Just needing to vent

[PGY1IsNotMyFave]

I'm starting to wonder why in the world I signed up for this whole doctor thing. I am only a few weeks in and I've already quit several times in my head. I am already tired of the long hours, ungrateful patients, demanding family members (I mean really dude....it is not my fault that your family member is intoxicated and requiring detox...AGAIN). I'm tired of not having time for a life outside of the hospital. I'm also tired of chronically feeling like a schmuck because I do have an M.D., but I can't remember ANYTHING AT ALL! It's like I didn't even go to medical school, Also, I just need to say to my third year medical student who is convinced that working up one patient in four hours is so much harder than my measly little intern job...you are ridiculous!

Am I the only one feeling this way? Any PGY-2's and above have any thoughts on how to get through this year without getting really discouraged? PLEASE HELP!!!

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[QofQuimica]

Things that help me:

First, focus on getting through each day, and don't worry about future days. You can stand your job just for one day, right? Keep that up every day, and all of a sudden a whole rotation has gone by.

Second, plan something fun to do on your days off, even if it's just to watch a movie that you want to see or eat your favorite food. Having something to look forward to will improve your outlook, even if it's just something small.

Third, don't take other people's attitudes personally. Some people are just inherently jerks, and you're not going to be able to win them over. That's ok. Just be as pleasant and professional with them as you can, and mentally disengage from it. The way I figure, there's no point in trying to out-compete someone who has an axis II disorder in a toolishness contest.

Finally, talk to someone who cares. It can be a spouse, significant other, parent, counselor, fellow resident, advisor, or anyone else who will let you vent and give you moral support. Being isolated will make you feel alone even when you're not.

Hope this helps, and hang in there. We're already almost a week into month #2!

 

[Law2Doc]

Things that help me:

First, focus on getting through each day, and don't worry about future days. You can stand your job just for one day, right? Keep that up every day, and all of a sudden a whole rotation has gone by.

Second, plan something fun to do on your days off, even if it's just to watch a movie that you want to see or eat your favorite food. Having something to look forward to will improve your outlook, even if it's just something small.

Third, don't take other people's attitudes personally. Some people are just inherently jerks, and you're not going to be able to win them over. That's ok. Just be as pleasant and professional with them as you can, and mentally disengage from it. The way I figure, there's no point in trying to out-compete someone who has an axis II disorder in a toolishness contest.

Finally, talk to someone who cares. It can be a spouse, significant other, parent, counselor, fellow resident, advisor, or anyone else who will let you vent and give you moral support. Being isolated will make you feel alone even when you're not.

Hope this helps, and hang in there. We're already almost a week into month #2!

Good advice. Also keep in mind that intern year is a very steep hill to climb, but once you get over the peak, there's a lot of coasting you will be able to do. Things that take you a ton of time now will take you a fraction of that time by the end of the year. The folks who berate you now will regard you as competent as soon as there is another batch of incompetents who succeed you as interns. You will probably even enjoy the last few months of intern year because you will know how to do the job, will be less stressed out about the expectations and won't have that deer in the headlights look all of the time. But yeah, getting over that initial peak is rough. But be confident in the knowledge that a lot of worse prepared people than you made it, and so you probably will too. The months fly by before you know it. And there will be a whole new and very different set of stresses to replace those old ones.

 

[NYRN]

Hang in there, it WILL get better.

Being unfamiliar with the system of the hospital and not knowing who is out to make intern's lives hell makes things difficult at first, but once you get those things down, it will get a lot better for you. Intern year is tough, and at first you will feel like you don't know anything or that you are doing things wrong, or not good enough, etc. There will be people out there who like to shoot you down for no good reason, and with inexperience you think its you just not being able to handle it.

Ive been in this game a while, and although I haven't been an intern, I see a HUGE transition from intern to PGY 2, probably more than you see from years 2-3. You will learn a lot this year, you will gain confidence, and you will make it through I promise.

I'm sorry that there are people who are mean or rude to you, they are just miserable people, don't let them get to you. That being said, as long as you stay professional, there is nothing they can do to you. For example, if a resident is known to blow his/her top at everything and then someone complains about them, the people in charge will believe the complaint, even if its invalid, but if you stay cool and professional and some jackass tries to say that you blew up and screamed at them, they will take your side because they know you aren't like that.

Best of luck to you, hang in there, you can do it!!!

