I’ve finished the first month of internship and I think I ascended the major portion of the learning curve. Half the battle was learning the system; how to fill out the orders, notes, dictations, etc. I had a great experience and really enjoyed the team I worked with.
In my program, teams include two interns and two seniors (2nd or 3rd years). The schedule is rigged so that you admit new patients pretty much every other day with an overnight shift and a long call shift (7am-9pm) every 6th day. I had good days, horrible days, and mostly a mix between the two. The one horrible day involved being on “short” call, where you take the new admissions from 730am until 230pm. Somehow, I managed to “cap,” getting 5 new admissions in that window. So much for “short.” However, despite 80 hour weeks, I still got out and enjoyed Santa Barbara to the best of my ability and have established some “go to” hot spots.
I’d like to document some of the experiences from the first month of wards that had an impact on me, for one reason or another…
First, I realized I was spoiled by the electronic medical records (EMRs) available in Minnesota. Though none of the systems I’ve used at Fairview, Park Nicollet, HealthPartners, or Abbott, including the Epic “Solution,” are user-friendly and an ideal solution; but writing notes and ordering things by hand is horrible. The typical admission involves going through the vitals and old dictations on the computer, then seeing the patient and taking scratch notes while they talk with you, moving on to writing a History & Physical note on green paper, then writing admission orders on white paper, finally ending by dictating the note you just wrote from the green paper into the telephone to some service located who knows where. So many steps…so much inefficiency, it drives me nuts.
I’ve honed my process so that I take my memory and notes from talking with the patients directly to the phone, do a “stat” dictation, then print that out instead of chicken scratching onto the green paper. I think I’m going to work on photocopying some generic, standard orders that I can use on multiple admissions in the future as well.
Most EMRs, let you set up standard H&P’s that basically write themselves, incorporating medications, past medical history, and any other data already in the chart. All with no need for dictation. I guess this is good and bad…some of those digital H&P’s can get pretty skimpy on actual substance with Epic “blowing-in” pure worthlessness. It continues to boggle my mind that I can go to a friend’s Facebook page and within 1 minute figure out what they had for dinner, who they’re dating, where they currently live, the music they’re listening to, etc. but we can’t get a solid EMR that presents data in a way doctors need and want. Something has got to give….IT will set us free.
This is already long…now with more time to post, I’m going to break it up into two parts.
Up next…”Frequent Fliers,” “look and you will find,” and Santa Barbara hot spots…