Voxel,
I'm not really sure that interns can dump that much stuff during sign out to you (even if you are doing a sub-i).
Speaking from the point of view of an intern, there's nothing more annoying than interns who dump stuff to you during sign out. It is absolutely amazing to me how many labs get ordered at 6 P.M. instead of at 2 P.M. or 4 P.M. Granted, sometimes they are necessary at a specific time, but often they are not. Anyhow, I'm not really sure you can question an intern as a medical student, but as an intern, I often grill the intern so they at least feel guilty if they are dumping on me.
If there is lab work, CT scans, etc. that are ordered after sign out, I'll ask them why the lab work wasn't ordered earlier and what they are worried about. If you are worried about a low HCT, CHF, PNA, MI, etc., ask them what they want you to do with the information (especially since you are a medical student still). Yes, you can figure out how to treat a standard MI, CHF, etc., but sometimes attending have specific things they want done or the patient may have other co-morbidities that prevent you from giving the standard treatment. When you are cross-covering, you really don't have time to sit there and figure all this stuff out. Have them write down exactly what they want done for what they are worried about. Personally, I never sign out CXRs, CT Scans, EKGs, etc. I sign out very little lab work as well and anything that can wait until the morning should wait until the morning. Unfortunately, many interns make diagnoses by CXR and lab work rather than relying on clinical judgement. We have interns that will order daily CXRs on patients with CHF or PNA.
Also, be aware of how much you sign out as well. Do you dump on other interns? Often, the ones who complain the most about getting dumped on are also the ones that dump a lot on their sign out. This often becomes a vicious cycle. Make sure you don't sign out too much stuff before you give another intern a hard time. On several occassions, I've refused to let an intern sign out an unstable patient or some BS lab work in the middle of the night. I've actually told them to cancel that order and either order it in the AM or earlier that night.
I actually have a really good relationship with most of the interns because they know that I do my work and don't dump on them. Also, I follow up on almost everything the sign out as long as the tests were warranted. Many of the annoying calls in the middle of the night can be avoided by giving parameters. Personally (depending on the patient), I have parameters for potassium, HCT, fevers, urine output, etc. including when to call H.O. Unless contraindicated, almost all patient get prn or qhs orders for sleep, pain, nausea, no BM, etc. The night float loves me and many of the interns have copied some of these standing orders. Obviously, you have to use your clinical judgement as to which patients you can't do this for. Often, however, you will find that you get called with silly things in the middle of the night and all too often, you are just baby-sitting nursing home residents or patients looking for placement.
Things that you will often get called about and you should learn how to manage are:
1. Fever
2. Chest Pain
3. SOB
4. Pt. fell out of bed
5. Low urine output
6. Mental Status changes
7. HCT of < 27
8. Bleeding
9. Abdominal Pain
10. Increased or decreased HR, BP, and Glucose.
