Super Quick Question About Patient Census

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walkeen

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This is for anyone who has been on internal medicine inpatient wards. Om a 3rd year med student, I am on wards 4 weeks total including a weekend off, a weekend on, a saturday on, and a sunday on (not bad). However, I'm seeing veryyyy few patients The first week i"m not on call, so they won't let me admit patients (fair)

I'm a ****ty little 3rd year so i asked if i could just go see/talk with them (we are split into two teams; i even offered to write the note)for practice since this is like my 1st 2 weeks in the hospital ever. She looks at me like I may be ******ed and say "yuh nno, no one wants to chat allday when theyre sick."

This goes on M, T, W, Th, then im on call, we get 2 pts. One goes home same day, the next one didnt havt a ride and goes home saturday. Then...No more admits.,.. now im sitting at 2 weeks having seen 2 patients. Is this normal. How do you;ll learn ****(till friday night. Just one. He threw up, and went home on saturday. I then came off call so none during the week, then none friday, or saturday, so my resident say go home. And yup, no one.

Basically I'm wondering how I am supposed to be good at anything in 4 weeks...let alone if I end up seeing 4 patients. Is there a recommended minimum? I mean this can prepare u for ****

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That's inappropriate for this time of year. I was carrying 3 patients at a time and had decent turnover so I probably saw about 10 different patients over 2 weeks. Saw them independently, presented to the attending, wrote notes, etc
 
I also carried 2-3 patients that I would see before rounds, write note and present to attending during rounds. Your best bet is to be nice to the intern and go with them on pre-rounds, offer to call consults, write discharge summaries (scut work), ask to accompany them on admissions, etc. At least, you'll see more patients and they may be nicer about teaching.


As for minimum number of patients, we were required to log 10 diagnoses a week.
 
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This is problematic and worth talking to the rotation director about. As with the others ITT I also carried 2-4 patients at a time and had a fair amount of turnover with q2 admitting days, had 8 weeks of inpatient medicine, and was expected to preround, present, write notes, call consults, and put in orders for my patients as much as possible.
 
This is for anyone who has been on internal medicine inpatient wards. Om a 3rd year med student, I am on wards 4 weeks total including a weekend off, a weekend on, a saturday on, and a sunday on (not bad). However, I'm seeing veryyyy few patients The first week i"m not on call, so they won't let me admit patients (fair)

I'm a ****ty little 3rd year so i asked if i could just go see/talk with them (we are split into two teams; i even offered to write the note)for practice since this is like my 1st 2 weeks in the hospital ever. She looks at me like I may be ******ed and say "yuh nno, no one wants to chat allday when theyre sick."

This goes on M, T, W, Th, then im on call, we get 2 pts. One goes home same day, the next one didnt havt a ride and goes home saturday. Then...No more admits.,.. now im sitting at 2 weeks having seen 2 patients. Is this normal. How do you;ll learn ****(till friday night. Just one. He threw up, and went home on saturday. I then came off call so none during the week, then none friday, or saturday, so my resident say go home. And yup, no one.

Basically I'm wondering how I am supposed to be good at anything in 4 weeks...let alone if I end up seeing 4 patients. Is there a recommended minimum? I mean this can prepare u for ****

OP, are you at a MD school or a DO program?
 
It is an MD school. The reason I was asking is because I was spending 100% of nearly every day doing actually nothing, or at least that is how it felt. Kinda hard to get really into doing questions when people around you are actually doing stuff. This is obviously frustrating. I went back and looked at my official log. In 4 weeks I saw a total of 7 patients. Usually admitting 1 or 2 at a time, but then going 3 to 5 days without another new patient. Often I would discharge them and literally have nothing. I did nothing. I just waited. I honestly do not have anything to compare it to really. Thats why I was asking, but I really felt like I was doing nothing at all. For example, my first week stared on a Monday, and I did not see a patient until friday. I just sat in a room. I would say that I was waiting for a patient, but I asked and the resident just said no you are even getting the one after the next one. I'm just disappointed I guess. Is this normal? concerning? am i just being ansty cuz im new? IDK 7 pts in 4 weeks seems like...idk...is there not any regulation out there? lol Any advice is appreciated.

BTW thanks for the replies
 
This is problematic and worth talking to the rotation director about. As with the others ITT I also carried 2-4 patients at a time and had a fair amount of turnover with q2 admitting days, had 8 weeks of inpatient medicine, and was expected to preround, present, write notes, call consults, and put in orders for my patients as much as possible.

This was my thought process at the time because we also are supposed to be getting U/S images so on day 2, X comes in late morning and I said, "Dr. X, are there any patients I should go see, or anything you need me to do?". Her response was something along the lines of "I will assign the patients the way I assign them. And I don't have one right now so I will probably take the next one." Now, I can see she was kinda being nasty, but at the time I was just like "OK good I just want to make sure. Let me know." Then, since she just said I had nothing to do I assumed that this was a good time to ask if I could go find a patient to ultrasound as per this assignment." She insulted this idea for a minute, made it clear that she would let me know who and when I could go get images...because "you can't just walk around the hall ultra sounding people". Im really glad she told me this because I had already put on some sunglasses and hoody and taken my U/S out (because I'm a complete idiot, obviously). So yeah...back to sitting. I'm a really docile/ non-argumentative person so I think she actually had a brief self-awareness moment at this point and said, "Q is your intern, you can just follow him around. He right there." I said thanks, I think she felt fulfilled. And scott could hear **** over his headphones sooo...i went and sat back down.
 
This is problematic and worth talking to the rotation director about. As with the others ITT I also carried 2-4 patients at a time and had a fair amount of turnover with q2 admitting days, had 8 weeks of inpatient medicine, and was expected to preround, present, write notes, call consults, and put in orders for my patients as much as possible.


