Stuff They Should Tell You (But Don't)

[oompaloompa]

hey guys, I just started my first inpatient rotation and it seems to me that I had to learn a whole bunch of unspoken "rules" about hospital life from my own blunders or those of others. Maybe I'm an idiot, but some of these weren't so obvious to me at the beginning. Here's hoping that someone gets some good advice or a good laugh from this thread. Please add some "unspoken rules" of your own, here's some I learned.

Question: "That phone has been ringing for 10 minutes straight now, should I answer it?"

Answer: Absolutely not! It may seem like the responsible thing to take action, but the person on the other line will most likely send you on a wild goose chase looking for some person, object, or lab result you will never find. Not worth it.

Question: "There's a patient that's been crying and shouting "Help me!" for a long time now, and all the nurses are just ignoring him. Do they know something I don't?

Answer: You bet they do. Unless you want to be trapped in an endless conversation with Mr. Demento, Mrs. Delirious, or Ms. OldAndLonely, than watch the nurses and follow suit.

Question: I'm pretty sure my attending said something wrong, should I correct him?

Answer: Let it go, man. Even if they are wrong and you're right. Even if you're intentions are pure. They WILL remember how you made them look stupid and you WILL pay for it.

Question: There's a box of doughnuts at the nursing station. Are they for everybody?

Answer: You know how most nurses look like they ate an entire kindergarten class for breakfast? Well, they didn't get that way by sharing their food with students. I say hands off if you want to keep 'em.

Question: So where exactly do I fit in the power structure? Is there anyone I can order to do something?

Answer: Well let's go through the hierarchy, shall we. First there's the Chief, the Attendings, the Fellows, the Residents, .........(and so on).........the migrant dishwashers, the janitor they call when someone sh*ts on the floor, the homeless people that sleep in the ER waiting room, and then, oh yeah, you. The point is, the only reason anyone will do anything for you is pity. Or maybe sexual favors, but mostly just pity.

Hey guys, I'm still green and learning the joys of hospital life, so if any of our more experienced (read: cynical and jaded) friends out there have any interesting quirks to add, I'd love to hear 'em. Cheers!

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[San_Juan_Sun]

Remember, you are always "Just the medical student." If you act like anything else, you'll quickly get called on it.

But it has it's benefits too: when the nurse wants you to order some crazy sedative because the old guy in room 234 (who isn't your patient) didn't like his Jello, well... "Sorry, I'm just the medical student."

It's kind of weird. The staff views you as a doc (sort of). And the docs definately let you know you aren't one of them. You're kind of in a no man's land, but rest assured, if this were an airplane, you're the guy who who goes without the parachute.

Thankfully, the residents and interns are really cool usually. But they still won't give you their parachute.

 

[San_Juan_Sun]

One more thing. I was writing a note near the nurses station the other day, and saw a nurse running around frantically out of the corner of my eye. I kind of knew something was going on, and then she came up to me.

Her: "Are you a doctor?"

Me: "No. Sorry."

Her: "Are you a student nurse?"

Me: "Nope, I'm just the medical student."

Her: "Well, you can't help me then..." <scurrys off>

I think she needed help giving some meds or something. Nice to know that I can't be of service.

 

[worriedwanda]

Ok here are some I learned:

Don't get excited:
If one of your patients has something that seems incredibly wrong to you- DON'T run into the hall looking for whoever will listen that there's some sort of crazy emergency with your patient. There may be- but you'll definitely save face if you act calm- and ask you resident if it's "normal" that your patient's monitor looks like he's in V Tach. Then he'll go in and see that you're reading his pulse Ox and laugh at you anyway- but at least you didn't alarm the whole team and get all of them to laugh at you as well. (true story). Also- if you think that your patient's bowel just exploded when you listened to his abdomen- don't run out and tell the surgery team that they need to see him right away. They'll tell you to put in a consult, and make you feel really dumb (also happened to a friend).

"Help" the surgical staff set up the room:
Even if you don't have a clue how to take the OR bed apart, or move the patient- you'll be judged poorly if you don't look like you're helping. Usually you'll start off mostly getting in their way- but then you'll find ways to actually help.

