The Intern Musings Thread

[bravotwozero]

I think it's hilarious there's actual hospitals named sacred heart with residencies


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[HoosierdaddyO]

Here's to totally goofing up an intubation while your chief and assistant PD are hovering right over you !!!! Yayy for residency and excuse me while I self loathe for the next 45 min ;(. Any generic words of wisdom and calming would be highly appreciated lol

 

[Apollyon]

Here's to totally goofing up an intubation while your chief and assistant PD are hovering right over you !!!! Yayy for residency and excuse me while I self loathe for the next 45 min ;(. Any generic words of wisdom and calming would be highly appreciated lol

Dude - you f'n suck. On SDN, we're all perfect, and we're all above average. (Note the irony.) None of us miss tubes, lines, or diagnoses. We are all paid in the 25th percentile or higher, and the only patients that complain about us are ****bag drug-seeking dinguses.

It's all good. Your faculty are your safety net. If you NEVER screwed up, then you wouldn't need residency. Serious. You didn't kill the patient, and, if they were a code, they were dead already.

 

[HoosierdaddyO]

Appreciate the words of encouragement all while making me laugh lol

 

[Psai]

Here's to totally goofing up an intubation while your chief and assistant PD are hovering right over you !!!! Yayy for residency and excuse me while I self loathe for the next 45 min ;(. Any generic words of wisdom and calming would be highly appreciated lol

I can barely do a google search when my attending is hovering over me

 

[RustedFox]

Here's to totally goofing up an intubation while your chief and assistant PD are hovering right over you !!!! Yayy for residency and excuse me while I self loathe for the next 45 min ;(. Any generic words of wisdom and calming would be highly appreciated lol

I missed dozens of tubes before I figured it out.

It's all about the tip. Just the tip. It's gotta be snuggled down in there, right tight in the vallecula.

 

[Alyla]

Anyone in MICU? 1 week until my life is officially over

 

[Fox800]

About to start inpatient medicine, then surgery after that. Trying to stay positive. Going to miss the ED for the next two months.

 

[medic4lyfe]

ED month coming up. I'm okay with it.

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[bravotwozero]

Hope you guys aren't playing Pokemon go during Ed conference ...


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[medic4lyfe]

Almost made it through my first month without having to do a manual fecal disimpaction. Today that streak... ended... shall we say?

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[theseeker4]

Had an easy orientation month in July, total of seven 6-hour shifts plus all the lectures and training sessions, and now I have a half month of OB overnights followed by a half month of anesthesia. Not too bad of a way to start off residency.

 

[Psai]

Almost made it through my first month without having to do a manual fecal disimpaction. Today that streak... ended... shall we say?

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You need some medical students bro

 

[theseeker4]

Can't wait to hear from you next June. An easy start means an awful ending. A string of ICU months will break your soul.

Only one ICU month first year, cardiac ICU. That and two surgery months, trauma and vascular, are the most demanding rotations this year for us.

 

[Daiphon]

It's all about the tip. Just the tip. It's gotta be snuggled down in there...

This is giving me HS flashbacks. d=)


Semper Brunneis Pallium

 

[Zebra Hunter]

Only one ICU month first year, cardiac ICU. That and two surgery months, trauma and vascular, are the most demanding rotations this year for us.

Vascular!? Woof

 

[medic4lyfe]

You need some medical students bro

No kidding...

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[Cinematographer]

Can't wait to hear from you next June. An easy start means an awful ending. A string of ICU months will break your soul.

Yikes. I have 5 weeks of MICU (we do 8 weeks total as PGY1) as my second to last rotation of intern year. So far it's been pretty sweet, but do agree with you on that an easy start means an awful ending.

 

[bravotwozero]

Vascular?!? what a waste of time. I did that as a med student - great rotation as a student, but as a resident, it can't have much benefit. We spent about 1/3 of our time as interns in various ICU's - I actually loved it and highly recommend getting as much critical care exposure as you can.

Vascular is only useful if they'll let you get comfortable with putting in Quentins. Otherwise agree that it is kinda useless.