And I am telling this story retroactively. I did go talk to the rotation coordinator. I received a very different reaction than I expected.
 
And I am telling this story retroactively. I did go talk to the rotation coordinator. I received a very different reaction than I expected.

Never complain to anyone. They have absolutely no reason to help you and it can only hurt. I tried talking to one about a terrible rotation I was in from a resident's advice and this person just took down my email address and said they would get back to me. Looking back, it was a very stupid move. In any case, just keep your head down for a few weeks and move on
 
Never complain to anyone. They have absolutely no reason to help you and it can only hurt. I tried talking to one about a terrible rotation I was in from a resident's advice and this person just took down my email address and said they would get back to me. Looking back, it was a very stupid move. In any case, just keep your head down for a few weeks and move on

You speak the truth brother. I made this mistake early on as well. It is the first piece of advice I give. It is so dangerous. I actually had an administrator call an attending to tell him to expect trouble, as if it isn't obvious what he was saying. Complain early and live on to be a walking example of a self-fulfilling prophecy. When they say not to worry if you don't get along with a resident or attending I always laugh. There exists no bigger crock of ****.
 
What did you expect vs what did you get?

I don't feel comfortable sharing on here to be honest as I have suffered a great deal of anguish for merely expressing my frustrations. If you are truly asking out of concern and want to PM I can tell you more. If you are asking because you are confident that I am to blame, and that I should have been thankful for paying thousands of dollars to see a patient a week then, sorry. It took me a long time to decide that I did not deserve to be consistently harassed and maltreated for pointing out an obvious failure by the school. There is nothing that can be done about it. I just really want people to understand that targeting does exist, and has a drastic negative affect on the victims. With a med school education costing 100s of thousands of dollars and countless years, I truly cannot believe that some of those in power are so willing to basically destroy peoples lives based on their opinion (an opinion that they have supported with years of self-fulfilling fantasy). The medical hierarchy will be remembered as one of the most embarrassing portions of medical history. Just such a waste and a danger to both patients and young men who chose to dedicate themselves only to end up with debt.
 
I don't feel comfortable sharing on here to be honest as I have suffered a great deal of anguish for merely expressing my frustrations. If you are truly asking out of concern and want to PM I can tell you more. If you are asking because you are confident that I am to blame, and that I should have been thankful for paying thousands of dollars to see a patient a week then, sorry. It took me a long time to decide that I did not deserve to be consistently harassed and maltreated for pointing out an obvious failure by the school. There is nothing that can be done about it. I just really want people to understand that targeting does exist, and has a drastic negative affect on the victims. With a med school education costing 100s of thousands of dollars and countless years, I truly cannot believe that some of those in power are so willing to basically destroy peoples lives based on their opinion (an opinion that they have supported with years of self-fulfilling fantasy). The medical hierarchy will be remembered as one of the most embarrassing portions of medical history. Just such a waste and a danger to both patients and young men who chose to dedicate themselves only to end up with debt.

If you'll follow a few of my rantings, you'll find that I was exposed to similar experiences in medical school that paled in comparison to the toxic residency I went to -- and this was in Family Medicine -- I was physically abused (literally slapped in the head by an attending), verbally abused (told I was too stupid to read the English language by a renal fellow) and generally harassed my entire time there --- I feel your pain -- it's very hit and miss in terms of the quality of educational experience you get -- the exams, while trying to be objective, only indicate that you guessed correctly 1/5 times over 70 percent of the time for any given exam day ----
 
I would offer that when you're on a rotation that stinks to just remember that you're paying not for the attending's time but actually paying for that diploma at the end that says you're a doctor. Yes rotations are important but every school has their good rotations and not so good ones. Residency is where you'll get your best and most important training.


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This was my thought process at the time because we also are supposed to be getting U/S images so on day 2, X comes in late morning and I said, "Dr. X, are there any patients I should go see, or anything you need me to do?". Her response was something along the lines of "I will assign the patients the way I assign them. And I don't have one right now so I will probably take the next one." Now, I can see she was kinda being nasty, but at the time I was just like "OK good I just want to make sure. Let me know." Then, since she just said I had nothing to do I assumed that this was a good time to ask if I could go find a patient to ultrasound as per this assignment." She insulted this idea for a minute, made it clear that she would let me know who and when I could go get images...because "you can't just walk around the hall ultra sounding people". Im really glad she told me this because I had already put on some sunglasses and hoody and taken my U/S out (because I'm a complete idiot, obviously). So yeah...back to sitting. I'm a really docile/ non-argumentative person so I think she actually had a brief self-awareness moment at this point and said, "Q is your intern, you can just follow him around. He right there." I said thanks, I think she felt fulfilled. And scott could hear **** over his headphones sooo...i went and sat back down.

Yes, maybe this is a malignant program/rotation and it's unfortunate that you'll have to chalk it up to that. However,

1) Possible communication issue. Perhaps you're writing this on your phone or something, but I find it somewhat difficult to follow what you write. This whole "sunglasses and hoodie" thing (is this a joke?...). Who is this Scott and why does it matter what he hears over his headphones? You don't "insult" ideas. Maybe there is a breakdown in communication between you and the residents. Ask for feedback on how you work in the team and your interpersonal skills and if there's anything you can do to improve from that aspect.

2) You should not be sitting around. They told you that Q was your intern and you can follow him around. That is what you should have been doing from day 1, not sitting in a room waiting for a patient to fall in your lap. Of course shadowing isn't the best way to learn, but it beats sitting around doing nothing. You need to be proactive, not sit around while people do work.

I obviously don't know the whole story of what went on or the mistreatment you faced, I'm not saying that you're to blame and they're not. I've just seen several instances of students complaining about stuff that happens (or doesn't happen) on clerkships and often times the student shares part of the blame for what's going on.
 
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