 

[SalseraDoctora]

I'm also tired of chronically feeling like a schmuck because I do have an M.D., but I can't remember ANYTHING AT ALL! It's like I didn't even go to medical school

I just said this exact same thing to everybody who I could convince to listen to me complaining. If it's worth anything you made me feel better for writing this. I am also 100% positive that we two are not the only interns who are thinking this now/have thought this in the past/will think this in the future. I definitely have the little in my head two part conversation. Negative Nancy Salsera says maybe you won't ever remember this obscenely enormously overwhelming quantity of information and you will get chucked out of internship and have to go live under a bridge. And Sane Got-some-sleep-last-night Salsera says you are doing fine, you will be okay, just keep on trucking and try not to complain more than 400 times a day.

I am sure we will be okay. Perhaps not now but eventually

 

[cowme]

Beats being a med student

 

[Dral]

Beats being a med student

Agree. I liked my first month on medicine floors better than anything I did during medical school because I felt that I actually contributed something substantial.

 

[Doctor4Life1769]

Agree. I liked my first month on medicine floors better than anything I did during medical school because I felt that I actually contributed something substantial.

I still don't care for the med wards

 

[Dral]

I still don't care for the med wards

I hear ya. Some of the patients that get transferred to the floor...you hear about their back history from the resident and you just know it's going to be bad...not bad as in they're sick and you get to figure out what's up, but bad like they have 24 social issues going on....just have to power through and do it.

And then there's the "Call the aunt to find out what cardiologist they saw five states over in 2008 to see if their stent was a drug eluting or not...if they even have a stent...yeah find that out...and get the records sent here....and make sure that cardiology gets them...and then make sure their Metop dose is correct.

*Calls Cardiology to give the stent information*...actually, can you order an echo? Here's my pager, let me, know about the results. *Echo results aren't back yet...calls radiology*. "Yeah, come down here and we'll show you the results"..."Um, I have a bunch of other...um. ok." ugh. Resident: Ok, you should go to noon conference. "But...I have to..." Ugh.

haha. Still better than being a med student though imo.

 

[DarknightX]

Agree. I liked my first month on medicine floors better than anything I did during medical school because I felt that I actually contributed something substantial.

Totally agree. I learned more in my first 7 weeks of residency that I did my whole fourth year of medical school.

 

[colbgw02]

*Echo results aren't back yet...calls radiology*.

I'm curious - is this a mistake or do you really have radiologists reading echocardiograms at your institution?

 

[Dral]

I'm curious - is this a mistake or do you really have radiologists reading echocardiograms at your institution?

Nah it's not really like that...I was just typing a bunch of jibberish out in a row to demonstrate that just a bunch of seemingly random stuff happens throughout the day on the wards.

 

[DD214_DOC]

I survived med wards and most other rotations by sensible delegation. Very rarely was I in house more than 12 hours at a time. For example ...

Patient requires a follow-up appointment s/p hospitalization within 7 days. Give the patient the appt line # and write it into the disharge summary and make them set it up themselves

Patient on coumadin, titrating to therapeutic INRHave pharmacy dose it and follow INR

Need collateral information from family members on patient's ADL, etcHave the med student call and report back
Have social work call and leave a note

Family members of a patient want daily updates or want to talk to you all the time for something that really isn't that seriousTell the nurses they had to go to college to be a nurse for a reason. Update the RN on the plan, show the RN where the notes are, and have the RN communicate with the family. That's part of their job. I made a point not to talk to family unless something was seriously wrong with the patient; it wastes too much time and the RN can tell the family the same stuff I would tell them.

PRN meds
Order basic PRNs with hold parameters so the nurses won't page you 500 times a day for stupid things like conspitation and basic aches and pains.

Sensible call parameters
Set up your call parameters and nursing orders so that initial things can already be done by the time nursing pages you. For example, put, "If SBP > 160, recheck with manual. If still > 160, page MD". Or, "For complaint of chest pain, check EKG and page MD". It's a non-invasive test that is readily available, so who cares if it ends up just being MSK or GI in origin.

This will buy you time during the day to read and allow you to better scrutinize your patients.

You'll learn this stuff as you progress and get more comfortable with things, especially once you're comfortably with the typical bread and butter stuff you see. Then, your goal because more about minimizing your work than patient care (since by then the bread/butter patients are just routine).

It'll get better. I survived and did remarkably well on medicine, actually, and I'm just a stupid shrink.

 

[Best4Med]

The transfer from med school to practice is not something you learn how to do in school, or actually get prepared for. I think best advice is really as others said - to share your concerns with others close to you, and at the same time get advice from experts. Finding the specific tactic to get you through will grow from a wider understanding of your personal situation.

