So dermatology was a pretty light month because I spent most days in the private dermatology clinic in Bellaire. But it was a lot of shadowing which I absolutely hate. Fridays were dermatology clinic at my clinic (where the residents see patients) and that was fun. No shadowing on Fridays and I do all the procedures. I basically do a lot of full skin exams to look for cancer. I got pretty comfortable by the end of this rotation.
I also did at least a dozen shave biopsies and freezing (liquid nitrogen) on pre-cancers (actinic keratoses). And I did a few steroid (kenalog) injections on keloids/hypertrophic scars. So I will definitely continue to do these procedures in my clinic. I'm glad I got the chance to get comfortable with these procedures. Next month I'll get to do other procedures. I'll be on surgery so I'll probably do excisions of cysts in clinic, I & Ds, and suturing in the OR.
Plus most of my weekends were free. Only on call twice this month.
Also, I did the NALS (neonatal) course this month. That was much easier than the PALS course. There's no monitor to look at. Don't need to shock the babies.
Saturday, August 22, 2009
Thursday, July 9, 2009
My First Call
Being on call in medical school is much different than being on call in residency. We have 2 different types of call as interns. One person does adult/pedi admit and pedi floor call. The other person does adult floor call. I haven't had adult floor call. But it is much much nicer because you just occasionally get a patient complaining of something minor (if it hasn't been ordered yet, like prn meds). Or go to code blue (which doesn't happen that often either). You mostly get to sleep, watch movies, etc.
But I had admit call. Initially I was optimistic until I realized I finished a long day of seeing patients and doing discharges. I was tired and didn't want to do anything. After getting dinner, I met with my senior for the night to get an idea of what to do. Since I haven't had peds yet, I wasn't excited to have to deal with peds. I was given a handbook 2 weeks ago on everything I need to know for peds, but I haven't had time to read it yet. It's a very to the point book and tells you exactly what to do. But you still have to know what to look for. I had 2 admissions before midnight. I then had several pages from the nursery telling me what the bilirubin & RBC count were. How annoying? In my mind, I'm like, "Stop calling me! I don't know what those numbers mean." Eventually I was forced to open the pedi book, to figure out who is okay to go home and who needs bili lights, blah, blah, blah. My senior was kind enough to help me figure out what to do with these results. It was just overwhelming to have to think about kids and adults at the same time. Plus one kid had a high white count, that I wasn't checked out about and nothing was in the chart stating that they were aware of the white count. So we had to assume possible sepsis. Especially since the kid was hypothermic and the nurse put the baby in the warmer bed without telling us. So even though I was taught how to do a baby exam at orientation, I didn't feel comfortable doing the exam. Anyways baby looked fine and was eating better and repeat labs were normal.
My next admit call is in 2 weeks. Then I have floor call 4 days later. So this month I have 3 calls. My senior wrote down some pages of the book to read for next time. So I will try to be prepared next time. Thank goodness, I didn't have any pedi admits or newborn exams in the middle of the night. My other classmates have had it worse than me, but they weren't on inpatient service. I learned from one of them that they had 7 newborn discharges and that the paperwork was easy. It was just that they had to spend time to educate every mom on signs and symptoms of sepsis, jaundice, etc.
Overall, call sucks. But maybe it'll get easier next time.
After I finished call at 7am, I had to present my 3 admit patients and then had my patients to round on. I was tired. But I was so glad to be back in the day time. I finished seeing my patients and did 2 discharges. Got lunch and hung out with other interns for a little bit and went home at 1pm. The good thing is I get one day off every week and my day off this week is Thursday. So I had 1.5 days off if you include Wed afternoon.
But I had admit call. Initially I was optimistic until I realized I finished a long day of seeing patients and doing discharges. I was tired and didn't want to do anything. After getting dinner, I met with my senior for the night to get an idea of what to do. Since I haven't had peds yet, I wasn't excited to have to deal with peds. I was given a handbook 2 weeks ago on everything I need to know for peds, but I haven't had time to read it yet. It's a very to the point book and tells you exactly what to do. But you still have to know what to look for. I had 2 admissions before midnight. I then had several pages from the nursery telling me what the bilirubin & RBC count were. How annoying? In my mind, I'm like, "Stop calling me! I don't know what those numbers mean." Eventually I was forced to open the pedi book, to figure out who is okay to go home and who needs bili lights, blah, blah, blah. My senior was kind enough to help me figure out what to do with these results. It was just overwhelming to have to think about kids and adults at the same time. Plus one kid had a high white count, that I wasn't checked out about and nothing was in the chart stating that they were aware of the white count. So we had to assume possible sepsis. Especially since the kid was hypothermic and the nurse put the baby in the warmer bed without telling us. So even though I was taught how to do a baby exam at orientation, I didn't feel comfortable doing the exam. Anyways baby looked fine and was eating better and repeat labs were normal.
