Advice to New Interns: Hospital Edition
- Find a secret bathroom. Heck, find 3 secret bathrooms. This is the MOST IMPORTANT advice I can give you. You must have a bathroom that you can run to when bubble guts strikes.
- Put faces to the specialists’ names you see signed on consultation notes on your patients. The better you know them, usually the nicer they are to you and your patients. And while you’re at it, call them early. No one likes getting a consult when they’re walking out the door to go home.
The most knowledgeable person in the hospital is the telephone operator. If you don’t know the answer, she can connect you to someone who does.
Keep a sheet or cards on each of your patients. Jot down major events and labs and dates so that when it comes to discharge summary time, you don’t have to rack your brain to figure out what happened during that 10 day hospital stay. Alternatively, use your A/P in your progress note as a guide for your summary.
Dictate everything the day it happens. Don’t wait a day. You’d be surprised how much of a procedure or hospital stay you can forget in one day. Clearly much of your hospital time will be spent finding ways to make dictations easier. If a patient does or says anything that rubs you the wrong way or strikes you as a bit sketchy, document the heck out of it. With quotations. It may save your tail one day.
Never half-@$$ an H&P. Sure, it’s a simple COPD exacerbation. Do a thorough exam anyway and hit all your systems. You may find your simple case isn’t as simple as you thought. On that same note, don’t always run with the diagnosis the ER gives you for the admission. Come up with your own differential.
Check, double check, and then have your backup check your discharge med lists. This is probably the most important thing you can do to prevent bounce-back admissions. Get to know your hospital discharge planners and social workers. Check in with them every morning and see what the status is on your patients waiting for placement. Your face makes a good reminder for them to work on your patient’s case. If you put the patient on telemetry, check the telemetry strips! This sounds like a “duh” thing, but you’d be surprised how many times I’ve seen interns not know if their A-fib patient had converted yet. Check the dang strip.
Don’t forget to look for update notes from nutrition or the hospice team or PT/OT. Sometimes they’re hidden in weird places on the chart but they have useful info in them. Everyone needs ambulation or activity orders. None of this bedrest foolishness unless absolutely necessary. The more they’re up walking, the earlier they’re walking out the door. In the hospital cafeteria: when in doubt, grilled cheese.
