How to be a good intern on nightshift.

I am a cranky cranky person on nightshift.  I don’t sleep well during the day (even less now with a baby), I take ages to wake up during the night and my notes can be very thought disordered.  My saving grace is that I care.  Nothing makes me more annoyed than people who show up to work to write notes and tick boxes and order tests and completely forget about the person in the bed.  And since I’m on nightshift and so far it’s been a week of rage and things left unsorted, I thought I’d write this list for the next generation of interns.

How to be a good intern on night/evening/any after hours shift.

  1. If you order a test you chase a test.  If you order a test but your shift finishes prior to its return, you tell the incoming person to chase the test and tell the medical registrar the result.  Always tell the medical registrar the result.  Even when it’s normal.
  2. You do not diagnose anxiety or heartburn on an evening/weekend/night shift.  Ever.  The med reg is allowed, the boss is allowed, you are not allowed.  Ever.  If you suspect heartburn, you have to prove to me it’s not a heart attack.  If you suspect anxiety, and do no blood tests, no chest xray, basically nothing to show me there’s not pneumonia, a pulmonary embolis, a heart attack, or something else bad, you’re in big trouble and not just from me.
  3. You do not prescribe valium, or any other benzodiazepines without checking with the medical registrar first.  Ever.
  4. If you say to me “I don’t know what’s wrong with them but I think they’re sick”, you get a gold star.  Thankyou for having the courage to recognise the limitations of you knowledge, and the clinical judgment to recognise something is wrong.  This is all I need from you.
  5. None of us like doing lumbar punctures.  If you don’t know how to do one or don’t feel comfortable, tell someone.  Don’t try and get out of doing it. The patient needs it.  End of story.
  6. If you say to me “I don’t know what’s wrong with them but I think it’s nothing” or “the patient was admitted with x, but I don’t think they have x” and have no basis for either of these statements other than your own reluctance to collect blood/put in a cannula, then you’re in trouble.  Big trouble.
  7. You don’t need to diagnose anything.  You need to come up with a differential diagnosis in order of most scary disease to least, do the appropriate investigations, and tell me about it.
  8. Tell me if you’re drowning.  Gold star if you recognise you’re drowning.  Double gold star if you ring me up and say “the nurses keep calling me and all this work is piling up but I have so many clinical reviews to do and I’m not going to get to it all”.  I will manage your workload for you if you let me.  If you tell me nothing and I have every ward in the hospital telling me that you’re not answering your page and I ring you up and you tell me you’re fine, again, you’re in big trouble.
  9. “I feel uncomfortable doing this thing you/a boss/some other doctor told me to do and here’s why” = gold star.  Trust your gut.  Don’t let anyone give you shit about it.  Don’t worry about angry doctors – remember why you’re here and ask yourself “what does this patient need and how do I achieve it for them?”
  10. Split up your workload.  When I was an intern I’d do a round when I got to work, then at 1am, then at 5am.  The first round I’d do any outstanding cannulas.  The second I’d do all the morning insulins and drug charts.  The third I’d do any cannulas that popped up during the night that were needed for the morning drugs.  On every ward I would write “Board/book cleared at 0100am, will return at 0500am, please call if anything urgently required”.  That way you wouldn’t get a million phone calls.  Of course things get busy and people get sick and it’s not always that straightforward but if the nurses know you’ve been and are coming back, they feel a lot more confident in your abilities.
  11. As always, your registrar always appreciates chocolate.  Always.
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