Category: Opinion

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The Difference Between An Intern and a Senior Resident

At my hospital, we call first year residents ‘interns’ and all of the second and third year residents are the ‘senior residents’. It makes it easier for everyone in the hospital when you introduce yourself as ‘the intern’ or ‘the resident’. It set’s different expectations right from the get go. The biggest difference I’ve noticed between an intern and a resident is the following:

Now take a step back all the way to medical school where you don’t even know what you don’t know. It’s absolutely terrifying. You finish two years of classroom lectures and two years of clinical rotations and are eventually given a degree that essentially says ‘I know enough medical stuff to not kill someone’. And then on day one of residency you’re given 10 patients and realize they didn’t teach you any of this stuff in medical school. And that’s normal and okay. I still barely know what I’m doing everyday (I know, not really what you want to hear from your doctor).

My point that I’m trying to make to any medical student or intern reading this is that residency is terrifying at times and you won’t be okay. For some reason people don’t acknowledge this fact. That you are going to freak out at some point along the way either from anger, anxiety, fear, or all of the above. Just know that it’s going to get better.

I remember my first rapid response. A patient was in new onset atrial fibrillation with rapid ventricular response with a heart rate in the 180’s.  He was hemodynamically unstable with oxygen saturation dropping into the low 80’s in front of my eyes. I arrived to the patient’s room and there’s one nurse getting a new EKG, another two nurses placing a new IV and drawing labs and an arterial blood gas, another nurse helping the respiratory therapist adjust the ventilator settings, as well as the rest of the floor nurses gathered outside the patient’s room to witness what was going on. “Oh good, the resident is here!” one nurse exclaimed. And then all of a sudden everyone turned and looked at me for guidance. Oh, and did I mention that this was the first time I had ever met this patient before? I was just covering overnight.

Thankfully this situation happened later on in the year so I was comfortable handling it. Not to mention I love being the center of attention and hearing the sound of my own voice so I live for these kind of moments. Ultimately the patient did fine and we resolved the underlying issue (mucous plugging caused hypoxia which induced a.fib which caused hypotension and altered mental status so regular deep suctioning would prevent this in the future).

Looking back at that rapid response, I would never have felt ready to handle that type of situation if you asked me during my first few months of residency. Even halfway through intern year I still would not have been nearly as confident in my medical knowledge or even in my ability to handle the stress of the situation. It is normal to be overwhelmed. You are only one month into residency. We don’t expect you to be full fledged attending physicians yet (again, I’m still figuring stuff out on the fly half the time). Just promise yourself to be better tomorrow than you were today. At the end of the day that’s all we can ask for. Micro improvements each and every day.

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When will we start taking mental health seriously?

As a fourth-year medical student in a sub-internship in internal medicine, I have something that no doctor in America has. I have as much time as I want to spend with my patients. Don’t get me wrong, I am still a student. I’m still paying hospitals to let me be there, and I only have a maximum of four patients per day, but I inevitably end up spending more time with each patient than the average resident.

Today, I spent my time with one patient in particular. She was a Caucasian woman who was a previous intravenous drug abuser who has been sober for fifteen years. She is on methadone and takes Xanax for anxiety. She presented to the emergency department for a week of worsening malaise and generally feeling unwell. She also suffers from chronic respiratory failure secondary to chronic obstructive lung disease (COPD) due to her extensive cigarette smoking history.

We worked her up and ruled out pneumonia, a COPD exacerbation, urinary tract infection, an underlying malignancy, infection, or anemia. She was stable and not acutely ill, so we readied her to be discharged from the hospital. When we told her the good news, she broke down, cried, and begged us to help her. Not exactly what we were expecting.

She told us that she didn’t want to take the Xanax anymore. That she was becoming increasingly dependent on them. She understood that she was physically healthy but flat out told us that she was mentally ill. I remember she said, “It feels like something clicked in my head, and I don’t know what to do to get better. I just want help.” The problem was that she was physically healthy, wasn’t a good candidate to be transferred to the psych floor, and that she could simply follow up as an outpatient. She understood but was distraught.

“Please help me,” she insisted. I can see how more experienced doctors hate these types of patients. Previous drug abusers who end up in poor health and are looked upon as a succubus who drains the healthcare system of its resources. Occasionally however you find someone who just wants to get better. I believe, maybe naively so, that this was an example of the later.

At what point will sickness of the mind be treated equally as sickness of the body in our society and culture? There is a terrible mental health epidemic currently occurring in the United States, but the only thing I know about the problem is that we need to fix it. I believe that the first step that we as physicians, friends, brothers, daughters, and loved ones can do is to perceive and prioritize illnesses of the body equally to sickness of the mind. Maybe then we can start to take care of the patients who truly want to get better.

 

The original post was published on KevinMD.