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How exactly does a SubI work?

Discussion in 'Clinical Rotations' started by devildoc2, Mar 10, 2007.

  1. devildoc2

    devildoc2 Membership Revoked
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    Pardon my ignorance, but I'm starting a SubI in pediatrics and later in medicine and wondering what my responsibilities are.

    Do I have authority to write orders or do I have to get an intern to write them?

    Are all of my patients followed by an intern too, or am I the primary contact person for these patients?

    Do I have to ask my chief resident or intern if its OK to draw blood or start an IV or something or can I just do those on my own without telling them?

    Do I get paged by the nurses about these pateitns or do they page the intern?

    When I admit new patients is there going to be an intern shadowing me like in basic clerkships or can I just go down the ED by myself and do everything from H&P to admission orders without their interference?

    Whats the difference between a SubI and a regular intern? Is it just the number of patients we carry or what?
     
  2. Arsenic

    Arsenic posting from the future
    Physician Moderator Emeritus 10+ Year Member

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    since im a 3rd year too, i havent been on a sub-I yet either but I can tell you what the sub-Is on my internal medicine team did.

    so our team had 2 residents, 2 interns and 2 med students. when the 2 interns rotated out we got 1 new intern and 2 sub-Is to do the work of 1 intern. NO, they couldnt sign orders. instead what they did was bring blank order sheets to table rounds in the morning. whenever we got to one of their patients and we said something like "lets just get a CBC and CMP on them today" or whatever, the subintern would write the order and then just slide it over to the resident to sign. the subI would then put it in the patients chart later that morning.

    our subinterns each carried an intern pager so they were constantly being paged by nurses, etc.... so yes, they were difinitely the primary contact for their assigned patients. when returning pages they would either take messages and then just tell our resident or answer the nurse's/consult's questions about the pt.

    whenever we'd get any new admissions the sub-Is would go down to the ER and work up the patient by doing the full H&P. then they'd go and present to the resident who would ask them for a plan, then they'd write admission orders together or in some cases the sub-I had admission orders already written and the resident would go over them and add stuff or cross stuff out before signing. bottom line was that in the end, only stuff signed by a resident counted. a subI could not just see a patient and write orders without supervision. at our hospital our MD's have 5 digit ID numbers they have to use whenever they sign anything so without a number, you cant get anything done in terms of orders.

    as far as how many patients the sub-Is carried, on our 14-16 patient census the intern would carry about 7-8 patients and the sub-Is would carry about 3-4 patients each, so yes they carried a little less.

    i hope that cleared it up a little for you, im sure its a little different at each hospital but thats at least how it works down here in Miami for our IM sub-interns.
     
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  3. emtji

    emtji Senior Member
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    So, the answers vary a little based on the hospital. but here is what you should expect:
    -generally still no authority to write orders. sometimes nursing takes the orders off regardless, even though they're not supposed to. if you're making a big decision (ordering a procedure, changing abx), whether a sub i or intern, there should be team discussion/ resident or attending approval.
    - your patients should not be followed by the intern. you report directly to the resident, or in some cases, the attending. you are effectively, the intern. of course, as a member of the team, you should know all the patients on your service, as should the intern. so, if you need a quick signature by the intern, he/she will feel comfortable doing so.
    - in general, it's okay to start something minor on your own (drawing blood, abg, starting an iv, daily labs, chest x rays, diet, etc). big decisions go by the attending or the resident.
    - you may get paged by nursing. you may not. this is hospital dependent. you should write orders and notes so that they're unambiguous. if the intern or resident get paged on one of your patients, they should tell you and you should take care of the matter. if the answer isn't clear, discuss with team.
    - for admissions, you do everything- h and p, orders- and present to the resident/attending. you run the show.
    - difference between sub-i and intern? the intern carries more patients. the intern is more unhappy. intern doesn't need a cosign. otherwise, not much difference.
     
  4. racystacey07

    racystacey07 Member
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    I am confused about the whole SubI thing, too. We do not have SubIs at my hospital, but it sounds like our program is ran very differently...? We get anywhere from 7-10 of our own patients, and we do our own H&Ps. We have to get the orders from the physician, though, but we can make our own recommendations. The physical part of the H&P is usually checked by a resident once we are done to be sure we are not missing a surgical abdomen (or whatever). We may or may not round on any given day, and may or may not see our resident. I usually spend my day seeing my patients and figuring out how to manage them or admitting from the ER. Is this like a SubI, and should I try to get my level of responsibility put into my evaluation? I appreciate your input. Thanks.
     

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