Ate Resident's Tips to Junior Interns & Senior Interns: Don't Let the Patients Bully You

I'm always a pro-senior intern type of resident.  I may favour senior interns more than junior interns but I think this post will apply to both audiences.

In my 4 years as a surgical resident, I would always get irritated when some patients will bully my senior interns.  This usually apply to the private division.  There's a recent post here I read and discovered from social media of an intern writing about how the patient from a government hospital accused her or "Wala ka kasing Puso, Pinagpapapractisan niyo lang kami." Sometimes you even encounter patients who won't let you interview them. I was surprised actually that a patient from a government hospital would behave like this.  Because in our clinical division, we seldom encounter these patients.

We always encounter these patients in the emergency room.  Well you can understand, the stress of a patient or a parent for his/her child.  They would want always the best medical care be given to them. Because to them this may be a matter of life or death. So understanding their situation is a very important key area in these situations.

But you must understand also that being a junior intern and senior intern is a journey.  Every doctor undergoes this stage.  Even the most successful doctor in the whole wide universe did undergo that stage.  That stage when while young, your exposure to real patients after undergoing 3-5 years of theoretical books in medical school.  That most successful doctor you could think of will not be what he/she is today without undergoing this stage in their path of becoming a consultant.

Do you ever wonder why it's not the 1st year medical student, nor 2nd year nor 3rd year medical student who is inside the emergency room? or who is in the out patient department (OPD) interviewing the patient? Well it's because only a junior intern or someone who has completed 4 years of medical course is QUALIFIED to be inside the emergency room and inside the out patient department.  So don't feel too degraded when you're the youngest inside the emergency room and inside the  OPD. You're QUALIFIED to be there.

We all wished that we'll be in the ideal set-up, a 1:1 doctor:patient relationship.  But right now, in the Philippines, we sometimes can't always have the ideal set-up.  We're still a developing country.

So when a patient comes inside the emergency room and demands that he/she sees a resident or a consultant. Don't feel degraded or sad.  Because at that moment when your resident or your consultant is not around because they're attending to another patient or saving someone else more critical, or in the conference, you're the ONLY one there that's qualified to diagnose and to give first aid to that patient. Well you're the DOCTOR there right? You're the one in there that's most knowledgeable about diseases and how to treat them.

I'm not saying that you be arrogant.  You can always ask the patient, "Hi I'm Dr ____, I'm sorry but the resident/consultant is currently attending to a patient/attending a conference, is it ok with you that I attend to your concerns first before they arrive or are you willing to wait for their arrival?" Then let the patient decide.  For sure, if the patient thinks the condition is urgent, they will agree that a young doctor sees them rather than none. If they decided to wait, then let them wait, unless if it's critical.. like the patient has difficulty breathing or has a gunshot wound or a stab wound.  Do everything you need to do and render 1st aid and CALL your resident.

So don't let the patients bully you and let you feel degraded.  They're just as agitated because of their concern with their lives nor their loved ones.  You just need to remember, you're not an INTERN LANG. You're an INTERN NGA. There's a reason why hospitals chose to place you there in the first place. You're a Doctor there, and it's part of your job to treat these patients.

Residents and Interns are a team.  We back each other's back.  Be sure though that before you give your treatment that you verify this with your residents and consultants, because you're still under their care by law, and it's their license which is at risk of losing if anything goes wrong.

Always remember, You're the Doctor there, and Don't let patients bully you.  You're the one who is most qualified to treat them when your residents or consultants are not around.

Ate Resident's Tips to Junior Interns: Proper OR Attitude

I always start with a disclaimer.  These are all my personal opinions and tips for you junior interns as a surgery resident.  They're not in any way endorsed or rules implemented by the Surgery Department.  These tips are most applicable to the UST Hospital Setting, since I had my junior internship, senior internship, and residency in the UST Hospital. Different rules may apply to other institutions.

Greetings my fellow junior interns =D.  Welcome to Surgery Department, here you'll experience lots of fun things and sad events, and these are important in your process of becoming a physician.  They say, that this department is one of the coolest department (nagbubuhat lang actually ako ng sarili kong bangko/lamesa) hehe. Anyways, let's get to the tips and enough lame intros.

Every year, there'll be an incident when a junior intern will be asked to scrub out of the OR.  This is a common thing, ever since I was a junior intern, may napapascrub out na.  As  a junior intern, you don't know why pinascrub out ka??? Then you come in to conclusion, residents are power tripping.  This is the stupid "hierarchy" in UST.

