intern year

[Slamdunk]

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i just wanted to know if anyone other interns on the forum are having trouble making decisions while on the floors, icu etc. Decisions in terms of dosages of meds, frequency of doses, management etc. I'm assuming its normal to feel this way but i constant find the need to double or triple check at times lol, certain decisions that i made or want to make.... i'm just not confident in myself.

Anyone have or had the same experience? Any suggestions?

 

[WhoisJohnGalt]

i just wanted to know if anyone other interns on the forum are having trouble making decisions while on the floors, icu etc. Decisions in terms of dosages of meds, frequency of doses, management etc. I'm assuming its normal to feel this way but i constant find the need to double or triple check at times lol, certain decisions that i made or want to make.... i'm just not confident in myself.

Anyone have or had the same experience? Any suggestions?

If you WERE 100% confident in your decisions in August of your intern year, I would be terrified to be your patient, because that would mean you weren't seeking consultation when you definitely should be. Regarding meds, epocrates or your pharm book should be pretty helpful; if I don't know the dose or frequency I look it up before I ask my upper level. If there's a range in the reference, I try to use clinical judgement but will usually err on the lower end of the dosing and titrate up if need be. Whatever's in the range of your reference should be fine if the patient's creatinine and LFT's are good and they're not 90 years old. However, if their liver or kidneys are gorked and the med is excreted that way, I ask. That's what your upper level and/or attending are for; to keep you from killing patients, because you're NOT expected to know it all right now. Chin up, we'll figure it out eventually 🙂

 

[coKinetic]

I'm not an intern, but if you ever need any dosing recommendations don't be afraid to ask one of the inpatient or clinical pharmacists, especially for renal or hepatic impairment. Pharmacists can be a good sounding board when you don't have easy access to the rest of your team.

 

[EternalMD]

I'm not an intern, but if you ever need any dosing recommendations don't be afraid to ask one of the inpatient or clinical pharmacists, especially for renal or hepatic impairment. Pharmacists can be a good sounding board when you don't have easy access to the rest of your team.

i used to do this all the time on the floors - sometimes they would obviously be looking things up online but to be honest, they knew exactly where to go to find the right information. It would take them 30 seconds but might take me 5-10minutes. Don't ever be afraid to call the pharmacy to ask stuff like this. It's especially useful in certain situations - i.e. patient lost IV access and needed antibiotics but didn't want a new IV placed at that time but wouldn't mind a different route. I called the pharmacy and they told me about an IM form. But sometimes you should document it as "discussed with pharmacist regarding appropriate dosage and route" to cover yourself because you never want to be criticized for being a gun slinger when you are doing the right thing

 

[Buzz Me]

I find pharmacy especially helpful for pharmacokinetics (e.g. vanc/gent dosing), renal dosing, immunosuppressants, peds dosing, and PO --> IV conversions (e.g. Synthroid).

 

[IMdocT]

you're not the only one feeling this way. here's hoping that it gets better for all of us by the end of the year

 

[JustPlainBill]

It's ok --- we're all feeling that way....Have they cut you loose to do your own admits yet?.....

Are they including you in the decision loop yet or still making decisions between the upper leve/attending and forgetting to inform you but letting you get paged to field the results of the treatment decisions? Yeah, I love that one.....Do they send you to put in orders and then walk off to see another patient and forget to tell you where they're going? Yeah, great team builder, that one....

In general, it sucks, there's no teaching and a higher standard of responsibility....