How do you remember your patients in a list of 40 patients

[EeePC1005PR]

I have very bad memory, and it runs in the family. I think I am going to have dementia soon. Every time when going shopping, I have to make a conscious effort to remember where I parked, or I end up not able to find my car after shop. I once spent 2 hours trying to find my car. It is so bad I sometimes have to get out of the car park, pretend I am a car, and walk through the gates, and try to follow how I came in, until I finally found my car. I've been going out with my girlfriend for 2 years, and I can't remember her phone number. So this is my baseline.

Now on the ward I sometimes have a list of 40 patients. People can ask you about any of these 40 patients and expect you know their history, current status, test results etc.
It is a nightmare.
Even the ward clerk knows what's happening better than me.

What I ended up doing was this:
Every morning I would fold one white piece of paper 5 times, this gives me about 32 little rectangles each about 5cm x 3cm. I would put a patient name and bed number in the corner of each little box. Any new agenda I would put in to the appropriate box. At night at home, I type these patients into a Word file. The Word file would be like this:

Patient 1, ward x, bed y, medical record number 111222
12/12/2009: acute appendicitis admitted through ED. WBC 20, culture negative. NBM since midnight. Plan is for monitoring. Keep NBM.

Patient 2, ward x, bed y, medical record number 222333
12/12/2009: day 2 post lap chole. Wound clean. Draining well. Pain under control etc etc.

Patient 3, ward x, bed y, medical record number 333444
12/12/2009: etc.

Next day, I again have a fresh 32 boxed sheet during the day and I fill it up as the day progress. At night, I add to my Word file again, so it's now like this:

Patient 1
12/12/2009: acute appendicitis admitted through ED. WBC 20, culture negative. NBM since midnight. Plan is for monitoring. Keep NBM.
13/12/2009: symptoms settling. Trial of oral fluid. Plan for discharge end of this week. Book for elective appendicectomy.

Patient 2
12/12/2009: day 2 post lap chole. Wound clean. Draining well. Pain under control etc etc.
13/12/2009: cough, fever, desaturation over night. Hypotensive. ?atelaxis ?pneumonia ?PE ?bleed. Await bloods, CXR, U/S. Antibiotics commenced. ?HDU

Patient 3
12/12/2009: etc.
13/12/2009: etc. etc.

So on and so forth. My Word file gets longer and longer. When a patient is discharged, I take him/her off my Word file.

On the ward, when people ask me about any particular patient, if it is about today - I look at my 32 boxed sheet. If it is about before today, I look at print out of my Word file.

Above mentioned approach is highly labour intensive. It sort of works, if I have the time to type it up, and if when asked I have the time to look it up. It also saves time when I write discharge summaries. But sometimes people ask you on the spot and you just can't flip through the pages each time.

My question is, how do you remember all the key details about each and every one of the patients on your list? Any advices would be greatly appreciated. Thanks very much.

Generally for me, I need to have seen a patient daily for one to two weeks, to remember him/her. But usually by 1 - 2 weeks, a lot of patients are already discharged and new ones have come in. How do you remember your patients please? Thanks.

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[45408]

We use Excel for our patient list, and all the residents on the team - as well as the cross cover residents - keep it updated. How do the other residents remember all the patients?

 

[Winged Scapula]

That seems awfully complex. Then again your user name also tells me that you like to make things complex.

I have found that as I went through my training I just naturally remembered more about the patients. I don't know why but this is common as I've heard many others say the same thing. Your memory can't be that bad or you would have never made it through college or medical school. I suspect you are more "absent minded" as we say here in the US or have had crutches to help you (I don't know my best friend's phone number either but that's because with the phone I just have to say her name and it dials her automatically).

I don't have any suggestions about how to improve your memory but have some thoughts on how you are making things needlessly complex which might make it more overwhelming to remember what you need to.

We had daily printouts of the patient list which was something like this:

Room # Name DOB MR # DX Attending

There was room to right little notes on each patient's entry and you could fold the sheet lengthwise and put in labs, test results for each patient as well. I would keep the sheets together and could generally hold 1 month's worth of lists in my lab coat pocket. I kept the lists because some annoying attendings would want to know the WBC from 3 days ago - and I was faster thumbing through my sheets than looking it up on the hospital EMR. So yes, most of us have to look things up - if your consultants are expecting that you remember minutiae from several days ago, that's probably unreasonable (but it happens).

You appear to be writing from outside of the US and perhaps don't have an automatic patient list so are having to hand write everything. Have you considered using some form of electronics? There are several apps available for smart phones etc in which you can enter patient data and keep longitudinal data, rather than typing into a Word document, printing, etc. This would at the very least be more efficient and environmentally friendly.

