nebuchadnezzarII

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I'm trying not to be overdramatic here, but I'm dying. AMG, did fine in medical school, dead average on STEP 1-3. Just finisheda few months of psych and performed pretty solidly as an intern. But now? I'm on medicine and it's more difficult than I had imagined. A large contributing factor to this is that I was never able to take my medicine subinternship/acting internship during 4th year because a bunch of my rotations were cancelled due to COVID, back in March.

So...I kind of graduated with incomplete credentials. The last time I took internal medicine was in December, 2-years ago, as a third year medical student. Yep. And I have only done psychiatry as an intern thus far. Because of COVID, and this being a big city, the patient census is extremely high. I have about the same responsibilities as other IM interns but I don't know jack **** (even if my passing scores on USMLE say otherwise). I am performing poorly on the rotation thus far. I'm just a few days in, and I'm asking my resident for help on everything.

Does anyone have any advice for me? I am feeling very overwhelmed with the patient load and the expectations, even though I am technically an "extra intern" on the medicine team. Good thing is I have a week of vacation soon and maybe I can do something to change my downward trajectory? I do not want to be dismissed as an intern for failing internal medicine. My main problems are as below:

1) It is very hard to present for me. My presentations are garbled garbage. When the attending asks for a specific history or lab value of the patient I can't pull it off my paper off hand. On psych, I get in a little early, write out a little blurb, check the labs, etc. On medicine, there is TOO much to check on and I find it extremely hard to present new patients since there is not enough time. Is there a specific flow to the morning/day you recommend following? For me, I need some time to synthesize and put together what I'm doing before I can present, but I am just overwhelmed with the number of patients that I don't have time to do a thorough chart review/pick out history.

2) When I do a physical exam, I have no idea what I'm looking for. It's been almost 2 years since I've done a legit physical lol. Help.

3) How do I stay organized? Consults come and go throughout the day and the nurses constantly message me for small thing (re-order lab please, patient had a bowel movement, etc.) and I can't seem to keep on top of it. For example, if I'm running an antibiotic on someone and then ID comes in the middle of the day and recommends a change, all the while I'm doing 10x other things, how do I reflect that change throughout the day? In my note?

4) Are there any places where I can look up basic "to-dos" or basic algorithms when on call? For example, what do I do if a patient has low O2 sats? What if they have low glucose? I know the simple answers on a test (give oxygen, give glucose/dextrose/etc.) but I find it really difficult in real life with real patients. I feel like a medical student again.

5) All that said, I did learn a hell of a lot in just a few days as a medicine intern. If the hours weren't garbage and the responsibility wasn't real, it would ALMOST be kind of fun. I'm trying to keep up a good attitude but I feel really useless and stupid and I'm positive that the attending thinks I'm intellectually challenged.
 
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BorntobeDO?

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Just show up. I can already tell you will greatly improve by the end of your first block. Keep it up, and use this as a reminder why you choose psych later when something annoying happens.

no one masters anything without practice.
 
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nebuchadnezzarII

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Just show up. I can already tell you will greatly improve by the end of your first block. Keep it up, and use this as a reminder why you choose psych later when something annoying happens.

no one masters anything without practice.
Haha thanks. I do hope so but I just have a hard time seeing myself being functional. Just gonna try to stick it through and give it my best. All I can do. And you’re right. The worst day in psych is better than the best day in medicine.
 
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Everyone who isn't going into medicine or related fields is feeling you hard right now. I came from a DO school and matched a top tier coastal program, and the first couple of months of medicine were an absolute crapshow. I felt like a complete imbecile 99% of the time. Trust me when I tell you it gets better. Hang in there.

More concretely,

1) can you pull up epic on your phone? This was probably the biggest game changer for me. No wasting time in the morning prerounding and making sure I write everything down on paper. Instead, I use the EMR to my advantage. I mean either way, you're not gonna memorize you're 6-10 medicine or ICU patients, so it's not like you'll look bad for depending on your phone.

2) Do not update your notes. For the love of god, just don't. Try to get them signed and ready asap, sometimes even before rounds, and let the chips fall as they may.

3) Regarding synthesizing and plans for patients: I'm awful at this. Easy to do for old, stable patients, but if I'm overwhelmed with patients I honestly just yolo the plan for new patients. So no good advice here, just saying I can relate. Obviously if the census is low and I have time I try to at least come up with something using uptodate (rarely happens).

