Attending Physician Guest Author and Contributing Writer Emeritus
Intermountain Healthcare
Justin Jones is an outpatient primary care physician in Utah. He completed his residency in 2018 in Colorado and wrote for in-House during residency. He blogs at Residency Hacker.
Realizing that we have both inpatient and outpatient months, which require different skill sets, I feel that it would be better to split these lists into both outpatient and inpatient suggestions. After a few month of being on outpatient rotations, here is my list of eight things to master in order to break the successful intern barrier in the outpatient world.
Twenty minutes of cardiopulmonary resuscitation. Fifteen beats per minute. Seven nurses. Five doctors. Three paramedics. Two anesthesiologists. One transcriber and me. And then the eerie silence of the trauma room as the death was called.
“Hey hey! How are you?” someone calls out as I walk into the fluorescently lit emergency department I call home. “Living the dream,” is my habitual answer, and it’s only half facetious.
Everyone warns you that intern year is hard. It’s a year of little sleep, a rollercoaster of emotions both good and bad. Frustration and guilt in wanting to know everything now because everything you don’t know might be what matters for this patient, this time. And tremendous successes. Some of the things I did this year, I really can’t believe I was able to do. And survive.
Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother — although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense of helplessness I felt due to my lack of medical knowledge fueled my desire to help and serve others as a physician.
A surgical resident writes: “Several recent studies suggest current general surgery residents are poorly trained and unprepared for independent practice at the completion of residency. In general, do you agree that current general surgery residents are poorly trained and unable to operate independently at the completion of residency?”
Have you ever had that experience when you think what you’re doing is futile, and that thought goes through your mind: “Why am I doing this? I’m torturing him. This feels wrong.”
I feel like there are so many things to work on in medicine. I need to be more efficient at taking a history; I need to gather morning data more quickly; I should be better at chart review when I get a new admission; I need to be more thorough at following up on labs; I could write the H&P more quickly, and so on. I also feel, from time to time, I do poorly on one thing — maybe I stay at work way too long writing my H&P — and then I obsess over how I can get faster at it.
It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “okay,” but I don’t move. I am momentarily frozen by my unease with the bedside procedure ahead.
In an ideal world we would all die at home with our loved ones caring for us, slowly slipping away in our sleep into the placid beyond. But why doesn’t it happen this way? There’s a dignity to that way because of its organic simplicity. It’s how people used to die prior to modern medicine and before we started needing to always “fix the problem.”
Over the course of residency and fellowship training, it’s likely that almost all trainees will encounter veterans through rotations at Veterans Affairs (VA) facilities. With mandates from Title 38 and long-standing relationships with academic institutions nationwide, the Veterans Health Administration plays a significant role in shaping the education of future medical professionals.
As I reflect on the year that was, I am excited and yet terrified of what lies ahead. Intern year is unlike any other during which the training wheels—otherwise known as the short white coat—are abruptly stripped. The mannequins are traded for breathing patients, the co-signatures are traded for signatures, and the infamous “I am just the medical student” transitions to the equally unassuming “I am just the intern.” Here are my takeaways from the year that was.
Resident Physician Contributing Writer
Georgetown University Hospital
Hi! My name is Manik Aggarwal, I am currently an internal medicine resident at Georgetown! I plan to pursue cardiology training with an emphasis on heart failure. I'm originally from Texas and like nothing more than watching my Dallas Cowboys on Sundays. I enjoy writing, reading and teaching and look forward to hearing your opinion on my pieces!
