How early is too early?

[qw098]

How early is too early to preround on my patients?

I'm in internal medicine and am considering going in at 6AM to see my patients so that I'm ready come 8:30 with the boss. Or is something like 6:30AM more acceptable?

Thanks!

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[qw098]

However early you need to be prepared for rounds?

Waking up a patient at 6/6:30 AM is OK? Sorry for my ignorance


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[Smurfette]

Waking up a patient at 6/6:30 AM is OK? Sorry for my ignorance


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Yes. Unfortunately, hospitals are terrible places to actually get sleep. Remember that RNs, CNAs, etc. are in and out of rooms all night. 6/6:30 is not ridiculously early in the hospital setting....odds are the various surgical services are already rounding as a group by this time (and prerounding far earlier).

 

[ProfMD]

When I was a resident we started rounding at 530 (no prerounds). Even now, my resident usually calls me around 7 when he is done rounding and I see my patients between 7-730. If patients expect to get good sleep in a hospital, they will be disappointed.

Show up as early as you need to finish prerounding. Depends how efficient you are and how many patients you have. As time goes by, you will become more efficient and be able to preround later.

 

[qw098]

Thanks guys


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[Crayola227]

Waking up a patient at 6/6:30 AM is OK? Sorry for my ignorance


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yes, usually they have been already been woken to be stabbed by phlebotomy for morning labs, usually between 4 am- 5 am

they will often be pissed you are waking them a second time this early as many fall back asleep after that

some rotations you might well be so early as to be on the tails of phlebotomy!
I remember following their cart on surg to disturb my patients a little less

in any case, this is your JOB and your EDUCATION so you must wake them whatever time necessary to complete your exam and your rounds
the hospital is the worst place in the world to "rest" so don't feel bad

sometimes I might change my order of rounding to accommodate a patient, and it's good to come in so early that if you have to skip a patient because someone else is doing something with them (nursing, etc) you still have time to swing back around and see them

some patients would get upset or ask me, "is this really necessary"
don't tell them it isn't, and be willing to try to convince them to let you examine them

"but the last person just did the same thing" "or is this the last time? any more docs on the way?"

I would say, "My least favorite part of my job is waking you up early, although I do look forward to seeing you. I'm sorry we couldn't coordinate all seeing you at the same time, but it's important each of us dedicated to your case do their own exam and talk to you to be sure nothing is missed, and to give you the best possible care. Medicine is a team effort. In just a few hours, myself, 2 students, 4 resident physicians, and an attending will all discuss your case in depth to come up with the best possible treatment plan. " This often calmed feathers as I was trying to make all this attention seem like it was because the patient was so important that an entire team of highly trained professionals were "on the case."

Don't look at your history and exam as a meaningless bother to the patient. While you have less experience picking up and interpreting exam findings, I find the med student exams are frequently more thorough and careful and can often find things that would have been otherwise missed. It can feel like you're just bugging patients needlessly at 6 am, but this is par for the course.

 

[GUH]

During weekends on surgery when each student was following six to eight patients, we would begin prerounding at 3 or maybe 3:30 once we knew what to do. We would try to jot down vitals, I/O, lab values etc. first to give the patients as much time as possible to sleep but usually start seeing them around 3:30 to 4 at the latest in order to finish our notes and scut work by sign out.

We were officially not supposed to wake them up until 5 but nobody followed that.

On medicine I start seeing patients at 6 and was told by the residents to do so. So 6 isn't too early.

 

[qw098]

During weekends on surgery when each student was following six to eight patients, we would begin prerounding at 3 or maybe 3:30 once we knew what to do. We would try to jot down vitals, I/O, lab values etc. first to give the patients as much time as possible to sleep but usually start seeing them around 3:30 to 4 at the latest in order to finish our notes and scut work by sign out.

We were officially not supposed to wake them up until 5 but nobody followed that.

On medicine I start seeing patients at 6 and was told by the residents to do so. So 6 isn't too early.

Prerounding at three!! That's unbelievable

 

[akwho]

Prerounding at three!! That's unbelievable

Agree three seems early. Ortho trauma which in my experience is usually first to the hospital usually starts intern/MS4 prerounds at 0345, R2 at 0400, team rounds at 0430. Rounds, morning conference, notes done by 0645, in preop area by 0700 to mark patients and start cases.

 

[byaaaaaaah23]

Come earlier than you think you need to at the beginning of the rotation, then titrate upward as needed.

 

[mimelim]

I see all of my patients between 430 and 6am. I generally find that my standards are higher than other residents/fellows though. When I walk around with a fellow or attending after 7am, I expect my note to be in and plans communicated to the nurses/case managers etc. If I disappear at 7:30am for a case and don't resurface until the afternoon, my service should not skip a beat. I expect my students to see the patients on their own and then see the patient with me before 6am when I get to them. I try to see their patients later/last to give them time to see them.

