Welcome to the Jungle...
So I sucked it up for the past month on the Medicine floors paying the hospital about $200/day to play intern... and I have never been sooooo frustrated with how things run in the medical world. Diagnostics/studies/consults are ignored or delayed because of where the patient's request was put in line behind the other 600 beds in the hospital. Nurses are paging with annoying dietary/social work complaints that my 8 years of higher education have not prepared me to deal with. Patients are left to rot over the weekend because their nursing homes "don't accept transfers on the weekends"...even though they had no reason to be there in the first place and there is no good reason they couldn't be tossed from stretcher to bed by the medics.
Just to rub in the awesomeness...Snowpocalypse hits, not once but twice in 1 month causing every service in the hospital to be sent home by noon...except for the medical call team...which happened to be my team both times. Not only did most of the medical housestaff shirk their responsibilities (leaving us to pick up the slack), but they drove home in the middle of a blizzard for the express purpose of shirking their responsibilities. For Christ's sake, the nurses and techs were sleeping in empty beds, lounges, offices, etc to make sure that their responsibilities were taken care of despite the snow (which made them understandably happy to be at work for 36+ hours straight), but the housestaff skedaddled as soon as they were told it was a half day. Such a ridiculous disparity...
Then there's the spectrum of attitudes from the nursing staff which varied from loving (hugs, smiles and cookies) to legitimate questions of patient care ("How do I mix this tube feed at half strength? Tap or sterile water?") to downright adversarial (from a covering nurse, "I've never seen this done in 30 years of nursing, you are incompetent" because I'd rather give an IV antiemetic regimen that worked wonderfully this morning before the patient pulled her IV access instead of IM because A) she is unable to tolerate PO, B)is going to bitch and complain about any IM medications because she has the pain tolerance of a 2 year old and C) has annoying, micromanaging parents who will have you page me every 10 minutes until she stops being a giant baby about her arm hurting...more on this to come in a later post).
Looking back, I've been spoiled with my time in the ED.
The team just works better in that environment. Attitudes are generally directed at patient care over making it through the tedium of the day. The problems with the patients are more often acutely medical rather than dietary/social work. My hours aren't spent documenting the full diagnostic workup and recovery of every patient for weeks on end. People go home when I say they go home. The consultants come (usually) when I need their help. People get a CT within 2 hours of me deciding they need a CT. Labs come back within 45 minutes. There are no rounds to dissect every morsel of the patient's life and how they may contributed to their metabolic syndrome. There are no pagers. There are no pages over ham sandwiches at 9:30 at night. The nurses don't blow me off when I'm managing their patients and address their doubts about my competence with helpful guidance instead of thinly veiled disgust.
I'm just not cut out for the floors...I'll take a double shift in the pit any day.