Meltdown-The Feelings of an Intern Physician

Intern Year PicIt’s July, and that means this month thousands of brave new doctors will begin to do what they have dreamed of doing their entire lives…practice medicine!  For these interns, up until now, becoming a doctor has always seemed so glamorous.  Looking back to my medical school days, I remember thinking, “I can’t wait until my doctor signature actually means something.  I can’t wait to hear my pager go off because someone wants my opinion.”  Well, to the new doctors, if you haven’t figured it out yet; being an intern physician is not at all glamorous!  You have ascended from being the big kid on campus while in medical school, to a new bottom of the totem pole.  So, before you break down and decide you want to quit residency (this thought crosses the minds of many young physicians), let me give you insight regarding 3 negative emotions and feelings you will experience this year.

1) STUPIDITY.  Yes…stupidity.  Do not worry, many of us have felt this somewhere along our journey (and when I say us I am indeed including myself).  Scenario 1: You are rounding on a new patient who you admitted the previous day.  This will be the first time your attending hears anything about this patient so you are more nervous than a cow at Burger King.  The beads of sweat ball up on your forehead and your voice begins to tremble.  Fortunately, just like they taught you in medical school, you get through your presentation.  Yes! You think to yourself…I presented that like a boss!  Just then, your attending asks a question, “So Dr. [Your Name Here], what is the pentad for TTP?”  It’s not fair, I didn’t know this question would be on the test…I didn’t prepare for this.  One second, two seconds, three seconds pass and you remain silent.  Then a voice comes to the rescue, “Well Dr. [Your Attending’s Name Here], that is a fairly simple question.  Renal Failure, Anemia, Purpura, Altered Mental Status, and Thrombocytopenia.”  You feel a sudden rush of relief and as you lift your head from the prior state of shame, you lock eyes with the third year medical student on your team who just answered the question.  Your countenance drops and you feel stupid!  You knew the answer, but it just wouldn’t make it to the forefront of your brain.

I’ll bet a pretty penny that this, or something very similar, will happen to you during your intern year and you will feel stupid.  As a matter a fact, many things will happen that will make you feel this way.  What you need to know is that most of us felt that way at some point in our training (and sometimes still do), and your attendings know that you are under tons of stress.  They do not expect you to know the answer to all of these questions.  These are opportunities for them to teach you.  Tip: each night before you go to sleep, look up the patients who have been admitted to your service and find the one with the most interesting diagnosis.  Spend 10 minutes before you go to bed reading about this medical condition.  The next day during rounds, you’ll be ready for the most important questions about the most interesting diagnosis of the night.  And if your attending does not ask a question, at least you’ll be that much smarter anyways.

2) OVERWHELMED.  Scenario 2.  It’s the first day of your second rotation as a doctor.  The rotation is Pulmonary Medicine.  You’ve just inherited a service of 17 patients and you are responsible for 10 of them.   9:01 AM, your pager goes off.  “Dr. [Your Name Here],  Mrs. [Sickest Patient in the Hospital] has a blood pressure of 81/49.  He is due for his Lasix injection.  Should I hold it or give it to her?”  Before you get a chance to pick up the phone and call the nurse back, your pager goes off 2 more times, your upper level resident tells you it is time to start rounds, and the lab calls you with 3 critical results.  Finally you call the nurse back then realize you have absolutely no idea what to do in this situation of hypotension in a pulmonary hypertension patient.  Intelligently you tell the nurse, “We are about to begin rounds and I will make sure we come to her room first.”  At the end of rounds  2 hours later, you have a task list of 23 things to complete and your notes are not yet complete.  AAAHHHHHHH!!!  WHERE DO I START?  I’M OVERWHELMED!  Oh….and its time to go to the mandatory noon learning conference.  Yes, we have all experience this.  Too much to do and not enough time.  What makes the situation even worse is that the dreaded pager you always dreamed of as a medical school never stops beeping.

When I was a resident, my chief told me something that has stuck with me.  “The difference between a good intern and a bad intern is that the good intern knows how to check boxes!  Make checky boxes”  Checky boxes, checky boxes, checky boxes!  Use them.  Every time your upper level or attending tells you to do something, make a small square (this is your checky box) by the patient’s name on your rounding sheet and write the task down.  After your upper level or attending dismisses you to work, start doing the tasks and checking them off your list.  Review your checky boxes after rounds, in the mid afternoon, and just before you go home.  Check off ALL the boxes before you go home!

The other key thing to understand is the order in which you should complete your checky boxes.  Call all consults as early as possible (if you can do this during rounds that is very much appreciated by the consulting services).  These checky boxes should be completed first (as long as there are no emergencies or time dependent procedures).  After consults, do the checky boxes that require you to place orders.  Once those are complete, move on to do your procedures.  After that, complete any outstanding notes which you did not write before rounds.

Be a good intern…use checky boxes!

3) DEFEATED. Scenario 3:  Scenario 1 just happened and then scenario 2 followed immediately.  As if nothing worse could happen you get a page that your critically ill patient in scenario 1 just died unexpectedly.  Did I wait too long to make the lasix decision?  Sufficient to say, you are about to have a major meltdown and feel defeated…defeated like a sweep in an NBA championship series.

If you take nothing else home from this blog, please understand that nobody expects you to be perfect.  Doctors are human beings as well. No matter how much someone tries to glorify you and blow your head up, always remain humble and know that your role as a physician is to serve your patients.  It is not about you being the smartest doctor around, it is about the patient’s well being.  Those of us who have practiced medicine a little longer than you have remember what it feels like to be in your shoes.  That being the case, never hesitate to admit when you are in over your head and need help.  Never hesitate to say, “I don’t know the answer to that question, BUT I will look it up and get back to you.”  Never hesitate to tell a friend that you had a hard day.

Stupidity, overwhelmed, and defeated.  We’ve all felt that way.  Just give it some time and those negative feelings will transform to; knowledgeable, manageable, and relieved.   You are capable and will become excellent physicians.  Just truly care for your patients, go the extra mile for your colleagues, work hard, and say a prayer.  You’ll be great!


2 thoughts on “Meltdown-The Feelings of an Intern Physician

  1. Profile photo of Joy N-BoampongJoy N-Boampong

    Dr. Dale you are awesome for providing such detailed insight into a typical intern year. I just finished writing these great points down. They will make my life easier when my time comes! Very much appreciated, and please keep them coming.God bless!

  2. Profile photo of Dr. DaleDr. Dale Post author

    These are feelings that a lot of us have but people rarely speak on them. Being a doctor is hard…being a new doctor is VERY HARD. Go in as prepared as you can be. We are privileged to care for people’s lives. Not their houses, or pets, but their lives. That’s a big deal! Work hard to be good at it and remember it a privilege. The fact that you are taking notes already suggests to me that you will be a phenomenal doctor!

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