

I personally am grateful to be at my program, super cool attendings and senior residents.

So... my last advice to you...

DON'T LET MEDICINE CONSUME YOUR LIFE.

PS: Keep the patient's best interest and health in mind eventhough you may have to speak up to the upper powers and family members......You are there to treat "the patient" first not "the disease"
 
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dhb

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Hey lfesiam you seem to have this intern shiite down maybe you should go for another year ;)
 

lfesiam

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Hey lfesiam you seem to have this intern shiite down maybe you should go for another year ;)
Sure man, I heard Obama just added a new clause, the MEDICAL INTERN EQUALITY act to the new bill!

Limiting all PGY-1 work hours to 35 per week and raising the pay to midlevel 90,000 a year!

Who hooooooo! Jk

counting down the days no no no ...seconds to anesthesiology:D
 

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on ur orders, load up on PRNs. hydralazine q6 prn for HTN, zofran q4 for nausea, norco moderate pain, ntg/morphine protocol for chest pain, albuterol/atrovent nebs q4 prn sob, xanax prn anxiety, ambien prn sleep. saves you pages and will cover most things that occur at night.

night float- when covering for other teams ur job is to make sure the patient survives the night and only that. If a nurse calls about changing important medications or antibiotics cuz of anything less than an allergic reaction or the patient dying tell that person to wait until the primary team.

Learn to prioritize tasks i.e seeing sick pts first over doing a discharge summary, etc.

In addition to toothbrush, floss, and washing your face, bring a new pair of socks. it makes all the difference in the world.
 
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Jay K

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25a) Working on the Run - I did this in internship and would work while my co-interns presented on their patients; One trick was to call your consults early and always leave your own cell phone number as the call back number. That way you were always on hand to get the call back and get your patients on the list for the ever important discharge enhancing GI/CV/Surg/Ortho/ID/PICC line/Rads approval for CT/MRI/X-ray workup. No consultant ever appreciated the 4pm consult after rounds or all other extraneous stuff was done; It was also less likely to get your patient in for whatever they needed. It would've been better had I an unlimited talk plan. Also, you never had to run around looking for a free hospital phone to use, or perhaps the workstation/computer you were at didn't happen to have a phone.

99) Whenever you were called about anything, I always took down the name of the person calling me. That way you could always refer to Dr. _______ from radiology said the pt was approved to go to CT today, Dr. _______ said so-and-so could be discharged on these antibiotics. Take down RN and ancillary staff numbers as well when you talk to them; Opens doors - when you say, well "Angie" said it would be fine (and she actually DID say this) to add so-and-so for a PICC TODAY or get the scope TODAY, then they have less to argue against you with. They'll always ask, "Who said that or who said it was OK?" If you've a name, it will always benefit you. Also, learn ancillary staff's names and treat them like human beings, because the next time you call and address them by first name and they recognize you as the sweet intern that you are, more often than not, you'll get them to "work things out" with you.

100) I always believed in the adage, "You catch more flies with honey than vinegar." It'll make your life as an intern better w/ hourly wage ancillary staff who are just watching for when their shift is up and people have been badgering them all day for things. I was never the "baked cookies for the staff" intern, but I treated and chatted with them like good people when the moment was there.

All the other gems offered in previous posts are great. Nice thread.
 

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My advice for the incoming interns:

1. You will get the angry, demanding, bitc*y, demented, unappreciative, stupid, crazy, weird and unusual patients and their family members. Get use to it.
2. Pt and their family can be angry and rude. Never yell back, never escalate the situation. Listen to them and call your upper level/attending.
3. Don't let nurses push you to do things you are uncomfortable with. Just say that you'll call back after checking with your upper level/attending.
4. get your upper level cell phone number.
5. Enjoy the time, it'll pass by quickly. I can't believe that I have 2 months of internship left.
6. Best of luck!!!
 

fakin' the funk

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on ur orders, load up on PRNs. hydralazine q6 prn for HTN, zofran q4 for nausea, norco moderate pain, ntg/morphine protocol for chest pain, albuterol/atrovent nebs q4 prn sob, xanax prn anxiety, ambien prn sleep. saves you pages and will cover most things that occur at night.
YES YES YES.

But you forgot the most important PRN's: senna and docusate!

PRN's for nausea, mild things for pain (APAP, vicodin), APAP for fever, and something weak for sleep (ambien, temazepam, etc) will save you and your night float colleagues probably 5-8 pages a day for your patients. Remember, signing out to nightfloat means making the SCUT part of their job EASY (ordering zofran for example) so that when your patient is crashing and needs to go the ICU they're not bogged down with bowel regimen requests.
 

lfesiam

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69) GET LAID OFTEN - In other words, make the most of your free time, whatever that entails. You will rapidly lose perspective, if you do not. I've seen residency DESTROY personalities...particularly intern year.
hahaha, u are one funny dude, dream.

