A Day in the Life
Day in the life of an average Senior
Senior style varies widely rotation to rotation – and senior to senior – however, commonalities exist between all of the wards and the residents running them. Henry Ford is unique compared to many programs in that we have geographical wards so that any given month you may be either covering general internal medicine or a sub-specialty floor such as nephrology, cardiology, pulmonary or infectious diseases. Which service you cover can affect your daily routine as you shoulder extra loads for dialysis patients or reviewing which pick-ups may need cardiac stress testing versus heading straight to the cath lab.
I am undoubtedly a morning person, so my day starts earlier than most. Typically, I wake up around 5:15 to start my first coffee and breakfast and get ready for work. I have a 20-minute commute and like to beat traffic so I’m out of my house by 6 on inpatient months. Once I’m at the hospital I like to give my interns room to do their thing so I’ll go to our atrium or resident lounge and do all of my chart review there before heading up to the wards around 6:45. When I get to the floor, my priority is relieving the night float of the phone, and when on call, the code pager. I typically then see patients who were on tenuous footing the day prior, seemed to be heading the wrong way on my morning chart review or that the interns want an extra set of eyes on. From there it’s a collaboration with the interns to make sure late consult recommendations from the day prior have been followed up on, any new consults for the day are paged, and a well-rounded plan is place.
Every Tuesday is our Resident Morning Report from 8-8:30 led by one of the floor seniors and facilitated by the chief residents. Attendance is expected of all residents on inpatient rotations and is often also joined by the current rounding faculty. After morning report rounds begin and can last until around 11, then 11-12 is our “Progressive rounds” with the floor nurses, case management and social work. During Progressive’s - discharge needs are anticipated, concerns communicated across the team, and a plan is put in place to expedite patient care.
At noon residents break for an hour of protected didactics given by faculty from our various sub-specialties, general medicine, or chief residents. Additionally, we have monthly journal club, MM&I conference, as well as end of the month evaluations which are general summaries of the readmissions by floor/team, code blue outcomes, and naming of intern/ICU/Senior of the month
After 1PM it’s time to tie up loose ends, get recommendations from consults and review any testing done earlier in the day. When not on call I’m typically out of the hospital around 4 and home with time and energy to take my dog for a run, catch up with my wife and either read for pleasure or find a review article pertinent to a tough patient case. On call days go until 8PM when night float arrives. The day team takes admissions that arrive to the floor before 7:30, though on busy days the team may get some extra relief by the night residents who often take a patient who “hits the floor” before 7:30.
Alex Michaels PGY-3
Day in the Life of an Intern
Starting medical school, we all dreamed of that day we would go out in the real world and start making a difference. We saw that faint light at the end of the tunnel while studying long hours and having sleepless nights. As an M3 and M4, we were one step closer to our goal by being in the hospital and taking care of patients. Then one day, with the blink of an eye, it was time to graduate. We were handed that glorious medical degree and assumed the role of a resident, awaiting the success and challenges that would mold us into an excellent physician. Not only is this moment exciting but it can also be overwhelming. Keep in mind that you are not alone! You will find an excellent support system as you transition from a medical student to a resident. You will be welcomed by attendings, co-interns, senior residents, administration that want to see you succeed and will help guide you as a new leader in this program. This may not always be easy, this may not always be what you imagined—but stay motivated. Keep on challenging yourself so you can be the best. We have the privilege to learn and take care of patients who are at their most vulnerable. Remain compassionate and embrace this opportunity. As Ralph Morston once said, excellence is not a skill, it is an attitude.
First day every month is a new and exciting experience. A typical day as a new intern on the general internal medicine floors starts at approximately 6:30am. I would aim to arrive at the hospital around 6:15am so that gave me enough time to park, grab coffee, and settle down in my workspace. First order of business is usually touching base with the night float (commonly comprised of a senior resident and an intern) about events overnight with patients. If significant issues were present, discussions should take place so as to offer learning experiences, educating the team in guiding future decisions and interventions. Admissions overnight will be divided amongst the two teams on the floor. Each intern will usually pick-up a few patients who then become a part of your team for which you will be providing direct care.
You will then start to go over your assigned patients. Tasks will include reviewing vital signs, labs, imaging studies, consult recommendations. After updating assessment and plans, it is time to go see your 5-7 patients. Pre-rounding can result in changes in management. You might need to call additional consults or place more orders. Make sure to review your patient list and plans with your senior prior to rounding (with full team and attending) so everyone is on the same page!
Rounds with your team and attending start at 8:30am. You may be assigned a medical student who will be your partner in crime, helping present patients and learning from your vast knowledge. Teams usually consist of an attending, senior, co-interns, medical students, and often a pharmacist. This multidisciplinary team ensures efficiency, appropriate and safe health care, and an interactive learning experience.
If you are on call, the senior carries the admission phone and will notify you of any new admission(s) coming from the ER, outside hospitals, or transfers from within the hospital such as ICU or specialty floors such as Cardiology. Admissions will allow you to take the lead on placing admission orders, identifying key problems, diagnoses, and formulating assessment and plans. These new cases will be presented on rounds the following day.
As you finish up your call, you will sign out patients to the night float, providing them accurate and quality updates to keep patients alive. It is then time to go home, eat a delicious meal, rest, and pat yourself on the back because a job well done today is the best preparation for tomorrow (Shiv Khera).