isbars

anonymous asked:

Dear Fahye, your writing is breathtaking and creative and sharp and delightful & the fact that you manage to pursue medicine and also write ALL THE THINGS is insanely inspiring. I just graduated from med school and am one week away from my first day of intern year in internal medicine (OH GOD). Do you have any advice for a thrilled / terrified baby doctor (& aspiring writer)? Is there anything you wish you had known / done before you started practicing medicine? Thank you for being amazing.

GOOD LUCK TO YOU, ANON, I hope your career is everything you hope it to be and more :)))

things I wish I had known before I started my intern year:

  • remember to pee
  • remember to eat and drink
  • no matter how smart and confident and level-headed and awesome you are, there are going to be days when you feel like an incompetent fool who should have quit med school after a week and become a florist instead. THIS IS NORMAL. 
  • it’s helpful to talk to dead people when you’re declaring them dead. use their names. be calm and chatty.
    • there are some weirdass sounds going on in someone’s chest when they’ve recently died. it’s not breathing. it’s ok.
    • that said, if a nurse pages you to declare a death on the ward, it’s not urgent. do the other five things on your list first. that way they’ll be cold when you get to them, too, and that tends to remove all smidgen of doubt re: whether this person is Actually Dead.
  • you will ruin at least one pair of shoes with blood. don’t worry about it.
  • similarly: for the love of god keep track of when you’re meant to be in theatres so that you can bring your comfy shoes and not end up having to do a surprise half-day caesarian section list IN HEELS.
    • this may not apply to you, given what you said about internal medicine, and how early the USian system divides you onto specialist tracks, but the ankle swelling and foot pain I had at the end of that day were so memorable that I am passing this lesson on to you regardless.
  • no matter how bad a day you’re having, be nice to nurses. be nice to admin staff. be nice to the pharmacists and the physios and the switchboard staff. this will make your life ten thousand times easier, and also it’s the decent thing to do.
  • ALWAYS be nice to the radiology staff. the day your specialist wants you to get an urgent CT scan at 5pm, you’ll be glad you did.
  • some nurses are dicks. some doctors are dicks. NEVER, EVER BADMOUTH THE OTHER CLINICAL STAFF IN FRONT OF PATIENTS. try not to do it at work in general. do it when you get home. 
    • also, sometimes you will find yourself being a dick
    • this is a stressful job
    • apologise, and move on
  • one of the best skills you can have is the ability to communicate quickly, firmly and concisely over the phone. if you’re waking someone up, they want to know why. do you guys do ISBAR? learn ISBAR. love ISBAR.
  • the camaraderie between junior doctors is intense and life-saving. you’re all in the trenches together. you will lean on one another, and help one another, and debrief about the absurd and gory and downright traumatising things that your job presents to you on a daily basis.
  • however, hold on to your non-medical friends. keep in touch with them. socialise with them. you need them for perspective. otherwise every single social occasion outside work becomes talk ABOUT work, and next thing you know it the waiter is asking you to maybe keep your voices down because the next table doesn’t want to hear that level of detail about bowel resection and urinary catheters when they’re eating.
  • a final word on female urinary catheters:
    • the number of people who have attempted to catheterise a clitoris, myself included, is mind-boggling. the urethral opening is lower.
    • no, lower than that.
    • that’s it.

Wondering how to give handover to another midwife, doctor, colleague? Follow ISBAR and you can’t go wrong.
At the same time always check through the documentation when receiving handover from someone else as they may have forgotten to include something!

I’ve seen a few colleagues get quite flustered about giving handover,, but its not as daunting as you first think!