Can’t stop the clock

May 4, 2008 at 4:20 am | Posted in internship | 3 Comments

53 days of internship remaining…

Back on General Surgery this month. The first day on service was incredibly painful. Not only was I taking over for an intern who was actually a mostly-trained general surgeon in another country (and thus finds everything in general surgery easy and straightforward, unlike me), but I also had a schedule that day which literally required me to be in two places at once for most of the day.

In any event, things calmed down after the first day. Part of the problem was that I’d never really had to pre-round on a general surgery service since the point at which all the vitals and allied health notes were switched over to the new computer system. So the first day, I was completely unable to find large chunks of the info I was expected to have available on rounds. I know exactly where to find it on the old system, but that knowledge is now useless.

On a side note, it sucks to be an intern during your hospital’s changeover from one EMR system to another that’s completely different. You have to know all the details, and when they’re suddenly somewhere else, and buried in a non-physician-friendly format on a program that loads information slowly (this is a key point), patient care can easily be compromised.

The slow-loading program is what’s currently pissing me off. It takes twice as long as it should to collect the data I need in the morning, and most of my time is spent waiting for pages to load and display information. And the pages purporting to provide an “MD Summary” are frustratingly incomplete, superficial and completely un-tailored to the patient’s primary service. The programmers were clearly lacking sufficient breadth of physician input.

If it’s going to be that slow to load, there should be some way for me to create a tab for myself that automatically loads all the information I need, as a surgery intern, and allows me to add or delete things as my data collection needs change on various services and with various supervising residents and attendings. Man, if I could do that, I’d be Super-Intern. There would need to be a huge variety of things I could pull into my tab, and I’d have to be able to control the format to a reasonable extent, but I know it can be done. It’s just a matter of institutional will to make it happen.

Theoretically, it’s possible to do that with notes. But I find the process to be prohibitively difficult and the options on formatting and information retrieval limited. It’s OK for attendings, whose formatting needs don’t change every month. But for residents, and particularly interns, on whom the brunt of data gathering and documentation rests, it’s actually more efficient just to wait for the pages to load. Seriously.

Anyway, when I had initially looked at the schedule for this rotation, it appeared that I would be in clinic nearly every day. Thankfully, that has turned out not to be the case. I have dedicated clinic time on Tuesday and Friday afternoons, and occasional duties at other times when the load is particularly heavy. And the clinic I work is a vascular service, with an attending who mostly does research, and loves to teach.

So it’s not as bad as I expected. Although it seems that most of what I learned about vascular disease in medical school is wrong. I don’t know what kind of vascular program Tulane had–I don’t recall meeting any faculty who were vascular surgeons, but it’s possible I did and just forgot. I did see some truly horrendous vascular disease in New Orleans, but I don’t recall seeing any that had been surgically treated. It’s a real gap in my education, and the subject is interesting enough that some remediation is welcome at this point.

But the hospital I’m at is notorious for its bureaucracy, which makes any rotation here just that much more painful. The joke is that JCAHO ran screaming from the building when they came to accredit this hospital, because we have more policies, procedures and forms to fill out than even they want to deal with. And the internal culture is such that everyone seems more concerned about getting the proper form filled out than anything else related to patient care. Also, if you like having some autonomy as a junior, you won’t get it here. The sphincter tone is substantially higher at this hospital, no matter how competent a resident you are. I don’t know if patient care is any better, but the leash is definitely shorter. It’s kind of funny – I had more autonomy my first three months as an intern than I do now in my second to last.

I figure if I just pretend I’m a med student again–albeit one with order-writing authority and twice as many patients–I should get through this rotation without running afoul of anyone. I was frustrated then at not having authority to make even low-level intern decisions. That’s all I get to make on this service, so that should be just about right.

Anyway, in less than two months it’ll be all neurosurgery, all the time. So things are about to get a whole lot more interesting. And two rotations is nothing, compared to the eleven I’ve already done.