 

[Hurricane]

One of my senior medical students gave me this sage advice: The secret to doing well in third year is "Be perky, and be early."

Other useful things to know:

If your resident tells you that you can go, go. Don't hang around in a misguided effort to look like a hard worker or whatever. You'll just get in the way and keep them from getting the work they need to get done so they can go home themselves.

When you are on call and it is a slow day, go to the call room and catch a few zzz's. Your body will thank you when you are admitting a patient at 3 AM. Just remember to take your pager off vibrate.

Don't call a consult unless you have all of the patient's demographic info in front of you, and you have a specific question for the consult team. If you don't know, ask your resident. "We'd like them to take a look at him" is not a valid reason, and the person on the other end of the phone will be very annoyed at you.

 

[JuicyMary]

hey guys, I just started my first inpatient rotation and it seems to me that I had to learn a whole bunch of unspoken "rules" about hospital life from my own blunders or those of others. Maybe I'm an idiot, but some of these weren't so obvious to me at the beginning. Here's hoping that someone gets some good advice or a good laugh from this thread. Please add some "unspoken rules" of your own, here's some I learned.

Question: "That phone has been ringing for 10 minutes straight now, should I answer it?"

Answer: Absolutely not! It may seem like the responsible thing to take action, but the person on the other line will most likely send you on a wild goose chase looking for some person, object, or lab result you will never find. Not worth it.

Question: "There's a patient that's been crying and shouting "Help me!" for a long time now, and all the nurses are just ignoring him. Do they know something I don't?

Answer: You bet they do. Unless you want to be trapped in an endless conversation with Mr. Demento, Mrs. Delirious, or Ms. OldAndLonely, than watch the nurses and follow suit.

Question: I'm pretty sure my attending said something wrong, should I correct him?

Answer: Let it go, man. Even if they are wrong and you're right. Even if you're intentions are pure. They WILL remember how you made them look stupid and you WILL pay for it.

Question: There's a box of doughnuts at the nursing station. Are they for everybody?

Answer: You know how most nurses look like they ate an entire kindergarten class for breakfast? Well, they didn't get that way by sharing their food with students. I say hands off if you want to keep 'em.

Question: So where exactly do I fit in the power structure? Is there anyone I can order to do something?

Answer: Well let's go through the hierarchy, shall we. First there's the Chief, the Attendings, the Fellows, the Residents, .........(and so on).........the migrant dishwashers, the janitor they call when someone sh*ts on the floor, the homeless people that sleep in the ER waiting room, and then, oh yeah, you. The point is, the only reason anyone will do anything for you is pity. Or maybe sexual favors, but mostly just pity.

Hey guys, I'm still green and learning the joys of hospital life, so if any of our more experienced (read: cynical and jaded) friends out there have any interesting quirks to add, I'd love to hear 'em. Cheers!

LMAO!

They're all true, but my favorite has to be the one with the donuts and the nurses

But don't worry, it gets better when you become a resident. I also showed your post to my students and we had a good laugh today

 

[sacrament]

Question: "There's a patient that's been crying and shouting "Help me!" for a long time now, and all the nurses are just ignoring him. Do they know something I don't?

I love this one. I've often commented that hospitals (hospitals!) are maybe the only place in the world where a feeble old lady can scream "Somebody help me!" for hours and hours on end and nobody, nobody, looks even remotely interested. This is happening on every floor of every hospital in the United States, even as I type this. And I could not agree more: never go into the room.

 

[oompaloompa]

hey guys, I just started my first inpatient rotation and it seems to me that I had to learn a whole bunch of unspoken "rules" about hospital life from my own blunders or those of others. Maybe I'm an idiot, but some of these weren't so obvious to me at the beginning. Here's hoping that someone gets some good advice or a good laugh from this thread. Please add some "unspoken rules" of your own, here's some I learned.

Question: "That phone has been ringing for 10 minutes straight now, should I answer it?"

Answer: Absolutely not! It may seem like the responsible thing to take action, but the person on the other line will most likely send you on a wild goose chase looking for some person, object, or lab result you will never find. Not worth it.

