what to do????? intern needs help and advice....

[andwhat]

I am a first year Medicine resident, and we work very very hard and long hours.... I have not had a day off in over 2 weeks, easily am over 80 hours per week, and know for a fact that I am at least one or maybe two days behind on sleep due to my hectic call schedule.... well the burning question in which I have not found significant relief because its a sensitive issue and one in which I am not comfortable with discussing to my colleagues.....
it starts and goes like this..... the other night I got SLAMMED with calls and admissions in the ER, not to mention covering for the hundreds of patients calling in as we cover many physician's patients as well. So also we cover each other's patients (resident to resident), call is usually just either eerily too quiet, or miserably busy like mine have been lately exactly - you really hope to get paged during clinic sometimes to lighten your patient load and less dictations to do later, but it never ever happens somehow I always get paged right after clinic and of course dictations to do, and never ever in between busy and not busy maybe rarely, as you all may know... so more than once my colleague has had patients with complicated social issues, and the nurses paged me repeatedly asking me to come and see the families of the patients because they are rude to the nursing staff, and explain things to the families.... now how exactly should I have to do that, on top of my numerous admissions and ER consults and serious sleep deprivation, not to mention early as he** rounds and presentation with faculty regarding admissions, how on earth is it possible to help bear the grunt of an unsatisfied family with their nursing care????? I just do not understand this.... and to top it off heres the REAL issue, the nurses had the damn nerve to complain about me and this issue behind my back to my colleague the other resident physician.... now as stressed out to the maximum and dedicated to my patients welfare as I am, and continuing to help others around me and cover other patients, how in the hell is it my responsibility to go and get abused by a family whom is fed up with the nursing care or medical care or whatever..... I got these EXACT words by the nurses that night "well we want to discontinue this intervention because the family doesnt want the kid stuck so many times, and start a peripheral or central line" now this scenario is just made up but it is something exactly like this... so I am stuck, what should I do, make a decision like that on a patient whom I have no clue about other than what the checking out resident has told me - NONE of this which was obviously on the menu, or speak with the upper level who would more likely hear about the admissions and so forth, in which I would feel the same way.... I think that it is extremely sneaky and horrible that the nurses complained about me behind my back to my colleague like that ... and am extremely disappointed, because that makes me look less dedicated to their patient's care, and makes me look extremely selfish.... what to do.... please help me.

---

Members don't see this ad.

 

[LADoc00]

Dude, suck this up and prepare for a life of B.S., Im afraid it never ends. On the plus side, relish the moments you tell some hot chick you are a doc at a night club.

I actually had my department chair haul me in, fire me and call me back later and say it was mistake...I was completely dumbfounded, no explanation, nothing. And I am wayyyy past pgy1-land friend.

 

[redstorm]

Dude or dudette,

I completely feel for you... the system does not get better.. but it will get better because you will learn how to deal with it better.. Learn how to cut nurses off in mid sentence to ask them to get to the point... Learn a little passive aggressive behavior.. towards everyone.. I mean everyone.... This is your way of getting back.. especially your attendings and chiefs who screw you... and nurses.. dont talk to ancillary staff unless you KNOW THEM PERSONALLY.. KNow exactly the things you can get in trouble for( telling a nurse to **** off,) and things you cant get in trouble for ( giving potassium IV PUSH causing cardiac arrest.. leading to death).... Just keep on pressing on, understand that the system is abusive. and learn behaviors that will keep you sane... Page your attendings or chiefs to the radiology suite repeatedly.. sometimes late at night...... Whatever you do.. never let on ever that you are upset, pissed off, discontent with the system.. If you wanna let on that you are discontent.. write a anonymous letter to acgme.. or resign from the program... I sincerly wish you the best..

 

[A. Melanoleuca]

I hate call. Absolutely loath it. With that being said you just have to suck it up and use it as a learning experience. The other thing is to realize that you can only do what you can do.

If you are post call you must be released by 1 PM that day from all clinical and educational duties. Those are the rules and there are no exceptions except in the direst straits of urgent patient care. (You are running a code at 1:03PM) It is your program's responsibility to schedule you accordingly if you are rotating on their service and to make sure that you are not abused on other services.