I suspect you are being too detailed in your notes. Do you really need to list the DDx for a patient who desats? Are you really spelling all the words out (there are abbreviations for most things in medicine)? If a patient is being monitored with a possible surgical abdomen, do you really need to list that they were admitted from the ED and that they are NPO since midnight and that you are keeping them NPO? This sounds more like an issue with medical knowledge if you are having to remind yourself that this is how these patients are managed. How about just writing down the pertinent negatives - ie, if a patient's pain is well controlled it doesn't need mentioning - however, if they are not being discharged because of problems with pain mgt, THAT deserves mentioning (both on the list and in your report).

So try and focus on the big picture, the pertinent facts about the patient and you will remember more.

 

[dynx]

I've been with my wife for 6 years and still can't remember her phone number or email address so don't worry about that (in a memory sense that is...never good for the relatioship when it comes up)
if you're just starting out (3-4months in?) is often a matter of repetition then the important things stick and you filter out the stuff that just takes up space in your mind. I have no idea what 95% of the K values are on my service right now other than they are normal. But the folks with renal failure I can tell you the value on probably thier last 3 lab draws. Keep with your system if it works and it will come with time.
But, if this is a new memory problem you're having (wasn't an issue in medical school) or it persists beyond the time frame you see other interns dealing with it, you might want to get it checked out.

 

[EeePC1005PR]

Thanks everyone for answering and helping me out. I am PGY2.​

>You appear to be writing from outside of the US and perhaps don't have an
>automatic patient list so are having to hand write everything. Have you considered
>using some form of electronics? There are several apps available for smart phones
>etc in which you can enter patient data and keep longitudinal data, rather than typing
>into a Word document, printing, etc. This would at the very least be more efficient and >environmentally friendly.​

Winged Scapula, I tried using a pocketPC to track my patients but it is extremely slow to type on those hand held devices. You are pretty much punching in letter by letter. Even if you use hand writing recognition it is still quite slow compared to hand writing it out on a piece of paper. I type a normal keyboard quite fast, actually almost as fast as it is spoken at normal rate. I tried taking my laptop onto ward round and literally typing things in. My consultant became irritated and asked me to put it away. I also frequently write numbers eg. MRN, pager numbers, times etc. on my skin and gown. My consultant asked me to stop it as it is unprofessional. I thought of attaching an external keyboard to my pocketPC so I can type things in during lunch time (if there is sunch a thing). But that still won't work because frequently I need to update things real time as we speak, not later, not tonight but update things now. I end up going back to pencil and paper.​

>I suspect you are being too detailed in your notes. Do you really need to list the DDx for a

>patient who desats? Are you really spelling all the words out (there are abbreviations for
>most things in medicine)? If a patient is being monitored with a possible surgical abdomen,
>do you really need to list that they were admitted from the ED and that they are NPO since
>midnight and that you are keeping them NPO? This sounds more like an issue with medical
>knowledge if you are having to remind yourself that this is how these patients are managed.
>How about just writing down the pertinent negatives - ie, if a patient's pain is well controlled
>it doesn't need mentioning - however, if they are not being discharged because of problems
>with pain mgt, THAT deserves mentioning (both on the list and in your report).​

I am junior and my knowledge is basal that I will admit.

You are also right I am too detailed. Partly because I have no idea and so I write down extra. It is hard to know what the big picture is when everything is new to me. Quite many people have told me to not complicate things and punish myself, but I somehow just can't quite stop doing it. I seriously don't enjoy complicating things..
Thanks also for the good advice that I should look at writing down only pertinent information.
I think you may also be right about absent minded. New memory cannot be formed without attention.
I am guessing all of above should improve with experience.​

Thanks dynx for the advices. I will stick with my system and try to enhance it by using

abbreviations and being less detailed about less important information. ​

Thanks Prowler for suggesting Excel. We use that as well.

Any new/additional advices will be greatly appreciated.
Thanks again.

 

[Dr.LeoSpaceman]

Thanks everyone for answering and helping me out. I am PGY2.​

>You appear to be writing from outside of the US and perhaps don't have an
>automatic patient list so are having to hand write everything. Have you considered
>using some form of electronics? There are several apps available for smart phones
>etc in which you can enter patient data and keep longitudinal data, rather than typing
>into a Word document, printing, etc. This would at the very least be more efficient and >environmentally friendly.​

