Well, I'm on call again. Have actually had a good weekend so far. Had to stay a bit late on Friday...hospital bs. Nothing is simple when you're in the hospital. Studied a bit on Saturday then went for dinner for a friends' birthday. Now I'm back at the hospital for the next 30hours. I'll do a bit of studying but man, is it boring.
I can't believe we only have 3 weeks left of this rotation! Seems like yesterday that I had no idea what I was doing! This isn't to say that I know what I'm doing now, but at least I am able to operate the patient computer program to get relevant information! I'm even a bit more confident in assessing sick people when I get called to the ward, even though I still get palpitations when my pager goes off. This is part of our training is gaining confidence in our (limited) abilities.
A few things have bothered me about working in the hospital:
1) The evil unit clerk in the emergency department. I swear she's put on this planet to test how far she can go and still have med students be nice. She must also have boundary issues: she yells at us if we're in HER space. She's my classmates nemesis.
2) How every little thing is micromanaged and made an issue.
For example, my classmate had the experience where she was discharging a patient, but the nurses didn't think she should because the patient hadn't had a bowel movement for 2 days. For crying out loud! There are many, many, MANY people walking around in this world who are constipated, but because they happen to be in the hospital, it MUST be treated!!! Same thing for loose bowel movements (not diarrhea), headaches, nausea, fatigue, poor sleep, minor aches and pains, etc. Every little complaint a patient has is brought forward by a nurse, discussed by the team, investigated to see if it's something serious, and then treated.
3) Needing to write orders for things that patients can get themselves over the counter at the drug store.
Why do I have to write an order for Tylenol, or peptobismol, or ibuprofen or whatever if the patient can just as easily have someone bring it to the hospital for them or bring it from out of their purse? And for me, it's not as simple as just writing an order. Being a med student, technically, I have to go to the patient and get a history from them about why they need this drug, examine them, check their lab tests just to make sure the drug I give them won't harm them. Then technically I need to discuss this with my senior resident who can give me the verbal order for the drug, then I can write the order in the chart "Discussed with Dr. So-and-so". We make it a habit to write "prns" in the orders when we admit patients. This will ensure that these type of meds will be available for the nurses to use "as needed" so we don't get called in the middle of the night for tylenol.
4) Contact precautions for MRSA/VRE patients.
MRSA and VRE are what the media calls the "superbugs". They are bacteria that live on skin and usually don't cause a problem unless the skin is broken (ie infected wound) or it gets into the blood. The infection can't be treated with the standard antibiotics if someone has an infection, special ones must be used. With the population of patients this hospital has, it is rare that someone is NOT a carrier of these bugs. Problem is, if you want to examine these patients, you have to do what we call "gown and glove". You have to put special gowns on to protect your clothes, put gloves on and make sure you wash everything that goes into their room after you are done. Pens and paper included. For nurses this takes considerable time to do it many times a day. That fine and all if it would prevent the spread of these bugs and prevent infections, but here's my issue: if the patients are well enough, they are allowed to roam the hospital, go outside for a smoke, get food in the cafeteria, and do whatever they want. What's the point of contact precautions if these people are able to go around touching everything so other people can get their bugs? That's not even mentioning the fact that these people have been carriers long before they came to hospital and have touched god knows what in public places!
I think that's enough for now!
I can't believe we only have 3 weeks left of this rotation! Seems like yesterday that I had no idea what I was doing! This isn't to say that I know what I'm doing now, but at least I am able to operate the patient computer program to get relevant information! I'm even a bit more confident in assessing sick people when I get called to the ward, even though I still get palpitations when my pager goes off. This is part of our training is gaining confidence in our (limited) abilities.
A few things have bothered me about working in the hospital:
1) The evil unit clerk in the emergency department. I swear she's put on this planet to test how far she can go and still have med students be nice. She must also have boundary issues: she yells at us if we're in HER space. She's my classmates nemesis.
2) How every little thing is micromanaged and made an issue.
For example, my classmate had the experience where she was discharging a patient, but the nurses didn't think she should because the patient hadn't had a bowel movement for 2 days. For crying out loud! There are many, many, MANY people walking around in this world who are constipated, but because they happen to be in the hospital, it MUST be treated!!! Same thing for loose bowel movements (not diarrhea), headaches, nausea, fatigue, poor sleep, minor aches and pains, etc. Every little complaint a patient has is brought forward by a nurse, discussed by the team, investigated to see if it's something serious, and then treated.
3) Needing to write orders for things that patients can get themselves over the counter at the drug store.
Why do I have to write an order for Tylenol, or peptobismol, or ibuprofen or whatever if the patient can just as easily have someone bring it to the hospital for them or bring it from out of their purse? And for me, it's not as simple as just writing an order. Being a med student, technically, I have to go to the patient and get a history from them about why they need this drug, examine them, check their lab tests just to make sure the drug I give them won't harm them. Then technically I need to discuss this with my senior resident who can give me the verbal order for the drug, then I can write the order in the chart "Discussed with Dr. So-and-so". We make it a habit to write "prns" in the orders when we admit patients. This will ensure that these type of meds will be available for the nurses to use "as needed" so we don't get called in the middle of the night for tylenol.
4) Contact precautions for MRSA/VRE patients.
MRSA and VRE are what the media calls the "superbugs". They are bacteria that live on skin and usually don't cause a problem unless the skin is broken (ie infected wound) or it gets into the blood. The infection can't be treated with the standard antibiotics if someone has an infection, special ones must be used. With the population of patients this hospital has, it is rare that someone is NOT a carrier of these bugs. Problem is, if you want to examine these patients, you have to do what we call "gown and glove". You have to put special gowns on to protect your clothes, put gloves on and make sure you wash everything that goes into their room after you are done. Pens and paper included. For nurses this takes considerable time to do it many times a day. That fine and all if it would prevent the spread of these bugs and prevent infections, but here's my issue: if the patients are well enough, they are allowed to roam the hospital, go outside for a smoke, get food in the cafeteria, and do whatever they want. What's the point of contact precautions if these people are able to go around touching everything so other people can get their bugs? That's not even mentioning the fact that these people have been carriers long before they came to hospital and have touched god knows what in public places!
I think that's enough for now!
posted by MSI (Med Student Intern) @ 10:51 AM
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