* * Anonymous Doc

Friday, July 17, 2009

I got yelled at yesterday morning by the night-float intern when I got there to sign in.

Apparently I forgot to tell her to run a extra set of labs on one of my patients overnight. We've been closely monitoring her to make sure a new drug isn't causing any dangerous side effects, all the numbers looked good in her last set before I left, and even though I'd written in the chart that we needed to monitor her, I didn't say anything specifically when I was signing out... so the night float intern, who didn't have time to read the charts and was just going on what we'd told her, didn't know to do it, and by the morning the patient's lab values were way off the chart and we needed to stop the new drug... and even though nothing happened...

I apologized to the intern, right away.

"I should have told you, it was my mistake, I'm sorry."

And she starts yelling back. "You needed to tell me, everyone else tells me if someone needs something tested overnight, I can't read your mind, I can't be expected to read every chart, you could have been the reason a patient died and I would have been blamed because it would have been on my watch..."

"I said I made a mistake. It won't happen again."

"Well, you can't make mistakes like that."

"Oh, come on, you're an intern too. We've both been here two weeks. You don't know any better than I do. We're both making mistakes."

"I'm not making mistakes."

"That's not true." The other day she told me a patient was doing fine, and I went into her room and found that she was practically unresponsive, due to a medication issue. It was lucky we checked on her when we did, or she would have been dead. But we caught it, she's getting better, and it's not as if I blamed the other intern-- I know we can't be everywhere at once, I know most of us are just doing our best.

"Yes, it is. We can't make mistakes. You can't make mistakes. I already told the chief what happened."

"Fine. How's the patient?"

"She's doing okay."

"That's the important thing, isn't it?"

"No, not really."

And I walked away. Fine, I should have flagged that we had to run an extra set of labs. But she should have read the chart, and she definitely should have been just a little less insane about blaming me for nothing happening. We're both new, neither of us knows what we're doing, and she doesn't deserve to put herself on some moral high ground. Luckily the patient is okay, that's what's important... and I feel bad enough for what happened that I don't need another intern's judgment.

This is one of the things that makes it so hard here. You'd think, medicine of all things, there'd be a culture of cooperation and teamwork. That we'd all try to be focused on the same page, of treating the patients as best as we can. Instead, it's a culture of "not my fault." Everyone wants to do just enough to not be blamed, and wants to do everything they can to find someone else to point the finger at. You didn't do this, you didn't do that. Not, we should do this now, because it's in the patient's best interest.

It makes it extra frightening to feel like no one has your back, that they're waiting for you to do something wrong. Instead of trying to help you do something right.

And the patients suffer for it.


  1. I'm a brand new 4th year med student in NY. And I love your blog - preps me for what to expect out of intern year, and needless to say, you got me a little nervous
    Good Luck

  2. I think what's also important is if you guys disclosed the "error" to the patient and explained why you (?temporarily) discontinued the medication.