4) DO THE SAME THING EVERY SINGLE DAY YOU PREROUND. Meaning, check the same tabs on EMR and be as robotic as possible. That way you don't miss the small things. My interpretation of intern year is that you're gathering info for the team. They can figure out the rest, but do you job well, so they can do their better, and therefore more time for teaching.

TBC... (I'm dying in the ICU right now, no time!)
 
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Agree with above. Notes are a snapshot in time. The ID doc also will be writing a note with recommendations, which can be referenced. If you get your notes in early one part of your plan can be “antibiotic regimen x currently, ID following will appreciate recs”

impossible to know everything about a patient. There isn’t an internal medicine person alive who answered an attendings every question. If you have cointerns during rounds they can help fill in some gaps. You *should* know overnight events, important things you are following and the major reasons why the person is in the hospital and what you are doing about it and any dynamic changes to that thru the morning. At this point, I wouldn’t sweat if the attending asks you a question about a less important detail and you don’t know. This is normal and what interns go thru literally all the time. And everyone knows that you’re off service.

Physical exam: everyone should get a cardiopulmonary, abdominal and basic neuro exam (like, mental status and making sure they are moving their limbs the same way they always have). Heart sounds should be audible and regular, lungs should sound clear with possible exception of mild bibasilar crackles in patients who spend all day in bed (and they will need to sit up for you to hear this). Abdomen should be soft, and the patient should be mentating and moving normally. Target your examination beyond these basics that everyone gets based on the chief complaint and reason for hospitalization. Are they there for a diabetic foot infection? It’s not always feasible to take down the dressing but you can time with other services about how to visualize together but it should be seen. Are they there for a heart failure exacerbation? Try your best to see JVD (patient supine watch their neck and see if their facial hair at their jawline is pulsating, or their earlobe, press on their belly to see if this pulsation becomes more prominent), see where they are at with pedal edema, lung sounds. Etc etc rinse repeat

consolidating this massive amount of info is hard, and you’re not going to feel great at it (and you aren’t great at it, and that’s okay cus that’s the point). But always come back to chief complaint/reasons for hospitalization. Focus your stuff from there.
 
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I'm trying not to be overdramatic here, but I'm dying. AMG, did fine in medical school, dead average on STEP 1-3. Just finisheda few months of psych and performed pretty solidly as an intern. But now? I'm on medicine and it's more difficult than I had imagined. A large contributing factor to this is that I was never able to take my medicine subinternship/acting internship during 4th year because a bunch of my rotations were cancelled due to COVID, back in March.

So...I kind of graduated with incomplete credentials. The last time I took internal medicine was in December, 2-years ago, as a third year medical student. Yep. And I have only done psychiatry as an intern thus far. Because of COVID, and this being a big city, the patient census is extremely high. I have about the same responsibilities as other IM interns but I don't know jack **** (even if my passing scores on USMLE say otherwise). I am performing poorly on the rotation thus far. I'm just a few days in, and I'm asking my resident for help on everything.

Does anyone have any advice for me? I am feeling very overwhelmed with the patient load and the expectations, even though I am technically an "extra intern" on the medicine team. Good thing is I have a week of vacation soon and maybe I can do something to change my downward trajectory? I do not want to be dismissed as an intern for failing internal medicine. My main problems are as below:

1) It is very hard to present for me. My presentations are garbled garbage. When the attending asks for a specific history or lab value of the patient I can't pull it off my paper off hand. On psych, I get in a little early, write out a little blurb, check the labs, etc. On medicine, there is TOO much to check on and I find it extremely hard to present new patients since there is not enough time. Is there a specific flow to the morning/day you recommend following? For me, I need some time to synthesize and put together what I'm doing before I can present, but I am just overwhelmed with the number of patients that I don't have time to do a thorough chart review/pick out history.

2) When I do a physical exam, I have no idea what I'm looking for. It's been almost 2 years since I've done a legit physical lol. Help.

3) How do I stay organized? Consults come and go throughout the day and the nurses constantly message me for small thing (re-order lab please, patient had a bowel movement, etc.) and I can't seem to keep on top of it. For example, if I'm running an antibiotic on someone and then ID comes in the middle of the day and recommends a change, all the while I'm doing 10x other things, how do I reflect that change throughout the day? In my note?

4) Are there any places where I can look up basic "to-dos" or basic algorithms when on call? For example, what do I do if a patient has low O2 sats? What if they have low glucose? I know the simple answers on a test (give oxygen, give glucose/dextrose/etc.) but I find it really difficult in real life with real patients. I feel like a medical student again.

