On call first night of Internship

[Solideliquid]

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Since we have this thread in the general residency forum I thought I would get some insight from our psych residents about the first week of the internship year. How did you handle your first call? I think my first rotation will be a month of IM inpatient and then three months of IM outpatient.


Thanks!

P.S.>Psychologists pay attention, because I am seriously beginning to think that a residency after medical school is really the only safe route to the prescription pad.

 

[mucha]

🙂 Yes, that's an excellent question.
Some interns in inpatient psych told me that during 1st year, there are only a few meds to know and use, just to temporarily stabilize. They weren't asked to do anything else. Is that true? What meds?

 

[Anasazi23]

I was also on call my first day of internship. I started in the inpatient psych unit. There were lots of drugs that were busted out the first day, and you're expected to have a basic grasp of just about all of them.

The call was nerve wracking. The ER was busy, and I was being called for consults on the medical floors.

Luckily, our program has new first years on-call with a third year for a period of time, as sort of a 'training' period. So in the end, I had backup. Still, they were only available for new patient evaluations and consults. The endless pages for floor scut and medical complaints and even most emergencies were up to me. That was the scary part.


Definately pick up a copy of Stahl's Prescriber's Guide, and get through most of it this summer. Know your DSM criteria cold.

Residency is a trial-by-fire in this way. Look at some of the books in the books sticky above and pick out one or two to keep in your coat pocket.

You get three months of outpatient medicine? You are very, very lucky.

Inpatient medicine call was pure hell.

 

[Poety]

Solid, I have my inpatient medicine the last TWO MONTHS Of internship year! THAT SUCKS! So essentially, I have outpatient medicine X2 mos, addictions x2, neurology x2, va psych x2, and then inpatient med x 2 WTF?

 

[mucha]

Does 4 (all) months outpatient exist?
Does inpatient help that much for a psychiatrist, especially one who wishes to do outpatient psych later?
UVA has more outpatient than inpatient because too much inpatient is not that helpful, from what I heard them say.

 

[Anasazi23]

I believe the residency requirements state somthing about continuous medical care for a certain amount of months. That's why couldn't do, say ER medicine for 4 months straight.

 

[mucha]

Thanks for your input!

 

[Adam_K]

Solid, I have my inpatient medicine the last TWO MONTHS Of internship year! THAT SUCKS! So essentially, I have outpatient medicine X2 mos, addictions x2, neurology x2, va psych x2, and then inpatient med x 2 WTF?

Sounds like a sweet schedule to me. Only 2 months on inpatient IM?!

And at the tail end, after you've learned the system?

Seriously, that can't be that bad.

 

[willow212]

I started out on IM inpt. I remember how nervous all the interns were who got the first night of internship (I think I might have been on 3rd or 4th night). And of course, all interns are anxious about whether they'll know enough, or if something bad will happen while they're on call.

I don't remember the details about my first call night, which must mean it wasn't too traumatic. I do remember that all the nurses and seniors were very helpful and constantly around, and I never felt over my head because of that. After that first call night, I felt like a "real doctor" - it was a pretty cool feeling.

 

[Doc Samson]

First night of intern year, I was on call in the CCU. Complete and utter terror, until the first admission arrived then I just got lost in the work... you know a lot more than you think you do.

We did 6 months of inpatient medicine, with 2 unit months (CCU/ICU). Your schedule's looking pretty sweet to me Poety.

 

[Anasazi23]

Solid, I have my inpatient medicine the last TWO MONTHS Of internship year! THAT SUCKS! So essentially, I have outpatient medicine X2 mos, addictions x2, neurology x2, va psych x2, and then inpatient med x 2 WTF?

Yes, inpatient medicine at the end of the year is sort of demoralizing. You're sort of ostracized from your psychiatric colleagues (at least you feel that way) and the most difficult schedule hits you at the end, when you're tired. People (3rd year med residents) are in F-it mode, and aren't around to help as much, if at all.

I know this because it happened to me.

The bright side is that you get to bond with the psych department early, and you know the hospital system, and its quirks very well by the time you'll need it very badly. The fact that you do two outpatient months is pretty sweet. A lot don't have that luxury.

You'll be fine.

 

[Anasazi23]

I started out on IM inpt. I remember how nervous all the interns were who got the first night of internship (I think I might have been on 3rd or 4th night). And of course, all interns are anxious about whether they'll know enough, or if something bad will happen while they're on call.

