VICDOC Autumn 2023 - Magazine - Page 55
In this context, I have been pleasantly
surprised to find that knowledge gaps
have not been the major hurdle I expected.
Rather, the major challenge I did not
anticipate has been time management
and task prioritisation. In most industries,
junior entry-level staff tend to have fixed
responsibilities assigned to them. In my
previous jobs as a junior in the service
industry, I performed one well-defined
role at a time while my manager rotated
me through different responsibilities.
When I became a manager and
gained responsibility for delegation and
balancing workload, I delegated tasks to
my juniors – the well-known Eisenhower
matrix, which categorises tasks by urgency
and importance, says to delegate tasks
downwards that are 'urgent but
not important'.
Likewise, as a medical student, I worked
on one job at a time that I volunteered
to do, or that my intern offered to me –
typically jobs that were relatively simple or
non-critical. But now, as an intern, I carry
the pager and screen all the tasks that come
through on it. Despite being the most
junior doctor on the team, I find myself
having responsibility for divvying work
up between myself and the residents, and
escalating registrar-level tasks. Rather than
delegating tasks downwards to juniors,
I am distributing tasks among my peers,
and referring matters upwards to my
seniors. Whereas as a medical student I
only needed to focus on what I was doing,
I now find myself needing to appreciate
what everyone on the team is doing, in
order to divide the work effectively.
This has taken some practice, and
some getting used to.
Perhaps the most humbling and sombre
reflections of internship so far have come
from one major increase in scope of
practice between medical school and
internship – prescribing.
Research shows more than half of
hospital discharge prescriptions contain
a medication error. I wish I could say
I've not contributed to that statistic.
Unfortunately, I've committed my share
of textbook prescribing errors, including
prescribing penicillin for a patient with an
allergy, prescribing a modified-release opioid
as immediate-release, and inadvertently
converting a PRN medication to a regular
prescription. I'm thankful that in each case
these mistakes have been detected and
patient harm has been averted.
All this is a reminder that, in between
all the paperwork and service provision,
internship is also a time of transition and
growth. I will inevitably have many basic
questions to ask, and many basic mistakes
to commit, and it is best that this happens
while I have a supportive team to guide me.
I will savour each moment of uncertainty as
an opportunity to learn – now I know how
to prescribe amlodipine – and reflect on
each mistake as a time for growth –
I have not made the same medication
error twice.
As I continue to move through my
internship, I will strive to end each
day with better knowledge and skills
than when I started.
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