My next admit call is in 2 weeks. Then I have floor call 4 days later. So this month I have 3 calls. My senior wrote down some pages of the book to read for next time. So I will try to be prepared next time. Thank goodness, I didn't have any pedi admits or newborn exams in the middle of the night. My other classmates have had it worse than me, but they weren't on inpatient service. I learned from one of them that they had 7 newborn discharges and that the paperwork was easy. It was just that they had to spend time to educate every mom on signs and symptoms of sepsis, jaundice, etc.
Overall, call sucks. But maybe it'll get easier next time.
After I finished call at 7am, I had to present my 3 admit patients and then had my patients to round on. I was tired. But I was so glad to be back in the day time. I finished seeing my patients and did 2 discharges. Got lunch and hung out with other interns for a little bit and went home at 1pm. The good thing is I get one day off every week and my day off this week is Thursday. So I had 1.5 days off if you include Wed afternoon.
Saturday, July 4, 2009
My first rotation - Family medicine inpatient service
I started on Wednesday bright and early (although it wasn't that bright). Getting up was hard. Once I arrived at the call room where everyone gets together, I realized that this was the end of my vacation/freedom. I will be practically living in the hospital for the next 3 years.
I got a pre-checkout of my patients the previous day so I can get an idea of what to expect. I was really hoping for a short patient list. But it was almost FULL. Maximum is 8 patients per person. I had 7 to see. We round at 10 am and so I felt the pressure to start seeing my patients and be back on time. I got there at 6:30 but didn't really get started until 7am. After seeing one patient and about to see my next patient, my senior resident told me to discharge one of my patients this morning. She was really helpful and showed me how to write discharge orders and other paperwork I needed to fill out. So I finally discharged the patient which included discharge orders, seeing the patient, writing a note, writing new prescriptions, and calling the clinic to set up a follow-up appointment. Now I learned how to discharge a patient and it was almost 10 am. I still had 5 more patients to see. Yikes! My senior said to be quick and that we'll start rounding at 11am instead since it's our first day. I'm not used to feeling so rushed and overwhelmed. I finally finished a little after 11am. They were fine with me showing up late.
It was just crazy to go from not using my brain for most of 4th year, moving at a comfortable slow pace, and then to feeling like I'm running a marathon (not that I know what that's like). During rounds, I was finishing up the notes. I barely read most of the H&Ps of my patients to find out what to do next. btw, we do table rounds which is nice. When we finally finished, we had lunch around 2pm.
Afterwards, I had to put in orders in the chart or call the nurse to do it. We carry hospital phones and pagers. The hospital phones (called banana phones because they are yellow) are like pagers but the nurse can call you directly to ask a question. I also had to consult a few of my patients whom I knew very little about for GI consult or surgery consult. I finally got to sit down and rest at 6pm when my shift ended. My senior helped big time because I didn't have time to put in all the orders and she organized the checkout list of my patients for the incoming on call residents. This rotation is a lot of paperwork. I had 3 discharges on day one. Now I had to dictate 3 discharge summaries within 48 hours (that's the rule). I had Friday off this week so I spent most of my Friday working on discharge summaries (I had already accumulated 6 of them).
Day 2 was much better. I finally got a break at 5pm and had time to update the check out patient list. It was also easier to wake up on day 2.
Friday - day off, but technically I had a pile of catch up paper work to do.
Saturday (day 4) - I learned it was a short day. Yeah! I still need to work on my speed in seeing patients. We round earlier at 9 am. I had 2 new patients plus 4 old patients. I felt super rushed to see them all. Plus I had 2 discharges to do before noon. Overall, it was nice to be done by 12:30 pm and just hang and chat.
Then I went home to write this blog so I can remember what my first week as an intern was like. In a few words - crazy busy, overwhelming, clueless.
I got a pre-checkout of my patients the previous day so I can get an idea of what to expect. I was really hoping for a short patient list. But it was almost FULL. Maximum is 8 patients per person. I had 7 to see. We round at 10 am and so I felt the pressure to start seeing my patients and be back on time. I got there at 6:30 but didn't really get started until 7am. After seeing one patient and about to see my next patient, my senior resident told me to discharge one of my patients this morning. She was really helpful and showed me how to write discharge orders and other paperwork I needed to fill out. So I finally discharged the patient which included discharge orders, seeing the patient, writing a note, writing new prescriptions, and calling the clinic to set up a follow-up appointment. Now I learned how to discharge a patient and it was almost 10 am. I still had 5 more patients to see. Yikes! My senior said to be quick and that we'll start rounding at 11am instead since it's our first day. I'm not used to feeling so rushed and overwhelmed. I finally finished a little after 11am. They were fine with me showing up late.
