Why do I always have the most patients??

Discussion in 'Internal Medicine and IM Subspecialties' started by artsydoc, Aug 20, 2015.

  1. artsydoc

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    I started my intern year and I've noticed my census is consistently higher than every other intern's on my current rotation. I'm getting frustrated when there are interns with half the patients I have relaxing and studying all afternoon and then a new one comes up and I still get them. What's the deal? Am I not doing well and need more practice? Am I doing well and it's a vote of confidence? This is a consistent pattern. Part of it is inevitable because I'm a prelim and categoricals leave for clinic a couple afternoons a week so I cover their patients and take new admissions so inevitably wind up with more but it happens even when everyone is here. This is part vent and part solicitation for insight. I don't feel comfortable asking my own seniors because I think there's too much of an element of whining in the question.
     
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  2. asahi88

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    Whatever the reason, it's certainly not a good thing. For one, people will think you're inefficient.
    In the words of Dr Stone, one of my favorite attendings at MGH: think about what's keeping your patient in the hospital each day and what you need to do, so they can go home, SNF, hospice, or whatever. Try to figure this out from day one.
    Be familiar with plans for everybody. Once you have that down, just get into autopilot mode and knock them all out. Ask your senior for help -- that's why they're there.
    I know it can be real tough having 8-10 patients every day, especially when you've only just begun. Try not to get so stressed but the key is to keep it simple. Good luck.
     
  3. Gastrapathy

    Gastrapathy no longer apathetic
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    Probably just the clinic issue. You're a prelim. We hate you. They undoubtedly know it isn't fair.

    Seriously, its unlikely you have much to do with the rate your patients are moving. You could talk to the social worker and see if she thinks you aren't moving the meat.
     
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  4. Nivakia

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    oh i dont know, maybe because you havent learned the tricks that your colleagues have and never shared with you. if you want to talk more pm me
     
  5. rokshana

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    well its early, but where i was, interns that weren't doing well, on the edge of probation, etc were given less pts because it was felt they were able to handle a full load...

    ...or maybe you are a black cloud...
     
  6. Gpan

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    OR someone doesn't like you :whoa:
     
  7. PinkLithe

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    I'd say speak to whoever manages your team about the team numbers. You shouldn't have to carry more. What I find inevitably happens at my program is that the residents who are most efficient and are known to "take care of business" usually get more patients because people know they can handle the load.

    You can also look at it this way: Pro's and con's of more patients
    Pro's:
    1) You learn how to be an efficiency master. Super important, super respected, all around good skill to have as early as possible.
    2) You're better at multi-tasking.
    3) You can probably learn how to triage who's sicker, who the dispo gomers are and deal with everything accordingly. This one is kinda #1 and #2 combined.

    Con's:
    1) You're more stressed.
    2) You find life unfair.
    3) You're more tired/easier to burn out.

    I'd say bring it up with someone if it really bothers you. Otherwise look at it as a learning opportunity and run with it.
     
  8. ArkansasMed

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    Honestly it's a crap shoot and so dependent on the structure of your gen med floors. I wouldn't take it to heart. I got nailed in the beginning myself and realized it's the luck of the draw with admissions and the type of people you have. just look at it this way, you are learning more and will be that much better come second half of inter year.
     
  9. shiftingmirage

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    At my place, there are 2 interns and one senior per floor team. Floor teams rotate call, and some days are busier than others, which resulted in some teams having more patients than other teams. Generally my cointern and I had similar volume of patients, maybe off by 1-2 or so. If the census got lopsided, we would just redistribute by ourselves. Are you not allowed to do that?
     
  10. JP2740

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    Man the way some of you talk. The culture of IM can be so ****ty.
     
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  11. Gpan

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    it takes a special someone to go into IM. We're that special lol

    Joking aside, I love my specialty
     
  12. visari

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    As a senior resident, I usually left it up to the interns to split up the census and they did a good job keeping it even most of the times. If I noticed that they weren't doing that and the distribution was consistently unfair I would bring it up and tell the one(s) with fewer patients to pick up one or two. If you were too lazy to offer help, I would ask you to help and I would make sure you feel kinda bad about it (in a nice way ... like: hey you shouldn't leave your co-intern with twice as many patients as you. you're expected to pick up a few of his/her pts if this happens...etc)

    another thing I did when I had prelims on my team, I usually assigned the more complicated pts to the categoricals. whenever possible

    A lot of these issues are program-culture kind of thing. hard to change if they're not already there

    but in the end ... your senior resident is not really doing his job
     
  13. krps85

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    Bring it up with your upper level in a nice way. Either he just didn't really notice since he's busy setting up his fellowship interviews and the situation will get better, or he actually hates you in which case you're screwed anyway.
     
  14. Raryn

    Raryn Infernal Internist / Enigmatic Endocrinologist
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    *shrug*. I redistribute patients between my interns every Monday, and then divvy out the overnights when we are postcall to whomever had fewer patients to make sure it stayed balanced throughout the week, so it was never a problem. That said, our prelims had the same amount of clinic as our categoricals, so that was never a factor either. I treat everyone the same, with the caveat that I try to give the psych interns more of the crazy patients and things like that.
     
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  15. thehundredthone

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    Do you tend to redistribute the newest possible patients, just for familiarity's sake?
     
  16. Raryn

    Raryn Infernal Internist / Enigmatic Endocrinologist
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    Always. Old patients go to whomever had them on Friday. Any new admissions from Friday-Sat-Sun get redistributed to even out the team. Whichever intern worked over the weekend I tend to give the extra if we had an odd number.
     
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  17. Gpan

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    at the same time we have to take in consideration of how well or efficient the other residents are. Maybe the other residents are discharging pts left and right so they can keep their lists shorter than yours. We cannot just making sure all the lists have the same amount of pts because that is like punishing people who work efficiently. Consider this as a motivational system. Get your **** in order and be more efficient.
    Back then we even have a little friendly competition on how many pt we can discharge . We kept tally on the number of DC at the bottom of the lists. Of course the senior residents were keeping an eye on everything and made sure they were appropriate discharges. A system of check and order.
     
  18. thehundredthone

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    With a balanced approach letting the efficient ones have some more patients if they're discharging a lot can be motivational too, they learn to handle the volume. Evening out the list doesn't need to be at the cost of bombarding an efficient resident while going easy on the one that's seemingly less so.
     
  19. Gpan

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    tough love!!!! the less efficient ones need to learn.

    I can now see what the attendings meant by us getting soft. Back in the days...lol, JK
     

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