Question: "There's a patient that's been crying and shouting "Help me!" for a long time now, and all the nurses are just ignoring him. Do they know something I don't?

Answer: You bet they do. Unless you want to be trapped in an endless conversation with Mr. Demento, Mrs. Delirious, or Ms. OldAndLonely, than watch the nurses and follow suit.

Question: I'm pretty sure my attending said something wrong, should I correct him?

Answer: Let it go, man. Even if they are wrong and you're right. Even if you're intentions are pure. They WILL remember how you made them look stupid and you WILL pay for it.

Question: There's a box of doughnuts at the nursing station. Are they for everybody?

Answer: You know how most nurses look like they ate an entire kindergarten class for breakfast? Well, they didn't get that way by sharing their food with students. I say hands off if you want to keep 'em.

Question: So where exactly do I fit in the power structure? Is there anyone I can order to do something?

Answer: Well let's go through the hierarchy, shall we. First there's the Chief, the Attendings, the Fellows, the Residents, .........(and so on).........the migrant dishwashers, the janitor they call when someone sh*ts on the floor, the homeless people that sleep in the ER waiting room, and then, oh yeah, you. The point is, the only reason anyone will do anything for you is pity. Or maybe sexual favors, but mostly just pity.

Hey guys, I'm still green and learning the joys of hospital life, so if any of our more experienced (read: cynical and jaded) friends out there have any interesting quirks to add, I'd love to hear 'em. Cheers!

I need to make an addendum:

Question: The patient asked me to get him a soda/take the empty tray/find out what's for dinner, should I go ahead and do it myself?

Answer: Can't hurt to help a brother out, right? Wrong! Wrong! Wrong! Even though you have 20+ years of education, the patient now considers you his personal concierge. At first it may sound elitist, but you need to let the techs and nurses do their jobs so you can do yours. Of course you shouldn't ignore the request, instead consider a nice deflective responsive like "You can use the CALL NURSE button to ask about that". Anything that lets them know that cleaning and food service isn't really your area.

Call me an dingus if you want, but I didn't go through 7 years of higher education and acquire $100,000 of debt to bus the lunch tray of a homeless guy.

 

[DOCTORSAIB]

Call me an dingus if you want, but I didn't go through 7 years of higher education and acquire $100,000 of debt to bus the lunch tray of a homeless guy.

 

[loveumms]

I need to make an addendum:

Question: The patient asked me to get him a soda/take the empty tray/find out what's for dinner, should I go ahead and do it myself?

Answer: Can't hurt to help a brother out, right? Wrong! Wrong! Wrong! Even though you have 20+ years of education, the patient now considers you his personal concierge. At first it may sound elitist, but you need to let the techs and nurses do their jobs so you can do yours. Of course you shouldn't ignore the request, instead consider a nice deflective responsive like "You can use the CALL NURSE button to ask about that". Anything that lets them know that cleaning and food service isn't really your area.

Call me an dingus if you want, but I didn't go through 7 years of higher education and acquire $100,000 of debt to bus the lunch tray of a homeless guy.

I agree completely but, the only problem is 9 times out of 10 the nurses are talking on the phone or eating ice cream, the techs are mad b/c its their job to clean up patients messes (and they think they should be doing the 'better' jobs) so they are no where to be found.

 

[21JumpStreet]

I need to make an addendum:

Question: The patient asked me to get him a soda/take the empty tray/find out what's for dinner, should I go ahead and do it myself?

Answer: Can't hurt to help a brother out, right? Wrong! Wrong! Wrong! Even though you have 20+ years of education, the patient now considers you his personal concierge. At first it may sound elitist, but you need to let the techs and nurses do their jobs so you can do yours. Of course you shouldn't ignore the request, instead consider a nice deflective responsive like "You can use the CALL NURSE button to ask about that". Anything that lets them know that cleaning and food service isn't really your area.

Call me an dingus if you want, but I didn't go through 7 years of higher education and acquire $100,000 of debt to bus the lunch tray of a homeless guy.

