Me, as an intern:
Hello? This is Porter, general surgery intern.
Yeah, this is Engel. What’s going on? The nurse said you’re treating a tachycardia.
Hi, Dr Engel. Yeah. There’s a post-op heart patient here…um…64-year-old man who is status post…
Did you call the cardiologist?
How did you know what to give?
From the ACLS algorithm. I just took the class.
You just medicated a post-op CABG patient with an ACLS card?
Um. Yeah, was I sup…
You didn’t call the cardiologist, the surgeon, or your senior resident? Man, you got some balls. The nurse called me cuz some cowboy intern was pushing drugs…
Sorry. I didn’t know I was supposed…
Besides clinical medicine, new computer software, cutting, sewing, and where to find a Kerlix, a fresh surgery intern has to learn his/her expected scope of practice, communication protocols, chain of command, and social norms in hospital culture. It takes time.
My instinct was to do whatever anyone asked me to do. As I result I packed bleeding noses I had no business packing, admitted patients without calling anybody, ordered x-rays without checking results.
Chief would tell me to order a CT on our inpatient and I would, without bothering to tell the patient or the nurse. I’d hear later the patient was refusing his CT scan.
I wrote transfer orders to the ICU without checking if a bed was available.
On speed rounds, an attending handed me a chart and said, put her back on Coumadin, whatever dose she was on, and discharge her. See you in the OR in five minutes.
I looked at her last Coumadin order – 10mg – wrote it in her discharge orders and ran to the operating room.
Asleep on the couch after a thirty-six-hour day, I was paged by a very excited internist and schooled on Coumadin dosing. (The woman’s usual home dose was 2 mg.)
It’s July. Remember who’s watching the flock.