Winged Scapula, I tried using a pocketPC to track my patients but it is extremely slow to type on those hand held devices. You are pretty much punching in letter by letter. Even if you use hand writing recognition it is still quite slow compared to hand writing it out on a piece of paper. I type a normal keyboard quite fast, actually almost as fast as it is spoken at normal rate. I tried taking my laptop onto ward round and literally typing things in. My consultant became irritated and asked me to put it away. I also frequently write numbers eg. MRN, pager numbers, times etc. on my skin and gown. My consultant asked me to stop it as it is unprofessional. I thought of attaching an external keyboard to my pocketPC so I can type things in during lunch time (if there is sunch a thing). But that still won't work because frequently I need to update things real time as we speak, not later, not tonight but update things now. I end up going back to pencil and paper.​

>I suspect you are being too detailed in your notes. Do you really need to list the DDx for a

>patient who desats? Are you really spelling all the words out (there are abbreviations for
>most things in medicine)? If a patient is being monitored with a possible surgical abdomen,
>do you really need to list that they were admitted from the ED and that they are NPO since
>midnight and that you are keeping them NPO? This sounds more like an issue with medical
>knowledge if you are having to remind yourself that this is how these patients are managed.
>How about just writing down the pertinent negatives - ie, if a patient's pain is well controlled
>it doesn't need mentioning - however, if they are not being discharged because of problems
>with pain mgt, THAT deserves mentioning (both on the list and in your report).​

I am junior and my knowledge is basal that I will admit.

You are also right I am too detailed. Partly because I have no idea and so I write down extra. It is hard to know what the big picture is when everything is new to me. Quite many people have told me to not complicate things and punish myself, but I somehow just can't quite stop doing it. I seriously don't enjoy complicating things..
Thanks also for the good advice that I should look at writing down only pertinent information.
I think you may also be right about absent minded. New memory cannot be formed without attention.
I am guessing all of above should improve with experience.​

Thanks dynx for the advices. I will stick with my system and try to enhance it by using

abbreviations and being less detailed about less important information. ​

Thanks Prowler for suggesting Excel. We use that as well.

Any new/additional advices will be greatly appreciated.
Thanks again.

KISS. Keep it simple, (stupid). And take this with a grain of salt, because it's only been 3 months so far. It has seemed to work so far, though.

I generally try to know the patient's presentation, operations they've had, and and significant past medical history. The big ones I can think of are a-fib (and whether they are anticoagulated at home), PE/DVT, CHF, AKI/CKD, liver dysfunction and lung disease. Basically, the "biggies". I honestly don't care who has arthritis or hypothyroidism.

On a day to day basis, I'm only trying to remember the trends in white count, H&H, creatinine (especially if they have AKI/CKD), and liver function tests if they have liver disease or had cholecystitis. Amylase and Lipase are going to be important in those with pancreatitis. INR/PTT for those who are anticoagulated. Basically, focus on the lab values that are directly related with the patient's active problems. If you are sitting down and writing out the entire lab panel for every patient, you're wasting your time. If someone is going to bust your balls on a random bicarb level, there's nothing you can do about it.

You really have to learn to triage information. It's absolutely impossible for a normal person to know absolutely everything. It's just learning, through experience, what you can skip and what's going to come up later in the day on rounds, etc.

 

[krmarine123]

I have very bad memory, and it runs in the family. I think I am going to have dementia soon. Every time when going shopping, I have to make a conscious effort to remember where I parked, or I end up not able to find my car after shop. I once spent 2 hours trying to find my car. It is so bad I sometimes have to get out of the car park, pretend I am a car, and walk through the gates, and try to follow how I came in, until I finally found my car. I've been going out with my girlfriend for 2 years, and I can't remember her phone number. So this is my baseline.

Now on the ward I sometimes have a list of 40 patients. People can ask you about any of these 40 patients and expect you know their history, current status, test results etc.
It is a nightmare.
Even the ward clerk knows what's happening better than me.

What I ended up doing was this:
Every morning I would fold one white piece of paper 5 times, this gives me about 32 little rectangles each about 5cm x 3cm. I would put a patient name and bed number in the corner of each little box. Any new agenda I would put in to the appropriate box. At night at home, I type these patients into a Word file. The Word file would be like this:

Patient 1, ward x, bed y, medical record number 111222
12/12/2009: acute appendicitis admitted through ED. WBC 20, culture negative. NBM since midnight. Plan is for monitoring. Keep NBM.

Patient 2, ward x, bed y, medical record number 222333
12/12/2009: day 2 post lap chole. Wound clean. Draining well. Pain under control etc etc.

Patient 3, ward x, bed y, medical record number 333444
12/12/2009: etc.

Next day, I again have a fresh 32 boxed sheet during the day and I fill it up as the day progress. At night, I add to my Word file again, so it's now like this:

Patient 1
12/12/2009: acute appendicitis admitted through ED. WBC 20, culture negative. NBM since midnight. Plan is for monitoring. Keep NBM.
13/12/2009: symptoms settling. Trial of oral fluid. Plan for discharge end of this week. Book for elective appendicectomy.

