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Just finishing my first string of night float shifts as a PGY-1.
Being the “on call” intern overnight is a moment of real stretch and growth. I feel I’ve learned so much!
One thing I’m committing to thinking and learning more about: how we manage pain in the hospital.
1/11
Being the “on call” intern overnight is a moment of real stretch and growth. I feel I’ve learned so much!
One thing I’m committing to thinking and learning more about: how we manage pain in the hospital.
1/11
It’s a frequent call for any night float: “patient complaining of pain.”
At first, I wondered why I got such a disproportionate number of those calls when I recalled receiving far fewer during my DAYS on wards.
2/11
At first, I wondered why I got such a disproportionate number of those calls when I recalled receiving far fewer during my DAYS on wards.
2/11
There’s a zillion factors at play for each patient.
My (purely anecdotal and inexperienced) hunch is that for many, it’s related to sleep - pain becomes less tolerable when it’s part of a multitude of factors preventing you from resting well in the hospital.
3/11
My (purely anecdotal and inexperienced) hunch is that for many, it’s related to sleep - pain becomes less tolerable when it’s part of a multitude of factors preventing you from resting well in the hospital.
3/11
At any rate - getting so many calls for pain gave me ample opportunity to reflect on my own habits, preferences and biases when it comes to pain management.
Some takeaways below (in true intern fashion, accompanied by knowledge gaps and many a clinical Q to research).
4/11
Some takeaways below (in true intern fashion, accompanied by knowledge gaps and many a clinical Q to research).
4/11
First takeaway: even for minor pain, bedside evaluation makes a difference.
Not just to assess the where/when/how/why of pain. In the best cases, I also got to set realistic expectations around the relief available.
5/11
Not just to assess the where/when/how/why of pain. In the best cases, I also got to set realistic expectations around the relief available.
5/11
Admittedly: easier to accomplish on slow nights. But when I managed it, I found (anecdotally) that patients were more comfortable.
TL;DR: I’m thinking about best practices for broaching these convos as the daytime team - even when I don’t anticipate any pain overnite.
6/11
TL;DR: I’m thinking about best practices for broaching these convos as the daytime team - even when I don’t anticipate any pain overnite.
6/11
A takeaway I’m still working through: when and how to escalate to opioids for acute pain.
The coverage on the opioid epidemic really blossomed during my medical training. As a result, I’m very cautious and cognizant of creating dependence in my patients.
7/11
The coverage on the opioid epidemic really blossomed during my medical training. As a result, I’m very cautious and cognizant of creating dependence in my patients.
7/11
But I’m starting to realize that it may also cut the other way - that sometimes, the stigmatization of in-hospital opioids may cause us to withhold meds and undertreat pain when there’s a real reason for it.
8/11
8/11
A final takeaway: giving NSAIDs.
Unlike our other go-to meds, NSAIDs target inflammation - which in certain cases can really nip discomfort early on and prevent pain from getting out of hand.
9/11
Unlike our other go-to meds, NSAIDs target inflammation - which in certain cases can really nip discomfort early on and prevent pain from getting out of hand.
9/11
But I found the primary teams tended to avoid NSAIDs. And I found myself similarly trepidatious when it came to giving them.
Said plainly, they’ve got a bad reputation (think renal & GI adverse effects).
But where’s the line here? How cautious should we be?
10/11
Said plainly, they’ve got a bad reputation (think renal & GI adverse effects).
But where’s the line here? How cautious should we be?
10/11
I know a lot of this is “bread and butter” intern fare.
But:
1. Bread is universally delicious
2. Pain is a huge part of our patients’ hospital experiences and can really shape how they interact with the healthcare system. It’s worth learning - and learning it well.
11/11
But:
1. Bread is universally delicious
2. Pain is a huge part of our patients’ hospital experiences and can really shape how they interact with the healthcare system. It’s worth learning - and learning it well.
11/11