 

[Witch Doctor]

Seriously, this thread just made my day! First time I've actually laughed about all of this! On the first it was a total nightmare, tons of these chronic patients with 20 problems (all new to me) and even more social issues, annoying family, and my favorite overbearing micromanaging senior! Who wouldn't love this?? I'm so glad I paid $100,000 to be allowed to be tortured like this.

I'm just not sure what happens all day, but at the end of the day I feel a little like a a bad doc and a little like a miracle happened... lol

I guess all you can say is that thousands have made it through before us, I'm sure one day we'll all look back and remember this (kind of) fondly.

 

[Dral]

"PRN meds
Order basic PRNs with hold parameters so the nurses won't page you 500 times a day for stupid things like conspitation and basic aches and pains.

Sensible call parameters
Set up your call parameters and nursing orders so that initial things can already be done by the time nursing pages you. For example, put, "If SBP > 160, recheck with manual. If still > 160, page MD". Or, "For complaint of chest pain, check EKG and page MD". It's a non-invasive test that is readily available, so who cares if it ends up just being MSK or GI in origin."

These are two really good pieces of advice. I've just now started to realize how helpful they are. A little time putting in the order can save you much time later. The other day we finished rounding and I was trying to start working on notes. I was paged or had to go do something else literally once every few minutes...right when I finished one thing and logged back into the comp, I was paged again...mostly for issues that those pieces of advice could solve.

As a bonus, it makes things a lot easier on the night float person as well.

 

[Janedoedoctor]

It'll get better, really. You're at the nadir of misery in medical training. If you make it past this, you can do it all.

You will get LOTS faster and more efficient at just about everything as you progress. Some advice, although most of it has already been said

1. Concentrate on your core task: medicine. Master the art of cutting short any useless and time-consuming conversation without offending the other person.

- You should not be the one who has to listen to patients and family members ramble endlessly about social issues. Get social services involved EARLY and let them do their work.
- You're not your patients' secretary. if they need a follow-up appointment, don't spend time making it for them, just provide a timeframe and the number where they can make the appt themselves.
- Family members are NOT entitled to personal and daily updates on a stable patients' status. If nothing spectacular happened that day, you don't need to make time for a talk. Have each family appoint one spokesperson (if the pt cannot do/be this himself), and spend time talking to that person only. It's up to him/her to communicate with the others. Internal family conflicts aren't your problem.

​

2. Efficiency on the ward boils down to having results of labs and other tests available early in the day. Make every possible effort to expedite them, so you don't have to make major changes in the plan in the PM.
For the same reason, call consults as early as possible.

3. Avoid having to go back to the same file/patient twice. This hangs together with point 2. You shouldn't spend time on a chart before the labs are in, because you'll just have to pick it up again when you have the results.

4. If you can anticipate a complaint/symptom, write a PRN order for it. Over the course of your medical training, this will save you about a million calls. (caveat: use common sense. Chest pain, etc should not be handled like this. But you knew that.)

 

[rachmoninov3]

May I hijack an intern vent thread? I lasted two months in intership, and while I'm doing my best to study and care for patients, there's another whole annoying side of residency to learn. On top of all the learning to be a doctor stuff, is all the really poorly organized other cr*p that goes with the new duty hours restrictions and programs not having their act together? Be here at this time, be there at this time, this take precedent over that. The rules aren't clear b/c we're changing them for duty hours!

Today was the second time I was dressed down by a nurse because previous intern classes have had more structure as to what they are supposed to do. Of the two incidences, one was transferring a patient in PTL at 29w with only talking to my attending and having his blessing. Talked to specialist/accepting attending myself, told them who my attending was. Somewhere in a rule book I never received I should have an attending physician there with me. Today, Maternal Fetal Medicine clinic was cancelled, and then no one said that L&D was the new MFM clinic (NST's, BPPs). Doesn't help that I haven't really got to go to MFM clinic because there's been too much L&D and nursery work, and I don't remember being told that I absolutely have to go to clinic rather than getting work done. So I have the sub-i see a patient, she writes an incomplete note, and then I'm yelled at when I come there to d/c the patient and I have to assess her myself b/c of the poor quality note. Rather I should only be there and see the patient initially and all the way through. Would have been nice to have the handbook.

That learning is a SOB I understand, the lack of structure and support I worry may be the program specific and be a bad sign.

My liver has not been working nearly hard enough thus far during internship.

thx for the rant

 

[cartoondoc]

The beginning of intern year is rough for everyone. It's pretty much like this:

http://doccartoon.blogspot.com/2010/07/intern-year-guarantees.html

But it does get better. Or is bad in a completely different way.