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[deleted245139]

Yeah, to the above points, really try to capitalize on your time that you spend on critical care and pedEM rotations.

 

[sonofva]

Vascular!? Woof

GET THAT MAN SOME COPRESSION STOCKINGS, STAT!


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[theseeker4]

Vascular?!? what a waste of time. I did that as a med student - great rotation as a student, but as a resident, it can't have much benefit. We spent about 1/3 of our time as interns in various ICU's - I actually loved it and highly recommend getting as much critical care exposure as you can.

LOL, I don't make the schedule...

From what I understand though, on Vascular the surgeons all want to be in the OR, so we end up doing most of the bedside interventions and such, making it a valuable month for learning things we might actually do in the ED. This is just what I heard from more senior residents though, will have to see for myself.

 

[Fox800]

I'm on inpatient (impatient?) medicine right now, drowning in progress notes, H&Ps, and discharge summaries. Holy hell I could never be a hospitalist. Gag.

 

[Psai]

I'm on inpatient (impatient?) medicine right now, drowning in progress notes, H&Ps, and discharge summaries. Holy hell I could never be a hospitalist. Gag.

****ing yes
I feel like I'm drowning too
Why do we need all these notes? Who has time to read all of them? Why do the nurses call every 2 seconds?
I hate notes, they take forever to write

 

[engineeredout]

Vascular is only useful if they'll let you get comfortable with putting in Quentins. Otherwise agree that it is kinda useless.


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Why on earth would you need a vascular rotation to learn how to put in temporary dialysis catheters? You do that on a standard ICU month, or sometimes even in the ED. Not to mention that it is virtually the same procedure as any other central line

 

[wonderbread12]

****ing yes
I feel like I'm drowning too
Why do we need all these notes? Who has time to read all of them? Why do the nurses call every 2 seconds?
I hate notes, they take forever to write

it's not the notes that bother me (most of it is copy-pasted and unread anyways)

what bothers me (and no disrespect meant) but has anyone else noticed that on non-call days IM folks dilly-dally like no other? I'm stuck for hours with nothing to do but await a page from a nurse while they screw around reading 1000 of papers on obscure medical questions with results that hardly direct management. If i'm asking what else can I do like a damn med student then might as well send me home

 

[Cinematographer]

How are you folks doing? I'm on my anesthesia rotation right now, so I can't complain much

 

[Driftinglily11]

.

 

[medic4lyfe]

EM. Had something every day last week. But, I have 5 days off coming up.

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[Renaissance Man]

Do you all follow up on patients that you see on a shift? I sort of was at first but find myself too busy and too tired at looking at the EMR to read up on anyone that isn't super interesting. Mostly I complete my note, and never look back.

 

[medic4lyfe]

I did... when I picked up their chart again the next day.

#chronicbackpain

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[mimelim]

Vascular is only useful if they'll let you get comfortable with putting in Quentins. Otherwise agree that it is kinda useless.


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Why on earth would you need a vascular rotation to learn how to put in temporary dialysis catheters? You do that on a standard ICU month, or sometimes even in the ED. Not to mention that it is virtually the same procedure as any other central line

Not a single ER physician at the 3 hospitals we go to feel comfortable placing lines that are "larger than 7 Fr". Thus, they have specific policies that make them call vascular to place them. At which point I normally send the MS4 or intern to do the line. I always show up to proctor, but the vast majority of the time I don't gown and glove. I would kill for ER physicians that have some comfort with placing quintons.

Placing quintons is dangerous. You can hurt someone very badly with bedside lines, regardless of size, but in the last 5 years of residency, I have lost track of the number of line complications that I have dealt with from the ER and various ICUs. While I trust our MS4s and even some MS3s to do lines, there are nuances to placements that should be taught by people that are a) facile with ultrasound, b) have seen/done a lot. Certainly does not have to be vascular surgery, but a healthy level of respect for shoving 13 Fr dialators into someone's left neck should be had.

