Congratulations on matching! All the years you’ve waited to finally start applying your knowledge, finally start making money, and to finally throw away that short coat that has cadaver stains on it is here. Intern year can be intimidating. You may be thinking to yourself “people’s lives are going to be in my hands,” but its not that bad. Your step 2 knowledge, basics of pathophysiology and pharmacology will come back to you at a speed you won’t even realize. You will be making decisions on patient care all on your own. I am 3 months away from completing my first year in internal medicine and I was in the very same position you are in now.
The 2 big question we all have are:
How do I not kill someone
How can I be the best intern?
Practice of medicine is a team game. Your seniors and attending will assist you in patient care, but remember communication is going to be key, so developing good relationships with your residents is vital to providing patient care and “not killing someone.”
So on to the big question; being the “best” intern doesn’t only entail having a deep understanding of disease processes and management [that’s actually only a smart part of it]. The most important thing is going to be the “other things.” When you start residency you will soon see beyond what you saw as a medical student of doing blood draws, trending labs, and following up imaging results; a lot goes into a patient being set up for discharge. The social issues: whether the patient has a family to look after him/her, does the patient need rehabilitation, is he/she homeless, has financial issues, whether their insurance will cover their medications, and whether this patient is a high risk for non-compliance. What does this require? This will require you to develop a good relationship with the case manager and social worker, which can help expedite the process of not only discharging the patient, but also transitioning them to continuity of care. The main goal of acute inpatient care, is to treat, have a plan placed for them for discharge once they are stable, and to communicate and develop trust with the patient so that he/she will follow up with medications and appointments.
Depending on the hospital you will work for, relationship with ancillary staff as you know and have heard multiple times from relatives or friends, are VITAL! If you have phlebotomist, that’s great, if not you will have to have the nurse draw it. If they are busy and you are not you will draw them. When you help them out, they will most definitely help you. This is where medical students can help as well. We all have been through it and it’s all part of the process, so teach them and help them help you. I personally kept a reward system; if I was tied down with discharge summaries or I had to catch up on my work medical students would draw blood for me and I would let them go at noon.
As you know by now communication is important. Communicate with your senior resident and update them on any new consults that have seen your patient and have made recommendations. Don’t forget your patient! We get so caught up in following up results and making sure orders are placed that we forget to update our patients. Imagine tests being done on you or your mother and not knowing what the results were. Make sure to stop by and explain to them what the results were and break it down in layman’s terms; they will thank you later and it will make for a happier patient. If he/she is not capable of understanding their current state then make sure to communicate to a family member.
Before signing out to the night team, make sure to renew your orders and follow up with any last minute questions your patient may have. It’s okay to say I don’t know. Never BS your way through with patients. Communicate the truth and it won’t come to bite you in the ass. You will learn along the way, the doses of medications, how a certain attending likes to manage one disease process over the other, how to put in certain orders, and what to do in an emergency situation. But to set yourself apart these are some of the key characteristics you can develop to shine as an intern. Remember to enjoy every part of it, and don’t be afraid to ask questions. Uptodate and epocrates will soon be your best friend. Wish you the best of luck! Enjoy the last bit of freedom before you start residency.