Is it bad if my attending is editing my notes?

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voxveritatisetlucis

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I’m on my first rotation (ambulatory portion of IM) and I just reviewed the notes I’ve written thus far and the attending has made slight edits to most of them ranging from changes to the HPI, objective, assessment and plan. It’s my fifth day of the rotation and I’m worried that I already jeopardized my chances at honors. Is this common?

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RIP, just drop out now and save the tuition money.




It's common. I occasionally edit notes but primarily will just correct them in the attestation, e.g. "patient said X (differs from resident note), plan is Y (not Z as in resident note)." You'd have to be a little neurotic to edit medical student notes, unless the attending is billing from them (I would just write a separate note).

Keep in mind the medical record is actually important and documentation should be accurate, but ALSO keep in mind you are learning and no one expects you to be perfect. If you notice these edits, good, consider it constructive feedback. The issue is not the corrections, it's the students/residents who don't care that their documentation needs correction.
 
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I’m on my first rotation (ambulatory portion of IM) and I just reviewed the notes I’ve written thus far and the attending has made slight edits to most of them ranging from changes to the HPI, objective, assessment and plan. It’s my fifth day of the rotation and I’m worried that I already jeopardized my chances at honors. Is this common?
The residents used to do this with us to teach us the preferred content. I don’t think it’s a bad sign
 
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The residents used to do this with us to teach us the preferred content. I don’t think it’s a bad sign
Should I begin to alter my notes to his liking. For example, he always edits the physical exam portion of my note. Would it be okay to just copy his template in all of my notes going forward?
 
Should I begin to alter my notes to his liking. For example, he always edits the physical exam portion of my note. Would it be okay to just copy his template in all of my notes going forward?
Sure, as long as you include pertinent findings which change from patient to patient.
See if he wants to hear your plan or do that part himself
 
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Opposed to knowing how to write a great note during the first week or two of a rotation, picking up on how the attending likes to do things and altering what you do (within reason) to make things easier for them can contribute to honoring a rotation.

There's a relatively fine line between helping with efficiency and brown nosing. What you are doing falls under the former.
 
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Law 11 from the House of God.
Show me a medical student who only triples my work and I'll kiss his feet.

Seriously, those are not draconian edits. Pay attention and improve. 3rd year is spent mostly learning basics like these. Expectations for 3rd yrs arent high, just continue to learn.You'll be fine.
 
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I’m on my first rotation (ambulatory portion of IM) and I just reviewed the notes I’ve written thus far and the attending has made slight edits to most of them ranging from changes to the HPI, objective, assessment and plan. It’s my fifth day of the rotation and I’m worried that I already jeopardized my chances at honors. Is this common?
Not at all! You’re learning and everyone knows that. Pick up as much as you can from edits. Some attendings just like to structure things differently or there may not be enough or too little details in your note. Learn as much as you can from the edits and also you can ask for direct feedback on your notes as well. You’re a student, your notes aren’t going to be at the level of a resident or attending. View it in a positive light and keep pushing yourself to learn!
 
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Agreeing with the others - nobody expects you to be good at this yet. Note writing is an art and very individual. I actually don’t even have students do notes at all when in clinic with me because I’m very picky about what’s in them and how it’s all worded mostly because of billing and insurance issues. I don’t want to get stuck doing a peer to peer because a medical student wrote a beautiful note but didn’t phrase something the way I know the bean counters at Aetna want it to be! There’s also the issue that the note is a legal document and my signature means I’m taking responsibility for everything in it.

So definitely pay attention and learn from the edits. Don’t be surprised when the next attending does it differently or ignores your notes completely or doesn’t even have you write them. Soooooo much to learn at this stage- just keep getting better each day and you’ll honor it easily.
 
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You’re lucky they use your notes lol. I do my own and use theirs just as learning tools for them. I also have a dotphrase for my exam so even if I used theirs, it’s faster for me to delete their exam and put mine in
 
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I’m on my first rotation (ambulatory portion of IM) and I just reviewed the notes I’ve written thus far and the attending has made slight edits to most of them ranging from changes to the HPI, objective, assessment and plan. It’s my fifth day of the rotation and I’m worried that I already jeopardized my chances at honors. Is this common?
I wouldn’t sweat it but would definitely look at why he or she’s doing that as it’s good learning and if you improve your notes before the attending tells you, that comes off being a self sufficient learner.

I spent an hour with the brand new third years today and handed down maybe a year’s worth of intern knowledge, advice, and wisdom mixed in. They were appreciative but I made sure at the end I told them that my advice would be stuff they’d spend working on for the entire year and I didn’t expect them to come in tomorrow and do everything I had advised
 
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thanks for the advice everyone.


It’s also super frustrating because he hardly gives me any positive feedback. Never good job or anything. I was at the top of my class for preclinical but now I feel like an idiot and probably destined for a pass at this point.
 
thanks for the advice everyone.