Now that I'm a resident, let me tell you "MY" side of the story as a Resident.

Being inside the operating room is a privilege, you know why? Because of all the 400-500+ junior interns in your batch, you're the one chosen by God to be involve in a surgical case, whether it's appendectomy, knee replacement, nephrectomy, thyroidectomy etc.  Not all are given the chance to go inside the operating room and be involve in a case to save the life of a patient.  So do you get my point? Treasure every case you have.  Because not all junior intern can see a person opened up to cut out his kidney, thyroid, breast, etc. Who knows, this may be your last chance to witness this case, you may never be able to go inside the OR again if you will not choose the surgical field.  So treasure this chance!

Now that you see that every case is a privilege, you should also accept that this comes with a responsibility.  With every privilege comes with responsibilities (Parang iba ata to sa Spiderman quote, great power comes with great responsibility ata sabi dun).  As being the JIIC (Junior Intern in Charge) of the patient, you have the privilege to go inside the operating room and be part of the surgical team.  You're PART of the surgical team. The patient has entrusted his/her life to the 'surgical team'.  So it's your responsibility as part of the team to study about your case.  

Let me stress this out more:

If you'll imagine, you're the patient, "Kanino ka magpapaopera?" 

• To someone who is a summa cum laude who did not study about your surgery? or 
• To a normal surgeon who studied every detail of your surgery/case?

Every time I ask this, to my junior interns, I always get the same answer.  And yes, your answer is their answer.

So it's just fair and just to the patient that you go inside the operating room, and cut open a part of his body but YOU SHOULD Have at least an Idea of what you are doing! Because I personally would never let another doctor who knows nothing about the surgery to do any surgery on me.

So now do you get my point? Study every case before going inside the operating room.

What do I have to study as a junior intern you'll ask....

1. First of all, know your patient, meaning, you should have talked to the patient, interview him, why is he here admitted in the first place?
2. Study the anatomy involve in the case.  If you'll do a nephrectomy, study the kidney anatomy, if you'll do breast surgery, study the breast anatomy. - You spent 1 whole year studying human anatomy, you spent a lot to buy Netter, might as well use it now.

Those are the 2 basic things that EVERY JIIC SHOULD KNOW.  Knowing the process of the surgery, why the surgery is being done are plus things you should know.  If you know the first 2, I guarantee you that you will not be asked to scrub out of the case.

Another responsibility is being the JIIC, you should know the schedule of your surgery: Meaning, you should be the first one inside the operating room, you should be the one accompanying the patient from the ward to the operating room.  As a patient, isn't it nice to see that one of your doctors is with you all the way from the ward to the operating room??? This is what the UST Compassion is about.  You are how old already? 20+ right? You're an adult, you're freaking going to do surgery already, so you should be disciplined enough to be there on your own.  It's not the nurse's, not the resident's, not the consultant's responsibility to call you why you're not in the operating room yet.  It's YOUR OWN responsibility to be there on time.  For me, this is responsibility and discipline, this is NOT hierarchy. Besides the surgery can start without you, and it's not the residents nor the nurses loss that you lose that opportunity to see a surgery.

Oh yeah... another thing, please eat before you go inside the OR.  You falling down and contaminating the surgical field is the last thing the residents/consultants need to worry about.  Not eating your breakfast or your lunch prior to OR and going hypoglycemic will only endanger the patient and predispose the patient to infection if you fall down the operating field.  There's nothing martyr in not taking your food prior to the OR.

Lastly, bring your proper gear.  Be responsible enough to bring your own scrub suits, your own hair net, your own mask, and don't forget your smart phone.  Who knows you might need to call your runner to get some things needed.

These are some tips I could think of as of now.... I'll add more if I thought of more. Enjoy surgery rotation =D Remember, we've been there... Nagawa na namin yun kalokohang ginagawa ninyo ngayon. =D Naging junior interns din  kami dati =D.

Medical Clerk's Battle Gear

I was once a medical clerk 5 years ago, and this friday, a new batch of medical clerks or should I call Junior Interns will be rotating in the hospital.

First of all, welcome to the new junior intern, if you're a junior intern reading this post.  You feel so excited that after 3 years of reading and studying in medical school, you can now apply all the theoretical information in medical school.  Everybody will look up to you, since you're a senior when you were in 3rd year, and all the medical students will look up to you now that you are a junior intern.

