Thursday, July 29, 2010

What Does an Intern Do?

New doctors in the first year of their residency training are referred to as 'interns' and much of modern academic medicine is built on their backs.

Certainly, internship has a steep learning curve. It is the moment of transition from 'medical student' to 'doctor' and many, many competencies must be mastered.

It is a privilege to have access to all this learning, and the cost of that privilege is scutwork.

Scutwork (also known as 'scut'): Monotonous work or menial tasks that--while not pleasant or fulfilling--have to be done, usually as part of a large complex job or project, often by an underling.

Scut is, by definition, neither direct patient care nor clinically-relevant learning. Unfortunately, all residents (all doctors, for that matter) must manage some degree of scut, but--at least in academic settings--a large portion falls on the intern.

My daily scut work looks about like this:
-enter nursing/medication/diet/imaging/PT/etc orders on the computer
-talk to the ward social worker (now called a "patient resource manager") to make sure that patients' insurance companies will pay for their necessary care
-call Radiology to make sure that all the imaging studies I've ordered will actually be performed
-call the clinical laboratory to find out why missing blood test results aren't back
-make 1289746166739509 follow-up appointments for the patients who are soon-to-be discharged
-write 23891612876498793877466 prescriptions, because every patient goes home on a full pharmacy's worth of medications
-type discharge instructions for the patients who are leaving the hospital
-call Radiology again to inquire why the studies they said would would get done haven't been done yet
-answering plenty of pages from the nursing staff
-change wound dressing, stick fingers in surgically-created orfices, put tubes into various bodily openings

Nonetheless, there are still upsides of being an intern:
1. Painful though it may be, you are still a doctor. You wouldn't have gotten this far if that wasn't important to you.
2. Sometimes (rarely, since you don't know anything) you can actually help people.
3. In one year, you won't be the intern anymore, and you will have an intern of your own to carry out all the necessary but painful tasks of the modern medical center.

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