It was just crazy to go from not using my brain for most of 4th year, moving at a comfortable slow pace, and then to feeling like I'm running a marathon (not that I know what that's like). During rounds, I was finishing up the notes. I barely read most of the H&Ps of my patients to find out what to do next. btw, we do table rounds which is nice. When we finally finished, we had lunch around 2pm.
Afterwards, I had to put in orders in the chart or call the nurse to do it. We carry hospital phones and pagers. The hospital phones (called banana phones because they are yellow) are like pagers but the nurse can call you directly to ask a question. I also had to consult a few of my patients whom I knew very little about for GI consult or surgery consult. I finally got to sit down and rest at 6pm when my shift ended. My senior helped big time because I didn't have time to put in all the orders and she organized the checkout list of my patients for the incoming on call residents. This rotation is a lot of paperwork. I had 3 discharges on day one. Now I had to dictate 3 discharge summaries within 48 hours (that's the rule). I had Friday off this week so I spent most of my Friday working on discharge summaries (I had already accumulated 6 of them).
Day 2 was much better. I finally got a break at 5pm and had time to update the check out patient list. It was also easier to wake up on day 2.
Friday - day off, but technically I had a pile of catch up paper work to do.
Saturday (day 4) - I learned it was a short day. Yeah! I still need to work on my speed in seeing patients. We round earlier at 9 am. I had 2 new patients plus 4 old patients. I felt super rushed to see them all. Plus I had 2 discharges to do before noon. Overall, it was nice to be done by 12:30 pm and just hang and chat.
Then I went home to write this blog so I can remember what my first week as an intern was like. In a few words - crazy busy, overwhelming, clueless.
Monday, June 29, 2009
A Boring Day of Computer Training
Today was about learning how to use the clinic EMR and how to communicate patients with it such as email. There was a lot of just listening to people talking about the program. And after a few hours I just zoned out. I am so glad today is over.
btw, it FINALLY rained this evening. It's been a drought for over a month. Most of my flowers in the flower bed died. It's been so bad that there was a burn ban and certain fireworks weren't allowed to be sold for 4th of July. It was 105 degrees while I was driving home today.
Well . . . tomorrow is my last day of orientation. It'll be a laid back day with a hospital tour and I'll be picking up some free scrubs to wear for Wednesday. I'm starting on inpatient service.
btw, it FINALLY rained this evening. It's been a drought for over a month. Most of my flowers in the flower bed died. It's been so bad that there was a burn ban and certain fireworks weren't allowed to be sold for 4th of July. It was 105 degrees while I was driving home today.
Well . . . tomorrow is my last day of orientation. It'll be a laid back day with a hospital tour and I'll be picking up some free scrubs to wear for Wednesday. I'm starting on inpatient service.
Saturday, June 27, 2009
Last Weekend before starting real work
Friday Morning was about infection control. You know, like, washing your hands and knowing about personal protective equipment, and isolation. It was also more talk from the program director about clinic. And talk about logging in work hours which I completely zoned out from. And we had a tour of the clinic and met the LVNs and MAs who will be working with us. The good thing is they have all been there for atleast a few years. The LVN that works in my corner of the clinic has been there for over 20 years so she will be very valuable in knowing lots of stuff.
As a first year resident, we have clinic 1 to 2 half days per week and start off by seeing 3-4 patients. We get atleast 1 hour per patient and present to the preceptor. The first few clinics will be either mock patients or shadowing the preceptor. So it's a slow transition. It also gives us time to learn more about the EMR since it's a completely paperless clinic.
Then we had pictures taken in the afternoon. It was going to be our picture for the next 3 years and the picture they use on the website and post on the clinic wall. Then we went over the residency manual. This manual basically covered the contract we signed and explained what was required of us to complete residency. It mentioned that I should be reading 3 journals per month (#1 was American Family Physician journal which I've received for the past 4 years, but hardly read). I guess I have to start opening the journals I get in the mail now.
This evening was the Senior Banquet. Food was good and we all dressed up for the occasion. I wore the same dress I had on for the graduation/awards banquet at TCOM. I'm actually tired of going to socials. I really wanted to just stay home and do nothing. But I knew that I should probably participate. I finally learned where all the graduates were going since it was on the program. I was surprised to see that most weren't immediately joining a group practice.
