October 18, 2010

• The Safety Net

  Today was my first day as a senior resident. It was weird.

  The last few months, I have been on consult services. medical subspecialties basically, where I am still acting as basically a more knowledgable intern, carrying out the fellow’s orders and occasionally making suggestions for treatments or changes to the plan. Being on a subspecialty service is great because you end up getting a great depth of knowledge about conditions affecting the lungs, the blood, the liver, or whatever other service you are on.

  Being on wards is more about the breadth of knowledge you acquire, or what we refer to as “bread and butter” medicine. Each wards team is made up of an attending, a senior resident, and two interns. Occasionally there is a medical student as well. 

  So what do I do as a senior resident? I dont write notes…that is for the interns to do. I dont replete lytes or order basic labs, the interns do that too. Unless my team is running behind, or I want to be a nice resident, I dont even admit. SO what the hell am I actually responsible for?

  I am somebody’s safety net. There may be things that the interns dont know to order, or forget to do. Somebody needs to catch little things before they slip through the cracks, making sure a patient is not on an uneccesary medication, is actually scheduled for a procedure they are supposed to be, and someone who keeps an eye on what needs to be done before the patient can be discharged. I am at this point presumed to have the knowledge to do all those things and thus my day is spent reviewing the interns notes to catch potential mistakes, and making recommendations to the attending about the plan and or getting feedback. It’s a lot more autonomy, as I mentioned in the last post.

  But now if the interns have a question about why we are doing some test, or what causes something, or what we should do with some lab result, I am the first line of defense to answer them. It’s a bit like the blind leading the blind…or at least the one eyed leading the blind. I have no problem telling someobody I dont know the answer, but it definetly encourages me to read more…nobody wants to be the stupid senior. So despite my longstanding opposition to doing any work related things when I am not physically at work, I  I now find myself scanning the new england journal of medicine, or browsing uptodate (a more medically specific version of wikipedia for doctors) just so I dont get caught with my metaphorical pants down.

  Because now it’s not just the patients relying on me, it’s the other doctors. And when it comes to mistakes, you have to read your interns notes and orders like pokemon

  gotta catch em all.

  • 9:34 pm
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