I am glad that I have experienced the opposite of this attitude. In our local hospitals, I was impressed when I saw physicians help out with nursing and janitorial tasks. On my psych rotation, I saw a patient complain to a psychiatrist about not receiving the food that he ordered. The psych made sure that his patient got the food that he asked for. The psych explained to me that they (doctors, nurses, cna's, janitors) all work as a team. And the team concept did not only apply to saving a patients life. It simply meant helping each other out in anyway they could for the benefit of the patient. I have also seen other similar behaviors from docs occuring on other wards, too.

 

[robotsonic]

I am glad that I have experienced the opposite of this attitude. In our local hospitals, I was impressed when I saw physicians help out with nursing and janitorial tasks. On my psych rotation, I saw a patient complain to a psychiatrist about not receiving the food that he ordered. The psych made sure that his patient got the food that he asked for. The psych explained to me that they (doctors, nurses, cna's, janitors) all work as a team. And the team concept did not only apply to saving a patients life. It simply meant helping each other out in anyway they could for the benefit of the patient. I have also seen other similar behaviors from docs occuring on other wards, too.

I agree. Although the nurses should be doing their jobs just as I should be doing mine, patient care is really everyone's job. And the patients usually appreciate it (they don't start treating you like their personal slave). Once in the ER a homeless woman with AIDS came in, very sick, and told me she was hungry. I asked what she wanted and said she really felt like having some M&Ms. So I left the ER to go buy her some M&Ms (I made sure she wouldn't be needing an OR visit). It was a little thing that she really appreciated and made her a tiny bit more comfortable. It took 5 minutes of my time, but I think it was worth it. Other times, on the floor, patients hadn't been able to eat during their regular meal but were hungry, so I searched the floors until I was able to get them something. I get patients tissues when they ask. And I don't ever regret doing this stuff. It takes so little time and it really makes such a difference to patients when someone in the hospital does something nice for them. And as a medical student I am not too busy to help them. In fact, I think it is the medical student's duty to perform these kind of "scut" activities because the med student is the one with the most free time (compared with the intern).

Perform your duties as a med student and stop complaining.

 

[EctopicFetus]

Yes.. Should...But believe the fact that some patients mistake the hospital for the 4 seasons! Anyhow.. Your statements above are 100% true. Sometimes you do have to pull some extra weight, but usually it is tit for tat. I had a pt in the ED who waited 2 hours for some morphine cause she was in extreme pain.. Anyhow I chased the nurse around and then finally she says. I need to start a line.. then she will get her meds. I offered to start the line and draw blood in exchange for my pt to get morphine..Sad..But this is the way the world works today!

 

[kaos]

I agree. Although the nurses should be doing their jobs just as I should be doing mine, patient care is really everyone's job.

I don't get why nurses complain so much. Seriously, all the ones I know only work 3 days a week and have huge labor unions to back them up.

 

[21JumpStreet]

I agree. Although the nurses should be doing their jobs just as I should be doing mine, patient care is really everyone's job. And the patients usually appreciate it (they don't start treating you like their personal slave). Once in the ER a homeless woman with AIDS came in, very sick, and told me she was hungry. I asked what she wanted and said she really felt like having some M&Ms. So I left the ER to go buy her some M&Ms (I made sure she wouldn't be needing an OR visit). It was a little thing that she really appreciated and made her a tiny bit more comfortable. It took 5 minutes of my time, but I think it was worth it. Other times, on the floor, patients hadn't been able to eat during their regular meal but were hungry, so I searched the floors until I was able to get them something. I get patients tissues when they ask. And I don't ever regret doing this stuff. It takes so little time and it really makes such a difference to patients when someone in the hospital does something nice for them. And as a medical student I am not too busy to help them. In fact, I think it is the medical student's duty to perform these kind of "scut" activities because the med student is the one with the most free time (compared with the intern).

Perform your duties as a med student and stop complaining.

I agree with you. You said what I was trying to say. Now that you mention the ER I remember being a patient in one. I was vomiting and during my seven hour stay two ER docs offered to empty my bowl for me. I let them do so because I couldn't get out of bed. I know this may be TMI. Also, one even offered to fix a zipper that was jammed on my dress.

