You know you're not enjoying wards when...

[chromaticscale]

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Let's commiserate together


...you get a call from radiology that one of your patients who recently got cath'ed might have a pseudoaneurysm (AND you're on call for admitting patients). General surgery and IR are consulted but each of them say there's a contraindication and it's not an actual pseudoaneurysm or something they can intervene on. Thus you're left with the patient not knowing exactly how to manage the hematoma since the consults left you in the dark.

...you call the nurse because the TTE hasn't been done though it was ordered yesterday. Then she tells you that the charge nurse said that the patient needs to be NPO before the procedure and to call GI for questions. So you have to explain the difference between a transthoracic and transesophageal echo.

...you get paged five times by the nurses for the patient's daughter to get a work note, but you can't print it out because the EMR has a glitch so you spend 30 minutes on the phone with IT when you could have spend that time doing patient care.

...you get so close to discharging a patient, but the nurse pages you that the patient's home environment is not livable (diarrhea all over the furniture). (and you paged me and not the case manager about this because?....) But thankfully your senior resident goes over there to yell at the nurse and to solve the problem, which is that the patient will stay at a friend's house instead.


Though I do enjoy learning medicine, sometimes things like these affect us and contribute to burnout on the wards. I was told one tip to avoid burnout: do something that reminds you of why you wanted to do medicine, such as spending more time with your favorite patient.

Feel free to share some of your experiences.

 

[InvestingDoc]

Stopped reading here "since the consults left you in the dark. "

If that happens I pick up the damn phone and talk with them to see what exactly is going on. Lack of communication is a destroyer of many things and you need clarity here.

Pick up the phone and demand an explanation on what is going on and politely state your concerns if you still are not satisfied. This is part of learning to deal with patient care because this happens and you and the other doctors need to work it out. As the hospitalist you are the "captain of the ship."

If the captain doesn't know all the critical information, the ship will sink.

 

[bobow98]

Stopped reading here "since the consults left you in the dark. "

If that happens I pick up the damn phone and talk with them to see what exactly is going on. Lack of communication is a destroyer of many things and you need clarity here.

Pick up the phone and demand an explanation on what is going on and politely state your concerns if you still are not satisfied. This is part of learning to deal with patient care because this happens and you and the other doctors need to work it out. As the hospitalist you are the "captain of the ship."

If the captain doesn't know all the critical information, the ship will sink.

As an intern yes it can be hard to do all these as above.
However once you are the resident, you will naturally need to get good at what InvestingDoc wrote here.
This is because once you're the attending, there will be times where you will be the intern, senior resident, and attending at the same time, and you're the only person keeping the patient safe.

 

[xoggyux]

Hello,
I understand your frustration and admittedly chances are none of this will change in the foreseeable future. The good news is that It is up to you to create the systems to mitigate all of this and more. The bad news is that this is not limited towards, internal medicine or even medicine in general. The EM doc has to deal with the Urologist that does not want to come to the ED (even though he is on call) for testicular torsion. The surgeon has to deal with some of shis surgeries being re-scheduled because the nurse thought that even though there was a clear NPO order patient told her that he thought surgery was going to be Wednesday and not Tuesday or half the ORs being down because the AC system is broken, etc.

I remember when I used to get extremely mad and rabid when working on my part-time retail job they would ask me to move merchandise from A to B on Monday just to tell me on Wednesday that they actually like it better on B and ask me to bring it back.

Sometimes it takes energy and an active will to purposedly not get frustrated and mad, it takes practice but it is a skill you can develop. I know because I was like you and I was able to. Half of the non-sense **** that happens in the hospital is not even due to incompetent/ignorant nurses/practitioners but simply because they all want to cover their ass. They call you in the middle of the night to report a lab that has been in the computer for 48h because they just want to be able to put a short line in the computer "I called such and such, MD aware, No orders given". Honestly, I understand them.

One simple thing that I found out that helps a lot with menial work is to involve the patient and family members more. Not only they appreciate it as they don't feel useless and help them understand what's going on, but it also serves to give you a break about the silliest chores. Tell the patient and/or family that a BMP has to be drawn in 4 hours to check if the anion gap is improved so that they can start eating and it is going to be 70000% more likely that the lab actually gets done on time. Tell the family that when consultant A (who is difficult to get a hold off) shows up in the room, to hold him hostage there for 10mins and give you a call so you can show up and discuss with everyone at the same time whats the next plan.

 

[chromaticscale]

I appreciate everyone's input. I'm an intern and yes, I understand that these things happen because we are human. I'm aware that being outwardly frustrated at others isn't productive which is why I avoid that (and I instead have seen my senior residents get really angry at nurses or other consultants behind their back). I'm trying to avoid the burnout that is becoming more evident as a trainee in residency.
In regards to asking for more clarity, my attendings always make sure that the patient gets the appropriate care and follow-up, so I do what they tell me to do, e.g. I had to follow up with vascular surgery, IR, and cardiology regarding that patient's hematoma management in the end before we discharged them.

 

[mdjo]

Just came here to say that it gets better. It took me over a year after finishing residency to get un-burned out, but here I am enjoying clinic and enjoying spending time with patients again.

 

[Trogghunter]

...when the window by your computer got sealed shut because there's a concern that a fly will get in and find it's way down a patient's tracheostomy, even though that unit is about 100yds down the hall and through at least 4 doorways.

 

[shemer77]

Ive been told this all gets better, but to be honest I think you just get better at dealing with it. You know what to expect from certain consultants.