Response from Sohil H. Patel, MD (Resident, St. Vincent'sHospital, New York,)
Beginning your intern year is daunting. I know of few other timeswhen one's level of responsibility changes as dramatically aswhen a medical student becomes an intern. In some respects, thetransition requires an understanding that the first time throughmany new experiences, you may be slow and you may makemistakes. There are certainly ways to minimize such mistakesand, most importantly, to learn from them so that they are notrepeated.
Arm Your White Coat
As a subintern, I lumbered around in my short whitecoat with pockets brimming full of "survival guides," includingmy personal digital assistant, a pharmacopoeia, my stethoscope, areflex hammer, various scraps of paper and notecards with illegi- ble notes and phone numbers, and maybe a flattened granola bar or two. Early in my subinternship, I was called to see a patientwith abdominal pain and lower gastrointestinal (GI) bleeding.My thoughts immediately became as scattered as thecontents of my white coat. In fact, my first 3 thoughts were: Is thisan emergency? Should I be worried about colon cancer or angio-dysplasia? What are those other causes of lower GI bleeding that Imemorized for the boards? As I pondered these deep questions,my resident thankfully arrived and ordered me to check vital signsand do an examination. Only afterward did I look through thevarious resources in my white coat and find at least 3 resourceswith the same algorithm for dealing with GI bleeds.So, my first piece of advice is: know what's in your white coat!
If you buy a survival guide , read through it before you put it in your white coat. Use only 1 survival guide, and become very familiar with it. Likewise, use either a personaldigital assistant or a pharmacopoeia or an online pharma-cology Website (if your hospital has enough computers),and learn how to use whichever resource you choose.I also found it helpful to carry a few blank notecards. Every day, I jotted down important phone numbers,or room codes, or simple instructions on how to get thingsdone in the hospital. My notes were a mess, so each night I would rewrite them neatly on a new note card.Other white coat essentials include a stethoscope,a (functioning) pen light, a prescription pad, your sign-out,and at least 2 black ink pens. For internal medicine, theMass General
Pocket Medicine
book is an excellent re-source. If you can fit a snack somewhere in your pockets,that always comes in handy.
Recognize Emergencies
This is probably the most important skill learned duringintern year. When a nurse calls you about a patient, particularlyearly in your intern year, you should try your best to always seethe patient. See for yourself what types of calls and complaints areemergent and which are non-emergent.When you see a patient, the best way to determinewhether the problem is an emergency is to talk to the patient andget a set of vital signs. Then, compare these findings with the patient's baseline findings. These 2 simple steps will providecritical information about a patient's neurological and cardiopul-monary status.Certain nursing calls and patient complaints will man-date that you see the patient. Chest pain, shortness of breath, acuteabdominal pain, hypotension, mental status change, new neuro-logical deficit, GI bleed, and new fever all qualify. Learn whichcauses and consequences of such complaints are emergent, anddirect your history, physical examination, and management ac-cordingly. Thus, if a patient complains of chest pain, your firstobjective is to rule out a myocardial infarction, pulmonary embo-lism, or aortic dissection. Only after doing so should you explorewhether the chest pain is actually musculoskeletal in nature.Finally, especially early on, accept a low threshold for calling your senior resident about all suspected emergencies.
Arm Your Brain
The more medicine you know, the moreyou will enjoy and learn from your experiencesas an intern. Unfortunately, the fourth year of medical school is a well-known cause of brainatrophy. Thus, I found it helpful to brush upbefore starting intern year. Review the mosthigh-yield, commonly encountered diseases inyour specialty, and know them well (includingpresentation, diagnosis, and treatment). Youmay also benefit from reviewing school textbooksand study aids. At a minimum, every new intern shouldknow how to read an electrocardiograph, inter-pret an x-ray, and understand a blood gas result.
Am I Ready for Residency?
by Sherlyn Marcella
An excellent advice for our fellow students who will
soon face the ‘real world’ of medical service. ~ Ex-
tracted from Medscape Med students ~.Question
“I am starting my residency soon, and I am worried
about being prepared. What resources should I bring tothe hospital? How will I know what to do when I'm
alone during night call?”
Anesh says,man and his wife were once sitting by the door of their house, and they had a roasted chicken set before them, and were about to eat it together. Then the man saw that his aged father was coming,and hastily took the chicken and hid it, for he would not permit him to have any of it. The old mancame, took a drink, and went away. Now the son wanted to put the roasted chicken on the table again, butwhen he took it up, it had become a great toad, which jumped into his face and sat there and never wentaway again, and if any one wanted to take it off, it looked venomously at him as if it would jump in hisface, so that no one would venture to touch it. And the ungrateful son was forced to feed the toad everyday, or else it fed itself on his face; and thus he went about the world without knowing rest.
The above story is one of many written by the famous German author-siblings,the Grimm brothers. About ungratefulness. Thanklessness. The above story illustrateslack of filial piety, about a son who is ungrateful to his own father. The story is sym- bolic of course, but I am sure the Grimm brothers wanted to point out a major setback of society in reality, that is the inability of people to appreciate what others have donefor them, parents, relatives, friends, co-workers, colleagues, teachers, lecturers, vice-deans, etc.
We have to admit, most of the time, we take things for granted, especially people, and especially
the closest people in our lives. We might think that our fathers’ constant nagging of not going out alone in
the night is ridiculous, but when we get beaten up by some unruly Russian teenagers on the streets, hisvoice will be ringing in your ears.Maybe some of us never really gave those close friends back at home the proper treatment theydeserve, underappreciated them, and when we came to this icy land, we realized that spending even 5minutes with them would be heaven on earth.It is but human nature for us to only appreciate things once they are gone. But you can change thisif you try. Appreciate and cherish the little things in life, and the people around you. We always want moreand more, but why not first take a good look at what you already have, think and only then, decide whether you would want more or not.Do I need to say further about being thankful for having a perfect set of limbs, for having the
ability to see, hear and speak, when there are some people who can’t even do that? This notion has been
drilled into our heads for a million times, but let this be the millionth and 1st time. Are we even thankful
for having mental sanity, when there are some people out there, schizophrenics and maniacs, who can’t
lead a normal life?
And for those of us here, shouldn’t we be thankful for being given the opportunity to study medi-cine, to be doctors, to become future members of such a noble profession? So shouldn’t we not waste this
chance, and strive to be good medical workers?
Sometimes we just don’t realize the amount of things we already have that we have to be thankful for. If
you are one of them, take action. Thank your parents for being there every step of the way, and promisethem you will be there every step of the way forward too.
Thank your friends for lending you a shoulder to cry on in those times of need. And last, and most definitely not the least, thank God, for it is because of Him that we havewhat we have.
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