Probably the two most contradictory words you will hear throughout your experience in your first year in any speciality. My personal opinion is that no matter how hard you try, you will still find yourself struggling to manage your patient load, medical and social, in addition to making it home on time, barring emergent situations with your patients.
A few things I have come to learn in my short stint as an internal medicine resident. The first thing is getting to know whether you are a morning or a night person. If you are a night person, the first thing you will need to learn is…how to become a morning person. It goes without saying because you will need to pre-round on your patients before meeting with your senior resident, and then with your attending. Hospitals vary how they round, and you will also find your niche. For me, I would print off my patient list, write their vitals, review their labs, and then off to the races to interrogate my patients for a few minutes before preparing their progress notes. I went from writing down nearly all of my patient’s review of systems to jotting down their pertinent findings in short form. All the while you will be fielding pages from your nursing teams and other ancillary staff to answer questions and concerns. As the time proven saying goes, “time flies”, and it truly does. So time management is key to understand each of your patient’s history of presenting illness, their medications, allergies, and other relevant history, and how it may or may not contribute to how you treat them during their admission.
We also all took some version of Step 2 CS. We are only allowed 15 minutes in each patient encounter to introduce yourself, perform a full physical examination, and offer your thoughts on their diagnoses and what the next steps are. Knowing you have so many patients to see in the morning, you can also time yourself to ask only the pertinent questions for now. After rounds, I would return to the patient room to update them of the plan, especially discharge planning because that would be a terrible surprise to patients. Prior to our noon conference, I would update each of the nurses about the plans for the day, from medication changes to discharge planning. Unless your program has a nursing rounds, you will need to do this too to ensure everyone is on the same page. No matter the size of your program, floor staff talk, and you do not want to be on anyone’s bad side because they can make or break your experience during rotations. I felt that by doing this, I had a sense of completion that even if I left the floor or did not touch base with the nursing staff from then on, they would know the plan or changes to management. It also sets up a line of communication between you and floor staff so they continue to communicate and advocate on your behalf.
You then should set aside a portion of time to prepare discharge summaries for your patients that likely will be discharged that day or even a day after. You will learn to insert various tasks during brief moments of free time to get ahead of the curve. It is an art that no matter what stage of training you are in, should be an area we consciously focus on. Thats it for now folks, talk to you later. Save a life!