What I wish I'd known before starting internship

You will (eventually) not be terrified every time your pager goes off
I can vividly remember the first time my pager went off on day 1 of internship. I was sitting in our haematology multidisciplinary meeting and the intrusive beeping just about made me jump out of my skin. I called back, timidly introducing myself as “Kate, the new intern… someone paged me?” When the nurse on the other end of the phone asked me to review a patient who had chest pain, my immediate thought was ‘oh I better let one of the doctors know…’ - it took another minute to realise I was one of the doctors. I walked down the corridor towards the ward, internally panicking that I was about to walk into the room to see a patient half-dying in front of me. Thankfully I soon found out that not only was the patient alive and well, but they also had a history of reflux and had currently had similar symptoms, which were beginning to ease after taking their usual medications. Crisis averted. After an uncoordinated and stressful examination on my part (terrified I would miss something crucial despite a perfectly well-looking patient in front of me), I returned to the meeting and my heart rate gradually returned to normal. 

Whilst in reality 90% of times I was paged over the year were for non-urgent problems or paperwork issues, it took at least 6 months to stop my heart from racing when my pager beeped, and to stop having dreams about work that mainly revolved around being paged repeatedly or my pager going off but not being able to find it. Had I realised at the start of the year that in a real emergency situation I’d never be alone for long, and that most pages would be a nurse asking me to rechart a medication or pharmacy needing me to sign something, I’d have saved myself so much stress and pager-related anxiety. 


You know more than you realise
The initial weeks and months of internship provide many opportunities for the new intern to feel useless, be talked down to by rude colleagues, fumble through poorly-planned consults and not have answers to any questions patients or nurses ask you. For every thing you realise you don’t know, there are another three things that you do know and you don’t even realise. 

The first few rapid response calls (MET / PACE / whichever system your hospital uses) that you are called to, you’ll feel stupid, helpless and need to ask multiple questions of your seniors to convince yourself that your fluid bolus or your stat analgesia order won’t kill the patient. Fast forward a few months, and you’ll start initiating management of deteriorating patients before senior help arrives, and running your initial plan past them rather than waiting for them to turn up and decide on the plan themselves.

Every single patient you see is adding to your subconscious ongoing learning and it isn’t until you sit back and remember how much of a bumbling idiot you felt like in the first weeks of doctor-hood that you can really see how much you are learning without even trying. Four to six years of medical school is only the tip of the iceberg in terms of a career’s worth of ongoing learning, but don’t discount how much you have learnt already. As long as you know your scope and when to ask for help, you will be a safe and competent intern.


…but it’s a steep learning curve
Having said all of the above, be warned that despite having senior help often close at hand, you will have to put in effort and reflect on your own practice to truly progress in your knowledge and clinical skills. It would be easy to coast through the year without so much as peeking at Up To Date, but to capitalise on the rich clinical exposure and breadth of patients you will look after, a little reading around some of what you are seeing on ward rounds or in clinic will do wonders to consolidate your knowledge.

After being thrown in the deep end with a highly sub-specialised first rotation, it took me a while to feel like I had the time and energy to do anything work-related outside of the hospital. But when I did take the time to jot down patient cases that were interesting or unusual, or just common things I didn’t feel confident in managing, and then spent 5 minutes having a quick read on eTG/Up to Date etc, it made it so much easier to learn having that patient in my head. If you treat every patient as a learning opportunity and do a little bit of study here and there, it will really help to solidify your skills for the next time a similar case comes along.

The year will be overwhelming at times, as well as frustrating and exhausting, and you’ll feel physically and mentally drained if you don’t step back and take care of yourself. Recognise when you are getting exhausted and speak to someone (GP, friends, supervisor etc) if you need help. It’s a massive change from being a medical student - remember that no one is expecting you to be an expert.


There’s no way to sugar-coat it - after-hours shifts can be awful
My first after-hours ward call shift was terrifying - a 14.5 hour shift on a public holiday and absolutely non-stop the entire day. I finally paused to eat something at 5pm (after getting to work at 7:30 in the morning) and was running between wards until I finally handed over to night shift. The day was a constant stream of rapid response calls, patients needing new cannulas, clinical reviews for fever/rash/headache/hypertension and endless medication charts to be redone. I needed the rest of the weekend just to recover from the onslaught.

There are no two ways about it, these shifts are long and tiring. Ward call / after-hours shifts involve skeleton staffing and lots of patients per doctor. You just have to get stuck in, prioritise what needs to be seen early and keep a list of things that can be done later. Get into the habit of finding out as much info about each patient you are asked to review when you are called, and get the management started over the phone before you get to the bedside:
    - what are the patient’s obs, and what is the trend?
    - what is their relevant history?
    - when were their medications given? 
    - do they need an ECG?
    - do they have a cannula?
    - can I give a phone order for a medication or arrange anything else in the interim?
Think about what you need to know that will help you manage the patient when you get to see them, especially if there are other more urgent reviews and this patient might be waiting a while to be seen by you.

On the plus side, you will learn lots, get more confident at managing common problems (chest pain, shortness of breath, fever etc), and overtime penalty rates are always well-deserved and welcomed come pay day.


Being an intern is actually an enjoyable and privileged job
There’s been a lot in the media this year about doctor wellbeing, bullying amongst the medical profession and work-related distress. These are real and troubling problems. Luckily on the whole, I have found internship to be highly enjoyable and rewarding, and has cemented that I have made the right career decision in pursing medicine. We are in the privileged position of looking after patients who are vulnerable and suffering through the worst times in their lives. Though being amongst it everyday normalises the whole situation, we have the potential to make such a huge difference in the lives of others. Finally being able to do procedures independently, make clinical decisions and formulate management plans for common problems, be part of discussions about patient care and contribute to the medical team are all incredibly satisfying.

Over the course of my intern year, I have seen patients die despite intensive medical care, those who were on the brink of death recover and walk out of hospital and others walk in with a simple problem end up with a life-changing diagnosis. I have seen the routine illnesses and injuries benefit from our world-class public health system and bounce back to their normal lives. It is easy to get caught up in the mountains of paperwork, discharge summaries and medication charts that interns are lumped with, but when you finally get to work in the field you’ve spent years studying towards, it doesn’t matter. I have worked alongside some fantastic doctors who I now count as fantastic friends.

The year has flown by and I’m only a few weeks away from launching into residency and training as a GP registrar. There have been some extremely challenging days and weeks this year, but finally being able to step up to the plate and begin my medical career has made it all worthwhile.
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