Residency makes a lot of people bitter/angry/resentful

[platon20]

I'm a pretty laid back guy. I never yell or get agitated about anybody.

But residency has really changed me and it sucks and I dont like the change its made in me. Now I find it hard to go out of my way to be nice to people, especially nurses. I'm not outright rude to them or anything, but I know that whenever I step out into the hallway to do one simple thing, about 50 nurses are going to accost me to do a bunch of **** I really dont have time to do. It makes me angry, resentful and I hate that feeling. It just comes out because I just DONT HAVE TIME TO DEAL WITH THAT CRAP and I'm tired of people bugging me. Its not the nurses fault, its not the patients fault, its the SYSTEM'S FAULT for screwing me over by making me cross cover and micromanage too many small ****ing details at the same time.

I'm on internal medicine, and we have a traditional Q4 system. We have to cross cover about 75 people and usually admit anywhere between 4-10 (cap at 10). Whenever I'm walking down the hall to go to the ER to admit yet another patient, I can feel the nurses eyeing me and waiting to jump out and grab me so they can let me know that room 10 doesnt have a diet order, or that room 15 is complaining of chest pain, or that room 8 stopped breathing. Its just too much ****ing stuff for one person to handle. I find myself wanting to bitch slap anybody who tries to get my attention--because I know its going to result in me having to spend at least a few minutes putting stuff in the computer or god forbid go to bedside and therefore let the ER admits keep stacking up against me.

I'm losing the happy go lucky personality I used to have. Its not hte patient's fault, its not hte nurses fault, its the SYSTEMS FAULT. Now I understand why docs are so cranky and treat nurses and others so badly. We're all overwhelmed and pissed off about having more **** put on our plate.

End of rant.

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[nsap102]

I guess you're an Intern. Usually by PGY-2 year things seem a lot less overwhelming.

I hear your frustration and have shared it at one time or another. Furthermore, we're not the only ones. I'm sure many others like you feel the same pains and frustrations.

The key is to face it and learn how to deal with it. That's the hardest part and once you figure it out, things will sail a lot more smoothly for you. No matter what you do, you cannot change the system. Don't bother fighting it. Its like throwing a brick at a rock the size of a city.

Take the system a part bit by bit and master it. For myself, I learned to embrace the RN's and smile at them even if I'm overwhelmed (which I only figured out recently). Figure out which RN's you trust and which ones to take seriously. If they want you to see a patient they think is unstable then go. Sometimes, I'll ask the RN directly if this is something that can wait or something which needs taken care of now. As for the other RN's who may be full of it, tell them that you've got a couple of things on your list which require more urgent attention and that once you've finished you'll get to them.

Overall, be nice to the RN's, but don't be afraid to share your "list of things to do" because it lets them know that you really do have a lot of work. Be nice to them and in the future they'll think twice about calling you for things which may be dealt with the next day. Give orders over the phone if you're comfortable (i.e. advance the diet if tolerating and patient not NPO).

Also, when you get a chance, i.e. have a chill night, then go do the things the RN's ask you. They'll pay you back later on in the night by letting you sleep, not mention in the future when you're busy by not bothering you.

Also, make sure you get good check out from the other teams. Figure out which of thier patients are seriously ill and so when you're called you know who to go see...and of course who not to worry about too much. During check out make note, or even directly ask, if a team has taken care of this situation (i.e. I got check out that a 80F was waiting for surgery so I asked the team if she was NPO and if she was on fluids...turns out that no one had bothered giving her fluids for 48 hrs. This would havfe caused touble during the night...especially if she went into surgery).

GL

 

[sandraf]

platon20:
I'm sorry to hear that. It sounds like a very difficult situation, no wonder you are not recognizing yourself under such pressure and being overworked like that. I hope things will get easier as you go and start to adapt and learning what works and what doesn't.
I have a question, though: is it like that for everybody, are all the interns having these type of difficulties? Isn't there any person you could maybe talk to, as a group, and ask for help, try to find a way to make it more bearable? I may be naive, but sometimes voicing it the right way to the right person may lead you somewhere. Sorry if you only wanted to vent, not to hear any suggestion.
I'll be praying everything will get better for you.