5) All that said, I did learn a hell of a lot in just a few days as a medicine intern. If the hours weren't garbage and the responsibility wasn't real, it would ALMOST be kind of fun. I'm trying to keep up a good attitude but I feel really useless and stupid and I'm positive that the attending thinks I'm intellectually challenged.
You’re a psych resident off service..who cares how you do? You don’t fail by doing poorly on off service rotations, they’re off service for a reason everyone knows you don’t care, just don’t be unprofessional and move along..that’s all anyone can expect
 
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nebuchadnezzarII

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You’re a psych resident off service..who cares how you do? You don’t fail by doing poorly on off service rotations, they’re off service for a reason everyone knows you don’t care, just don’t be unprofessional and move along..that’s all anyone can expect
Wow...okay I will try to adopt this attitude. Thank you.
 
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Crayola227

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Have the link?
 
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rokshana

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Wow...okay I will try to adopt this attitude. Thank you.
No...don’t do this...dont underestimate the off service rotation...you may not fail a psych year...but you certainly can fail an off service rotation and then will need to repeat it...and this is not an elective but a requirement for most psych residencies...has the potential to delay your graduation if you fail enough of them.
Do what you can to be reachable and willing to work...show up early if need be to get what you need to get done... if you can access your emr at home or on your phone that can help. Ask your senior or fellow intern for tips how to organize and present better.
I had issues with reading ekgs when on a cardiology rotation...and the attending noticed...I asked the fellow to go through my pts ekgs with me before rounds so I could answer the questions correctly at rounds. Most people are willing to help.
 
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Giovanotto

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No...don’t do this...dont underestimate the off service rotation...you may not fail a psych year...but you certainly can fail an off service rotation and then will need to repeat it...and this is not an elective but a requirement for most psych residencies...has the potential to delay your graduation if you fail enough of them.
Do what you can to be reachable and willing to work...show up early if need be to get what you need to get done... if you can access your emr at home or on your phone that can help. Ask your senior or fellow intern for tips how to organize and present better.
I had issues with reading ekgs when on a cardiology rotation...and the attending noticed...I asked the fellow to go through my pts ekgs with me before rounds so I could answer the questions correctly at rounds. Most people are willing to help.
I'd say a mixture of this attitude and the one above is the sweet spot.
 
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RangerBob

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No...don’t do this...dont underestimate the off service rotation...you may not fail a psych year...but you certainly can fail an off service rotation and then will need to repeat it...and this is not an elective but a requirement for most psych residencies...has the potential to delay your graduation if you fail enough of them.
Do what you can to be reachable and willing to work...show up early if need be to get what you need to get done... if you can access your emr at home or on your phone that can help. Ask your senior or fellow intern for tips how to organize and present better.
I had issues with reading ekgs when on a cardiology rotation...and the attending noticed...I asked the fellow to go through my pts ekgs with me before rounds so I could answer the questions correctly at rounds. Most people are willing to help.

I agree with this. I was a TY and on my off service rotations expectations were often lower than for the categorical residents, but I was still a doctor and still expected to do more than just show up.

Also, don’t underestimate how valuable medicine rotations are for psychiatrists. The best psychiatrists I know are also really darn good at internal medicine. Psych doesn’t operate in a vacuum—minds have bodies.
 
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One thing that helped me. Writing out each patients name and then anything I needed to check on underneath it with a check box and I’d check it off as I went throughout day. Ex labs not available id have check mark to check them later, Or blood cultures urine culture or whatever. I started getting to hospital an hour earlier than what I tried to do first week and it made a huge difference. Your note is how you present to the attending so if your note is done before rounds you can use it as a template for what to say. Ask your resident if they’ll help you practice presenting a patient to help as well.
 
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Candidate2017

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You've got some good advice here, and I will add you should sit down with a kindly senior IM resident and pick their brain when there is a down moment.

You're probably just anxious. Subjectively, you feel like you're incompetent and will fail. Objectively, you're probably just like every intern. You will bumble, you will look foolish, you will get yelled at by the occasional rude attending/senior/RN. But you will survive, maybe even enjoy medicine. Most importantly, you are there to take away some useful things that will help you better serve your psych patients.
 