Here's what they are doing:
a few doing hospitalist, a couple doing emergency medicine, one doing a fellowship at MDAnderson for palliative care, a couple doing group clinic practice, and the rest still looking for local jobs, but working temp jobs in the meantime.
As a first year resident, we have clinic 1 to 2 half days per week and start off by seeing 3-4 patients. We get atleast 1 hour per patient and present to the preceptor. The first few clinics will be either mock patients or shadowing the preceptor. So it's a slow transition. It also gives us time to learn more about the EMR since it's a completely paperless clinic.
Then we had pictures taken in the afternoon. It was going to be our picture for the next 3 years and the picture they use on the website and post on the clinic wall. Then we went over the residency manual. This manual basically covered the contract we signed and explained what was required of us to complete residency. It mentioned that I should be reading 3 journals per month (#1 was American Family Physician journal which I've received for the past 4 years, but hardly read). I guess I have to start opening the journals I get in the mail now.
This evening was the Senior Banquet. Food was good and we all dressed up for the occasion. I wore the same dress I had on for the graduation/awards banquet at TCOM. I'm actually tired of going to socials. I really wanted to just stay home and do nothing. But I knew that I should probably participate. I finally learned where all the graduates were going since it was on the program. I was surprised to see that most weren't immediately joining a group practice.
Here's what they are doing:
a few doing hospitalist, a couple doing emergency medicine, one doing a fellowship at MDAnderson for palliative care, a couple doing group clinic practice, and the rest still looking for local jobs, but working temp jobs in the meantime.
Thursday, June 25, 2009
OSCE & my first PAYCHECK
Yesterday:
Well, I survived OSCE. It was a bit nerve racking since I felt a bit rusty. They observed me through a video camera. It's not pass/fail but rather a way to critique us. They were really good at evaluating. I would cringe as soon as I was ready to present the patient to my preceptor thinking that I probably could have done a better job or performed a better physical exam. Also knowing the camera was there made me more nervous than usual. It turned out that I did much better than I expected. Next, I had to go back to the patient room and pretend it's a follow up visit and tell the patient her lab results which revealed that she had cancer. Briefly before going in, the preceptor (as well as a clinical psychologist) would ask how would I break bad news to the patient and what could I offer for her. I never really had to break bad news before so I really felt unsure of how to tell her. When I did go in the room to tell her, she broke into tears. I was like, wow, she really knows how to make this feel like the real deal.
Then I had to return to the preceptor to get critiqued again. They said I did a great job. Whoo! I felt surprised to hear that. They would comment on specific things I did or said. I was really impressed at how they gave really good constructive criticism.
As much as I initially dreaded doing this OSCE, it turned out to be very beneficial. I really got to learn what my strengths and weaknesses were. I later went back again to the patient's room where the patient critiqued me. She was really good. She told me that I would lose eye contact at times and look around the room (I didn't realize I was doing that, but I know it was when I trying to think of more questions to ask her). But she complimented me and said that I was very good about listening to her concerns.
Today:
Lots of boring talks - you know like EMTALA, more computer training, etc.
But the highlight was my first PAYCHECK !!!!!!!!!!!!
It was for just the 2 days of orientation last week so I expected to get very little. But the check was surprisingly big - $300. Not bad for 2 days. It is so nice to finally get paid. My next pay check will be July 9th.
Wednesday, June 24, 2009
Orientation
I started orientation on Thursday, June 18th. The first day was the longest. i had to listen to several people throughout the day about all kinds of stuff. Plus listen to a 1.5 hour lecture on performing a newborn exam and other pediatric stuff. The cool thing is they give you a handbook that they made on peds. So it has everything you need and it's in alphabetical order. It tells you what to do and what labs to order. My day ended at 4pm which is pretty good.
The previous evening, there was a social where I met the interns, chiefs, and faculty at the program director's home. It was nice to meet them all and it turned out that I knew more interns that I originally had thought. There's 14 of us total. It turns out that I ran into some of them during interview season. It was funny that some of us were at the same interviews at different locations.
On Friday, it was more paperwork. But it was much more laid back because it was at Human Resources and we learned about different benefits the hospital offers. They have cell phone discounts. For example, if I have AT&T, I get 24% off my monthly bill. Pretty cool, huh? After much research with all the different discounts they offered through Verizon and Sprint and AT&T, I decided to stay with my parents family plan with T-mobile. It's only $12 per month for me to be added on that plan. I spent a lot of time researching all the smartphones and plans and ultimately decided to hold off on it for now. I don't want the iphone. I love the palm pre (but it's too new and lacks a lot of the software I need, but great operating system and multitask ability).
