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PWang: A good article to share with other CMGs: on internship
作者:USMedEdu
发表时间:2008-10-14
更新时间:2008-10-14
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what I learned from a AMG website called SDN about internship, for sharing with other CMGs.

1. Show respect and gain respect - This will serve you very well when interacting with all health care professionals. Having a genuine interest and learning the names of the nurses, physical therapists, dietitians, pharmacologists, etc will benefit you greatly when you need their assistance. It benefits you in ways you'd never know b/c others wind up going the extra distance for you i.e. IV placement, transport, seeing someone first thing in the a.m. for you, etc.

2. Don't try and cover your ass with a bunch of PRN orders - I have seen lots of errors committed because of this. Yes, PRN bowel regimen on the patient with standing pain meds makes sense. No, PRN tylenol for fever in anyone who you are anticipating an infectious w/u in does not. You PRN orders should be based on the individualized plan for your patient. I had a crosscover intern order restoril 30mg on my ESLD patient who had insomnia b/c of hepatic encephalopathy just so she wouldn't get called at night. She looked like an idiot on rounds. When thinking of PRNs - consider bowel regimens for most people bed bound and on pain meds, but I would discourage using PRN ativan, pain medicines, sleeping aids (except maybe trazodone 25mg) or benadryl. Drug companies already get paid too much, why add to their profit margin by prescribing unneeded medicines.

3. Stay on top of your medication list - We have a system that automatically imports our medication list on our computer based sign on into our daily progress notes. Some people don't pay enough attention to keeping their med list up to date - which can really hurt your crosscover and is generally poor form.

4. Think of discharge planning issues early. When considering your plan for your newly admitted patient, you should think about dispo. Will they likely need PT/OT eval while in house? Will they need a PICC line for home abx? Will they need home nursing or wound care? Nothing is worse (for both you or the patient) than resolving their inpatient needs but then having the patient have to stay the weekend b/c you slacked on dispo stuff. Social Workers can be immensely helpful in this regard.

5. Be proactive - Ask your senior resident early on if you can take the lead in rapid response calls or codes. If a patient is crumping, call the resident for assistance but ask the resident if you can assume the lead. Midway through intern year, this can be very helpful and will prepare you for the next stage of training.

6. Read about one thing per day - You don't have to read an hour, but try reading about one topic for 15 minutes per day. Preferably, something related to your patient. UptoDate is great for this sort of thing, but it is also great to make use of review articles. People who just study the Pocket Medicine book are handicapped.

7. When things get tough, seek your friends and family - Internship is a marathon. Aspects of internship can be difficult and your work starts to become your life at times. When a patient dies or when things don't go well, try to remember the bigger picture. It can also help to seek the solace of an aged physician. This doesn't necessarily have to be in person. Jerome Groopman has a great collection of essays on his website that always help me remember the reasons why I chose this profession.

8. Be a team player - Nothing is more frustrating than getting a crappy sign out from your colleague b/c they "can't wait to get outside and enjoy the nice weather". Your co-interns will really appreciate it when you tuck your patients in.

9. Don't be afraid to pick the brains of the attendings consulting on your patient. If you just follow up the consult note, you won't learn that much. If you take part in the discussion of the consult service rounding on your patient you can come away learning a great deal.

10. Don't stop doing what made you happy before internship.

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