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Psychiatrist here. Do the best you can and take the rotation seriously. I wish I could tell you how many times my 2 months of IM came in handy in my job as an inpatient psychiatrist. It’s definitely hard to organzine and get in your groove. 100% agree with the idea of doing the same thing for every patient - I still do this today, I check labs, vitals, PRNs and consultant notes (and sometimes PMP) like a robot. Has never failed me yet. Seek feedback from your attending, they appreciate you trying to be a better doctor. Most importantly, practice some self compassion. You’re growing as a human being and doctor. Give yourself the space to grow but also stay accountable to what you need to learn to on the rotation be the best doc you can be. Balance between the two (even at the stage of the game I’m in) is a tough thing.
 
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Keladry

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I'm asking my resident for help on everything.
Good!!
As an IM resident who has supervised multiple psych & IM interns - this makes me so happy. The interns who ask me loads of questions (and look up what they can) are the ones I know are paying attention and know what they don't know. With extremely few exceptions, the interns who don't ask me questions are missing things and either don't care or don't know what they don't know.

Echoing the above advice - have a routine. For me, it's check vitals & write down any abnormalities, check labs & write any major abnormalities/trends, check overnight notes & orders (in case night float forgot to tell you they ordered blood cultures or whatever), go see patients, gather thoughts/start notes, then rounds.

For physical exam - listen to heart, lungs, push on belly, then examine anything specific to that patient (is their cellulitis improving, how's their JVD/lower extremity edema). It really should only take a minute max.

Best of luck!! You'll make it through and you'll learn lots by doing (and asking questions, and looking stuff up). Your attitude & want to improve goes a very long way toward surviving & improving.
 
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emergentmd

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Man, Brings back some good memories from yonder years.

My 1st rotation was General Surgery at one of the busiest Level 1 trauma center in the country. Walked in my first day at 330am b/c I knew I had to learn 20 pts for morning rounds. There was barely a car in the parking lot, dark/creepy walk through the hospital doors, up to the maze like floor to read through 20 charts before EMRs like trying to find 20 needles in a haystack.

It was no different than trying to learn 20 different languages. I thought I was the only idiot in the group.

Good memories. I passed. I am sure all interns felt the same way but no one was willing to admit/show weakness.

Fast forward a few years and I was a senior resident who was about to graduate. Felt like I could handle 99% of the medical cases in my sleep. Walked into shift and out of a shift like a BOSS walking through the park. The Off service interns, esp psych, I could tell had deers in the head lights look who wanted to be anywhere but the ER. All I could think was, I hope he learns something/does not kill anyone/leave me alone so I can run the dept. I had very little expectations other than having a good attitude and willing to learn.

This intern is you. I were you my 1st month in GS. This is the progression of an off service intern into an attending. It sucks, but learn to enjoy it b/c you will look back and wonder why you worried so much.
 
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Giovanotto

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Man, Brings back some good memories from yonder years.

My 1st rotation was General Surgery at one of the busiest Level 1 trauma center in the country. Walked in my first day at 330am b/c I knew I had to learn 20 pts for morning rounds. There was barely a car in the parking lot, dark/creepy walk through the hospital doors, up to the maze like floor to read through 20 charts before EMRs like trying to find 20 needles in a haystack.

It was no different than trying to learn 20 different languages. I thought I was the only idiot in the group.

Good memories. I passed. I am sure all interns felt the same way but no one was willing to admit/show weakness.

Fast forward a few years and I was a senior resident who was about to graduate. Felt like I could handle 99% of the medical cases in my sleep. Walked into shift and out of a shift like a BOSS walking through the park. The Off service interns, esp psych, I could tell had deers in the head lights look who wanted to be anywhere but the ER. All I could think was, I hope he learns something/does not kill anyone/leave me alone so I can run the dept. I had very little expectations other than having a good attitude and willing to learn.

This intern is you. I were you my 1st month in GS. This is the progression of an off service intern into an attending. It sucks, but learn to enjoy it b/c you will look back and wonder why you worried so much.
This one sentence explains why I sometimes hate medicine so much.
 

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This one sentence explains why I sometimes hate medicine so much.
I don't see why this is so bad. This is how we compete in life and in every field you go into.

If you are a group of new hire at Google, do you want to be looked at as the guy who appears nervous/unsure of himself? No, you walk in worried on the inside but confident on the outside. When I walk into a sick pt room and crashing all over the place, I act no different than when I am walking into a suture removal.
 

Giovanotto

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I don't see why this is so bad. This is how we compete in life and in every field you go into.

