Friday, March 22, 2013

Intern pages

One important piece of advice I got on my first week of intern year from an attending: "Write your order correctly the first time. You will waste massive amounts of time correcting each order if you don't."

That said....

Most popular reasons for an intern to get paged about her order:

“Doctor, you forgot to sign your order.”

“Doctor, you forgot to write down the dose of the medication.” Followed by: “Doctor, this is a really high dose. Why is it so high?”

“Doctor, you forgot to put the date on your order.” Followed by: “And now you forgot the time.”

“Doctor, did you really mean to give the patient 10 grams of Tylenol each day?”

“Doctor, the medication you ordered interacts with another medication the patient is on and will probably kill him. Do you still want it?”

“Doctor, the medication you ordered doesn’t actually exist.”

(In each case, “doctor” is said in sarcastic tone of voice.)


  1. Ah, poor interns. Every July in the ED or ICU, I wondered why I didn't take vacation. In the ED especially, the RNs job was to gently prevent the first-years from killing the patient. (Doctor, do you think you would like to try ...?)

    I believe the nurse's sarcasm was uncalled for (you have certainly worked with some angry, unhappy nurses), but you have to admit that the nurse is stuck with an order that s/he cannot follow. The pharmacy might not fill the order without a signature and the nurse could not give these dosages without follow up (or even then). That said, these are intern mistakes, as you pointed out. I bet you - oops - the intern - never made these same mistakes again, except maybe, leaving off the date and time.

    I reviewed some medical records of patients of one long-time physician whose specialty required a lot of inpatient care, and not one note, nor one order of hers was ever dated or timed. As I looked at this doctor's care, I came to believe that she did this purposely so no one could tie her down to anything, like when she saw the patient. EMR has since taken care of this problem. Tricia

    1. It's a JCAHO requirement though, and a hospital can now get in big trouble for no date/time on notes/orders.

  2. My case: "You forgot route. I know it's IV, but the pharmacy apparently doesn't."
    The 10g Tylenol is certainly somethin I've done. Specifically, antibiotics (which I sometimes forget to "div q6h"). Pharmacy and I were on speed dial to each other the first year of residency. I bribe all units and wards frequently, so the calls are always friendly.

  3. Nurses are busy, too. Calling doctors who don't follow protocol for writing orders is a major time suck. And a large percentage of docs will then be angry at the nurse for the stupidity of the rules (not our fault) or for them having to return to the floor to fix their own mistake. (Also not our fault.). Not an excuse for rudeness from the RNs, but I've heard a lot more abuse from MDs than from RNs. Nobody is perfect, but doing it right the first time (and not being a jerk about it when someone calls) would fix the problem.

    1. I wasn't ragging on the nurses so much as making fun of how lame I (and I'd imagine others) were as interns. All the calls I mentioned above are obviously entirely legitimate, and if I received them, were entirely my fault. And I probably deserved the scare quotes around the word "doctor."

  4. My favorite.... "I've never seen an order like THAT before..."
    - Grace

  5. No,Aeris, the pharmacy actually DOES know it is supposed to be IV (calling is meeting a legal and butt-covering requirement (both in my state)).

    My fav was calling an attending doctor about a drug that doesn't really exist- and stating that it is no longer available on the market. His response "that is okay, the patient can pick it up tomorrow"

    I will say the younger docs seem to be better with the escribe (overall) and are less likely to write scripts with 2-3 different sets of directions.

    1. I know :)
      My frequent call to pharmacy: "Uuhh what's the PO version of this thing?"
      Our pharmacy gave up on us, I think. They can put in their own correction, as long as the MD signs them, even as a VO or TO. As long as our scribble shows up eventually underneath.

      I don't mind being phoned about something stupid I wrote. It's the best way to learn, while I have multiple people checking whatever nonsense I may have written.

  6. Q: You know the most favorite way for OR nurses to swear?
    A: Yes, doctor.