Presenting patients

[saintsfan180]

Hey guys, almost done with intern year and I've only had one real ED month so far (off service requirements, ugh). So my question is when did you guys stop presenting every little patient before putting in orders? I'm sure this is very attending dependent but I feel like they get annoyed with me when I have a new patient to present. I'm trying to see between 15 and 20 in a 12 hour shift so I guess I just get tired of going up to them every so often and telling them about my patient with a cold and their white count which is obviously fine so they can be discharged. Point is, when do most attendings expect you to start doing more without constantly updating them, because I'd love that.

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[e30ftw]

hey i'm an intern and this is what I typically do:

If the ED is very busy and I am confident of the workup/dispo I'll just enter the orders and tell the attending when he has a moment. Example would be typical cardiac chest pain with stable vitals and no EKG changes. I usually tell the attending soon after placing CT or other significant imaging studies. For a healthy patient with isolated ortho complaints I usually order the radiographs and discuss the case with the attending when imaging is back. Before a procedure ie line//LP I always present the patient and my plan before doing the procedure.

My advice would be do you're comfortable with and what helps the flow of the department. If you pick up an uncomplicated fast-track patient one day when it's really busy, try to have discharge papers ready when it's convenient to present the patient. Most attendings seem to appreciate this and it helps with patient flow.

 

[Mudpile MD]

I think this is impossible for anyone else to answer. It all depends on how comfortable you feel with your plans, and how comfortable your attendings are with your plans. Nobody else can answer that for you. At this point in the year, most interns in my program are initiating plans/orders first, and then discussing the case afterwards, unless they feel the need to discuss first.

Also, you should not be getting a white count for all your colds...

Unfortunate that you have made it through 9 months of an emergency medicine residency and have only had 1 EM month.

Good luck

 

[deleted109597]

Easy.
1. If they're sick, order the sick person stuff, then go tell someone a short blurb. If they're real sick, they're probably already there anyway.
2. If they're not sick, order the usual stuff, but don't order expensive stuff (MRI/CT/US) until talking to someone.
3. Pt presentations shouldn't be long ever. If multiple attendings are interrupting your spiel to ask what your plan is, you're being too generous with the story. If the converse is true and they're telling you not to withhold information, then you're minimizing too much.
4. Don't ever admit/consult without talking to someone. I don't care how busy it is.