Thursday, December 07, 2006


Interns come in many shapes and sizes, as well as all levels of skill. Some interns are FMG's, foreign medical graduates; some were even attending physicians in other countries before coming to America. Some FMG's really suck; some American-trained interns really suck. Interns are like a box of chocolates: you never know what you're going to get.

My half of the team currently has two interns: one from Chicago and one from Europe. I'll call them C and E respectively. I am drawing no conclusions about their abilities based on their places of origin; I am simply trying to identify them in an anonymous fashion.

Intern C is efficient but rather bitter. It's funny bitterness, and not directed toward students, so I don't mind so much. He's pretty good with patients, likes to teach, and doesn't mind when I ask a million questions of him or of the patients. It's easy to get into "complain" mode when I'm around him for a length of time, which is my only real complaint (and it's not a strong one).

Intern E is almost entirely the opposite. He's a nice enough guy, new to this country. Since he's a recent immigrant, I expect things to be difficult for him in some ways: just learning America is tough, let alone American medicine or Texas (an entirely different proposition). However, he seems to think that students are his personal assistants, like we exist to do his work. If we don't do his work, or don't take patients with him, his work doesn't get done. He also makes decisions about patient care, after the attending has made his plan, without consulting the upper-level resident or the attending. Case in point: attending (an oncologist) makes a plan to consult pulmonology on a cancer patient with possible respiratory stridor. After attending leaves, E decides the patient doesn't really have stridor and therefore doesn't need a pulmonary consult. He didn't discuss this with anyone, so today when the attending came, this patient with a potentially life-threatening condition (if she really has respiratory obstruction due to her tumor) did not receive the consult he'd discussed with the team.

My attending, a very soft-spoken, nice man, has a side that I had suspected when I first met him. He is the nicest guy possible unless you obstruct patient care, and then he gets very angry. Politely angry, but angry nonetheless. While I continue to feel that some of the tests we order are not terribly necessary, he makes the decisions, not me--I'm not the boss (although I'm definitely bossy). He's willing to go to bat for the consults and tests he orders, he's made himself available at all hours to his residents and interns, and he's willing to come to the hospital at any time. One reason he orders so many tests, also, is he has worked at many private hospitals and is highly offended that the county hospital would treat patients any differently--I understand that, too. I respect the man, and I've seen residents politely debate (for lack of a better word) ordering certain tests or consults with him--he listens closely, and if they have a good reason for their opinion he gives it consideration. There is NO REASON to go behind his back and just not do something because you suddenly disagree with the plan.

I feel kind of bad that I've quit taking patients with E, because stuff doesn't get done on his patients. He doesn't listen while the attending is giving the plan, and expects the student to know everything that's supposed to get done. Never mind the fact that the plan is written in the attending's very thorough notes (it's part of why we round for so damn long every day)--he can't seem to be bothered to listen or go back to the chart to copy down the plan. The other student on my half of the team agreed, saying she didn't want to babysit him all the time.

He also gave me a little "lecture" the other day on patient care: "It's not your job to get the social stuff done, it's your job to get the medical stuff done." This on a patient who remained in the hospital overnight simply because he couldn't be bothered to write "d/c home" on her chart--I had to get the other intern to write it for me the next day at noon when she was still there. He had gone to see the patient after I paged him to tell him the wheelchair would be delivered to her home, and that she would be able to borrow one until then, so she could go home right away--since he'd gone to see the patient to tell her she'd stay overnight, I know he was still at the hospital, and I know he wasn't just being lazy, so what the bloody hell was he doing??

I think I want to try to talk to him first, or perhaps Intern C, but I'm unsure of what to say. I've thought about talking to the upper level resident, or the attending, but I don't want to do that just yet. I also know that I'm a know-it-all, and it must be annoying to have some smart-ass student always thinking she knows better than you, an actual MD. I don't want to offend him further. I'm really concerned that I'm going to say something that will get me in trouble, though, if I continue to be this frustrated. How in God's name do you not check the vitals on a patient with bacteremia and suspected endocarditis??? I feel like I could help his patients if I took some of them, but at the same time I don't want to cover for his ass.

I'm much too grouchy lately to be a doctor. Sometimes I think the only people I'm nice to are my patients and occasionally my long-suffering husband, who has heard me bitch WAY TOO MUCH about this situation. I'd better go kiss him to try to make it up to him.

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