If you are a group of new hire at Google, do you want to be looked at as the guy who appears nervous/unsure of himself? No, you walk in worried on the inside but confident on the outside. When I walk into a sick pt room and crashing all over the place, I act no different than when I am walking into a suture removal.
You're conflating two different things. Be honest with your peers, and be brave with your patients.
 
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nebuchadnezzarII

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Just wanted to bitch a little and say that the Covid situation has made this much much worse. Hospital is literally overflowing now and all my patients are Covid positive. I’m carrying a lot more patients than what my predecessors usually did...but I’m somehow hanging in there. I’m really slow still but I think people know that I’m serious, diligent, and trying my best. I wish I didn’t have to do so many weeks of floor non stop and start internal medicine just as Covid is rising insanely, but trial by fire I guess?
 
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Just wanted to bitch a little and say that the Covid situation has made this much much worse. Hospital is literally overflowing now and all my patients are Covid positive. I’m carrying a lot more patients than what my predecessors usually did...but I’m somehow hanging in there. I’m really slow still but I think people know that I’m serious, diligent, and trying my best. I wish I didn’t have to do so many weeks of floor non stop and start internal medicine just as Covid is rising insanely, but trial by fire I guess?
I'm sure its overwhelming at times but it sounds like you're doing what you can.
 
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You survived.
2.5 more months to go. I think I have a better flow in the morning now. It’s helping. Still don’t know what I’m doing but I know when and how to lean on my senior if I don’t.
 
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nebuchadnezzarII

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I thought you were there a month. Hang in there.
Thanks friend. It’s a physical/mental “endurance test” at this point. I hate using that term given he population we work with in psych. But I don’t know how else to put it. They have us seeing ICU patients now because COVID has complicated a lot of things...patient volume is scary. But hey, no more nausea, palpitations, and sense of impending doom when I wake up anymore!
 
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Mad Jack

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You’re a psych resident off service..who cares how you do? You don’t fail by doing poorly on off service rotations, they’re off service for a reason everyone knows you don’t care, just don’t be unprofessional and move along..that’s all anyone can expect
I was expected to perform at the level of a medicine intern and would have been failed if my performance was garbage. If anything, I viewed it as my responsibility to look as good as possible so other services would respect us when working with us in the future
 
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I was expected to perform at the level of a medicine intern and would have been failed if my performance was garbage. If anything, I viewed it as my responsibility to look as good as possible so other services would respect us when working with us in the future
Sorry to hear that
 

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Sorry to hear that
I don't know why you'd be sorry to hear that I was respected enough that I was expected to perform with the competency of a physician while in residency. It was a great experience and I made some good friends on service. To this day I still have the respect of the medicine attendings and residents with which I worked due to my work ethic and dedication
 
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I personally just print all the labs and tests, and highlight anything pertinent. Then staple them. 10x faster than writing everything and no memorization. I kill a lot of trees but it takes me 5 seconds to find whatever the attending wants. Not a good solution long-term but I’m not going into medicine either, just placating the higher ups for a month...
 
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Wow, brings me back to intern year!

You get more efficient with time. Have a routine, streamline everything, get in and out of the room fast, and start developing plans and decisions while gathering data and prerounding and getting information. Eventually you’ll get to the point where you can make most of the progress notes while prerounding, while gathering important data, and will get right to the point on rounds.
 
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nebuchadnezzarII

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2.5 more months left. I’m getting more jaded at this point but still keeping up a good attitude. Patient load and CoVID makes things a lot worse. Still messing up on a couple of things but hanging in there as the runt of the litter. I wish there was a formal tutorial to address common inpatient problems. Starting to realize I will not use 90% of what I’m learning here...but smiling, nodding, and trudging along.
 
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2.5 more months left. I’m getting more jaded at this point but still keeping up a good attitude. Patient load and CoVID makes things a lot worse. Still messing up on a couple of things but hanging in there as the runt of the litter. I wish there was a formal tutorial to address common inpatient problems. Starting to realize I will not use 90% of what I’m learning here...but smiling, nodding, and trudging along.
Back during internship, in the words of George Harrison, "all those years ago", there was a psych intern that was so afraid of being on-call, he couldn't do it. Plain as that. I don't recall what they did, and some of the psych (and Ob/Gyn) interns on medicine were spot on, but others were questionable, but made it through, so, you will be fine. One day at a time. Remember, "No matter what you do, some people will die. Also, no matter what you do, some people will live!"