ANOTHER ADVICE: RELATIONSHIP WISE - Get a ring on it or be ready for a bumpy ride during intern year + residency and beyond! :D:D:D
 
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DScully

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hahaha, u are one funny dude, dream.

ANOTHER ADVICE: RELATIONSHIP WISE - Get a ring on it or be ready for a bumpy ride during intern year + residency and beyond! :D:D:D
:laugh::laugh::laugh:

I have heard so many stories about the same theme...
 

lazylikeapanda

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Yes, I forgot about the all important bowel regimen, i don't understand why people need to have bowel movements at 3 am. Glycerine suppositories.

another advice for incoming interns
1. In addition to looking at notes, labs, and imaging, look at the orders section of your patient's chart to see if anything was written overnight.

2. sign your co-resident's telephone orders if you come across it in your chart, within reason. Some say that you can be held responsible for signing a verbal order that led to a bad outcome, so I'd avoid signing an order that said dilaudid 100mg IV, but sign the tyelenol orders etc. It'll save people the visit to med rec.
 

gclax30

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I'm loving all of the tips, please keep 'em coming...

A few questions as far as consults go:

HOW exactly do you get a consult initiated? What is the process from when I write it in the chart to when the consultant actually comes by? To this point I've only written "consult ____ (specialty)" in the chart and by some magical process, it gets done.

Also, it seems like if you have a heart, you get a cards consult. How do I learn when it is appropriate to get a consult for a patient and when the issue can be (and probably should be) managed by the primary team? Am I expected to know this by July 1st?

Thanks again, great thread. :thumbup::thumbup:
 

lfesiam

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I'm loving all of the tips, please keep 'em coming...

A few questions as far as consults go:

HOW exactly do you get a consult initiated? What is the process from when I write it in the chart to when the consultant actually comes by? To this point I've only written "consult ____ (specialty)" in the chart and by some magical process, it gets done.

Also, it seems like if you have a heart, you get a cards consult. How do I learn when it is appropriate to get a consult for a patient and when the issue can be (and probably should be) managed by the primary team? Am I expected to know this by July 1st?

Thanks again, great thread. :thumbup::thumbup:
Depends on the hospital my friend.

Before consulting:

A) Okay it with your Attending/Senior Resident (you can call consultants on your own after you get more experience + earn trust from the upper level)

B) Consult is initiated by contacting the consultant on call, procedures will depend on your hospital...usually it involve getting them page...you wait for them to call back. Or just a simple written or EMR order in the computer, or a combination of all mentioned.

C) Depending the culture and procedure of your hospital. (open vs. close consulting system)

for example, in one system, the consultants only write notes NOT the orders, so in this cases make sure you read their notes and write the orders they suggested...

however, in some places, once the consultant take over, they will do everything...

D) You are not expected to know this by July. Senior residents will guide you.
 
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DScully

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I know someone mentioned that March is a good time...Any other suggestions for when might be a good time to take vacation (ex. to avoid burnout)?

Thanks!!
 

lazylikeapanda

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I know someone mentioned that March is a good time...Any other suggestions for when might be a good time to take vacation (ex. to avoid burnout)?

Thanks!!
Either Thanksgiving, Christmas or somewhere in between. Being in the hospital during a winter holiday will put you in a funk fast.

another advice for intern year- don't complain directly to an upper level about having too much work. Follow the path of least resistance and take the extra work load assigned to you, usually you'll get street cred for being a hard worker and when you drop the ball on something people will be more forgiving. Complainers get dumped on even more and no slack given.
 

lfesiam

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FYI

July 1st is coming up, you are pooing in your pants, palpitation, anxiety, i'm sweating like crazy feelin''' ....what to do with your time off (2-4 weeks) between MS4/Graduation and the first day of Internship?

close your eyes.... imagine that you'll be in prison for a year in 4 weeks... (not trying to be extreme here but see what types of things come up to your mind)

..surfing on a beach in hawaii
..backpacking europe with college buddies
...drikin' n' chillin' with friends
...road trip
...vineyards hopin''
..hiking
...sailing
....taking your kids to theme parks....
...walt disney world w/ parents/wife/family...
...cruise...
...(ladies) shopping spree at an outlet mall? buying a new coach/hermes/LV bag?
...las vegas...sin city...
...poker night....
..all inclusive trip to a tropical paradise...
...going to a soccer game in europe..
...hostel hoping in paris..
...eating sushi at tsukiji market in tokyo..
..walking the great wall of china..
...climb the pyramid...
...going to a rock concert in iceland..


...what ever it is...(going nike on you all now..)


JUST DO IT.


don't wait! :)



but if you answered
...reading harrison's back to back....
...memorizing medication list...
....going to shadow an attending in ICU...

i will pray for you.
 
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