Last year I summarized my thoughts on internship into a single (vaguely) coherent piece for those about to commence work. It was, however, fairly non specific and more of a commentary on the healthcare system rather than containing much practical/useful advice. You should definitely carry two pens though.
I distilled the things that I remembered from internship and what I could bribe out of the intern I currently work with into a list of higher yield advice.
Calling/paging a specialty registrar
If you’re not sure why the referral needs to be made, find out! The two most important things to be clear about when calling are:
a. what the issue is
b. what you expect from them
The person on the other end of the phone can figure out a lot of the rest by asking you questions, but those two things should come from you. You’re also going to need to be sure you have the relevant patient information, charts etc. close to hand before making the call. If you don’t know something they ask for, please just say so.
Over time you’ll become familiar with the common referral patterns for each specialty and the questions they’ll ask – you can try and learn from this and figure out why they keep asking about those things. Finally, the person on the other end of the phone is human (usually) and if you’re pleasant/reasonable/supportive/inquisitive then you’ll make future referrals easier on yourself.
Managing your jobs
Your ward round will generate far too many jobs and it’s quite reasonable to feel overwhelmed by the volume. It’s important that you retain control of your priority list and don’t ever allow others to dictate it, or you’ll just pinball around the hospital helplessly. Requests from nursing colleagues, allied health etc. are all important to integrate into your jobs list but avoid automatically responding to the squeaky wheel.
I’d suggest triaging by
1. Things necessary for more clinically/acutely unwell patients
2. Things that require other people to do something (referrals, imaging requests etc.)
3. Literally everything else
You’ll find a way to keep track of them that works for you. I used the hi-tech solution of an A4 page with bed numbers written on the side, which was only a single extra piece of paper to carry compared to scribbling in the margins of a patient list. It doesn’t matter how you record them as long as you do, and it’s accessible.
Know your resources
Hopefully you were exposed to a few of the tools that support clinical decision making in medical school, but find out how to get a login/access through your health service to the various places that will tell you what antibiotic to use for what body area. I used MIMS, eTG and my local hospital policies the most (also Google).
I had the On Call book on my phone as a safety net as well.
Plan ahead
Medicine often embodies the need for the proverbial stitch in time. Anticipating future issues will often save significant efforts when the other proverbial hits the fan. There aren’t as many clear cut tips here but a few common examples might be:
If you know you’ll be in clinic, make sure plans are clear and there are no loose ends (missing medication orders!) before you leave.
Even if a patient isn’t scheduled to go until late in the day, get their script done the day before.
Long stay patients still need discharge summaries, which are far easier to compile on a weekly basis than all at once after four months.
The other area to plan ahead in, is your life. Unfortunately, work will consume an unreasonable amount of your time and you should find a way to balance that. Find out what social events your hospital organizes, take your co-interns out for dinner at the end of a difficult week, order food in bulk and prepare all your meals on Sunday night etc.
Miscellaneous tips
1. Don’t ever forget to order pathology. Bonus points if you actually check it before ward round the next day.
2. Find out what forms you regularly need and either carry them with you or keep a stash somewhere on your ward.
3. If you don’t know, ask. Please.
4. Be the change you want to see in the world (or at least the hospital system).
5. Know the doses of simple analgesia and antiemetics/laxatives.
6. Set (reasonable) limits early, before problematic habits form.
7. Buy a spare phone charging cable or one of those fancy powerpacks.
8. Find and save the number of the hospital switchboard ASAP.
9. Talk to people, not at them.
10. It’s impossible to kill a pager.
Finally, there will be many times you will miss something, feel inadequate or make mistakes. This is a common and normal experience, which is shared by all your fellow interns. Medicine can be a difficult environment to find your feet in and has some well documented cultural issues, but there are always people willing to support you. You can start with an organisation like the VDHP or your supervisor of intern training, speak with your colleagues (please support each other) or reach out anonymously via the internet and social media.