In less than 100 days of being a “doctor”, I’ve learned that intern year is all about pursuing two invaluable goals.
The first is efficiency. Medicine is unpredictable. Six new patients could show up in an hour. Other days may require having to see 15 known patients (with written progress notes) within a very limited time. Oh yeah, and patients can crash at any time. Whatever the case, I think having a methodical approach to each day lays the foundation for efficiency. Notes take less time… physical exams become more focused… and presentations on rounds become more relevant. Plus this affords more time for residents to grab lunch, teach medical students, and spend time at the bedside with patients. With regards to the ACGME’s intern hour restriction, one of my attendings told me: “Interns who complain that 16 hours isn’t enough to complete their tasks… well… they need to work faster.” Start with a method, continue what works, and modify what doesn’t. Rinse and repeat each day.
The next goal takes a lot of patience (and patients) – it involves knowing how to differentiate levels of “sickness.” Walk into a busy clinic and look around – you’ll see patients coughing, sneezing, and shivering. You’ll see others who are completely yellow in color, others who are in excruciating pain, and others who have absolutely no outward manifestation of any underlying illness. How does an inexperienced resident triage such patients? Who can (safely) return home after a breathing treatment or antibiotic? Who needs to be rushed immediately to the operating room? There is no substitute for experience in this discipline. An astute physician is able to begin the physical exam before even greeting the patient. Often times we’re so concerned about heart murmurs, abdominal exams, and lower extremity edema that we lose sight of the most obvious question posed by experienced attendings: “How does the patient look?”
Just over nine months left of intern year… an entire career to understand the imperfect science of clinical medicine. 🙂