Meet Morgan Jones, Internal Medicine Resident, Class of 2018
Every one of us came to a point during M4 year at which we felt that it was time to assume more responsibility and finally become a doctor. Despite this desire, each newly minted physician finds him or herself lying awake in bed before the start of intern year wondering what the next day has in store. The sage words of Spiderman's Uncle Ben seem appropriate when thinking about this requisite angst: "With great power comes great responsibility". As your patients' doctor, you will be the one performing most of the evaluations, ordering studies, making sure that medications are being administered appropriately, and talking to patients and their families. This is daunting, especially since most of us spend the few months before intern year relaxing and recovering from what was an arduous medical school experience. With all of this in mind, let me reassure you that the feelings that you will have are universal, and let me further tell you that you will be extremely well supported as you transition from being a student doctor to a new physician. The quality of the Senior Medical Residents, the Attending Physicians, and your co-interns in the Internal Medicine Residency Program will help you to assume your new role at the front line of patient care in as seamless a fashion as is possible.
A typical day as a new intern on an inpatient general medicine service begins between 6:00 and 6:30am. For me, 6:15am was perfect. I could park, grab my obligatory 3rd cup of morning coffee and head upstairs to talk to the night team about how patients did overnight. If issues arose, it is useful to determine if there were any additional interventions that could have been done during the day, or something that could have been more specifically signed out to the night team that could have helped make the night a bit smoother. On call days, it is common for the night team to then have 1 or 2 overnight admissions to tell each intern about. After hearing about the circumstances under which the patient or patients were admitted and talking through the night team's approach to their care, these patients become part of the cohort of patients to which you are providing care.
After chatting with the night team and making sure that your pager is again active, it is typically time go to the team room and sit down to review nighttime vitals, new labs or studies, and any consult notes that had been posted. With a tentative plan and a sense of how your patients seem to be doing, it is then time to go pre-round on the 6-8 folks typically under one's care. After seeing everyone and placing additional orders, paging any new consults, and running through the patient list with the Senior Medical Resident (Senior) to make sure that good plans are in place, it is usually time to round with the full team.
By 8:00 or 8:30 am, the full team is usually ready to see everyone admitted to one's service. This team typically consists of the Attending, the Senior, your co-intern, medical students, a pharmacy student, and often a pharmacist. The result is that when you present your patients you have a variety of individuals with different training backgrounds providing valuable input into patient care. As I emphasized above, each team member is very well-supported. This creates a remarkable learning environment and ensures that patients receive the best and safest care possible.
After rounds on admitting days, the Senior carries the admitting pager and typically is getting notified by the ED or various clinics about patients needing hospital admission. The Senior typically receives each patient's story and runs through it with the intern that will assume care of said patient. At this point, the Senior makes sure that you, as the intern, are well-aware of any red flag symptoms in the patient's presentation, and makes sure that you are comfortable in assessing such concerns. Most Seniors carry hospital-issued mobile phones so that if, when you see a patient, you get a sense that someone is very ill or may need additional levels of care, they are just a phone call away. Otherwise you will then see the patients, usually no more than 2-3 on an admitting day depending on the census, come up with a reasonable plan to be vetted by the Senior and Attending, and make sure that appropriate admission orders are placed.
When the admitting day is over, or, on non-call days, when foreseeable, pressing issues are managed, it is time to sign out your list to either the night team or the on call team taking cross cover, depending on the time. Your goal is to take a moment to look into your crystal ball and provide meaningful guidance on how to deal with the most likely and most dangerous issues that a patient may face based on their history and current presentation. This should be a well thought out "to do" item everyday, because the night team is covering a large number of patients and if you can provide "if this then that" type guidance, there will be much gratitude. With that, it is time to sign out your pager, go home, see your family, and relax, because tomorrow will most certainly come.
Meet Amit Gupta, Internal Medicine Senior Resident, Class of 2016
Gastroenterology and Liver Inpatient Service
6:00 AM - Alarm number 1. Snooze.
6:10 AM - Alarm number 2 and my wife asks, "Can't you just set one alarm and get up then?" Nope, I need two. Quick shower followed by scrubs if I'm on call, or my best attempt at GQ if I'm not.
6:20 AM - Enjoy a few minutes to read the NY times updates with a slice of toast at the kitchen table. If on call I may login to MiChart (EPIC) at home and take a quick glance at the H&P's for the night admits (maximum of five). Meanwhile, the Nespresso heats up brewing the perfect cup of cappuccino. Then it's just a ten minute drive to the hospital and a five minute walk to the team room on 5B. Guess no time for a Lebron James chalk toss this morning.
6:45 AM - Each senior has their own style. I like to review everyone's vitals, labs, and any late consult recommendations from the day before, but allow my interns the space to remain the point person for their patients. Sign out is precisely at 7 and punctuality is prized as we all value relieving the night team and allowing for safe transitions. The attendings (one for lumen and one for liver) arrive around 7:15 to 7:30 and the night intern presents only the highest acuity patients before heading home by 8.
8:00 AM - Team A rounds with one of the attendings while Team B rounds with the other, and then we switch. Thanks to the MiChart transition I am now able to bring my iPad on rounds, allowing me to reference vitals and labs if needed, and submit orders on the go, increasing our team's efficiency.
11:00 AM - Morning Report occurs daily at 11:00 AM, is required of seniors, and is always a favorite. This consistent requirement encourages efficient rounding to enable residents to attend morning report.
11:45 AM - Touch base with the interns, ensure all consults have been called, and run the list, before taking over their pagers at 12:30 so they can attend intern report (Tuesdays and Thursdays).
1:30 PM - The team is back together and the afternoon all depends on whether we're on call or not. If on call we continue to work through admissions until call ends at 5. I hold the admission pager until signout at 7, but admissions that get called after 5 ultimately go to the night team. If not on call, I try to teach or do physical exam rounds with the medical students. If we're lucky, we may even finish early and signout (earliest is 3 PM on weekdays), which frees the afternoon for heading to the gym, cooking dinner with my wife, or catching friends for a drink at the Beer Garden (a favorite open air option in downtown Ann Arbor)!