I thought it was hard being the intern and figuring out how to relate to the attendings and all the various levels of residents senior to me.
Figuring out what to do with my intern is even more complicated.
He’s not brilliant, but he tries hard enough that I can’t just write him off as a bad job. But how do I balance between pushing him hard enough that he learns what he needs to do to make a surgical service work, and being friendly? How do I let him make enough mistakes that he takes things seriously, but keep anybody from getting hurt? There are so many things that he ought to be doing, that we’ve told him about, but he forgets or doesn’t know how. So do I just do them myself, which would be the simplest, remind him endlessly and start looking like his mother or older sister, or let them go until he gets embarassed in front of the chief and/or attendings, to make him remember?
He’s not like I was as an intern, which also makes it complicated. If I’d had an intern as naive and hopeful and trusting, and incompetent, as I was, maybe I’d know better how to relate. Someone who says, I want to do it right, but is rather clueless, seems to me easier to deal with than someone who talks brashly and confidently, but doesn’t have the knowledge or skill to back it up. An intern mouthing off like a senior resident throws me off. The older residents have earned the right to make flippant remarks; my intern doesn’t have the experience that in my minds earns a little tolerance for making unkind remarks about nurses or patients. If the chief says he doesn’t care, I know that his record of hard work, long hours, and lives saved show he doesn’t really mean that. But for my intern to say that – it’s too early. The attending can say, “Ah, fibromyalgia, consult rheumatology,” because we know he has the experience to be confident that there’s nothing really the matter; the intern needs to think a little deeper before brushing someone off.
But I’m not the censor. My intern is an adult, and needs to sort things out for himself. I try not to comment on his attitudes or remarks, just on his work. Hopefully in a few months he’ll learn what’s acceptable and what’s not. I trust the nurses, too, to set him down when he needs it. They can do that better than I can. Time will tell. Like me, he needs to see bad things happen just to learn that they can; then he won’t talk about them so lightly.
July 19, 2008 at 5:18 pm
I seriously love your website. I am a 2nd year med student very very very much interested in the career of surgery. I really hope you continue writing, because, I really feel like I get an awesome insiders look at what it’s like to being a surgeon. Very few blogs give this feeling to a reader.
Thanks so much,
Eduardo
July 20, 2008 at 8:20 am
Thanks, Eduardo. I hope you meet some good teachers when you do your surgery clerkship.
As for my blog, I think I’m addicted to running my mouth in public, so it’s likely to stay around. 🙂
July 20, 2008 at 12:34 pm
what kinda things do you feel your intern should be doing but doesn’t know how or forgets?
July 20, 2008 at 2:51 pm
I was just like that guy as an Intern, well except I knew how to do a bunch of things, like floating PA catheters, till that time I floated one in a patient with a Left Bundle Branch Block. Was quite an Ugly Mortality and Morbidity Conference that week.
July 20, 2008 at 5:37 pm
If he’s categorical, spend time and effort to tune him up, it’ll be worth it in the long run when you need to rely on him as he gets to be more senior and has a job that you would be hard pressed to cover for him. If he’s just a short timer, just make sure that he doesn’t screw up, but don’t waste too much time (or emotional energy) on him…let him go *&*k up in another specialty.
harsh…yes. practical … you betcha.
July 20, 2008 at 6:49 pm
XoQo – Post-op checks, ordering am labs, checking on vital signs and ins-and-outs during the course of the day, post-op orders for the chief’s patients. Those are things that you get acclimatized to, so it’s not just that he doesn’t do them, but that he’s so brash and self-confident while not doing them.
Frank – Ok, enlighten me: what happened to that patient? Arrhythmia?
BTDT – He’s categorical, yes, so it requires more effort.
July 20, 2008 at 8:20 pm
Yeah, a LBBB’s a relative contraindication to doing a PA cath since if the baloon interferes with the Right Bundle, pt can go into complete heart block.
July 21, 2008 at 12:01 am
I suspect that much of his bravado is an attempt to mask his insecurity. I’d be inclined to pick a few important things and make a point of getting him to do them consistently. For the rest, try to figure out whether letting him be embarrassed will actually have an effect or whether you need to help him write a checklist so he isn’t. Either way, those things which are his responsibility need to become HIS problem.
If he’s alienating the nurses he’s making his job, and consequently yours, that much harder. If he has any potential at all, the nurses will definitely help you out with him. If he lacks potential, they’ll go right over your head and help deal with that too. BTDT – on both sides.
July 21, 2008 at 7:21 pm
Judy – Very good advice. Will try to remember it.
July 29, 2008 at 10:34 pm
““Ah, fibromyalgia, consult rheumatology,” because we know he has the experience to be confident that there’s nothing really the matter; the intern needs to think a little deeper before brushing someone off.”
I hate to be like this, hate it but, if fibromyalgia is nothing, I wish it upon all doctors, nurses, medical personnel that treat it as like that.
I have fibro and I manage it with Neurontin. I am in nonstop pain, every day of my life. If there is no fibro, I want the medical people to figure out what the hell it is that is wrong with me so I won’t have to be in so much pain.