Staying organized, intern year tips

[Eyeaboutthat]

Hi SDNers, with intern year underway, I'm finding one of the toughest parts of the job learning how to keep track of everything for each pt. Many times we'll get a consult during the day and I'll be trying to go through all the labs, vitals, imaging for the patient, (not to mention putting in admit orders and answering calls for other patients) and before I even completely understand what we're dealing with, senior residents or attendings will already be asking for my thoughts on management. How do more senior residents approach a new patient and what are some good ways to keep track of impt info for each patient (such as when next set of labs will be, what antbiotics patients are on, what maintenance fluids, what their ef was on that echo from 3 months ago, how much they got of this vs that medication)?

Thanks!

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[lulu09]

Are you on a medicine/subspecialty consult service or are you the primary team on a medicine service? It's kind of confusing from your post above.

Regardless, you will get better with more practice. I think what medical students and interns struggle the most with is weeding out what is irrelevant and paying attention to what is relevant (separating out the wheat from the chaff, if you will). Unfortunately, there isn't a magical way to teach this. With time, you will get better at "thinking like an attending" and paying more attention to what is relevant and disregarding what is not. A common fallacy in interns is to regurgitate a complete list of lab values every single morning during prerounding, and honestly most attendings do not care about every value (for example, I think I have seen the Cl- value (not as part of an anion gap calculation) be actually important exactly once in 3 years of residency). If they truly care about something, they'll ask you for it. The tricky thing though is to figure out what these things are.

To learn what is important, the best way is to have a systemic way of gathering relevant data on every patient. For example in every new admission, go from the CC to PMH to medications to exam to labs to imaging, focusing most on how they connect with the CC. For instance, just to name a few things, data collection in a CHF patient would be focused on last TTE and LVEF (PMH), BB/diuretics/aldactone (medications), LE edema/JVD (exam), BNP (labs), CXR (imaging). In a cellulitis/OM patient you would care about any outpatient therapies tried (PMH), current antibiotics and their coverage spectrum (medications), fevers/vitals/extent of disease marked by pen/vitals (exam), WBC/CRP/ESR/cultures (labs), XR/MRI (imaging) for example. A TTE will be more relevant in the first and a CRP will be more relevant in the second. You can't possibly remember everything about every patient from the chart, so you need to focus on what is relevant. Never go into a random data collecting mode frenzy without thinking about the significance of the things you're looking for. If you routinely ask yourself these questions, you'll be able to anticipate better what your senior and attending will be asking you for and quickly come up with a management plan for new admissions.

 

[Crayola227]

I've written some posts about being an intern that addresses this. It's partly specialty and attending dependent if they care if you can recite the Cl- value on demand on every patient or not, and that's more true early in the year. Regardless, the system you create now for going over everything will have value for when you don't have to regurgitate it all anymore.

The system you develop for morning pre-rounds, time in the room with patients, keeping track of PE, notes, important values, d/c of med courses like abx, etc I would argue matters and much of it will continue to serve you from intern day 1 to being a senior to an attending.

I didn't really have enough responsibility in med school to develop a system in response to pressure. I had to do it intern year. I share what I went through.

First of all, there is no "shining" as an intern. There's just differing levels of pain and humiliation. Create a reasonable goal for yourself, which isn't shining special snowflake, but surviving.

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Be as CYA saavy as @Law2Doc . He is a shark and just the sort of mindset you will be dealing with and needing to impress in many of your attendings/admin. Everything that @Perrotfish ever said, just remember almost none of your attendings will be as cool as him. I think @Doctor4Life1769 gives great advice especially on politics. @aProgDirector gives great level advice but I wouldn't go in expecting your PD to be as reasonable as they are. Check out their past posts on stuff to learn more about how things work.

My personal mantra, is that your job is to be safe, fast, and pleasant, in that order. Also, you are a notemonkey making love to a pager. Keep your head down and don't make waves.

As I say in my posts above, get as much admin crap out of the way before you start, learn your EHR if you can, gather resources to make your life easier (white coat pocket cards, USEFUL review books, and phone apps), and as others said, live as close to the hospital as you can, get all your affairs settled (dental work, car repairs, new tires, rental car benefit on your auto insurance, disability insurance, preventative care, IUD, dry cleaning, moving, and finding all the stuff you need in your new town like a new doc, drycleaner's, auto mechanic, etc) because you won't have time later.