 

[plainfacts]

I'll be praying everything will get better for you.

I'm sure that will be of great help. God will probably take a break from randomly giving out malignant cancers just to help the OP.

 

[sandraf]

Wow, plainfacts! I start to doubt your "fair AND balanced" statement. Or does it refer only to McCain?
I believe God will. Help. Whoever asks. But that's just me.
Peace!

 

[radslooking]

Yep. Consider another specialty.

 

[dragonfly99]

This is kind of typical for a medicine intern, although your crosscover list sounds a bit long. This is kind of a typical situation, especially in places where there is no night float. I wouldn't suggest going to any authority figures for "help" as they'll just tell you it's a part of the learning process, that you need to become more "efficient" and then will have time for everything, etc. There may be a grain of truth in that, but mostly it is as you suggest - a system problem which nobody plans to fix because they have you, the underpaid medicine intern, to deal with it. I think crosscover on a medicine service is particularly onerous because you generally have multiple sick, elderly patients and also other social admissions, etc. (i.e. personality disordered or homeless or drug seeking patients, etc.) who tend to have issues that come up and take up your time when you are trying to do admissions.

I don't have many suggestions besides those posted above...try to get good signout so you can anticipate problems, and do go to the bedside to assess any patients that sound like they are going south, and/or the nurses want you to see. Also, if you find that a patient doesn't have a lot of acute medical issues (i.e. young and all the major organs working well, and in the hospital for something kind of bogus...) but is sort of high maintenence and the nurses are always calling you, you can add PRN's to the chart such as Tylenol, Maalox, PRN laxative, etc. to try and avoid some of those calls ("patient says she is feeling a little constipated...she hasn't had a BM since this morning!" "patient says she has some burning in her stomach...yes, she did just eat 5 'fire engine' Tacos with jalapeno from the Taco Shack!"). But you have to be careful about PRN's...never put a bunch of PRN's on an old demented guy's chart b/c if he gets a sleeping pill and then gets snowed and totally confused in the a.m., that would be bad...

p.s. what you have posted is one of the reasons that people are shying away from primary care specialties...you become the dumping ground for other specialties and are overworked and underappreciated. Things will get somewhat better when you are a PGY2.

 

[elwademd]

This is kind of typical for a medicine intern, although your crosscover list sounds a bit long. This is kind of a typical situation, especially in places where there is no night float. I wouldn't suggest going to any authority figures for "help" as they'll just tell you it's a part of the learning process, that you need to become more "efficient" and then will have time for everything, etc. There may be a grain of truth in that, but mostly it is as you suggest - a system problem which nobody plans to fix because they have you, the underpaid medicine intern, to deal with it. I think crosscover on a medicine service is particularly onerous because you generally have multiple sick, elderly patients and also other social admissions, etc. (i.e. personality disordered or homeless or drug seeking patients, etc.) who tend to have issues that come up and take up your time when you are trying to do admissions.

I don't have many suggestions besides those posted above...try to get good signout so you can anticipate problems, and do go to the bedside to assess any patients that sound like they are going south, and/or the nurses want you to see. Also, if you find that a patient doesn't have a lot of acute medical issues (i.e. young and all the major organs working well, and in the hospital for something kind of bogus...) but is sort of high maintenence and the nurses are always calling you, you can add PRN's to the chart such as Tylenol, Maalox, PRN laxative, etc. to try and avoid some of those calls ("patient says she is feeling a little constipated...she hasn't had a BM since this morning!" "patient says she has some burning in her stomach...yes, she did just eat 5 'fire engine' Tacos with jalapeno from the Taco Shack!"). But you have to be careful about PRN's...never put a bunch of PRN's on an old demented guy's chart b/c if he gets a sleeping pill and then gets snowed and totally confused in the a.m., that would be bad...

p.s. what you have posted is one of the reasons that people are shying away from primary care specialties...you become the dumping ground for other specialties and are overworked and underappreciated. Things will get somewhat better when you are a PGY2.

nice post. nothing to add.