Confessions of an Intern

Week One

I don't know what I thought it would be like, being called 'Doctor' for the first time by someone who only knew you in that role. Sure, my family and friends had been calling me Dr. for some time, laughing and teasing me. But this being the first week of my intern year in family medicine residency, it has been loaded with firsts.

The first time I called a pharmacy and introduced myself as Dr. D__n and was received with graciousness and a pandering manner from the pharmacy tech. It was so odd. I had initially just introduced myself with my first and last name, resident physician. I was put on hold and then asked "Who are you again?" When I said Dr. D__n, the response was so different. Then today I called another facility that answered with the standard "Good afternoon, specialty hospital, could you hold please?" Not wanting to be contrary, I agreed to hold. When the nurse answered and asked how I could be helped I introduced myself yet again. This was met with a similar response. "I'm so sorry doctor, I should not have put you on hold."

Now, I've been on the 'other side' of medicine for a long time. I was a nurse for over ten years. I was always of the opinion that doctors are people too. We have a common goal as members of a health care team, that is to help our patients get well. I never did ascribe to the thought that we needed to show subservience to them. (Maybe that's my problem). I was never afraid to call a doctor. If they were an asshole, I'd call them on it and try to calmly state my case. Usually by the end of the conversation, we were on the same page. It's the same way I was when another nurse would tell me to treat a patient well, because they were a VIP. There was no way to more quickly get my hackles up than to say that. I have always felt that all of my patients were VIPs. The CEO or Chairman of the Board or the weatherman are no more important that the homeless guy in the next room. My response was all my patients get my best care.

My first month of my intern year is on inpatient medicine. I wake up at 4:30 every morning and show up at the hospital to do rounds. While I feel immensely at home in the hospital, I am finding it difficult to make certain role transitions. This week has already found me helping a nurse clean up a soiled patient, turning a patient onto her side because she was uncomfortable and could not turn herself (a task that a fellow resident had taken the time to leave the room, search out the nurse, ask them to do it, and return to the room, instead of just helping), performed mouth care, readjusted an IV pole and just sitting down for a very pleasant conversations with patients. Yes, I am busy with a tremendous amount of clerical work. The more education you receive, the more you have to document I find. I'm learning to dictate H&P (history and physicals), discharge summaries and write concise notes that make sense. I have already figured out why doctors move so fast. I've already found myself wishing I could just disapperate to my next destination to save myself precious minutes of walking several floors of the hospital.

I've found my relentless need for information pays off well, but also tends to open up a can of worms. For each problem we answer, there are five more that need addressed later. I've been told I need to work on refining my plan of care, and I agree, but everything seems important. I pray that I do not become a physician who focuses so much on the concise problems that I lose sight of the person I'm caring for.

I've had my first evaluation, and it went rather well. I am truly in my element. I love the atmosphere in the hospital. I love the busy-ness of it, the constant heightened sense of alertness as we don't know what the next moment will hold. But I regret that I am not more involved in the direct patient care. I do not think I can just become a statistician and documentarian. I have to touch my patients, pat their hand, just maintain that human touch.

The inhumaness of the new government requirements seem to be a huge stumbling block. While insisting we provide better, more efficient patient centered care, they government insists on our implementation of an electronic medical record. The problem with that is, there are not very many good EMR programs out there. Glitches, inconsistency and simple user interface idiosyncracies make it nearly impossible for the computer charting to become intuitive. I am at an advantage, as the computer system we are using I have used many years ago for a long time. I have not worked as a nurse for over 5 years. The system we used was old then, in a DOS format that no longer even has a script, so if it crashes the system is defunct. I had years to develop muscle memory for the use of fn keys. Yes, it uses fn keys to navigate the entire system. The electronic elephant in the room makes patient interface cold and unnatural. I hope to never become so bogged down as to sacrifice time for face to face encounters with my patients for trying to make the EMR say what I could enter in 30 sec on my own.

There will be more to come. It is only my first week after all.