Now, because there is still a lot of nostalgia for the very recent days when residents had no protection from being worked like slaves, you might be tempted to suck it up and work the extra hours without complaint, maybe even fudging your time reports. Your program, for their part, might decide to try to force you to exceed your hours. Your sleep and subsequent well-being does not figure into anybody's calculations but your own and if you are filling a slot your program is happy, especially in a big program which is ward-intensive.

The pressure to suck it up can be intense, I am told, at some programs and many are reluctant to get a reputation for weakness or for not being a team player. But the fact that your PD, attendings, and upper levels all "paid their dues" under the old system has no bearing on you. Too bad for them. I have done things a heck of a lot harder than intern year but I don't expect my superiors to mimic me. We all pay dues in our own way. Like you, nobody stuck a gun to your attending's head and made him choose medicine as a carreer. His generation operated under their rules, our generation will operate under ours.

I'm pretty militant about this even if I am pretty gung-ho on most rotations. Maybe it's because so much of what we do as interns is totally bogus and redundant paperwork that I am not keen to have any more of my rapidly dwindling life expended on it jsut because the "old school" is afraid of change.

 

[A. Melanoleuca]

Dude or dudette,

I completely feel for you... the system does not get better.. but it will get better because you will learn how to deal with it better.. Learn how to cut nurses off in mid sentence to ask them to get to the point... Learn a little passive aggressive behavior.. towards everyone.. I mean everyone.... This is your way of getting back.. especially your attendings and chiefs who screw you... and nurses.. dont talk to ancillary staff unless you KNOW THEM PERSONALLY.. KNow exactly the things you can get in trouble for( telling a nurse to **** off,) and things you cant get in trouble for ( giving potassium IV PUSH causing cardiac arrest.. leading to death).... Just keep on pressing on, understand that the system is abusive. and learn behaviors that will keep you sane... Page your attendings or chiefs to the radiology suite repeatedly.. sometimes late at night...... Whatever you do.. never let on ever that you are upset, pissed off, discontent with the system.. If you wanna let on that you are discontent.. write a anonymous letter to acgme.. or resign from the program... I sincerly wish you the best..

Oh man. I completely agree. As pissed off as I may get I am always the very soul of affability. I always have a pleasant smile even at 3 AM and if anybody asks me how I'm doing, even if I am getting hammered with admissions I say, "Just Great!"

I may vent a little here but I am perfectly correct, always gung ho, and never in a bad mood at any time when on the job. On the other hand, like I said, you can only do what you can do. The other night I had both pagers, my cell phone and my PDA all beeping at me at the same time with various pages, calls, and reminders while I was working on admissions in the ED. You could get a little distracted in that situation but you are only one person. If page number one is a nurse who needs you to sign a bogus piece of paperwork you can safely put that at the bottom of the priority list. Maybe even forget about it. You will get to it when you get to it. Patient care is the only real priority.

The other problem people have is their unreasonable expectation that they will sleep on call. I just assume I will be up all night and take a nap when I get home in the early, early afternoon as required when any of us are post call. If you get home at one, the you can sleep till six, get up, have a normal evening and go to bed at a decent hour allowing you to get up early rested and ready.

Try going to bed at nine-thirty if you have to be up at five. It will work wonders. Screw your social life. Sleep is more important.

 

[A. Melanoleuca]