Patient 2
12/12/2009: day 2 post lap chole. Wound clean. Draining well. Pain under control etc etc.
13/12/2009: cough, fever, desaturation over night. Hypotensive. ?atelaxis ?pneumonia ?PE ?bleed. Await bloods, CXR, U/S. Antibiotics commenced. ?HDU

Patient 3
12/12/2009: etc.
13/12/2009: etc. etc.

So on and so forth. My Word file gets longer and longer. When a patient is discharged, I take him/her off my Word file.

On the ward, when people ask me about any particular patient, if it is about today - I look at my 32 boxed sheet. If it is about before today, I look at print out of my Word file.

Above mentioned approach is highly labour intensive. It sort of works, if I have the time to type it up, and if when asked I have the time to look it up. It also saves time when I write discharge summaries. But sometimes people ask you on the spot and you just can't flip through the pages each time.

My question is, how do you remember all the key details about each and every one of the patients on your list? Any advices would be greatly appreciated. Thanks very much.

Generally for me, I need to have seen a patient daily for one to two weeks, to remember him/her. But usually by 1 - 2 weeks, a lot of patients are already discharged and new ones have come in. How do you remember your patients please? Thanks.

I want to tell you that I have the EXACT same issue!! I brought my child to be tested when he was 10 y/o and found out that he had dyslexia which runs in my family apparently! I went through all of the symptoms, problems, etc... that dyslexics have and I fit the picture to a tee! So, I am now a cardiology NP and in a new environment. I am struggling with learning new computers, new layout, employees, cannot and never could remember even my peers who I worked with for years because they didn't wear their badges or I didn't hear people call their names daily. Therefore, it's gone. It so bad for me that I googled this subject and here I am. I know this blog was years ago. Did you ever find anything that seemed to help you? Even if I have 5-10 people I have to pull my paper out to read what I wrote down about them. My issue is that I can really make an error easily when I am trying to get information from the computer to the document, so I am so focused that I do not retain what I am writing and then couldn't recall anything I wrote. I also only remember them until they are there for weeks and most of them come and go and there are new ones to master. That is sad and I HATE it! I am now considering an iPad, surface tablet, or something like that to use to pull up the patient's information electronically while running a word document on the side to jot down extra info when I am in the room. Don't feel bad! You are not the only one in this boat. BUT, I wonder how many others are out there like this that do not say anything out of embarrassment. I know it's embarrassing to me. Someone on this forum said that it was absent minded! NO, I take great offense to that. If you are like me, you take GREAT caution not to be absent minded and listen very carefully. One of my major issues is that I cannot remember names, but as soon as I see the patient I remember most of what they discussed with me. But, their name triggers nothing for me. Also, although I have this issue, I made highest honors. I just studied with other students and repeated and repeated and repeated until I knew it. I studied no less than 16 hours every single day to make those honors and am very proud of myself since I have this learning disability (hate that word, but it is). I hope others sign on and admit their issues and ways that they have compensated. I did also take a 5x8 card where I typed up info front and back that I needed and then duplicated that card. I seem to get frustrated by it to, but it's good organization, plus you would already have the patient's name, room number and attending, HPI, SH, SxH, FH, PMH written in pen bc it's info that won't change, I use pencil for the lab and meds specific to cardiology. I can send you a copy of that card and you can make one tailored to your needs if you want (smarine123 aolcom). Good luck! Please share any helpful advice.

 

[Winged Scapula]

You're responding to a 7 year old post and the poster hasn't logged on to SDN since 2013 so you're unlikely to get a response.

 

[deleted547339]

I've been with my wife for 6 years and still can't remember her phone number or email address so don't worry about that (in a memory sense that is...never good for the relatioship when it comes up)
if you're just starting out (3-4months in?) is often a matter of repetition then the important things stick and you filter out the stuff that just takes up space in your mind. I have no idea what 95% of the K values are on my service right now other than they are normal. But the folks with renal failure I can tell you the value on probably thier last 3 lab draws. Keep with your system if it works and it will come with time.
But, if this is a new memory problem you're having (wasn't an issue in medical school) or it persists beyond the time frame you see other interns dealing with it, you might want to get it checked out.

This. I have a service of 18 in the ICU right now. I know 3 patients hgb because they are abnormal and need to be addressed. I don't remember anyone else's hgb (including those GIB patients that are stabilized). I don't know anyone's K except my patients that are hyperkalemic. I have about 10 patients on the vent. 8 of them have normal peak and plat pressure and are on pretty minimal settings - can't tell you if RR is 12 or 18, because it doesn't matter. My 2 that are sick, I can tell you everything about them.

