The most common problem for a resident is “they do not think, don’t ask why, just follow routine and order”. Here is a typical example: In my hospital, when oncology patient develops fever with neutropenia, the standard of care is to add meropenam. If patient looks sick, add vancomycin and amikacin. One of my leukemia patient developed fever on a Saturday night. The resident started with meropenam, then quickly added vancomycin and amikacin. The patient received multiple fluid bolus due to low BP and went to ICU the next day.
If you looked at the management overnight and early in the morning, you would think the physicians did everything right, started antibiotics on time and gave fluid bolus appropriately. However, the patient had “capapenam resistent klebsiella sepsis” a month ago. The Klebsiella is resistant to
meropenam and amikacin, only sensitive to gentamicin. This is everywhere in the medical record and sign out – but no one bother to think “should this patient be on meropenam and amikacin just like other neutropenic patients?” The patient could have died.
It is extremely important for the trainees to follow the order from attending and standard of care. However, it is even more important for the trainee to use their brain!