 

[TheFish005]

"Question: I'm pretty sure my attending said something wrong, should I correct him?

Answer: Let it go, man. Even if they are wrong and you're right. Even if you're intentions are pure. They WILL remember how you made them look stupid and you WILL pay for it. "

One of our clinical med teachers addressed this the other day. He compared it to the scene in the first Star Wars movie (episode 4) where R2D2 is playing that game with Chewie and Han says something to the effect of wookie's pulling people's arms off when they lose and C3PO responds with "let the wookie win." Our teach said the attendings are wookie's and to "let the wookie win" when you know he's wrong.

 

[hotdocmitch]

I've also learned another important thing during my clinical years...DON'T PISS OFF THE NURSES! They can (and will) make your life hell. I learned the hard way.

 

[RuralMedicine]

I am glad that I have experienced the opposite of this attitude. In our local hospitals, I was impressed when I saw physicians help out with nursing and janitorial tasks. On my psych rotation, I saw a patient complain to a psychiatrist about not receiving the food that he ordered. The psych made sure that his patient got the food that he asked for. The psych explained to me that they (doctors, nurses, cna's, janitors) all work as a team. And the team concept did not only apply to saving a patients life. It simply meant helping each other out in anyway they could for the benefit of the patient. I have also seen other similar behaviors from docs occuring on other wards, too.

I couldn't agree more! (Plus even if you lack basic compassion it is frequently faster to get the patient a drink/blanket whatever than ask someone else to do it---one tip to medical students do be sure you know if your patient is NPO or on a restricted diet before getting them a drink or snack but I don't think you can ever go wrong with a blanket or a little compassion)

 

[Hawk22]

I am glad that I have experienced the opposite of this attitude. In our local hospitals, I was impressed when I saw physicians help out with nursing and janitorial tasks. On my psych rotation, I saw a patient complain to a psychiatrist about not receiving the food that he ordered. The psych made sure that his patient got the food that he asked for. The psych explained to me that they (doctors, nurses, cna's, janitors) all work as a team. And the team concept did not only apply to saving a patients life. It simply meant helping each other out in anyway they could for the benefit of the patient. I have also seen other similar behaviors from docs occuring on other wards, too.

I agree with this post 100%. If you take the above attitude that "I didn't go to school for X years to be a glorified waiter" as a medical student, you're going to be in for a rough time when you're a resident and attending and have that type of attitude engrained in how you deal with patients and staff. We're a team and we're all in this together. Yes we have roles and specific duties, but that doesn't mean you can't help out your co-workers a bit (within reason of course).

I worked for 2 years as a medical assistant before medical school so I could enter medicine from the ground up because I saw way too many doctors with a "holier than thou" attitude because they let their training go to their head. That doesn't mean you have to be at a patient's beck and call, but you can do little things to help out and make the whole floor run smoother. No one is above that.

My wife is also a nurse and trust me you don't want to tick off the nurses. Doing little things to make their jobs easier will get you huge points and will make your life easier in general.

 

[tupac_don]

I agree with this post 100%. If you take the above attitude that "I didn't go to school for X years to be a glorified waiter" as a medical student, you're going to be in for a rough time when you're a resident and attending and have that type of attitude engrained in how you deal with patients and staff. We're a team and we're all in this together. Yes we have roles and specific duties, but that doesn't mean you can't help out your co-workers a bit (within reason of course).

I worked for 2 years as a medical assistant before medical school so I could enter medicine from the ground up because I saw way too many doctors with a "holier than thou" attitude because they let their training go to their head. That doesn't mean you have to be at a patient's beck and call, but you can do little things to help out and make the whole floor run smoother. No one is above that.

My wife is also a nurse and trust me you don't want to tick off the nurses. Doing little things to make their jobs easier will get you huge points and will make your life easier in general.

When I see a nurse take on responsibility for treatment and willing to take call and go through all the other hardships doctors do I'll do their job. Point here is not that med students won't help, but it kinda pisses you off when you see a nurse talking about this and that and is too lazy to get off her ass to do anything.