 

[bravotwozero]

Do you all follow up on patients that you see on a shift? I sort of was at first but find myself too busy and too tired at looking at the EMR to read up on anyone that isn't super interesting. Mostly I complete my note, and never look back.

In my residency we were required to complete 75 follow up forms, one for each patient. Other than that, I only followed up on cases that I thought were really interesting or wondered if the crumping patient I sent to the unit made it out alive...


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[Fox800]

In my residency we were required to complete 75 follow up forms, one for each patient. Other than that, I only followed up on cases that I thought were really interesting or wondered if the crumping patient I sent to the unit made it out alive...


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We have to do 138. Blah.

 

[shoal]

We did 10 follow ups per month 360 total eeek


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[Zebra Hunter]

Not a single ER physician at the 3 hospitals we go to feel comfortable placing lines that are "larger than 7 Fr". Thus, they have specific policies that make them call vascular to place them. At which point I normally send the MS4 or intern to do the line. I always show up to proctor, but the vast majority of the time I don't gown and glove. I would kill for ER physicians that have some comfort with placing quintons.

Placing quintons is dangerous. You can hurt someone very badly with bedside lines, regardless of size, but in the last 5 years of residency, I have lost track of the number of line complications that I have dealt with from the ER and various ICUs. While I trust our MS4s and even some MS3s to do lines, there are nuances to placements that should be taught by people that are a) facile with ultrasound, b) have seen/done a lot. Certainly does not have to be vascular surgery, but a healthy level of respect for shoving 13 Fr dialators into someone's left neck should be had.

Sounds like y'all got duped into doing procedures that the ER doesn't care to do.

 

[Cinclus]

We did 10 follow ups per month 360 total eeek


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We do around that.

 

[witzelsucht]

it's not the notes that bother me (most of it is copy-pasted and unread anyways)

what bothers me (and no disrespect meant) but has anyone else noticed that on non-call days IM folks dilly-dally like no other? I'm stuck for hours with nothing to do but await a page from a nurse while they screw around reading 1000 of papers on obscure medical questions with results that hardly direct management. If i'm asking what else can I do like a damn med student then might as well send me home

im on ****ing trauma now, and other than just constantly fighting the urge to tell everyone to go suck a d1ck, i do NOT understand why were are not signing out on time. the night team is HERE, let's GTFO. i only have like 20 minutes to spend with my wife before needing to go to bed as it IS.

 

[mimelim]

Just for an alternate perspective... I'm a 3rd year resident and I have placed dialysis catheters in all 3 of our training sites. There is nothing special about this specific central line.

I suspect that the docs at your hospitals have found a way to avoid doing time consuming procedures, and that was to call you.

Out of curiosity, how many complications from quintons have you had to deal with? Are the steps virtually identical to every other line? Sure. But the same can be said for placing ECMO cannulas. But, the hardware is different and the complications and risk profiles is different. Sure, central line complications are rare, but having had to bail out general surgery half a dozen times after them ****ing up quintons in the last several years will give you a healthy respect for the differences.

Sounds like y'all got duped into doing procedures that the ER doesn't care to do.

Room is setup, consent obtained, we walk in, gown and glove. If I have to do it myself it is max 15 minutes, with trainee maybe 30. I bill for the procedure. It is stupid easy money. ER does the busywork, I do the procedure, we get paid to be the technician. Personally, I can't complain. Now, what I can complain about are GS residents shoving catheters into carotids, vertebral arteries (yes, that did actually happen) or chest cavity or ripping a 13Fre hole in the brachiocephalic vein with their dilator that they hubbed, or losing the ****ing wire. It is rare. Most of the time ig all goes well. But, 'quintons are the same as triple lumens' is a fairly naive perspective.

 

[Cinematographer]

At my program we are expected to do 2 follow ups per week for a total of 8/month.

Which means I have 16 follow ups to catch up with.