I am a first year Medicine resident, and we work very very hard and long hours.... I have not had a day off in over 2 weeks, easily am over 80 hours per week, and know for a fact that I am at least one or maybe two days behind on sleep due to my hectic call schedule.... well the burning question in which I have not found significant relief because its a sensitive issue and one in which I am not comfortable with discussing to my colleagues.....
it starts and goes like this..... the other night I got SLAMMED with calls and admissions in the ER, not to mention covering for the hundreds of patients calling in as we cover many physician's patients as well. So also we cover each other's patients (resident to resident), call is usually just either eerily too quiet, or miserably busy like mine have been lately exactly - you really hope to get paged during clinic sometimes to lighten your patient load and less dictations to do later, but it never ever happens somehow I always get paged right after clinic and of course dictations to do, and never ever in between busy and not busy maybe rarely, as you all may know... so more than once my colleague has had patients with complicated social issues, and the nurses paged me repeatedly asking me to come and see the families of the patients because they are rude to the nursing staff, and explain things to the families.... now how exactly should I have to do that, on top of my numerous admissions and ER consults and serious sleep deprivation, not to mention early as he** rounds and presentation with faculty regarding admissions, how on earth is it possible to help bear the grunt of an unsatisfied family with their nursing care????? I just do not understand this.... and to top it off heres the REAL issue, the nurses had the damn nerve to complain about me and this issue behind my back to my colleague the other resident physician.... now as stressed out to the maximum and dedicated to my patients welfare as I am, and continuing to help others around me and cover other patients, how in the hell is it my responsibility to go and get abused by a family whom is fed up with the nursing care or medical care or whatever..... I got these EXACT words by the nurses that night "well we want to discontinue this intervention because the family doesnt want the kid stuck so many times, and start a peripheral or central line" now this scenario is just made up but it is something exactly like this... so I am stuck, what should I do, make a decision like that on a patient whom I have no clue about other than what the checking out resident has told me - NONE of this which was obviously on the menu, or speak with the upper level who would more likely hear about the admissions and so forth, in which I would feel the same way.... I think that it is extremely sneaky and horrible that the nurses complained about me behind my back to my colleague like that ... and am extremely disappointed, because that makes me look less dedicated to their patient's care, and makes me look extremely selfish.... what to do.... please help me.

If your program expects you to cross-cover large numbers of patients, many if not most of which you know nothing about, then they either are not thnking straight or the acuity of your patients is pretty low. There is no way one intern can cover more than a handful of patients and do a decent job. We have between 15 to 20 patients on ther service where I am rotating this month which is probably the high end of optimal.

I had a rotation at the VA where, as an intern on call I was cross-covering for four other services and my own. You can only do what you can do. You cannot go to every chart and read up on every one of eighty patients. It is impossible. If you get a difficult question from a nurse go to her station, get the chart, skim the important parts, and call your upper-level if you are not completely comfortable handling the situation. (or got to the CPRS system if you are at the VA)

 

[andwhat]

A Melanoleuca, redstorm, LAdoc00 and others, I wholeheartedly do appreciate you all contributing to my thread and ESPECIALLY taking time to read my depressing and true everyday saga neverending story........fortunately a very minor part of my life on the whole prospective, if I didnt remind myself of the bigger picture aspect of things then I would be in the Psych ward by now... I mean its just horrible sometimes - of COURSE its not so bad that I would want to quit I love what I do sincerely, but its about as bad enough to be confrontational about it situations like this.....but of course I can suppress that for now, but it was me and my mistake for taking on too much responsibility, and not realizing that help is a page away, and hopefully the upper levels can take care of those complicated social issues from now on instead of me sitting there stuck between a rock and a hardplace.... me not knowing jack about a patients social issues and getting stuck and having the wonderful and clueless nursing staff (no that is not a knock against nursing staff because physicians make plenty of errors too but this is something completely different) making a critical error on behalf of the patients life just to please the whining nurses - I really do not care what people say about them, I mean a good nurse is your best friend supposedly, and I love nurses that show empathy and willingness to help the patient and physicians succeed, but I have dealt with the WICKED and evil ones sometimes in the ICU, the ones that demand that so called difficult patients be shipped out of their ICU how f%%%ing demanding and disappointing is that... I have dealt with difficult patients for WEEKS at a time, and GUESS WHAT NO F(((ING SHIFT CHANGE IT WAS ME 24 - 7 TAKING CARE OF THE DRUG SEEKING AND ANNOYING BIPOLAR PATIENT... you know I hate this aspect of medicine it is just awful, people like this particular nursing staff that fail to take responsibility for their patients actions or words, and then try and dump that onto someone else because they just cannot handle a little pressure, for instance a rude patient, good grief give me a freakin break and grow some thicker skin..... I mean they try and play like it is a medical issue, but then at the end of the sentence it always goes "well the patient and his family are extremely disrespectful and rude" and I am like what the hell ever underneath, but desperately trying not to lose my cool at the same damn time, and explain to them what it means to be doing two or three admissions at the same time, and having the ER physicians literally throwing charts at me like I am somebody's """ I dont know but that language would be explicit here, basically a pimps paycheck is how we are treated in the ER, below human. thanks everyone so much once again. If anyone thinks that I am arrogant then I wholeheartedly apologize, but I will not be considered a 'slack off' resident by some bs nursing staff that cant handle a little pressure, ridiculous.

