The most dreaded phrase to an intern…”Let’s run the list” Junior and Senior residents are charged with keeping a service running with the aid of one to three interns and sometimes medical students. The residents pre-round, write morning orders, replace electrolytes, deal with issues that arise during nursing shift changes…many oversights are caught when a fresh nurse takes sign out from a nurse who’s been on for 12 or more hours. WHile each intern may have anywhere from 2 to 8 or more patients, the upper level needs to know them all. Every resident has a different style of running the service…some micromanage their interns, constantly pestering them to see if potassium was repleted, were the morning labs ordered, did you fill out the consult for social work? Time spent micromanaging in this way does little for education. If the interns are up to speed with the minutea, daytime can be spent reviewing tests, exams, films and critically evaluating the care that you and your team are providing for the patients. On the other hand, if these small details are overlooked before rounding on the service with the attending, confidence in the team’s care responsibilities is diminished and time for teaching evaporates as you spend the morning chasing your tail.
To protect him/herself, the upper level “runs the list” with the interns. You systematically go through each patient, top to bottom, front to back and checkoff all the little boxes that accumulated during rounds. Again, this can be in the form of micromanagment (what’s his potassium level? Did you write for his coumadin tonight?) OR, it can be a very productive learning environment (what do you want to do for Mrs. O’Painaway if her stress test is abnormal? Mr. Stoneswontgo isn’t urinating and now he’s short of breath…what are your thoughts for what we should do next?) I’d like to hope that my style is more productive and education, but I’m learning that sometimes, strong management skills are needed. I’m understating myself here.
My strong intern comes to me to run the list…he wan’ts to be sure he hasn’t overlooked anything. All of his labs, consults, orders and tests are already written and we have time to consider the patients cardiac disease, the meaning of their stress test or catheterization. The other intern (I won’t say that he is the opposite of the strong intern) always seems overwhelmed and scattered. Running the list with him is tedious and time consuming. I don’t know what to do help him get his work done before rounds. I’m always following his charts, making sure that tomorrow’s tests are ordered and that we’re not getting behind on electrolytes. There are more interesting things to spend my day doing but sadly, this is the tedium of floor work.