Daily Tasks in the Life of An Intern and How to Do Them
Below is a collection of very common knowledge that you will likely pick up within your first few weeks of internship. This is by no means meant to be a comprehensive guide to surviving the year, but hopefully it will give you good insight and understanding, so you can hit the ground running when it comes time to do your jobs after your first ward round.
Consults are one of the main jobs you’re asked to complete as the intern on an inpatient team, and it will also be a large part of your ED rotation. A consult function is to ask another specialty or team within the hospital for help with a patient for issues outside of your team's field of expertise. They’re also one of the jobs that generates the most anxiety and overthought, as stories of inpatient registrars are often passed around between juniors at work.
Communication is key when making a consult. The ISBAR format that has been repeatedly drummed into you throughout your clinical years of medical school was built exactly for this. You need to clearly introduce yourself, including your name, the team you’re working with, and your position in the team. You need to state what your consult is in regards to— it is often good to do this early on in the piece so the consulting team has an idea of how to interpret what you’re telling them. To a reasonable extent, you need to have a good understanding of the patient's current treatment, background history, and plan for current management, as you will often be asked about these things by the team you’re consulting with.
It is normal to be nervous about making consults, and like anything, it takes practice to become adept at communicating clearly. Do not be too hard on yourself if during your first few consults you get to the end of your spiel and forget what exactly it was you wanted to ask, or if you find yourself fumbling through notes when you don’t have the answer to a question straight away. For your first couple of months on the job it can be a good idea to prep yourself by writing down the patient's story and relevant investigation findings on a sheet prior to making the call. Life in the fast lane has an excellent cheat sheet to help you know what is relevant for each specialty you will consult.
As a general rule it is better to try and make consults before lunch time, so the team being consulted has a chance to get around to seeing your patient or reviewing their file with adequate time left in the day. If the patient already see’s a specialist in the specialty that you’re consulting with, it is good to find out who this is and let the team know. It is also a good idea to chase the letters (see below) for whoever this specialist is, so the team your consulting has this information available.
Discharges are arguably the largest part of any interns job, and by the end of the year you will be able to power these out without a second thought. However, to begin with they can take time to get your head around. I generally split discharges into the follow components:
Writing Discharge summaries
This is a summary of the patient’s admission to hospital and it is the main communication to the GP on discharge. It is also an important point of reference if the patient presents to ED, and someone needs a quick overview of the patient's recent admission to hospital.
As a general rule a discharge summary should include the patient's history of presenting complaint (why they initially came into hospital), background medical history, progress in hospital, and any relevant investigations or results.
The progress in the hospital section can be tricky, especially if the patient has had a prolonged and complex admission. It normally takes the form of an extended issues list, which is most easily added to throughout the admission, so it doesn’t all have to be done at the end.
Medications can vary from hospital to hospital, but in general, a short supply of any medications which have been changed or commenced during the admission will be either prescribed (see below) or given to the patient at the time of discharge.
In rural hospitals, patients are often given scripts on discharge due to the funding of rural healthcare networks. In larger city hospitals patients are often given medication through the hospital pharmacy. When organising your patients discharge medications, your ward pharmacist will be your best friend. Do not be afraid to ask them even what you might think would be the silliest questions.
Follow up plans are extremely important for ongoing patient care. They will often involve following up with the patient’s GP (for ongoing scripts and general review) and with the treating team, however this will vary a lot from rotation to rotation. It is always a good idea to find out what the follow up plan will be for the patient during a ward round or when doing a paper round with your registrar, so you’re not stuck whilst they’re in clinic or theatre.
Writing scripts is a common task when working in outpatient clinics, ED or discharging patients from the ward, and it can be surprisingly nuanced with lots of requirements. During my first few weeks I had multiple scripts sent back from the pharmacy for not meeting the requirements needed for a legitimate prescription.
The vast majority of scripts you will write during your first year will fall into one of two categories: S4 and S8. S4 scripts are for the majority of drugs, including most cardiac medications, inhalers, antibiotics etc. S8 medications include opioid analgesia, and benzodiazepines. Both sets of scripts have some basic requirements, with S8 prescriptions having some additional necessities.
All scripts must have the following:
- The prescribers name
- The prescribers prescriber number
- 3 points of identification for the patient (generally name, date of birth, medicare number or address)
- The name of the drug (trade name or generic)
- The dose (including relevant units)
- The route of administration (oral, sub-cutaneous etc.)
- Administration instructions (daily, twice daily, at night, etc.)
- The quantity of the drug (number of tablets, millilitres of medication etc.)
- Number of repeats on the prescription
In addition, for S8 medication, they must:
- Be written on an S8 prescription pad (generally kept in a locked drug cupboard on the ward or in ED)
- Include the quantity of the drug written in numbers AS WELL AS in words
- If computer generated: the name, dose, quantity (in numbers AND words), administration instructions, and number of repeats written in hand writing as well as computerised
Other types of scripts (S35, S80 and S100) also do exist, but are not generally prescribed by interns.
Usually this involves calling the pathology, radiology, or whichever relevant department, and asking what the status of the patients results are.
This involves calling the patient's GP or specialist and asking them to email (or fax) you a letter or result. Often you will be required to put your request in writing and send it to the doctor you’re requesting it from.
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