 

[A. Melanoleuca]

A Melanoleuca, redstorm, LAdoc00 and others, I wholeheartedly do appreciate you all contributing to my thread and ESPECIALLY taking time to read my depressing and true everyday saga neverending story........fortunately a very minor part of my life on the whole prospective, if I didnt remind myself of the bigger picture aspect of things then I would be in the Psych ward by now... I mean its just horrible sometimes - of COURSE its not so bad that I would want to quit I love what I do sincerely, but its about as bad enough to be confrontational about it situations like this.....but of course I can suppress that for now, but it was me and my mistake for taking on too much responsibility, and not realizing that help is a page away, and hopefully the upper levels can take care of those complicated social issues from now on instead of me sitting there stuck between a rock and a hardplace.... me not knowing jack about a patients social issues and getting stuck and having the wonderful and clueless nursing staff (no that is not a knock against nursing staff because physicians make plenty of errors too but this is something completely different) making a critical error on behalf of the patients life just to please the whining nurses - I really do not care what people say about them, I mean a good nurse is your best friend supposedly, and I love nurses that show empathy and willingness to help the patient and physicians succeed, but I have dealt with the WICKED and evil ones sometimes in the ICU, the ones that demand that so called difficult patients be shipped out of their ICU how f%%%ing demanding and disappointing is that... I have dealt with difficult patients for WEEKS at a time, and GUESS WHAT NO F(((ING SHIFT CHANGE IT WAS ME 24 - 7 TAKING CARE OF THE DRUG SEEKING AND ANNOYING BIPOLAR PATIENT... you know I hate this aspect of medicine it is just awful, people like this particular nursing staff that fail to take responsibility for their patients actions or words, and then try and dump that onto someone else because they just cannot handle a little pressure, for instance a rude patient, good grief give me a freakin break and grow some thicker skin..... I mean they try and play like it is a medical issue, but then at the end of the sentence it always goes "well the patient and his family are extremely disrespectful and rude" and I am like what the hell ever underneath, but desperately trying not to lose my cool at the same damn time, and explain to them what it means to be doing two or three admissions at the same time, and having the ER physicians literally throwing charts at me like I am somebody's """ I dont know but that language would be explicit here, basically a pimps paycheck is how we are treated in the ER, below human. thanks everyone so much once again. If anyone thinks that I am arrogant then I wholeheartedly apologize, but I will not be considered a 'slack off' resident by some bs nursing staff that cant handle a little pressure, ridiculous.

I appreciate what you are saying. Look, as much as I like being a doctor, if I knew then what I know now I might not have gone to medical school. In my previous career I got up at a decent hour, went to work generally after sunrise, not before, and except for some overtime here and there for which I was generously compensated seldom worked past 6 PM. My weekends were generally my own and holidays were just that.

Not to mention that the typical malignant behavior which I have observed in medical education would result in a highly justifiable ass-kicking if the same behavior took place in the real world. I joke about it but I have "thrown down" (in my younger days) for much less than some of the abuse I see heaped on interns. I am older and since I don't tolerate abuse I don't get abused. (Except for richly deserved sarcasm or good natured ribbing if I do something stupid.)

And then after medical school I managed to not match into the specialty I wanted and find myself in a specialty for which I am totally unsuited and don't really care for.

So the point is that life is unfair and sometimes you've got to suck it up. If you don't like it, I mean don't like it to the point where you depsise going to work every morning, then switch specialties, switch programs, or find a different career. I know that I contemplated going back to my original career after not matching but decided against it because a) I will still make more money at this specialty than I could have in my old job, b) I am trying to match again this year (but switching specialties puts you at an automatic disadvantage in relation to fourth year medical students, c) I am carrying a lot of debt which I will need to pay back, and d) I am stubborn.

Just keep in mind that it will get better. Only one percent of all doctors visits take place at academic medical centers. That's right. Only one percent. Chances are that you will never again practice in such a malignant environment once you finish residency and if you do it will be your own fault. They work pretty hard in private practice but it is nothing like residency.

