Thursday, June 18, 2009

Top 20 Tips for Intern Year

1. When ordering a test or taking any action on a patient, ask your self the question, “Why am I doing this?” If it doesn’t change the patient’s outcome, reconsider your plan.

2. Evolve your communication skills to the maximum. Keep your attendings, senior residents, nurses, patients, and patient’s families up to date on the plan.

3. Ask questions when you don’t know the answer. Its okay to ask the nurse and even the actual patient, “What do you think is going on?”

4. When you’re on call overnight and sleeping in your plush intern bunk bed, and a nurse calls you about a patient with abdominal pain, chest pain, or difficulty breathing, get out of bed & go to see them ASAP.

5. If a diabetic patient comes in with nausea and vomiting with no chest pain or SOB, still consider Acute Coronary Syndrome (ACS) in your differential.

6. If someone yells at you or criticizes you, ignore the instinctual reaction of defending your position. Simply state, “Sorry. Mea culpa. It won’t happen again.” Even if it was not your fault.

7. Be nice to nurses, BUT don’t always listen to them.

8. Teach something to a medical student, nurse, PA, a junior resident at any free moment. Spend the additional 2 minutes to P.I.M.P. Doctor comes from the Latin word, doctoris, which means teacher.

9. If you say you are going to be somewhere, or promise to do something, follow through. If you can’t, let them know as soon as you realize it.

10. Be generous with pain meds. It’s better to give narcotics to fakers than to have a person in really bad pain. In trauma patients, consider fast acting fentanyl 1 mcg/kg

11. Do the things that scare you and see the patients that you find challenging. Be aware of your backups in case you suck. Feel the fear, and do it anyway.

12. Try not to hook up with co-workers, nurses, med techs, etc.

13. Exercise regularly.

14. During vacation weeks, go somewhere that requires a flight. You’ll come back much more refreshed. Also, don’t request vacations in the first week of a rotation, you might be lost when you come back.

15. When calling a consult, be sure to know the patient. Then introduce yourself by name. Verify that it is the correct service. Ask for their name. Ask how they are doing today. Begin with, “This consult is for…” and tell them the rest. End the conversation with, ‘Do you have any other questions about this consult?”

16. Try not to call bogus consults. You will recognize them after you’ve been an intern for that service.

17. If you have an infant who is crying, inconsolable, and everything else is normal, get the lidocaine eye drops. It just might be a corneal ulcer.

18. In the ED, ask the patient, “What made you decide to come in TONIGHT?” and if it’s a chronic problem, “What does your primary medical doctor think about this?”

19. If it doesn’t make sense to you, question your attendings and senior residents in a diplomatic way. They are human and make mistakes too.

20. Forgive yourself for the mistakes b/c you will absolutely make them. Just learn from each. James Allen wrote, “Circumstances don’t make a man, they reveal him”

Monday, June 15, 2009

If you're thinking about EM, consider this:

"They never exam the patient.

Those ER docs miss everything.

Why don't you see the patient first, then call me?

It's 3:30AM, do you really need this consult now?

Order the MRI, then let me know if anything shows up.

Didn't you realize you needed EKG on all diabetic patients?

Ovarian torsion? Ultrasound is terrible at detecting that.

So what are you going to specialize in after you are done with ER?

Trauma surgeon: Call Anesthesia, we need an airway STAT!

How could they have missed the septic knee, inferior MI, AAA, etc?"

EM is a young specialty, and we need to develop a thick skin.

It's the ultimate fishbowl, and everyone questions your decisions on Monday.

Bring it on.

Sunday, June 7, 2009

My Hero is Mel Herbert from EM Rap

This week, I went to the Cal/ACEP meeting in La Quinta Resort near Palm Springs. This place was AMAZING to say the least - over 50 hot tubs, about 20 pools, and most importantly, some amazing lectures over EM.

My favorite speaker was Dr. Mel Herbert...

"Mel Herbert, MD, is an award-winning educator and full-time member of the faculty at the Los Angeles County / USC Medical Center Emergency Medicine Residency. Mel's talent at producing EM:RAP is a natural extension of his gift for teaching. Within the past few years, he's received the UCLA "Chairman's Teaching Award" and the "Golden Stogie" Award, the Cal/ACEP Education Award, the Emergency Medicine Residents Award for Teaching Excellence, and Honorable Mention for ACEP's Outstanding Speaker of the Year Award." ~ EMRAP

Here's a picture that a good friend and I got with him as he was departing. Woohoo!