 

[Zebra Hunter]

Room is setup, consent obtained, we walk in, gown and glove. If I have to do it myself it is max 15 minutes, with trainee maybe 30. I bill for the procedure. It is stupid easy money. ER does the busywork, I do the procedure, we get paid to be the technician. Personally, I can't complain. Now, what I can complain about are GS residents shoving catheters into carotids, vertebral arteries (yes, that did actually happen) or chest cavity or ripping a 13Fre hole in the brachiocephalic vein with their dilator that they hubbed, or losing the ****ing wire. It is rare. Most of the time ig all goes well. But, 'quintons are the same as triple lumens' is a fairly naive perspective.

Oh, I'm sure it's not that big of a hassle for you, but it did sound like you were complaining. Maybe I'm mistaken, however. That procedure is definitely not "stupid, easy money" for the ER, however, because in the time it takes you to place that line, they have already seen 2 more patients, bringing in much more money than if they had been placing that line. Again, the ER might have convinced the head of your department that the reason you have to place quintons is due to the ERs lack of comfort, but it is much more likely that the main reason is so they don't have to waste 30 minutes placing the line, when they have a busy department to run.

 

[engineeredout]

Not a single ER physician at the 3 hospitals we go to feel comfortable placing lines that are "larger than 7 Fr". Thus, they have specific policies that make them call vascular to place them. At which point I normally send the MS4 or intern to do the line. I always show up to proctor, but the vast majority of the time I don't gown and glove. I would kill for ER physicians that have some comfort with placing quintons.

Placing quintons is dangerous. You can hurt someone very badly with bedside lines, regardless of size, but in the last 5 years of residency, I have lost track of the number of line complications that I have dealt with from the ER and various ICUs. While I trust our MS4s and even some MS3s to do lines, there are nuances to placements that should be taught by people that are a) facile with ultrasound, b) have seen/done a lot. Certainly does not have to be vascular surgery, but a healthy level of respect for shoving 13 Fr dialators into someone's left neck should be had.

I don't know what you have had to deal with or what administrative decisions have been made about who is allowed to place what, but the fact of the matter remains that it is the same procedure as placing any other central venous access. Should we be wary of the complications? Absolutely, as we should be with any form of central venous access. It is a bigger cannula than others, and by extension can cause a larger problem, but I am not more likely to cause a PTX or cannulate an artery because of its size. I check to confirm I know where I am when placing it just as I would for any normal TLC. You do not need to be a vascular surgeon to do that.

You brought up ECMO cannulas: now those do have some technical differences as I'm sure you're aware, but by the way if you were unaware, ED physicians are starting to place those too (http://edecmo.org).

 

[Cinematographer]

Shot out to the visiting med students who (1) introduce themselves to the intern and (2) ask if there is anything they can help with rather than awkwardly avoid all eye contact/conversation. I don't bite.

 

[Psai]

Shot out to the visiting med students who (1) introduce themselves to the intern and (2) ask if there is anything they can help with rather than awkwardly avoid all eye contact/conversation. I don't bite.

Shout out to all the med students trying their best to be helpful and not piss people off in a brand new environment where they don't know anyone, don't know the system, and are trying to impress.

 

[Fox800]

Achievement unlocked: had security escort a pt out for verbally abusing the staff, refusing to answer questions, refusing an examination, refusing EKG, and refusing all labs. Basically wanted to sleep in the ER bed all night.

 

[Fox800]

Any tips for being efficient while keeping the department moving? I'm trying to get into a good balance between following up on studies/dispoing people vs seeing new patients.

Also, does anyone else seem to drown in doing little things to help patients? I don't mind getting patients a blanket when they ask but if I had $1 for every time I'm asked for juice or food I'd be rich. I guess people don't realize (or give a crap) that I'm their doctor, and it isn't the best use of my time getting a cup of apple juice and graham crackers. I think I may tell them to hit the nurse call button and have the RNs get their snackies. They seem to have a lot more down time, judging from the gossip and joking I overhear while I'm hammering out notes and running around seeing patients.

Am I already jaded from my busy county program? I had 19 patients on last night's 8-hour shift.

