First Impressions

I've survived my first week of residency. Everything is going well as far as I can tell, though to be honest things are a little different than what I expected. We haven't been too busy at the hospital this month. I have heard from a few people that typically July is one of the slowest months of the year for the hospital. I have been getting to the hospital around 7 AM. My mornings typically consist of doing rounds on all of our patients and we always have at least one meeting or didactic education program scheduled to attend too. We usually finish doing all of our rounds around 11 AM. Then we head to the doctor's lounge and my attending asks me about the reading topic he assigned the night before. At that point, he usually takes off to go to his office and I stay at the hospital. I am to take care of any admissions that we get through the ER, including doing and dictating their history and physical and writing the admit orders for the patient to go to the floor. Trouble is we haven't had too many admits in the week that I've been there so I've only had to do this a few times. Most of our patients have been in the ICU and are fairly complex patients so anytime questions arise about them they usually just page the attending. Although I was there Friday when a clot was found in one of our ICU patient's arm and I was able to page the attending and write down the orders. I actually felt useful for a change! It was the first time I had written for coumadin to be given. I was a little nervous as this is a somewhat dangerous drug, so I wrote for the smallest dose. But in general I don't participate much in the care of these patients except to observe just like a medical student would.

As for the patients on the general medicine floor, we usually have only had a few at a time. The hospital has hired a nurse practitioner to work on this floor so she is able to answer a lot of questions that arise during the day. She is really nice to work with and I know why the hospital hired her - because there aren't always residents around to take care of stuff during the day. But when we are around it would be nice if we were to get paged about stuff that comes up that way I could at least try to make myself useful. Truthfully though, I don't think most of our patients have needed much during the day. Our patients on the floor haven't been too sick.

With few admissions coming in and a NP answering all of the floor questions, I frequently have a lot of free time in the afternoon. I usually try to get some reading done and work on my resident logs and other stuff like that. I usually make afternoon rounds by going back to the patients' rooms and making sure everything is OK. Though this can be a dangerous game because if you aren't careful you will get caught doing mundane stuff.

I usually stick around until 7 PM or so. My attending usually comes back to the hospital after his office hours to do evening rounds. After we see the patients again, I am usually out the door for the evening. So I am working 60-65 hours a week on my non-call weeks, and around 90 hours a week on my call week. We only have to take call approximately one weekend a month, so that really isn't too bad at all. I know people in my position who have it much worse.

To sum up, I think everything is going well. I really expected to be thrown directly into the mix a bit more, to have more input in patients' care. So far I've mostly been in a medical student role still. But I've only been a resident for a week. I am sure that I will gradually get more autonomy as I gain more experience. Mondays can be tough because you have to catch up on everything that has happened to your patients over the weekend and you have to catch up on all of the new admitted patients that came in over the weekend. A lot can happen in just a few days.