I also looked into gym membership. There's an awesome gym next door to the hospital and for employees, it's $28 per month. So I will be getting that. Everyday, they've been feeding us catered food for breakfast and lunch. As well as dessert and chocolates and snacks. So I will definitely need to hit the gym soon. But I can't really complain about the food. It's been awesome. - and remember, I'm a picky eater.
Friday evening was a social at a resident's home for just the residents. So I got to meet the 2nd and 3rd years and soon to be graduates from the program.
I then had the weekend off. But my weekend did not go without stress. Why? Because I had a PALS course starting on Monday and I didn't really prepare for it. I didn't think it would be coming so soon. So I read a little and worried a lot. Monday was BLS for child and infant followed by some advanced life support (ALS). They really want us to know BLS really well and pass it before proceeding to ALS. We had to perform CPR perfectly. I had to repeat infant CPR because I forgot to lift the infant's chin when I listened to it's airway for breathing. They even time you to make sure you listen between 5-10 seconds. If you listen for too short or too long, you have to get retested. The booklet came with the fold up card which abbreviated the steps on what to do with arrhythmias, shock, respiratory problems. I was getting really worried about Tuesday because that's when we are tested on the megacode which can be a combination of the 3. btw, this was not like ACLS at school. I found out that normally each person is individually tested to lead the megacode and must pass it. But we each got to lead a couple of practice scenarios which was good. I got nervous and would blank out on what to do. But each time I practiced, I got to more confident. They also said, you can only fail either the written or the megacode once and then you get a second chance. But you can't fail both. So I was really worried. I passed the written, but I did have to repeat the megacode. I forgot to check the rhythm on the monitor before starting CPR. Overall I passed. Yeah!!!
Today, Wednesday is OSCE day. They said there's no studying involved which is good. They just want to see how you do with simulated patients. I will be doing that this afternoon and the rest of the day I have off.
The previous evening, there was a social where I met the interns, chiefs, and faculty at the program director's home. It was nice to meet them all and it turned out that I knew more interns that I originally had thought. There's 14 of us total. It turns out that I ran into some of them during interview season. It was funny that some of us were at the same interviews at different locations.
On Friday, it was more paperwork. But it was much more laid back because it was at Human Resources and we learned about different benefits the hospital offers. They have cell phone discounts. For example, if I have AT&T, I get 24% off my monthly bill. Pretty cool, huh? After much research with all the different discounts they offered through Verizon and Sprint and AT&T, I decided to stay with my parents family plan with T-mobile. It's only $12 per month for me to be added on that plan. I spent a lot of time researching all the smartphones and plans and ultimately decided to hold off on it for now. I don't want the iphone. I love the palm pre (but it's too new and lacks a lot of the software I need, but great operating system and multitask ability).
I also looked into gym membership. There's an awesome gym next door to the hospital and for employees, it's $28 per month. So I will be getting that. Everyday, they've been feeding us catered food for breakfast and lunch. As well as dessert and chocolates and snacks. So I will definitely need to hit the gym soon. But I can't really complain about the food. It's been awesome. - and remember, I'm a picky eater.
Friday evening was a social at a resident's home for just the residents. So I got to meet the 2nd and 3rd years and soon to be graduates from the program.
I then had the weekend off. But my weekend did not go without stress. Why? Because I had a PALS course starting on Monday and I didn't really prepare for it. I didn't think it would be coming so soon. So I read a little and worried a lot. Monday was BLS for child and infant followed by some advanced life support (ALS). They really want us to know BLS really well and pass it before proceeding to ALS. We had to perform CPR perfectly. I had to repeat infant CPR because I forgot to lift the infant's chin when I listened to it's airway for breathing. They even time you to make sure you listen between 5-10 seconds. If you listen for too short or too long, you have to get retested. The booklet came with the fold up card which abbreviated the steps on what to do with arrhythmias, shock, respiratory problems. I was getting really worried about Tuesday because that's when we are tested on the megacode which can be a combination of the 3. btw, this was not like ACLS at school. I found out that normally each person is individually tested to lead the megacode and must pass it. But we each got to lead a couple of practice scenarios which was good. I got nervous and would blank out on what to do. But each time I practiced, I got to more confident. They also said, you can only fail either the written or the megacode once and then you get a second chance. But you can't fail both. So I was really worried. I passed the written, but I did have to repeat the megacode. I forgot to check the rhythm on the monitor before starting CPR. Overall I passed. Yeah!!!
Today, Wednesday is OSCE day. They said there's no studying involved which is good. They just want to see how you do with simulated patients. I will be doing that this afternoon and the rest of the day I have off.
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