A course of survival for interns and last year medical students. Chapter three: What not to do.

CHAPTER THREE

Every hospital or Health Center has its own routine to teach to the new interns, but believe me or not, Medical Education is such an open activity that sometimes bad habits are maintained inside the system.The new interns try to “imitate” in a way, what they see around , without a critical view of the details. They have to survive, especially in the first two years in an aggressive environment under pressure of the managers, nurses, other colleagues and their own insecurity. They feel that they have to imitate more than learn, to “clean” the Emergency Department when they have to do their duty there. After this first year they start to select the role models of their teachers or colleagues to follow a path of learning and discovery.

I would like to express here some advices for the new interns to start improving since the beginning, in a list of “NOT TO DO” actions and attitudes  for a better professional start:

THE “NOT TO DO” ACTIONS  FOR  FIRST YEAR INTERNS

1. Don´t assume a sign or symptom  without checking it. A name is just a piece  of information for communication . Imagine that your colleague says “paresis”, you must check the actual clinical situation.

2. Don´t write all the Anamnesis together. Try to select a Key sign or symptom and describe the information associated that could be useful for a diagnosis. It is always better to divide the rest of the findings of the classical apparatus list.

3. Don´t use words such as “banal” instead of saying “normal”.

4. Don´t forget to search for the real social support of the patient.

5. Don´t forget to keep the hope and the dignity of the patient, reassuring him or her , that he or she is the same person, but now with a health problem.

6. Don´t leave the “Clinical Judgment” space blank. Try to do a summary of the clinical problem, even if you are not a hundred percent sure. No one is never a hundred percent sure in Medicine.  Write at least three possible diagnoses ranked by probabilities.

7. Don´t forget to do a physical examination that includes Head and Neck, Thórax, Abdomen and Extremities (move the blankets and sheets). Look at the back of the patient.

8. Don´t leave the hospital after working in the Emergency Department without Know the final destination of the patient.

9. Don´t forget to communicate with your colleague during a handoff, the special circumstances or clinical incidents during your attention.

10. Do not make clinical decisions under pressure from the environment. Seek self and patient safety.

Author: Dr.  Lorenzo Alonso.  Medical Oncology

FORO  OSLER

Professor of Medicine. Málaga. SPAIN