Outside Hospital
All through medical school and internship the vast majority of my rotations have been in the military health system. As a result I have gotten quite comfortable with this system. But this past month I was rotating at an outside hospital for emergency medicine. As an intern on inpatient services up to this point, my job has been largely administrative - making calls to consultants, radiology, lab, and social work, making follow up appointments for patients, planning dispositions... Imagine my surprise when on this rotation there is a UNIT SECRETARY. With one simple click on the computer I can have her page someone for me and let me know when they’re on the line. She’ll help me contact other hospitals and make faxes. This is all my job as an intern usually. And, to make things simpler, the electronic medical record is ALL ONE PROGRAM. In the military system I have to use no less than 4 different programs on a daily basis - one program for inpatient records, another for outpatient, yet another for checking labs, and one for viewing radiology (in their defense, they're working on this, and a new EMR will be implemented by 2022…). Admitting a patient here requires a single checkbox on the computer. Normally there’s an entire checklist of phone calls and administrative steps I have to do.
The patients here are different as well. I have to request a translator on a daily basis. I also get different comments than I am accustomed to in the military world, “you’re too pretty to be a doctor, you look too young to be a doctor, when’s the doctor coming? Are you the nurse? How long have you been a doctor? Where’s your white coat?” And even a vulgar cat call walking past a patient’s bed. Being mistaken for a nurse is not new for me - I probably got those comments weekly before, but now they’re daily, and mixed in with other sexist and disrespectful remarks.
Another thing I wasn’t used to was having law enforcement involved with my patients. You may recall a viral video not too long ago of a nurse refusing to give a police officer a patient’s lab results. She was completely in the right, however I can now see why this situation arose, as this is not the expectation. When patients are brought in by law enforcement, officers frequently ask, or are told without asking, details of what’s going on with the patient. I had one patient brought in for an assault, and I had to ask the police to leave more than once to give her some privacy so I could do a pelvic exam. She also asked me if she could make a phone call, which I agreed was reasonable, but the officer disagreed with me in front of her and forced her back into the bed. Outside the room HE told ME what the patient’s drug screen results were. I was shocked, as I knew these results, but wondered who had told him. Aside from being a HIPAA violation, medical drug screens are not legal tests and cannot be used legally as they are not subject to the same chain of custody and regulations that legal drug tests are.
Despite the practical differences from my comfort zone, this was a great rotation. I finally had the chance to do some hands-on procedures. I had a laceration to suture almost daily. I cut out ingrown toenails and packed up bloody noses. This was a much welcome change from the past few rotations, where anytime a patient needed something done, another service was consulted.
Today marks the halfway point of internship! I can't believe it has been 6 months already. Tomorrow I will start on MICU, my final inpatient rotation of the year.