A combination of nothing particularly bad happening overnight or during the day, and me getting in earlier, made the day pass a lot more smoothly.

Interns, junior residents, and chiefs, think about a service differently. Interns are focused on the set of patients assigned to them. They know they’re responsible for that group, but anything else is out of their comprehension, and indeed they’ll probably get shooed away if they spend too much time thinking about patients they haven’t been assigned. Junior residents feel responsible to keep an eye on the intern’s patients, but they also limit themselves to some extent, because they know that the chief feels ownership of the entire service, and they don’t want to violate the chief’s prerogatives by taking too much responsibility for the service as a whole.

The chief, on the other hand, knows that there is no one but him to be responsible for the entire affair. Yes, the attending is responsible, but he’ll manifest that by asking the chief about anything that comes up, and expecting a solid, coherent, well-researched answer. The chief has to keep an eye out for the details on every patient, no matter which resident they are “assigned” to. He has to know all the important lab and imaging results, and the treatment plan for everybody, because that’s what keeps the service alive. If he misses a patient, there’s no one else to catch it.

I’m cautiously trying to develop that attitude. I can’t do it much when a real chief is around, because they hate it when the junior residents supervise too much. But when there’s no chief, I’m the one who has to make sure nothing slips through the cracks: no one gets mislaid in the ER, no important lab results get neglected for half a day, consultants are called as appropriate, patients who are going to the OR are prepped for the OR, and inspected for damages upon their return. I’m gradually shaking the intern habit of tuning out when a patient I’m not “following” is being discussed.

I’m also developing an amazing appetite for reading the textbooks at night. I’d better know more about what I’m doing. Just taking people’s word that “this is what we usually do” is not enough.

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