Recall, "Wouldn't give it up for a million dollars. Wouldn't do it again for 10 million dollars."
 
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Back during internship, in the words of George Harrison, "all those years ago", there was a psych intern that was so afraid of being on-call, he couldn't do it. Plain as that. I don't recall what they did, and some of the psych (and Ob/Gyn) interns on medicine were spot on, but others were questionable, but made it through, so, you will be fine. One day at a time. Remember, "No matter what you do, some people will die. Also, no matter what you do, some people will live!"

Recall, "Wouldn't give it up for a million dollars. Wouldn't do it again for 10 million dollars."
Thank you haha. I can empathize with that resident you mention. Great quotes too...so meaningful once you actually experience residency. Meaningless in medical school.

I think it’s extremely important to take it day by day. That way you can enjoy a good...err bearable...day and can wash your hands of a bad one.
 
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Just be transparent with your resident about your shortcomings. Hopefully they're willing to help you practice presentations, give tips for organization, etc. You're right that you really missed out by not being able to do a medicine sub-I. That rotation in medical school made the transition to intern year as smooth as it could have been. So the skills you didn't develop then have to be developed now: a way of printing off patient information and keeping check-boxes for all of the to-dos for those patients so that you can tackle tasks in an organized fashion and report to your supervisiors on key values and next steps that have not yet been completed.

I also wanted to note that it's 100% normal for a brand new intern (which you are, for medicine purposes) to need to ask their resident stuff frequently.
 
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clausewitz2

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I also wanted to note that it's 100% normal for a brand new intern (which you are, for medicine purposes) to need to ask their resident stuff frequently.

It's the interns who are too scared to ask when they don't really know that kill people.
 
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nebuchadnezzarII

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That gut-wrenching feeling of Monday morning is coming again. Just 2 more months. I can survive...I must.
 
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nebuchadnezzarII

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wait, are all your wards months back to back to back? When you gave the total time, I thought it was a discontinuous total.
Yep...back to back during peak Covid season. Getting some real adjustment disorder. I tried to come home and work on my hobby today but I just felt so mentally exhausted I stared at a blank wall for 30 mins. Lol
 
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Kaputt

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Yep...back to back during peak Covid season. Getting some real adjustment disorder. I tried to come home and work on my hobby today but I just felt so mentally exhausted I stared at a blank wall for 30 mins. Lol
Dude, I feel for you. You are taking me back to my intern days. Those days where you're there so long and you just feel so hopeless because you have to go straight to bed and wake up early to do it again...AHHH the worst. But you will power through it and your oasis of your chosen specialty will be waiting for you. It feels great when you get there.
 
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Giovanotto

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Dude, I feel for you. You are taking me back to my intern days. Those days where you're there so long and you just feel so hopeless because you have to go straight to bed and wake up early to do it again...AHHH the worst. But you will power through it and your oasis of your chosen specialty will be waiting for you. It feels great when you get there.
Yeah your program is killing you. I have a TON of wards and ICU this year, but it's staggered into 2/3 (only 1 all year is 4) blocks and almost always split by easier rotations/electives/vacations/etc. I'm finishing my 3rd week of wards right now and the F**ks I have to give are at practically zero.
 
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QuizzicalApe

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Yep...back to back during peak Covid season. Getting some real adjustment disorder. I tried to come home and work on my hobby today but I just felt so mentally exhausted I stared at a blank wall for 30 mins. Lol
Yowza. At my place not even the medicine interns did 3 months of wards back to back. The mere idea would cause a riot
 
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nebuchadnezzarII

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Halfway done. 2 more months...I feel like I’m running out of fuel. I’ve forgotten all the psych I learned too. Golden weekend coming up at least...
 
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nebuchadnezzarII

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7 more weeks 🤢 This is strange. I’m starting to feel genuine depression. Kind of funny since my spirits are always so high. Feels strange. It’s really kind of inhumane to keep an off service resident on medicine floors for this many months in a row lol...must hang in there.
 
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7 more weeks 🤢 This is strange. I’m starting to feel genuine depression. Kind of funny since my spirits are always so high. Feels strange. It’s really kind of inhumane to keep an off service resident on medicine floors for this many months in a row lol...must hang in there.
Lol let’s not take it that far..you’re practicing medicine you’re not a slave in the fields..not that big of a deal man just keep going you’re almost done
 
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