Lack of Supervision

The day to day routine at the hospital is alway different depending on who shows up. Some days we have a huge crowd with 10 medical students, two interns, 1 registrar, 1 attending, and myself. Other days it has been only me and the intern rounding on 50 patients. It is actually more fun and interesting the fewer number of people because it allows me to be more involved in patient care.

Today I was a little more involved in patient care than I prefered. Last month the intern I worked with was awesome. She knew what she was doing and just asked me for my opinion on certain issues. We have two new interns this week, one who is very strong and one who is extremely weak. Somehow today about half way through the rounds the registrar and good intern had to go to a meeting and I was instructed to "take over rounds." It was me, the weak intern, and 2 third year medical students. Talk about overhwelming. We had at least 40 patients on our service, about 10 of them were new admissions from the night before.

In the first 15 minutes of being the "attending" on my rounds today we had 4 patient that were completely unresponsive and one man with an acute abdomen. One unresponsive patient has cryptococcal meningitis and was actively seizing during rounds. Another man was in clear respiratory distress with an oxygen saturation of 68% (normal is 98%). Another patient I am concerned has TB meningitis (which I have seen twice in my life). The guy with the acute abdomen had severe rebound tenderness, guarding, and peritoneal signs.

I felt very helpless and overwhelmed today, but I was definately participating in patient care. None of the patients died during rounds or before I left for the day, which I thought was an accomplishment. I know I am getting use to the wards but I would prefer a little more supervision.