Advice for new interns

tallaght01

You'd know I'm on holidays at the minute, posting every 10 minutes. BUT, I've been thinking for a while that it might be a good idea to have a thread where doctors could give advice to new interns. It's a scary-ass time, and I remember reading a thread on a great UK website (www.doctors.net.uk) which had about 200 postings from experienced docs on this topic. Some of the info was really useful, and helped me out greatly.

There may not be enough traffic here from doctors to make this work, but it's worth a try. I know it's ages before the new interns start work, but it would be nice to have a few months worth of threads for them to draw on when they start.

If it's popular enough we could even make it a sticky? Or we could even start a "tips for final exams" thread if we get enough interest.

Anyway, I'll get the ball rolling with the very basics:

1) If you don't know, ask your seniors. They would much rather be aware of a problem early on, then when the patient is moribound. Even if they're busy, bleep them. It's their job to support you. They might be grumpy about it, but that's their problem.

2) Carry a bottle of water: You'll find that on busy nights you may not even get a chance to drink water. I've been admitted to hospital with kidney stones becasue of dehydration as an SHO, as have many many junior doctors.

3) Try and do an ALS course early on, coz there's nothing more terrifying than being the intern and being the first to arrive at an arrest call.

4) Try and have a life outside medicine: I know it's a cliche, but I'm only realising the importance of it now. Medicine can consume you. You spend many long hours in work, you phone in when you get home to check how your really sick patients are etc. So try to keep your hobbies up, and keep in touch with your non medical friends.

5) Regardless what you do, people will die: I remember after my first shift as an intern (I started on nights) ringing my dad in tears the next moring because a guy I'd treated died in front of me. I thought I must have been responsible, but I wasn't. He was just too ill to save. You'll learn to live with it, but it helps to know that every intern will have blamed themselves on a patient death at some point, regardless of the reality.

I could go on, but I'd be interested to hear what others have to say.

PoleStar

I have to emphasise one thing that tallaght said

Ask for help!

This is not only important for yourself, but also the patient. I think it is most important to recognise when you are out of your depth. If you have a sinking feeling in your stomach, dont slog on, call someone! As a consultant once said: "you shoudlnt lose sleep as a junior, you are not paid to do that, I am!"

I find also that as I go more senior, the more likely I am and less afraid I am to phone a consultant. Also on a purely medical note, I am sure all those past SHO have been called "eventually" to a patient who when you take one peep at them, no examination nothin you get straight on the phone to the gas jockeys and say "get your ass up here we need an ITU bed".



Also of critical importance: be nice to nurses. Why? Reasons:
-its much nicer to work in a pleasant environment where the nurses are your friends.
-for the guys out there, copper face jacks is a great spot!
-in the first few months, they really help you with doses etc
-but prob most importantly, if a nurse likes you and sees you as a colleague and a friend, someone she would go for a beer with, well then if its 4am and somethin silly needs to be done, she is much more likely to let it go til 7 am. On the other hand, if you are arrogant and un friendly she will only think " I hate that guy/girl, I dont care if they only sleep minutes, theyre paid to be on call"

Some people take this advice, some people learn the hard way, some people never................................

Dr Galen

be nice to the nurses......never a truer word spoken!

I've made friends with a number of interns and its worked out to benefit everyone. basically just don't be a prock and you;ll do just fine. there are times when you'll really appreciate the help/advice/friendship. and always remember, for some mad reason, nurses seem to have a very long memory!

also, empathise, think of how you would feel having a lumbar puncture, a colonscopy, orchidectomy etc etc and use that to your patients benefit. At the end of the day all of us, no matter what job you do are there for the patients and that reason only. sticking cannulas in at 4.30am, is a crappy job, but its crappier for the patient to have to get woken up, stuck and prodded, and then have antibiotics that might give them the runs given. you get my drift....

tallaght01

I sometimes give the introductory chat to the new interns. While keen to avoid yet another boards turf war, I always tell them that they don't have to be nice to the nurses, they have to be professional with the nurses.

Nurses are human beings. Therefore, some of them are absoloute angels. Some are complete wagons, and most lie in the middle ground like the rest of the human race.

When you wander into a ward at the start of the year, the angelic ones will be lovely to you. They deserve your full respect. You don't need me to tell you to be nice to them. Your own human nature will prevent you from being snappy with them, even after they've woken you up after 20minutes sleep.

The ones in the middle ground will get on fine with you, by and large. Treat them as they come. Some will become very close frineds, some will be just work colleagues, and there's very rarely any problems.