You learn what is important to know and what isn't. I have no idea what anyone is getting for tube feeds. This frees up bandwidth to know the important things. As you progress in training, you have a better picture of what is and isn't important.

 

[VincentAdultman]

NECROBUMP

 

[deleted547339]

NECROBUMP

Whoops.

 

[krmarine123]

You're responding to a 7 year old post and the poster hasn't logged on to SDN since 2013 so you're unlikely to get a response.

I understand that the post is 7 years old. I also understand that I may not get a response. That is with any post. However, this person could still get notifications to their post, even that long ago. Also, it is intended to help others who have similar issue, raise discussion, and possibly aid in tips/tricks used in the medical professional that could be beneficial. Therefore, it is fine if the person does not write back.

 

[krmarine123]

This. I have a service of 18 in the ICU right now. I know 3 patients hgb because they are abnormal and need to be addressed. I don't remember anyone else's hgb (including those GIB patients that are stabilized). I don't know anyone's K except my patients that are hyperkalemic. I have about 10 patients on the vent. 8 of them have normal peak and plat pressure and are on pretty minimal settings - can't tell you if RR is 12 or 18, because it doesn't matter. My 2 that are sick, I can tell you everything about them.

You learn what is important to know and what isn't. I have no idea what anyone is getting for tube feeds. This frees up bandwidth to know the important things. As you progress in training, you have a better picture of what is and isn't important.

Good point. Still progressing to figure out "what is and isn't important".

 

[deleted483969]

I want to tell you that I have the EXACT same issue!! I brought my child to be tested when he was 10 y/o and found out that he had dyslexia which runs in my family apparently! I went through all of the symptoms, problems, etc... that dyslexics have and I fit the picture to a tee! So, I am now a cardiology NP and in a new environment. I am struggling with learning new computers, new layout, employees, cannot and never could remember even my peers who I worked with for years because they didn't wear their badges or I didn't hear people call their names daily. Therefore, it's gone. It so bad for me that I googled this subject and here I am. I know this blog was years ago. Did you ever find anything that seemed to help you? Even if I have 5-10 people I have to pull my paper out to read what I wrote down about them. My issue is that I can really make an error easily when I am trying to get information from the computer to the document, so I am so focused that I do not retain what I am writing and then couldn't recall anything I wrote. I also only remember them until they are there for weeks and most of them come and go and there are new ones to master. That is sad and I HATE it! I am now considering an iPad, surface tablet, or something like that to use to pull up the patient's information electronically while running a word document on the side to jot down extra info when I am in the room. Don't feel bad! You are not the only one in this boat. BUT, I wonder how many others are out there like this that do not say anything out of embarrassment. I know it's embarrassing to me. Someone on this forum said that it was absent minded! NO, I take great offense to that. If you are like me, you take GREAT caution not to be absent minded and listen very carefully. One of my major issues is that I cannot remember names, but as soon as I see the patient I remember most of what they discussed with me. But, their name triggers nothing for me. Also, although I have this issue, I made highest honors. I just studied with other students and repeated and repeated and repeated until I knew it. I studied no less than 16 hours every single day to make those honors and am very proud of myself since I have this learning disability (hate that word, but it is). I hope others sign on and admit their issues and ways that they have compensated. I did also take a 5x8 card where I typed up info front and back that I needed and then duplicated that card. I seem to get frustrated by it to, but it's good organization, plus you would already have the patient's name, room number and attending, HPI, SH, SxH, FH, PMH written in pen bc it's info that won't change, I use pencil for the lab and meds specific to cardiology. I can send you a copy of that card and you can make one tailored to your needs if you want (smarine123 aolcom). Good luck! Please share any helpful advice.

Hey krmarine123, you sound exactly like me. Glad to know I'm not in this boat alone. Also glad you decided to post despite so much time passing from the original post!

 

[Vantablack]

I can related to this post so much. I feel so embarrassed of how little I remember. I can forget entire conversations.
It make me so worried that I’m not going to make a good doctor.
I’m a junior doctor, only on my second month and I know everyone says it will get better but even in my day to day life I forget the most basic things.
I’m also too quite certain I’m dyslexic. I often use my phone to secretly spell check really basic words. I pretty much spell check cannula on a second daily basis. Like you’d think I’d get it by the end of a fortnight of secretly spell checking it.
Arithmetic - another weakness of mine. How did I top statistics but don’t know what 4 x 9 is without using my fingers?

Just letting other posters know they are not alone in their struggle.