I don't remember the details about my first call night, which must mean it wasn't too traumatic. I do remember that all the nurses and seniors were very helpful and constantly around, and I never felt over my head because of that. After that first call night, I felt like a "real doctor" - it was a pretty cool feeling.

Willow makes some good points, especially about being nervous the first night.

If you're NOT at least a little nervous that you're responsible for patients in a very important and critical manner, something's wrong. I think for doctors, it's that feeling of uneasiness or worry that acts as our radar. As you get better, you'll refine your generalized and free-floating anxiety into constructinve clinical intuition and build experience, which is often the most important part of all of medicine.

 

[Solideliquid]

So what are some good Dos and Donts for the first new nights on call in IM inpatient?


Thanks!

 

[OldPsychDoc]

So what are some good Dos and Donts for the first new nights on call in IM inpatient?


Thanks!

DON'T PISS OFF THE NURSES!!!

 

[Doc Samson]

So what are some good Dos and Donts for the first new nights on call in IM inpatient?


Thanks!

Right... never, ever, ever piss off the nurses. Donuts go a long way to making happy nurses.

Otherwise:

DO ask for help whenever you need it.

DON'T be the first person to arrive at a code.

DO make sure all your patients have PRNs for sleep/nausea/pain (best to have you intern class agree to make sure that all admits get these)

DO follow the old adage... eat when you can, sleep when you can, leave when you can. (I think some people say "read when you can", but I say F@#$ that).

DO be nice to your co-interns and cover each others asses. Karma is a bitch.

DON'T expect to cure everyone.

DO figure out the minutiae of filling out death certificates.

DON'T try to be a psychiatrist on your IM months (though attendings will ask you to all the time).

DON'T have your pager on vibrate when you go to sleep, you'll sleep right through it.

DO make friends with all the ancillary staff (phlebotomy, radiology, security, cafeteria, housekeeping). They can all save you a bunch of trouble.

DON'T think you're the only one that feels like you're flailing.

DON'T forget to laugh (humor is a mature defense).

 

[MBK2003]

DON'T be afraid to let the medicine resident/attending know when their reason for wanting a psych consult is bogus (politely of course). E.g. "acute depression" in a unit patient or assessment for capacity is an obviously delirious patient flailing around in the ICU screaming about wanting to leave with their dead spouse --> let's just agree Mr. J lacks capacity to sign out AMA and move on to identifying/amending the sources of delirium.

If you are on call the your first night in the ICU/CCU, DO ask the nurses/RTs for their opinions on management since they've likely worked there long enough to run the show without the MDs.

DO get good at assessing attention and orientation in patients for whom you suspect delirium.

DO use your neuro months to practice LPs -> you will astound and amaze your medicine senior residents with your skills after you've learned from the neuro resident experts, and it will make unit months MUCH easier when you can tap a patient quickly and efficiently.

DO make it a point to attend any resident lunch that offers something other than pizza.

___



MBK2003

 

[Poety]

Ok, now i"m frekaing out. I've been doing all this gardening, perhaps I should be studying or something?

 

[OldPsychDoc]

Ok, now i"m frekaing out. I've been doing all this gardening, perhaps I should be studying or something?

I didn't see anything in Doc's post above about studying.
Tend thine azaleas, and allow the CN to eat some good healthy dirt.

 

[Poety]

I didn't see anything in Doc's post above about studying.
Tend thine azaleas, and allow the CN to eat some good healthy dirt.

She prefers eating ferns DUH! 😛 😉

 

[Doc Samson]

Ok, now i"m frekaing out. I've been doing all this gardening, perhaps I should be studying or something?

Studying? STUDYING??? Why would you want to go and do something like that? Deep breaths Poety, deep cleansing breaths. Or... throw Different Class on the stereo and sing along to Common People at the top of your lungs... that always works for me.

 

[Poety]

Studying? STUDYING??? Why would you want to go and do something like that? Deep breaths Poety, deep cleansing breaths. Or... throw Different Class on the stereo and sing along to Common People at the top of your lungs... that always works for me.

I WANNA LIVE LIKE COMMON PEOPLE, I WANNA SLEEP WITH COMMON PEOPLE LIKE YOU LALALALALALALALALALA

 

[Anasazi23]

DO remember that when faced with a difficult decision, the correct answer usually involves less sleep.