 

[Psai]

Any tips for being efficient while keeping the department moving? I'm trying to get into a good balance between following up on studies/dispoing people vs seeing new patients.

Also, does anyone else seem to drown in doing little things to help patients? I don't mind getting patients a blanket when they ask but if I had $1 for every time I'm asked for juice or food I'd be rich. I guess people don't realize (or give a crap) that I'm their doctor, and it isn't the best use of my time getting a cup of apple juice and graham crackers. I think I may tell them to hit the nurse call button and have the RNs get their snackies. They seem to have a lot more down time, judging from the gossip and joking I overhear while I'm hammering out notes and running around seeing patients.

Am I already jaded from my busy county program? I had 19 patients on last night's 8-hour shift.

Yep, had a homeless guy get mad at me because I didn't get him some water "the first 3 times I asked". Incredibly obnoxious. It's not my damn job to be his waiter. Another time I got a different homeless guy some water because I'm a nice person and he threw it out. Then he complained that he's thirsty and was mad that I didn't buy him a soda from the vending machine with my own money. Nearly discharged him right there. These people aren't even paying for their medical care.

But 19 in 8 hours is insane, I don't know how you keep up that pace.

 

[Fox800]

Yep, had a homeless guy get mad at me because I didn't get him some water "the first 3 times I asked". Incredibly obnoxious. It's not my damn job to be his waiter. Another time I got a different homeless guy some water because I'm a nice person and he threw it out. Then he complained that he's thirsty and was mad that I didn't buy him a soda from the vending machine with my own money. Nearly discharged him right there. These people aren't even paying for their medical care.

But 19 in 8 hours is insane, I don't know how you keep up that pace.

It was me, an off-service IM intern, and my senior...and every pt has to be staffed by a PGY-1 or 2, not just the PGY-3 senior by himself. Ain't no one else around to pick up that slack. Luckily a lot of ETOH/heroin cases, those are easy peasy, and fast to chart.

 

[WildcatS11]

Yep, had a homeless guy get mad at me because I didn't get him some water "the first 3 times I asked". Incredibly obnoxious. It's not my damn job to be his waiter. Another time I got a different homeless guy some water because I'm a nice person and he threw it out. Then he complained that he's thirsty and was mad that I didn't buy him a soda from the vending machine with my own money. Nearly discharged him right there. These people aren't even paying for their medical care.

But 19 in 8 hours is insane, I don't know how you keep up that pace.

Yeah that's crazy. You'll get there. But as a 3rd month intern, 2.5 PPH to see, chart on, order correct labs and safely dispo is near impossible. Wel done to Fox. Maybe your senior should do some charting to help out?

 

[Cinematographer]

Any tips for being efficient while keeping the department moving? I'm trying to get into a good balance between following up on studies/dispoing people vs seeing new patients.

Also, does anyone else seem to drown in doing little things to help patients? I don't mind getting patients a blanket when they ask but if I had $1 for every time I'm asked for juice or food I'd be rich. I guess people don't realize (or give a crap) that I'm their doctor, and it isn't the best use of my time getting a cup of apple juice and graham crackers. I think I may tell them to hit the nurse call button and have the RNs get their snackies. They seem to have a lot more down time, judging from the gossip and joking I overhear while I'm hammering out notes and running around seeing patients.

Am I already jaded from my busy county program? I had 19 patients on last night's 8-hour shift.

Gotta say 19 patients on an 8-hour shift is crazy. On my busiest shift so far I took care of 16 patients. On average, however, I end up seeing anywhere from 8-14 patients per shift.

Anyway, regarding your question: I find it useful to chart the ROS and PE while I am in the patient's room. I will often place orders also while I am in the patient's room. If the patient is not sick and has some bread and butter type of complain, I will often start entering DCIs without waiting for lab results that I anticipate will come back normal. If your program uses EPIC, then take advantage of the comments feature on trackboard. I will usually type things such as "Meds + PO challenge" or "Ortho to see patient at bedside" to remind myself of what is keeping the patient from being discharged/admitted.