Tips for the new ‘terns...
Rule #1: Don’t lose yourself in the system.
This is important. Intern year was, by far, the most difficult thing I’ve had to do. This includes cancer, grad school, and medical school. It’s really fucking hard. The hours are long and, often times, inhumane. The patients can be incredibly mean and unappreciative of your time and care. The learning curve is near vertical. This is near impossible to handle alone. Rely on your support system. Try to hold on to at least one non-medicine related activity. Regardless of what the medical education system seems to be saying, remember that you are a person, having a life outside of the hospital doesn’t make you a bad doctor, and you are allowed to put yourself first. YOU SHOULD NOT HAVE TO SACRIFICE YOUR HEALTH FOR THE SAKE OF YOUR PATIENTS. Seek out the support you need. Utilize Jeopardy as needed. This will be a hard year; take care of yourself and take care of your co-interns. Don’t let anyone around you drown, especially if that “anyone” is YOU.
Rule #2: Rely on your upper level residents.
Accept help when it is offered. Ask for help when you need it. This is harder to do than it seems. After four years of pain, you finally have that MD (or DO) behind your name. Your patients and assorted hospital staff are calling your doctor. You feel like you’re supposed to know what you’re doing… but you don’t. THIS IS OKAY. Medical school doesn’t prepare you for this. You are supposed to be stupid. If you came into intern year already knowing how to care for patients then residency would be a moot point. Absorb as much knowledge as possible from your upper levels. Ask all the questions. Quite literally there is no such thing as a stupid question during intern year. If you are drowning and feeling overwhelmed to the point of being unable to accomplish your work, SPEAK UP. No one is perfect, and your upper level may not recognize that you’re drowning. Remember, half of your upper levels were interns just a few hours/days ago. We are all still learning. Make your needs known, and accept our help when it’s offered. Especially early in the year.
Rule #3: Organization is the name of the game.
Your primary objective as an intern is to get shit done. Simple. You can’t do that if you’re disorganized. So, first things first, get yourself a system of organizing your patient-related tasks and stick with it. Write down everything. EVERYTHING. Afternoon urine output check on a heart failure patient? Write it down. Told a patient you’d drop back by his room to clarify some questions? Write it down. Need to remember to write your daily progress note? Write it down. Need to enter in daily labs for tomorrow? Write it down. You get the picture. I personally used the folded side of a printed patient list, but any organization system that prevents tasks from falling between the cracks is golden. Good interns aren’t the ones who know everything. Good interns are the ones who let as little as possible fall through the cracks. Book knowledge, knowing the next step in management? Overrated. That comes with time and repetition. This is how you get there.
Rule #4: Use your med students.
Let’s be honest here. By the time intern year starts, the third years are starting to get into a groove. They’ve been around for a couple of months at least, and, chances are, know way more about logistics of the hospital and the basics of the EMR than you do. The AIs are an even more seasoned source of info. Use these guys to your advantage. Given how useless you feel on any given day as a med student, I found it kind of nice to be able to help the new interns.
Rule #5: Don’t let anyone rush you into making a non-urgent decision!
This was really hard for me to grasp. I felt like a failure every time I’d get paged about a cross-cover situation that I couldn’t immediately handle. It’s fine, guys. Very few situations require an immediate answer. Take your time. Paged about a patient with hypotension? As long as they’re mentating appropriately, take a few minutes to see where the trend of their blood pressure over the day. Check to see if there’s a recent TTE to determine if they can handle a big IVF bolus. You have time. Don’t let anyone try to pressure you into making an immediate non-critical decision. It’s totally ok to admit that you need to look at the patient’s chart first and you’ll call them back in a few minutes. This isn’t a weakness. This is you practicing good medicine.
Rule #6: Play well with others.
Medicine is a team sport. Your part, while important, it only one piece of a larger whole. You’re going to have a bunch of different, though usually complementary, professions surrounding you in the hospital. Getting along in a team sport is all about appreciating everyone’s POV and contribution. Never, ever, ever dismiss someone’s input. If your nurse is telling you that she is concerned about a patient, ask her why. Try to understand. Don’t just blow her off as being paranoid. This sounds ridiculously basic but, trust me, that reaction is really tempting when you’ve got notes to write and seven other patients who also need your attention. Disagree with a nurse’s request for pain meds, anxiolytics, an ekg, x-ray, etc? Think out loud. Explain your reasoning. One of two things typically happen. One, she already knows everything you’re telling her and just had to pass along the request to get the patient denied from “the doctor”. Two, you teach her something. Beyond nursing, you’ll also be interacting with pharmacists, nutritionists, respiratory therapists, etc. Strike up a conversation with any of these guys and you’ll be AMAZED what all these professions can teach you. Trust me… it’s a lot.
Rule #7: Don’t let bad interactions taint your view of an entire profession.
You’re going to meet asshole nurses. You’re going to meet asshole doctors. You’re going to meet asshole patients. It happens. Difficult as it may be, don’t let one interaction taint your view of an entire population.
My method of organization (https://tmblr.co/Zzhx1h2M0rPsM)
Paging etiquette (https://tmblr.co/Zzhx1h2N9W0Fn)
Teaching med studs (https://tmblr.co/Zzhx1h2NWra51)
