Abandon Hope All Ye Who Enter Here ----
heheheh --- you are screwed, doo'd and tattoo'd --- heheheh --- Ah, yes, fresh meat on the service -- all you can hope for is kind upper levels who actually want to help you --
My experience sucked -- the seniors didn't teach anything, period -- worked hard to make fools out of the interns, fed us wrong information and never owned up to it, would make us wait during nighttime checkout while they BS'd with their friends who were coming on as night float without releasing us to go home, while they didn't make us they strongly hinted that if we didn't sandbag our hours, we would get chewed out/questioned as being incompetent because we couldn't do "everything" in the 40hours (or whatever) allotted.... hell, they treated medical students with more respect and taught them more than their own interns.....
Now, real upper levels/services will generally have a few weeks to get you signed off on all procedures, have noontime teaching conferences with specialists, let you have responsibility for less than 10 patients, set up a learning environment where you can ask questions, etc. You'll come out of your first month feeling a bit shellshocked but confident, 2nd month -- you got this -- 3rd month -- no sweat, do it in my sleep.
What can you do? Well ---
1) Run through admission orders -- most are automated but just go through them and look up the considerations now -- pay attention to DVT PPx, GI PPx, PRN meds -- pain, fever, HTN, cough, etc. with orders to contact you if it's a new occurrence.
2) also look at when do you order PT/OT evals, ambulation orders, activity orders, dietary orders
3) recall the basics of: CHF exac, COPD exac, DKA, hyperglycemia, cellulitis, asthma exac, pancreatitis, cirrhosis with ascites, pneumonia, DVT, pulmonary embolism, hypo/hypernatremia with FeNa and the other one you use when they're on diuretics -- you know, most of the stuff they get admitted for --- if your residency is anal retentive, you might memorize Well's/Ranson's criteria, PNA admission criteria (I forget the name), and the basics of treatment for the common admissions;
4) recall how to correct potassium, magnesium.
Get a Pocket Medicine by Mass General (used to be a little red book) -- they make blank pages the size of the book -- you can find what you need in there and use blank pages to make notes -- keep that freakin' book -- you'll use it until you graduate -- and afterwards if you're going to be a hospitalist...
5) Get good at reading EKGs and XRays -- highly pimpable material --- learn how to correct hyponatremia/hypernatremia -- again, highly pimpable material.
If you've got all of the above, you're ahead of the game -- expect shell shock -- now you're responsible ----
ONE KEY POINT: "I don't know" is not an acceptable answer --- ever; "I'm not sure, let me check on it and get back with you" is ok -- it implies that you're concerned, proactive and taking responsibility as a physician.
ANOTHER KEY POINT: You're a physician now -- act like one --- as an intern, I expect you to be able to identify a patient over a water fountain 2 out of 3 times, know how to do a PE, take an H&P -- at least have the info and give it to me in a coherent fashion and have a rough idea of the large chunks of what could be going on and the basics of what to do --- for example -- "Sir, this is a 54 y/o WM with a 3 day history of fever and productive cough. He's got a 40 p/y history of smoking and quit 2 years ago. He now has COPD -- given this, he's being admitted for a COPD exacerbation -- I'm starting A/A nebs Q2H, steroids Q6H and IV abx QD -- 2L of O2 by NC to keep sats above 92" That's your one liner to let me know you've got this under control -- I'll expect a formal presentation later when your note is done -- if I ask, and I will, you better have a choice of abx and dosage ready and be able to defend why that one rather than choice 2 or 3. It would impress me if you could cite the criteria you're using to help you make your decisions.
In other words, talk to me as a colleague -- remember your place on the team (i.e. don't be disrespectful or challenging in your attitude) but communicate to me like you're a physician, not some student who blows things off or isn't aware of the totality of the picture. Make me think you've got it under control -- I will be checking up on you either directly by prowling the chart or indirectly by talking with your upper levels who I trust -- don't try to BS me -- If you make a mistake, own up to it.
Also -- DO NOT try to pass blame for your screw-ups onto someone else -- that will make me want to squash you like a bug -- don't make me squash bugs.
If you don't know, look it up -- if you have questions, demonstrate that you have looked it up ("Sir, the book says that in this situation, we should use this abx for the patient -- it does look like he fits that criteria but I'm not sure. I couldn't find anything in the literature to say one way or the other?) and then ask the questions -- hopefully, your seniors will take care of this and coach you to make you look good.
And for God's sake, get there before the seniors do and leave when you're told to or after the seniors leave when the work is done. It's a right of passage.
