Tuesday, July 2, 2013

Take Pity On The Newbs

As Whitecoat's blog has reminded me, it's July.

Which, for those of you in teaching hospitals, means the new kids have been rolled out from med school and internships, and so Summertime Santa has delivered your shiny new batch of ER residents. The ones with about 5 minutes' experience, at this point.
Counting the time to get their name badges from security.

There will come a time to begin lovingly screwing with them a bit, but for now, handle them gently, like baby chicks and newborn bunnies. Everyone is new at some point. The Golden Rule applies.

I remember when I had a whole year of the ER under my belt at Seventh Circle Of Hell Hospital, when I had the unknown-to-me realization that "OMG, I know MORE than the DOCTOR!?!"

Because I experienced, on a lovely summer night one July, the dawning of comprehension of that fact courtesy of just such a larval example of the ER doc.

I'd been a nurse for most of a decade at that point, and done pre-hospital work for even longer, but my time in the big-time ER was just about at my first anniversary, so this was a new experience for me too. (Remember what I said about everyone being new at some point? There you go.)

So imagine my growing astonishment at finding a brand new ER resident, fresh out of his wrapping, as it became apparent he was staring at the patient chart in front of him, blank except for a Chief Complaint and curt but clear triage notes, evidently hoping for all the world that the very page would suddenly gain the power of speech, and exclaim to Dr. Freshmeat what in the wide world he should do.

As I ambled up to him, thinking perhaps there were some order I should note, I became aware that the entire chart was blank.

"Has the doctor seen the patient yet?" I asked.

"I'm the doctor." he said, and we introduced ourselves.

"So, first day?"

"First hour. I'm wondering what to do."

Honesty like that generally demands mercy, and he was a decent-seeming guy.

"Well Doc, usually with chest pain patients, besides the 12-lead EKG he already has, we do a stat chest x-ray, basic metabolic panel, CBC, and cardiac enzymes, repeated up to times 4, to rule out an MI." Because I'm not a genius, but after doing the same thing 500 times, I'd start to notice certain patterns...

"Great! Thanks!"

And he begins to scribble furiously in the orders block.

So figuring he's still got to actually see the guy, I move one bed down my area, just as the Head Attending, Dr. Doneitall, walks up to supervise Dr. Freshmeat, and ensure he hasn't killed anyone by 6:15PM.

"Dr. Freshmeat, tell me about your patient."
"He's got new onset chest pain, he has a negative initial 12-lead, so I'm ordering a stat chest X-ray, BMP, CBC, and serial EKGs and cardiac enzymes to rule out MI."
"Outstanding. Strong work. Carry on."

Which praise, at Seventh Circle Of Hell, from Dr. Doneitall, is the equivalent of Babe Ruth telling you you're a great baseball player. Especially to someone in his first hour in the ER.

Whereupon Dr. Freshmeat, behind Dr. Doneitall's turned back, whips around to me, throws me two thumbs up and a monstrous stage wink, and mouths "THANKS, DUDE!"

Because I just slowpitched him that hanging curve and he parked it in the bleachers. He just needed the initial nudge to help the textbook answers pop out of his forehead and flow onto the chart. Words cannot express how easy it was to work with Dr. Freshmeat the rest of his residency, and he did indeed grow into an excellent ER doc.

My other experience, growing after that night, was that I could generally run rings around the first-year residents, the second-years could keep up with me, and the third-year residents could bury me in orders in about 20 minutes that would kick my @$$ all night, and would, until they started to hone in on horses instead of zebras, and abandoned the shotgun approach to diagnostic work. It helped when they had the mentoring attendings, instead of the anal-retentive ones.

So unless they're total dicks from the get-go, cut the new kids some slack.
Keep an eye on them, shove them in the right direction from time to time, and help them to succeed, and it'll generally pay off. If not for you, for their patients for the next 30 years.

You can always screw around with them after a few months go by, just about the time they start to get a little cocky.

1 comment:

  1. I was hospitalized when pregnant with my twins. They had twin to twin and I had peripartum cardiomyopathy. On Jun 22 my perinatologis said, "It is time to deliver and get you out of here before the new residents get here. I don't want you scaring them to death."