I expect them to present to me a verbal SOAP note. They get ~30 seconds for their SO and a minute or two for their AP. I expect them to have a listed assessment with associated plans like this:

PAD - POD #2 s/p LLE BKA for CLI, doing well, dressing down tomorrow
HTN - Stable, controlled with current regimen
DM2 - Stable, continue current regimen

While it certainly is not how many/most physicians do it, I think that it is by far the best way for students to learn to think about problems that a patient is having. I don't really care if their plans make any sense or if they say, "Cardiology is managing" or whatever. As long as they aren't just regurgitating information I'm pretty happy.

 

[HooliganSnail]

During weekends on surgery when each student was following six to eight patients, we would begin prerounding at 3 or maybe 3:30 once we knew what to do. We would try to jot down vitals, I/O, lab values etc. first to give the patients as much time as possible to sleep but usually start seeing them around 3:30 to 4 at the latest in order to finish our notes and scut work by sign out.

We were officially not supposed to wake them up until 5 but nobody followed that.

On medicine I start seeing patients at 6 and was told by the residents to do so. So 6 isn't too early.

That IS a little too early. 5am seems to be the standard for most surgical services, with 6am rounds.

 

[HooliganSnail]

It was pretty standard at my med school for all the students on surgery to show up at about 3:30, sometimes 4:30 if you were on a lighter service.

Wow....worse med school ever.

 

[Winged Scapula]

Wow....worse med school ever.

Considering he's at one of the best schools in the country, I think it more likely that they've got a bunch of hard-working students.


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[jonb12997]

And this is why I'm not a surgeon...


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[Psai]

Considering he's at one of the best schools in the country, I think it more likely that they've got a bunch of hard-working students.


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Goddamn gunners. I can't even imagine getting in at 3:30 am. Getting in at 5 am sucked so bad and I'm an early riser too

 

[Alby]

That IS a little too early. 5am seems to be the standard for most surgical services, with 6am rounds.

0500 is sleeping in for a surgery intern! Good Med students are there before I get there (at 0400) and never throw around the "anything I can do to help"
Aka please let me go home early thing. I'm not unreasonable, I let them go home after sign out at 5:30 (even though I'm there until 8 ish most nights). I think it's important to get a feel for the resident life on each service, even if you have no interest in surgery.


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[HooliganSnail]

Considering he's at one of the best schools in the country, I think it more likely that they've got a bunch of hard-working students.


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It is precisely that attitude that is why physician lifestyle is so miserable. It's because we tolerate it, and actually encourage this abuse

How could getting up at 3:30 possible be "good for you'. It just silly.

No, the more accurate statement would be, "He is at a hospital which is maximizing profits by utilizing its servant labor force (residents and med students) to maximum effect by having lots of procedures scheduled early AM that requires the servants to round at the ass-crack of dawn"

Get real man

 

[HooliganSnail]

0500 is sleeping in for a surgery intern! Good Med students are there before I get there (at 0400) and never throw around the "anything I can do to help"
Aka please let me go home early thing. I'm not unreasonable, I let them go home after sign out at 5:30 (even though I'm there until 8 ish most nights). I think it's important to get a feel for the resident life on each service, even if you have no interest in surgery.


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Every med student you have ever had hates you. They talk about you behind your back

 

[ProfMD]

I have to agree here that pre-rounding serves little purpose. In my opinion, people should show up just a little early to jot down vitals / I&O's / etc. Overnight events can be reported by the post-call resident, nurse, and patient.

As far as started the OR early and using slave labor to do it just to make profits - that's a bit extreme. Hospitals as a general rule are not making bank. This is especially true of academic hospitals that tend to care for a lot of Medicare, Medicaid, uninsured, underinsured patients. Also hospitals tend to be non-profits, so any extra money at the end of the year is rolled back into the system to buy equipment, rennovate, etc.

In addition, the OR starts early so we can get our patients taken care of. The OR is a fixed physical space (at least in the short to medium term). So, as we have more patients with a growing population, we need to start early and maximize the time in the space we have.

 

[alpinism]

Unfortunately, hospitals are terrible places to actually get sleep.

If patients expect to get good sleep in a hospital, they will be disappointed.

the hospital is the worst place in the world to "rest" so don't feel bad

I hope you all appreciate the irony of these statements.

Since, you know getting a good nights sleep might be helpful for recovering from major illnesses/operations requiring hospital admission.

 

[ProfMD]

I hope you all appreciate the irony of these statements.

Since, you know getting a good nights sleep might be helpful for recovering from major illnesses/operations requiring hospital admission.

I do. This is why I cut back on the frequency of nurse checks as early as medically appropriate. Early after surgery, you have to balance good sleep with ensuring there stability of the patient. I also try and discharge as soon as possible - people who stay in the hospital too long get sicker.