THE 2019 cohort of junior medical officers is hitting the wards. The scuttlebutt is that the 2018 interns are noted for their low rate of rookie errors.

Let’s give this year’s interns some tips for success:

First, use the organs connected to your brain

As doctors, we feel the urge to have to do something. Almost reflexively, we’re spouting advice, writing scripts and picking up an instrument to poke at our patients.

Before we talk or move, we can glean much by listening, looking and smelling.

Talking to our patients is most important; however, what we hear, smell and see are the essential ingredients to our discussions.

Make use of your senior colleagues

While the new Fellows, hot-shot registrars and apostles of hi-tech may command all the attention, please do not ignore your senior colleagues. Their stories, advice and mentoring cannot be bought with MasterCard … it’s priceless!

Better latte than never…..

Walking around the wards with drink bottles and coffee cups sends all the wrong signals, even if you’re focused and well intentioned. Patients and colleagues may see you as distracted by your beverage, or as a hygiene risk, or simply not at your peak if you’re needing water or coffee when with a patient.

Leave your flasks and cups in the office or just use the cafeteria.

Bugs and drugs

An intern who knows about bugs and drugs is a very valuable asset. Here’s a very simple tip: just learn them. Know what causes infections and know your pharmacopoeia.

Help!

Don’t be shy and don’t be scared and most important of all … don’t be too proud to ask for help.

In 2019, help has never been so easy to access. Not only do you have the wonders of telecommunications and IT, you also have the largest number of colleagues of any generation of doctors.

Errors are always going to happen, hopefully infrequently. Many of those errors can be avoided with a simple phone call or internet search.

Subtraction is often better than addition

Remember that many of the problems you see are caused by medication, not solved by medication.

This is especially so in the elderly and, sadly, so many times it’s the sort of stuff medical school is supposed to teach you.

Two common examples I see are ACE-inhibitor coughs treated with puffers, and calcium channel blocker ankle oedema treated with furosemide.

Not all your patients are medical

Perhaps not so much on the wards, but certainly in ED and outpatients.

Patients often find their way to a doctor when the actual problems are family, social, financial or governmental. Driver’s licences, passports, superannuation forms, travel documentation, pensions and work disputes are just some examples of problems that have somehow become medicalised.

Doctors are often well placed to identify social issues and point patients in the direction of the appropriate services – if you feel a patient may be better helped elsewhere, talk to a senior colleague about an appropriate referral.

Emergencies and comfort zones

Emergencies are not everybody’s cup of tea and some doctors wisely make the decision to choose specialties where emergencies are rare. But note I wrote “rare” and not “non-existent”.

Use your junior years to learn as much as you can about emergencies and develop a set of skills that will stand you in good stead and give your patient a fighting chance in a crisis.

The community still has an expectation that all doctors know some basic emergency care.

Eat, drink and learn

Probiotics, prebiotics, gut flora and faecal transplants are some of the sexiest topics in medicine today.

However, errors are made by not asking simple questions about what your patient has had to eat and drink for the last few meals. Nurses are often very helpful in this regard.

A lack of urine over the past 12 hours may be because your patient has had nothing to drink. Therefore, a jug of water may be more useful than a shot of furosemide.

It’s hard to move your bowels well if you’ve had nothing to eat for 5 days. Therefore, a bowl of soup and slice of bread may be more useful than an enema.

Chronic problems don’t have acute solutions

As our society gets older and fatter, we see more chronic illness.

A patient does not develop hypertension, diabetes, COPD and a weight of 130 kg in 6 months. Not even 6 years usually. In fact, it’s probably a product of decades of “good living”.

So, as junior doctors, don’t expect to solve these problems in one ward round, or even in an entire admission.

Just like your career, it’s going to take years of education, patience, ups-and-downs and hard work to get to where you want to be.

You’ve chosen a great career, interns! Good luck and good labours!

Dr Aniello Iannuzzi, FACRRM, FRACGP, FARGP, FAICD, is a GP practising in Coonabarabran, NSW, and a clinical associate professor at the University of Sydney.

