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Just curious because this is really starting to suck. I am so much dumber than I was as a 3rd year and quite frankly, it's scary.
So when do you stop feeling like a total idiot?
- Thread starter pillowhead
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December 12th, around 10am
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I am 10+ years out from my residency.
I still feel like an idiot on a regular basis.
The difference between housestaff and faculty is that faculty are comfortable feeling like idiots.
You laugh. You don't believe me. You will see.
I still feel like an idiot on a regular basis.
The difference between housestaff and faculty is that faculty are comfortable feeling like idiots.
You laugh. You don't believe me. You will see.
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I think it is a good sign if you feel dumber as an intern, because there is alot to know in medicine, and nobody can be a specialist on every field, but having awareness of your deficits is very helpful so that you can call your senior resident when you are in over your head. . . I am 99.9% sure that you know more now than you did as a third year both in terms of book and practical knowledge,. . . unless you use drugs or drink EtOH excessively.
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there's a lot to know in medicine, and it's unlikely that you'll ever know it all!
the key is to know what you know, be comfortable with that; and when you don't know something, ask for help- either from a fellow intern, resident, attending, or consultant (depending on the case/situation).
the key is to know what you know, be comfortable with that; and when you don't know something, ask for help- either from a fellow intern, resident, attending, or consultant (depending on the case/situation).
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I second this one. Around December-time, I had realized that I was at least somewhat of a doctor.
But seriously, July and August are the toughest. September still feels kinda new. By October you will know where the bathrooms are, you'll have developed a schedule that works for you, and most people will stop scurrying in at 5 or 6am for the wards.
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My new favorite quote!
👍
My Pathology professor at school used to tell us that "sometime during your 3rd year of residency something clicks...and things begin to make sense."
So if it just begins as a PGY3 then I imagine the process is a lifelong one!
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deleted87716
True. You more you learn, the more you realize how little you really know.
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Working in the ED, I keep getting stuck in the fiery arguments between services. Trauma doesn't want to admit, Neurosurg says discharge, ED says admit, be a patient advocate. Seems like as an intern you are set-up to be the town's idiot.
Or sometimes I get yelled at cuz i don't give a patient enough morphine for their pain, and the other time I get screamed at cuz i give the patient morphine before dispo and she drop 10 pts in systolic blood pressure.
Anyone with similar experiences?
Or sometimes I get yelled at cuz i don't give a patient enough morphine for their pain, and the other time I get screamed at cuz i give the patient morphine before dispo and she drop 10 pts in systolic blood pressure.
Anyone with similar experiences?
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If a physician has evaluted a patient and does not feel they merit admission, then admitting them is not being "their advocate." If you personally feel they need to be admitted and YOU took care of them, then fine. But "feeling" like someone else needs to take care of someone isn't advocating, it's just irritating and largely baseless. Unless you think you know Neurosurgery better than the Neurosurgeons (and I'm not a neurosurgeon) down in the ER.
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This is exactly what I'm talking about. The fight goes on and on. I don't mean to take one side vs the other. But as an intern you're simply relaying what one attending wants to another attending. Of course you care about your patient and wants what is best ... but regardless the ultimate decision isn't yours. You get caught in between and you end up hated by both services.
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Sometimes it's the attendings within the same dept. For example: On the inpatient rehab unit, did my usual H&P workup where the plan is problem based, listed 1...2...3. Then I get it from one attending who likes to list plan as systems, more paragraph form. So I do that, figuring that's how its done in rehab. Then I admit for another attending and get slammed for writing it that way. So no matter what, you are the idiot.😕
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Blade28
As you advance in PGY level, the pain doesn't lessen. It just changes.
Trust me.
Trust me.
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Yes, I understand that you're caught in between two people. But the point is that the "fight" is one that doesn't even make any sense. The ER is trying to get someone admitted after they have been evaluated and deemed to not require admission. Does that make sense to you? Because it doesn't to me, but it happens all the time. But it's great because the people who want the person in the hospital for no good reason are the ones who don't have to actually take care of the patient. Again, what is the "fight"? That's like saying I'm "battling" a girl because I'm trying to have sex with her and she's refusing. That makes sense to the ER because they're the ones getting rejected.
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Right on the money, which is why it's good for EM to do rotations outside the ER. I dont blame the ER though, they are stuck needing to get rid of the semi-sick patients (which if you sit back and think about it... it's the reason why they have a job in the ER to begin with, cause anyone can tell you that a REALLY sick patient needs to be admitted or that a not sick patient here to refill a prescription doesn't need admission).
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That's fine, but people either need to be admitted or do not. People who admit patients "just in case" are not doing their patients a service and are also not practicing medicine. It's one thing if you can tell me why you (not you, personally) want someone admitted and make sense. It's another if you (not you, personally) just say, "I think they need to stay" and then trail off and mumble. That's pitiful, not persuasive. Can they admit people "over your head"? Sure, and they do. Great, so they've proven they have "more power," but less brains. All that happens is that the person sits in a bed, gets discharged first thing in the morning, everyone else has to do lots of paperwork, it waste's everyone's time (doctors, nurses), and nobody in the ER feels the impact. They just know they "won" a battle and, more importantly, have been spared the risk of taking responsibility for a decision. Good job, fellas.
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How so?
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I totally agree. Totally.
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Blade28
*Q4 in-house call becomes Q2 home call.
*Floor scut becomes ICU scut.
*Pre-rounding on the entire floor service becomes pre-rounding on the entire ICU service.
*Dealing with the nitty-gritty of the service (paperwork, social work, discharges, etc.) becomes dealing with every single consult that comes in.
*Pre-op and floor admission H&Ps become ER, consult and ICU H&Ps.
Etc.
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*Work hour rules meant for everyone, become meant only for junior residents; someone has to stay and do the worl
*Remembering the idiosyncrasies of each attending and imparting that wisdom to the team (ie, this attending wants Drug X on all patients needing GI prophylaxis, that attending prefers attending Y when consulting specialty Y, etc.)
*Higher expectations as you become more senior
*When juniors make mistakes, its because you didn't teach them the right thing to do
*Time crunch to learn as much as possible before being thrown to the wolves as the new junior attending
*Remembering the idiosyncrasies of each attending and imparting that wisdom to the team (ie, this attending wants Drug X on all patients needing GI prophylaxis, that attending prefers attending Y when consulting specialty Y, etc.)
*Higher expectations as you become more senior
*When juniors make mistakes, its because you didn't teach them the right thing to do
*Time crunch to learn as much as possible before being thrown to the wolves as the new junior attending
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Blade28
In addition:
As an intern, you try to just do the floor work and survive.
As a PGY-2, your job is to teach the med students and intern.
As a senior resident, your job is to teach the junior residents.
Etc.
As an intern, you try to just do the floor work and survive.
As a PGY-2, your job is to teach the med students and intern.
As a senior resident, your job is to teach the junior residents.
Etc.
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Is this another way of saying that there are different flavors of Cool-aid at advanced PGY levels?
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Blade28
Yeah, basically.
It's not that we become more immune or resistant to the pain dished out every year - it's just that none of it is a surprise anymore.
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Sounds like I'm getting the best of both worlds already!
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