The Definition of Insanity

There is a famous quote that the definition of insanity is doing the same thing over and over again and expecting different results. I have been reflecting on this quite a bit over the past six weeks as I adjust to life as an intern. As a medical student, I made mistakes, just like everyone else. If (when) I did something wrong, the tasks that I was expected to complete were usually simple enough that, with a little bit of focus and determination, I could do it right the next time.

“Hey, you should have asked this patient with chest pain about whether he smokes.” Ok, no problem. Mental note made: remember to ask patients with chest pain about more cardiac risk factors. It usually wasn’t too hard to remember that the next time, and I felt like I was learning and improving my skills. I felt like I was a better clinician from one day to the next. 

Being an intern is…. different. I am in a wonderful program with extremely supportive faculty and residents. I love the people that I work with, and I am very happy that I matched where I did. But every day, I feel like I make the same mistakes. It’s not because I’m an idiot (I think), or a terrible doctor (I hope), and it’s not because I’m not trying.

It’s because every day I am trying to do a dozen new things that I don’t know how to do, teach a medical student, care for patients, and remember to take care of a whole slew of “background” tasks. It’s like playing a giant game of whack-a-mole: you remember to do one thing that you forgot to do yesterday, but then you make a different mistake.

At the same time, you are learning a new culture, a new version of “the way we do things around here,” and building trust and rapport with your support staff. So while you think you know how to do a particular task, you don’t know how it’s done here. Everything takes longer this way.

For example, on labor and delivery where I went to medical school, we signed out using the system lists from Epic. At the hospital where I am doing my residency, we use a list that “lives” in an excel spreadsheet on a particular computer in the workroom. Someone has to manually enter everything from Epic into this list. It is my job as the intern to update that list. It sounds simple, but I swear every day I make a different mistake.

One day I move a labor patient from the “labor” tab to the “postpartum” tab and I forget to update their Gs and Ps so it looks like they are still pregnant. The next day I make sure that I update everyone’s Gs and Ps, but I forget to delete a patient who is discharged. The day after that I remember to update the Gs and Ps and to delete everyone who is discharged but I forget to add the most recent cervical exam on a laboring patient. I’m always screwing up “the list,” but I’m screwing it up in a different way every time. 

I guess the upside is that I rarely make the exact same mistake two days in a row, but it’s really demoralizing to hear every single day that you have screwed up the list, no matter how hard you try. Some days I know I screwed it up – I know that I got distracted by something else and didn’t update anyone’s cervical checks. Other days, I feel like I put a lot of work into it, I looked it over 5 times, and I’m pretty sure it’s water-tight, right up until the night team chief walks up to me and points out 5 things that I did wrong. Just once, I would like to hear that I did an ok job and the list is tolerable.

But I keep showing up every day, doing the same thing over and over again, trying over and over again to get it right. It makes me feel like a rat in a wheel, but at least I am trying and for an intern, I think that’s all I can hope for.

So, fellow interns, do you feel like you are losing your minds, too?

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