 

[InternalWhizzzz]

so my question to you guys...would you give any advice to pple considering going into internal medicine...are there any programs in particular that are malignant that you think are not worth considering?

 

[mamadoc]

To the OP:

Some of this stuff you're getting sucked into -- YOU are going to have to be the one to set the limits. Stop arguing with nurses who are asking you to do unreasonable things. Just say no. If they want you to lay down the law with an unruly patient or family member, tell them that if they are having trouble, they should call security. If they want you to have detailed conversations with patients who aren't familiar to you, explain that you are "on call" to handle EMERGENCIES, and if the patient's vital signs are stable, and his med and other care orders are clear, basically those questions aren't emergent and can wait for his regular doctors during rounds or office hours.

It amazes me, but some nurses just didn't get that we were there from 6am one day straight through until 12 noon the next day without any break. Because their work place paradigm is 12-hour shifts, they assume we do something similar. In my large teaching hospital as an intern I encountered LOTS of experienced nurses who did not understand the intern call schedule - and they weren't dummies. But why should they know my schedule? They're not there for 30 hours straight to observe that I never left.

Many people seem to assume that "on call" means that you are just working the night shift. Now as an FP resident taking home call, I'm amazed at the idiotic stuff people call about... it's like they are lying awake wondering about some weird random thing with their meds and it occurs to them: "I know! I'll call the doctor! I know she's up at 3am!" And weird as it seems, in the hospital apparently some nurses think the same thing - that you are the Microsoft help desk, awake, ready and eager to respond to whatever dumb question they feel like punting your way at whatever hour.

But back to the original dilemma. Don't get sucked into every imaginable problem with every imaginable patient. Most of those things can and *should* be deferred to their care team. Repeat after me: just say no.

 

[Wahoos]

hey andwhat, I feel for you, I am in the same shoe, a orthopedic intern on the general surgery service. When I was on my trauma month, as the intern, we do 14 hour shifts from either 6am to 8pm or 6pm to 8am. And when I am on at night, I get sign out from the neurosurg service ~ 15-20 patients each night with ICU patients, Plastics service 15-25 patients, Urology 10-15 patients, my own service 15-40 patients, and I am also first call to all neurosurgery consults including spine to the ED as well as to all the level I and II trauma alerts. I had nights when I had 70-80 patients in my pocket that I have no clue who they are besides a box that has the name, diag, day in hospital, and plan per team. Besides getting called all night long, I usually get anywhere between 5-15 trauma alerts to the ED every night between 6pm to 8am, 3-10 consults for neurosurg and/or spine and i am responsible for all the paper work, taking the pt to the scanner, and updating the list for all trauma pts. so that month was pretty much like hell.

And I lot of times in the night I get called on patients that i have no clue about and have to make decisions in their management. It sucks, but I kinda just take it and try to make the best decision possible given the situation. If I am over my head, or something I am doing for the 1st time or not sure, I always page my senior to ask for advice. I would rather have my senior say "how can you not know that" than for me to miss something that harmed the patient. And I have definitely ran into nurses or N.P.s that are very rude and thinks that they know everything or boss me around like "I need a order for this, NOW." The way I deal with it.... is that no matter how demanding or how much of an ass a nurse can be, always be clam and be professional with them. Because one bad interaction can really ruin you. Because the work enviroment in the hospital is small, almost like high school, people always talk, esp the nursing staff about everything, residents/attendings/etc/etc. It you piss off one nurse, she might spread rumors about you that you were rude, arrogant, or an ass, or did not care about the patient, incompatient, and pretty soon, those words might go back to your own residents or attendings, and once you get taged with that image, it is very very hard to get rid off. It is not worth it. I think no matter how much of an ass a person is to you, or that you are stressed dealing with all the crap internship hands to you, ALWAYS keep your cool, be clam, deal with the situation professionally, have a little humor, ask your senior if you are not sure and if you are blamed for something that was completely not your fault (which I am sure happened to all of us before) .... sometimes it is better just to say "it was my fault, and I will make sure it will never happen again." vs. trying to explain why it was NOT your fault, and pointing fingers at other residents or your senior res. And if you can do those things, in the end of the day, you will always have the upper hand and walk out of the hospital happier with life.