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.
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.