September 13, 2008

• Pushing Paper

  I was warned time and again by my doctors, by my med school friends and even on occasion, by myself-medicine is a lot of paperwork. However, it is only during the nearly completed first week of my sub-internship that I have realized how much.

  During my 3rd year medicine clerkship my responsibilities were basically limited too seeing the patient and writing the H&P. I had to follow lab values, of course, and write daily progress notes. But after that was completed, the remainder of my day could be spent studying for the SHELF exam (an end of rotation exam in whatever discipline you are rotating through). It was like being part of a big dramatic production where you go to rehearsals and learn your lines but never actually see or realize the existence of the tech crew who actually gets everything done

  Now for just a single patient (and mind you I cap at 6 patients and will usually be carrying around 4 at any given time) I not only have to do the intial admission note, but also the floor admission orders, medicatio and dvt prophylaxis orders, constant phone calls to social work, home health, any other team being consulted on the patient, antimicrobial orders, daily tpn orders for patients on parenteral (food by direct tube to your insides) nutrition and a host of other things on a day-to-day basis. Then, when I can finally get rid of a patient, I still have reams of paper worth of discharge forms to fill out to make sure the patient gets all the proper meds and follow ups. After all, I cant send someone home on an intravenous medication if they dont have a home health nurse or friendly neighborhood heroin user to help them inject their veins. Little details like that. Not to mention those damn dictations which suck up about an hour or more of time AFTER my work is done for the day.

  Now despite my whining, all this is actually a good thing. Sure I am being worked, and quite hard, but no more so than I will be during my intern year. And while classmates at other sites finish each day by 2pm and only carry 1-2 patients, I will be vastly more prepared and knowledgable when the time comes that I have to handle all this by myself.

  I have also begun to really be more on top of my patients and in one sense care about them more than I could third year. During the clerkship, I was mostly concerned with grades and amassing minutiae of medical knowledge. Now I am concerned that I have done everything I need to do for my patients at any given moment, and that I know them in and out should i be asked by an attending or consultant whats going on. Somewhere along the way i magically began being able to spew out med lists and dosages, lab values, and other things that I would have previously had to run to a computer and look up or say “i dont know”

  And while I still say I dont know on rounds, about half the time is now just from sheer intimidation or self doubt that my first instinct is wrong. On further reflection i often DO know the answer, i just cant reason it out in the five seconds time I am asked-but i get to eventually.

  All in all, not bad for a first week.

  • 5:48 pm
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