It’s also super frustrating because he hardly gives me any positive feedback. Never good job or anything. I was at the top of my class for preclinical but now I feel like an idiot and probably destined for a pass at this point.
You’re rarely going to get positive feedback. People have better things to do than stroke a students ego. lol your only focus should be on learning and getting constructive feedback.
 
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I typically write my own notes and not correct the resident or medical student notes, and have noticed they sometimes copy mine!!

You should just ask the attending for feedback on how to improve. As attendings, we write in a certain way because of need to be compliant with best practice guidelines, clinical strategic goals, coding and billing. The coders and chart reviewers for quality measures look for key words (hate this!) that you have to include in your progress notes. For coding and billing, for example, urosepsis is not accepted but UTI with sepsis is; malnourishment is not but malnutrition is, etc.

Finally, you will notice differences in styles and what one attending likes will be different from another, and copying one attending's style may cause you to be criticized by another. This will continue until you are an attending..... and you will then do the same to the MS and residents!
 
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I typically write my own notes and not correct the resident or medical student notes, and have noticed they sometimes copy mine!!

You should just ask the attending for feedback on how to improve. As attendings, we write in a certain way because of need to be compliant with best practice guidelines, clinical strategic goals, coding and billing. The coders and chart reviewers for quality measures look for key words (hate this!) that you have to include in your progress notes. For coding and billing, for example, urosepsis is not accepted but UTI with sepsis is; malnourishment is not but malnutrition is, etc.

Finally, you will notice differences in styles and what one attending likes will be different from another, and copying one attending's style may cause you to be criticized by another. This will continue until you are an attending..... and you will then do the same to the MS and residents!
Omg I didn’t even think of the coding and billing people!

Yeah OP better enjoy it while it’s just the attending making changes. It won’t be long til the coding folks who have no medical degree at all are filling his in basket with queries about whether a patient has moderate or severe protein calorie malnutrition, or what stage of kidney disease, or exactly how many cm an incision was. And of course they don’t change it, you have to do it yourself.
 
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Finally, last thing, is it bad if I’m with a patient and they come in mid-encounter? I’m hoping that it’s just due to time restraints and not that they don’t trust me to do a good job. It happened a couple times yesterday
 
Have you considered asking your attending for feedback on your performance thus far?
 
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I did but phrased it as how I can improve. It was pretty generic though
It sounds like you have concerns about specific aspects of your performance, and it's fine to ask your attending to give feedback on your notes, on your history taking, on your efficiency interviewing patients, etc. Nobody here can read their mind and tell you their motivation for editing your notes or walking into the room while you're interviewing a patient.
 
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Finally, last thing, is it bad if I’m with a patient and they come in mid-encounter? I’m hoping that it’s just due to time restraints and not that they don’t trust me to do a good job. It happened a couple times yesterday
Yeah usually that just means they need to move things along. Could mean you’re taking too long. Probably means that - most students are slow because they’re new at this. Or maybe the clinic was running behind. Happens all the time.

You will want to become more efficient but that takes a lot of time and you have a lot to learn before you get there. You have to do a lot of overly detailed med student H&Ps before you can start doing concise ones. You have to learn how to do the full shebang before you can trim it down and be efficient.

You’ve still got a good 5-9+ years before you’re an attending so don’t be surprised if you’re feeling like you’ve got a long way to go. You do.

Just make sure you’re actually learning something each day. It matters less that the attending came in mid interview and more did you learn something that will help you be more efficient next time. And there will be hundreds or even thousands of next times before you’re remotely doing this on your own. Just keep getting better and you’ll honor most everything you do. The good students improve and it’s always noticed.
 
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Finally, last thing, is it bad if I’m with a patient and they come in mid-encounter? I’m hoping that it’s just due to time restraints and not that they don’t trust me to do a good job. It happened a couple times yesterday
Probably means you're taking too long, which is expected as a med student, and often even as a resident. That and the attending is available and doesn't want to sit around all day since at some point they want to see their family. A few attendings did that regularly to me too. It drove me crazy because either I had to present the patient to the attending with the patient in the room, which I feel is really impersonal to the patient no matter how hard you try to incorporate them (if you disagree, try being a patient in that situation--it really feels impersonal to watch two docs talk about you, especially if the med student isn't particularly accurate...). Or, the attending just starts from scratch and your entire HPI/exam is ignored. Such was/is the life of a med student...

That's why it's not uncommon for one attending to work with a few students/residents in clinic at a time. That way the attending can stay on the move while the student/resident (and patient) wait for the attending to work their way over.

Most attendings will let you know if they actually think you're doing something wrong (taking too long to get an HPI, or making too many errors in your notes). It's literally their job to tell you when you're doing those things wrong. Most attendings are better at telling you what your faults are than what your areas of competence/excellence are.

Don't be surprised when you get polar opposite and mutually exclusive/incompatable assessments from attendings. :shrug:
 
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At my school getting honors has nothing to do with medical knowledge. It's work ethic and being nice. And then nailing the shelf.

But nobody is out here wowing attendings by answering enough pimp questions. You're OK, settle down. Again, this is just at my school. Sounds like a stupid system, but it is what it is
 
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