To start off, I'll be putting up a disclaimer.  The tips that you will find in this post are all my personal opinions that you may need in your clerkship.  You would likely benefit from this post if you're a Thomasian, since I had my clerkship/Junior Internship in UST.

Let's start of with your battle gear:

1. Have a decent stethoscope 

This is one of the fundamentals of being a junior intern, so INVEST on it, meaning, buy a quality grade stethoscope.  Of course having the brand of stethoscope depends on your personality.  If you're the type of person who loses a lot of things frequently then I would recommend you get NOT a Littman stethoscope.

If you're the type who takes time before you'll lose something or you never loses things, then I recommend you get a standard Classic Littmann Stethoscope. 

Personalise your stethoscope, there's a man who goes around hospitals who can engrave your name into your stethoscope and that's great since most of you will have the same color etc.  You can also place any accessory into your stethoscope so you will not lose it.

2. Sphygmomanometer 

A great part of your junior internship life will be on measuring blood pressure (BP) of your patients. Buy something you can carry around with you.  You can buy the usual sphygmomanometers in Bambang.  No need to buy the expensive one.  Have it calibrated in Bambang when you buy one.

3. Pulse Oximeter

When we were junior interns before, we were required to just have 1 in a duty group, but I think this is one of the basics at present. You can buy in Bambang, if you can't go to Bambang, you can order at MD Gadgets

4. Thermometer

There are different types of thermometer, there's the axillary thermometer, which is the cheapest, and which I recommend as well.  They come in different kinds, choose the 1 minute thermometer since you need to work fast in monitoring all your patients.

There's also the infrared ear thermometer which is more expensive.  I don't recommend using the infrared ear thermometer unless you're the type of person who never lose anything.  In the hospital, when there's a "code blue", then you have to drop whatever you're doing and go respond to a patient and do chest compressions (CPR) to a patient. You can forget your things and you might lose them.

5. Med Bag

This is where you will put all your equipments, you can either have a waist bag or a shoulder bag.  It's very popular in Bambang to have the black OB bag, but in my experience, I only used it during the first day and during revalida.  That's the bag where I put all of my medical supplies.  The first three are the very basic things, you'll be needing them in ALL rotations. Choosing the right bag depends on your personality/preference.  I first started using the waist bag, the Le Sport Sac replica, because I find it lightweight and many things I can put in that bag, but over time the waist gave some sort of strain to my lower bag due to the heavy weight.  So eventually I switched to a shoulder bag, at around last 3-4 rotations.  

6. Special Equipments

Here are some of the supplies you'll need in certain rotations.  Meaning, it's ideal to have them all, but if you could borrow, I think it's cheaper that way.

ENT

You should have a sterile tongue depressor in your med bag, just in case you have a patient that you'll have to check their mouth.  Have tuning fork at hand. It's recommended that you have Diagnostic Set within your reach, to check for the ears and nose.  I recommend the Welch Allyn Diagnostic Set since it's more durable than the other brands, although pricier than the other brands.  I would recommend you borrow this diagnostic set, if you're not planning on going to ENT, Paediatrics specialty.

Medicine

This is one of the major rotations, you should have a mini notebook with you to list down the things that you have to do and to write notes on the lectures of your consultants and residents.  Have a reflex hammer &  penlight at hand, just in case you need it.

Paediatrics

This is also one of the major rotations, and you'll be needing a lot of special supplies here since your patients are children.  Have a paediatric BP cuff, penlight at hand.  Bring lots of bling-bling and put it in your stethoscope, so that children can play with them while you examine the patient.  Have some candies in your pockets as well to give to the children.  If you're at the pedia OPD, have mask always, those kids are highly contagious!

Surgery

Have clean gloves always at hand, because you'll never know when will be the next time that you have to hold a wound or any trauma patient.  Have a penlight at hand to check for the pupillary reflex and GCS of your neurosurgery patients.

OB-Gyne

It's important you have a good quality stethoscope so you can listen to fetal heart sounds.

Neurology

This is one toxic rotation, since your patients are toxic as well.  Bring your tuning fork, reflex hammer, mini snellen's chart, penlight, coffee granules, cigarette stick, vinegar (to check for the senses).

Ophthalmology

Mini snellen chart, penlight

This are the things I could think of as of now, just comment down below if I forget anything or any rotation I failed to mention.

Enjoy your clerkship/junior internship!