The vascular service rotation went by quickly, being only 3 weeks. We were on call every third night. Post-call, the following day we stayed until early evening when Marie let us go. This was the expected routine on every surgical service in the hospital and no-one questioned it. Spending so many hours in the hospital taking care of sick patients functioned as a way to shorten the learning curve. The continuity of seeing everything that happened to a given patient was also invaluable, both for the intern experience and the patient care: there was no dropping the ball: since everyone was there almost all the time, everyone knew all of the essential details of what was happening with even the most complicated patients.
One way in which we, as interns, were clearly abused was in that we were expected to perform tasks that were nursing, clerical, or that should have been done on an outpatient basis. One example of a nursing task was the discharge paperwork. The rule was, the intern had to fill out a discharge instruction sheet with follow-up instructions, a list of medications, contact numbers, etc., and we had to give it to the patient, explain it to them, and answer any questions. This is a task performed by nurses at private hospitals. If a patient needed a study such as a chest x-ray, we had to write the order in the chart and fill out a special radiology order form. The filling out of such forms is done by a ward clerk (or is bypassed altogether and just the doctor's order suffices) in private hospitals. There were many such examples of requiring physicians-in-training to perform non-physician tasks both at the University Hospital and other academic centers at which I have worked. Finally, specific to the Vascular service, there was the inpatient work-up. This required us to arrange for and follow-up on a complete pre-op work-up on the incoming patients who were being admitted for elective vascular procedures. This work-up consisted of ordering, filling out the forms for, then bird-dogging the results of the EKG, chest x-ray, cardiology clearance, bloodwork, and even in many cases the angiogram. (Insurance companies will not pay for inpatient admission to do what is an outpatient workup these days, so I doubt this last intern task exists any more.)
We had to prioritize all of these nursing, clerical and pre-op tasks while still addressing urgent and emergent issues with our patients, or assisting in the OR. When there are only 24 hours in a day, and you have a long list of tasks with frequent interruptions for patient questions and issues that come up all day and night, personal necessities such as sleep and meals fall by the wayside.