Then you'll have some nurses who will have zero respect for the intern, and won't listen to a word you say, and will be unpleasant to you from the start. You don't have to be nice to them. But you should remain professional with them. Everyone tells you to make sure you're nice to the nurses when you start, without putting any of the onus on them to be nice to you. But you're human, so you don't have to stand there and smile if somebody is being rude to you. If they wish to wake you up every 5 minutes with bone jobs, then so be it. Grit your teeth and then have a word with your consultant about it.

In each of my first 3 jobs as a doctor, senior nurses screamed at me for various reasons (like taking a long time to get to their ward or whatever). IN each case I took them aside and told them they'd no right to speak to me like that, regardless of what they think I'd done wrong, and that I'd make a written complaint if it happened again. That's all it takes.

Remember, despite all the abuse you take an intern, you still have the right not to be bullied or harrassed.

I agree with nurse baz about empathising with patients when you're cannulating them etc. Patients are often terrified of hospital, and are even more terrified of even minor procedures. So, if you've missed a few attempts at that cannula, take a break and go do another job for 5 mins before coming back (unless your in resus cannulating a dissecting aneurysm, of course :P )

Bison

Are there any Irish forums like doctors.net.uk that med students use?

tallaght01

I don't know, Bison. It's a shame if there isn't, as DNUK is a fantastic site with lots of great advice. It's password protected though. I know Australian/NZ docs/students are allowed access though.

You could try emailing help@doctors.org.uk to see if they'd give you a password.

Dr Galen

for any new female interns one other piece of advice, somewhat of the record.

be cool to the male nurses (me included ) you'll find that we'll always look after you then, even if your not that hot

Vorsprung

^male nurses not that picky eh?

What about when you're an intern on your first time on call? How did you get on? Did you find yourself calling the reg on call for every half difficult case?

tallaght01

I agree with Baz. Female interns need all the friends they can get. Male consultants will usually be nicer to them, but the female nurses can be a bit nastier to the girls than the boys.

BigJim, I'm sure any intern will give you horror stories of their first shift on-call as a new intern. I on my first shift going to see a patient who was having crushing chest pain. I was so scared I could literally hardly speak. His name was "John Smith" (false name, obvioulsy). So when I got there, I couldn't string enough words together to call him Mr Smith or John. I said "Hello smith", "now smith where is the pain?", "did your spray make it any better, smith?". I have no idea why that happened. It's never happened since.

My worst moment was when I was called to 2 wards at the same time on my first nightshift.
I first ran to the male ward where there was a prisoner in a side room attached to 2 prison officers. He was in with breathlessness that was being treated with antibiotics and nebulisers. CXR showed patchy changes but nothing specific. He was a drug abuser, and was awaiting the result of a HIV test. He was also awaiting a CT chest the next day.
I was called because his temp had shot up and he'd become more breathless. So I gave him oxygen, nebulisers and I took bloods and cultured him. As his nebs were running through and he'd started to look a bit better/sats were improving I ran upstairs to see the other person I'd been called to see, and said I'll be back as soon as possible

She was a woman in her 70's, COPD exacerbation. Desaturating badly. I gave her some nebs and some IV hydrocortisone, and ordered an x-ray of her chest. Took me a while to get on top of things with nebs, but eventually I did.

So I legged it back downstairs to see how the first bloke was responding to his nebs and oxygen.

As I ran down the stairs to his ward I saw the arrest team running into his side room. My pager hadn't gone off for some reason. But he'd collapsed out of the blue. Ended up ventilated for a few hours in ITU, and died.

Took me a long time to get over it. I blamed myself for ages and ages. In hindsight, I don't think I did anything wrong, given his history and his clinical findings. But I still remember it as one of the worst nights of my life.

To answer BigJim's question properly, I spent a lot of time on the phone to my SHO during that first 3 weeks (we did 3 weeks of nights on the trot, before I'd even seen a day shift). But that's the way it should be. If you're not sure, you should just run things past somebody more senior. Nobody thanks you if somebody dies while you're trying to be a hero.

Dr Galen

tallaght01 wrote:

Nobody thanks you if somebody dies while you're trying to be a hero.

never a truer word spoken

Traumadoc

Its a pretty tough year .
I agree with what has been said before.
Please do not be afraid to call for help- I remember one guy saying how he never had to call his SHO- dont let anyone get you down also - it can be tough and some people will try to bully you I remember a sister in the ICU telling me how she could make or break my career... I was pretty upset at the time and did not tell anyone.. I should have.

tallaght01

I think the new interns are starting pretty soon, so I've just bumped this thread in case any of them read it, and in case anybody wants to add any other gems