 

[Hawk22]

When I see a nurse take on responsibility for treatment and willing to take call and go through all the other hardships doctors do I'll do their job. Point here is not that med students won't help, but it kinda pisses you off when you see a nurse talking about this and that and is too lazy to get off her ass to do anything.

1. You're unfairly painting the nursing profession with a very broad stroke there. Are there bad and lazy nurses? You bet. Are there bad and lazy doctors? Definitely. Are there bad and lazy medical students? You better believe it. The majority of all of the above categories are hard working, good people who got into their profession to help people. Some lose their way. Some never had their way to begin with and got into healthcare for the wrong reasons. Both of those are a minority in my opinion.

2. And oh, woe are you to "take call" and "go through all the other hardships" that you go through. Did anyone force you to sign up for medical school or force you to stay there? In your career, you'll have a positive influence on countless numbers of lives, you'll make great money, have financial security for the rest of your life, have widespread respect and be a part of one of the best professions in the world. Its hard work and medical school and residency suck, but most of us make it through.

3. Nurses do take responsibility for treatment, they just don't chose the treatment plan. That's not their job.

In the end, we all have our role on the team that is healthcare. Everyone should do their role as best they can and try to help everyone else out on the team too. That doesn't mean you do their job, but it does mean you can help with little things. We're all in this together and its not "us versus them" in this field.

 

[carrigallen]

I agree with being compassionate, and that we need to be more caring. Still, the thing to remember as a med student doing inpatient medicine is that there are maybe eleven people assigned to take care of Mrs. Jones in Bed 46b, but there is only ONE person taking care of you.

When in doubt, you need to think about your own needs and safety first. It is part of your primary responsibility to ensure you are not suffering from sleep deprivation, and that you are adequately fed and alert.

 

[sistermike]

For all of those who feel that nurses are lazy and fat:

How about we remove the nurses and see what happens? Whether one thinks so or not, nurses are a very integral part of the health care team and without them there would be no healthcare services available. Yes of course there are many that are lazy, as the same with doctors and every other healthcare professional. Ya'll remind me those doctors who feel they are god's gift to this earth. Just a reminder, your **** stinks just as much as the nurse next to you, and you are no better than them. Perhaps we should work together to form a healthcare team, rather than bitching about how the person next to you is lazy.

 

[BadVB750]

How about we remove the nurses and see what happens?

Then there would be more donuts for the rest of us. Right?

 

[T.S.garp]

just a reminder....not all nurses are doughnut hoarding fatties...i'm just a lowly pre-med, but in the hospitals that i've been to in my area i have seen plenty of hot skinny nurses and some fat doctors. actually one of my best friends is an RN...she's thin and she hates doughnuts. just because your hospital has some fat lazy nurses please don't think they're all like that.

 

[DOtobe]

For all of those who feel that nurses are lazy and fat:

How about we remove the nurses and see what happens? Whether one thinks so or not, nurses are a very integral part of the health care team and without them there would be no healthcare services available. Yes of course there are many that are lazy, as the same with doctors and every other healthcare professional. Ya'll remind me those doctors who feel they are god's gift to this earth. Just a reminder, your **** stinks just as much as the nurse next to you, and you are no better than them. Perhaps we should work together to form a healthcare team, rather than bitching about how the person next to you is lazy.

I really appreciate all the nurses in my hospital. They have saved me quite a few times. Especially the ICU nurses - it amazes me how much ICU nurses know. I feel like an idiot next to an ICU nurse

 

[KyGrlDr2B]

I really appreciate all the nurses in my hospital. They have saved me quite a few times. Especially the ICU nurses - it amazes me how much ICU nurses know. I feel like an idiot next to an ICU nurse

I think there is definitely a broad spectrum of nurses out there. Private and community hospitals tend to have great ones. A lot of university/academic institutions have crappy ones. The ICU nurses are not included in this generalization--they are usually awesome and are WAY smarter than you are. For some reason, my experience has been that the other nurses are often lazy and like to make your life hell because they know you are a student. They also like to complain a lot. Now, this isn't every nurse, nor at every hospital. But I think that hospitals with residents and students tend to have this problem more than other hospitals and that is why people like to make fun of nurses.

Good joke, though!