My rules for medical students . . .
1. Don't pick up two charts at a time. And don't ever present two patients to me at a time. One at a time is the rule. You are not there to move the meat. One patient every 1-2 hours is good enough. Capping off at 3 is enough.
2. Said already, but don't stand around next to the resident twiddling your fingers. They'll feel like they have a shadow and that you are not motivated. Find things to do, be active and moving around.
3. Don't take more than 10 minutes in a room, especially if the time is slow and the resident is waiting for you to come out. Learn to move quick, pick out the pertinent things, and redirect your patients. Go back and fill in the gaps if you need to later. The exam and history is perfected and completed on multiple reexaminations. The initial exam is to pick up the major history, organ systems, and develop a sense of direction. There are exceptions.
3. When the shift ends, don't ask to leave or give the impression that you want to leave. Patients still need to be wrapped up and if you have nothing go find something to do.
4. Keep presentations short, pertinent, and sweet. Don't belay me with the internal medicine H & P. I promise I my attention span will only remember 1/4 of what you say and we will be interrupted every 30 seconds.
5. Learn to give a Emergency medicine DDX. Approach your differential diagnosis with the worse stuff first. If you doubt it, say it anyway and then say why you don't think it is. Never be the medical student who always gives DDX such as gastroenterities, food poisoning, muscle aches. This may very well be the case but make sure you covered the bad things first and let the attending know you thought it.
6. Cherry Pick. Take things that will be straight forward. Do not pick up disaster charts such as the guy you know who has fifty medical problems and is here because he has chest pain, back pain, nose pain, testicle pain. You can only mess yourself up big time. If you are daring go ahead, but don't blame me when the case turns out to be non-educational.
7. Don't make me look up results, and pull up images, and tell you what is going on with the patient. You do it. If I get the labs and dispo the patient and you come along 30 minutes later asking me what happened, That is bad form. If the pt seizes, poohs blood, has chest pain, or is SOB, you should be the first one to know it and then should be telling me.
8. Help the RNs draw blood, hook up the patient to the monitor, place foleys, transport if needed. Be the first on to offer the pt. a blanket, ice chips if okay, and talk with the family. You're not an idiot, you won't say something stupid I should hope.