 

The statements or opinions expressed in this article reflect the views of the authors and do not represent the official policy of the AMA, the MJA or InSight+ unless that is so stated.

9 thoughts on “Tips for the intern class of 2019

  1. Peter Dewey says:

    Summed up by the great quote “more is lost in medicine by not looking and not listening than not knowing” Drummed into me as a student at London in 1955 and still very applicable.

  2. Ex-doctor says:

    Excellent advice Aniello. Might I add that “senior colleagues” should also include nurses. Charge nurses and their ilk are a rich source of practical information and survival strategies and can be incredibly supportive to interns who ask and seek advice.

  3. Dr Rashmi El-Salamani FRACGP MRCP MRCS DRCOG DFFP says:

    My surgical tutor always said ‘common things are common’. Don’t look for the rarest cause of what might be a simple common problem remember rare diseases are indeed, rare!

  4. Peter Terren says:

    Ridiculously, my first patient as an intern was a patient with a myocardial infarct in a major teaching hospital.
    I gulped, swallowed my pride and said to the charge nurse: “Sister what should I do?”
    Now 40+ years later I still say it as part of the wider information gathering process.

  5. Michael Gliksman says:

    Where were you when I was an intern, Aniello? Oh that’s right – I’m older than you.

  6. J, Anatomical Pathologist says:

    Good advice!

    Just a little add on, if any of the interns are reading this…

    If you are sending pathology specimens , i.e. histology or cytology specimens,

    – Please write relevant clinical history (i.e: site of biopsy, clinical impression, relevant past medical history, gestational age, your clinical question? a.k.a. lymphoma ? infection?). Relevant clinical history, impression and clinical question will guide us on how to deal with the specimens and to tailor the report to answer your question.

    – Ensure you place the specimens in the correct specimen jar: Formalin for histology, or fresh (if you would like flow cytometry, microbiology culture or cytogenetics) .

    – Ensure proper labelling of specimens with patient’s details, time of collection and fill up and signed the important sections of the request form. The last thing you want is a NO TEST of precious tissue samples (which means you would have to recollect the specimen), just because you did not signed or label specimen correctly.

    – The worst examples of clinical request form are: ” Histo”, “Skin”, “Placenta” or nothing…Yes, just like you, I can see a skin or a placenta on the lab bench and under the microscope. You would not want report to say ” Skin confirmed or placenta confirmed” right?

    – With the myHealth Records rolling out, patients can access their histology reports. Imagine if you are the patient and you read the report with no, limited or wrong clinical history? It reflects on you as the requesting clinician.

    You are our bridge to the patient who sits in front of you. A few extra seconds of your time filling in correct details and relevant clinical history makes a huge difference and would contribute to a correct and relevant diagnosis to your patient’s condition. Help us to help you and most importantly, the patient.

    Thank you,
    J, Anatomical Pathologist

  7. Anonymous says:

    Great advice – agree with all except the part about water bottles… take one with you, in a bag if necessary. Breaks can be few and far between… and all too quickly, you may become that patient that is anuric because you’ve had nothing to drink in 12hr!

  8. Vince Edghill says:

    Great advice.
    How things have moved on…from my fossilizing times back in the Caribbean in the 60,s. Fresh out of Edinburgh and clueless at a practical clinical level. Drink botttles and walking about with coffee ??. Geez
    Great nurses saved my skin. And the Pathologist comments are also great.
    But 60 years later we still have the best profession, fossil or not.

  9. Anne Malatt says:

    Great article and comments, and may I add:
    Please look after yourselves first, not last.
    We can only care for others as deeply as we care for ourselves and while our work often asks us to put the needs of others first, this cannot be sustained if we don’t care for ourselves too.
    Drink water, not coffee; eat food, not crap; get some exercise outdoors when you have a break and go to bed early when you can … your body needs to rest and recover from work that can be very intense at times.
    Enjoy being part of this wonderful rewarding profession, and as well as looking after your patients, support your friends and colleagues to care for themselves too.

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