Keeping up during rounds?

[footcloud]

Is it just me or does anyone else also have trouble keeping up in morning rounds sometimes? I find having to physically juggle the chart, write notes at the speed of lightening as the doctor spends like 1-2 min with the patient, doesn't tell me what the physical exam findings are, and then writing the orders, getting them co-signed, and then writing it in the progress notes plus getting lab values kinda overwhelming.

And I barely have time to process the pathophys or what is going on. Especially if there's like 30 patients.

Do you really get better with practice?

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[BigRedder]

In the ICU it takes me about 30 minutes to see a patient, look up labs, and write a progress note. Maybe a little less on the floors. Residents and attendings are much faster, but there are two reasons for that. They usually do a much more focused exam, and they don't have to think about what is necessary to write in the note.

I'm confused about what you are doing on rounds. We generally see patients on our own first, write notes, then present to the team on rounds. You shouldn't be writing notes on 30 patients. On medicine our interns are capped at 10 patients apiece, and we certainly aren't going to go faster than them.

 

[footcloud]

I'm talking about team rounds like when you're on call and it's only 2-3 people and the student has to do all the notes. The team moves FAST and I struggle to keep up and my notes always look like chicken scratch.

I'm fine with my normal progress notes and it does take between 15-30 minutes (or less depending on the patient/issue) to write up things.

 

[kryptik]

try to find time to see the patients before the team rounds, just let the other team members know you have to do that to be able to keep up so you dont look like a gunner or anything like that

 

[footcloud]

That looks bad though right? That you have to do extra work just to keep up. Usually what happens is that I just end up finishing the note later on in the day.

And I'm not that good with medications (something to work on for sure) so when people send order this, I never know the dosage or even how to spell the medication.

I guess I can start doing that for team rounds if I'm on call and with the attending only. But sometimes for other patients, I don't even know if I'm going to be assigned them so it doesn't make that much sense for me to go in early and start all these notes. Seems a bit presumptuous as if I'm hogging patients.

And there's so many times when I'm finishing stuff and everyone leaves and doesn't tell me where they're going and I get lost and have to page people.

 

[kryptik]

you will get more efficient as time goes on, but believe me you are not alone when it comes to feeling "lost". there is no shame in doing extra just to keep up, so dont feel bad about it, and if you explain to the team they should understand and not feel like you are hogging

 

[Depakote]

That looks bad though right? That you have to do extra work just to keep up. Usually what happens is that I just end up finishing the note later on in the day.

And I'm not that good with medications (something to work on for sure) so when people send order this, I never know the dosage or even how to spell the medication.

I guess I can start doing that for team rounds if I'm on call and with the attending only. But sometimes for other patients, I don't even know if I'm going to be assigned them so it doesn't make that much sense for me to go in early and start all these notes. Seems a bit presumptuous as if I'm hogging patients.

And there's so many times when I'm finishing stuff and everyone leaves and doesn't tell me where they're going and I get lost and have to page people.

Does your team not "pre-round"?

Everywhere I've been, it's common practice for the student/resident to see the patient and review labs before rounds. They usually try to write the note (or most of it) then. Then when rounds come, the team sees the patient, any adjustments to the plan are made and the attending makes his/her comments on the pre-written note and signs off. This leaves the student/resident free to pay attention to the plan and write orders.

 

[Droopy Snoopy]

Is it just me or does anyone else also have trouble keeping up in morning rounds sometimes? I find having to physically juggle the chart, write notes at the speed of lightening as the doctor spends like 1-2 min with the patient, doesn't tell me what the physical exam findings are, and then writing the orders, getting them co-signed, and then writing it in the progress notes plus getting lab values kinda overwhelming.

And I barely have time to process the pathophys or what is going on. Especially if there's like 30 patients.

Do you really get better with practice?

Welcome to third year of medical school. Wait, it's February. Not trying to be mean, but WTF have you been doing for 8 months?

 

[turkeyjerky]

Welcome to third year of medical school. Wait, it's February. Not trying to be mean, but WTF have you been doing for 8 months?

I don't know wtf you're talking about, to me it sounds like the OP is being used as a scribe; he's getting screwed and that's that.

 

[DrBowtie]

Sounds like OP needs to pre-round. I thought that was pretty common practice.

 

[footcloud]

Well when I was on peds, we did pre-round because we got assigned patients and would pre-round on them. On this service, it's kind of messed up because we get assigned our patients right before main rounds happens.

Like I was saying, there's like what 30 patients. While I like being helpful, it seems a bit meaningless for me to pre-round on all of them when I don't know who will be my patient that day.

So yes I will start to pre-round if I'm the ONLY person on call on a weekend or holiday.

But otherwise, I don't see the point of me pre-rounding on all the patients on a normal day with all the team there unless I want to be suepr eager beaver. And most of the labs aren't even available that early anyway.

We don't team round every day on all the patients, only new patients. I guess that's an input to the senior, but then again, I can't exactly be telling the senior how they want to run the show.

 

[DrBowtie]

Can you just write skeletons from all of the lab data before rounds?

PS. I think your interns/residents are abusing you. 30 patients for a student is crazy.

 

[2012mdc]

I'm talking about team rounds like when you're on call and it's only 2-3 people and the student has to do all the notes. The team moves FAST and I struggle to keep up and my notes always look like chicken scratch.

I'm fine with my normal progress notes and it does take between 15-30 minutes (or less depending on the patient/issue) to write up things.

I've never heard of a system like this. Is it common?

On the floors (before the transition to EMR) the student's job is to pre-round and write SOAP notes before rounds. On call days we got assigned patients and did full H&P's and presented them either that night or the next morning on rounds.

So OP, you are not being assigned patients until the morning of and then you have to write a note on a patient that you saw with the team and didn't even physically examine yourself? I don't know if I'm just ignorant of a common practice but this seems strange to me.

 

[footcloud]

Yeah we are being sort of used as a scribe service. We COULD go back and re-do the physical, but there's no one to confirm the results and no one cares since the attending/team already saw the patient that day.

Depends on the senior, but I like being assigned patients before I pre-round so I know who to pre-round on. Otherwise, it's kinda blind and I'm just checking on patients I had yesterday but may not even get today.

On call days if it's a weekend or holiday, there is only ONE person from our team there and maybe if the senior is from your team, then two people and attending. Obviously senior isn't going to write notes, so student writes the notes. That's how it is actually for all team rounds, because we don't round on all the patients. So of the people we do round on, doesn't matter if we were assigned or not, the students are to pick up the chart and write the note while the attending sees/examines the patients and do the orders at the same time. Yeah it's a scribe service. I suppose I do get faster at picking up drug names/dosages, but it usually goes too fast over my head for me to think.

 

[McGillGrad]

Never heard of the student scribbling the notes and being responsible for everything else. What exactly are your residents doing while you do this?

 

[footcloud]

Well on a normal day, aka not weekend/holiday, the whole team is there, so the student writes while the residents discuss the management and diagnosis with the attending then dictate orders for the student to write out, and then they just co-sign. The senior someitmes does the physical exam as well.

 

[McGillGrad]

Well on a normal day, aka not weekend/holiday, the whole team is there, so the student writes while the residents discuss the management and diagnosis with the attending then dictate orders for the student to write out, and then they just co-sign. The senior someitmes does the physical exam as well.

Sounds like you're getting hosed. One medical student doing all the writing, labs and orders during a business round for 30 patients?

At the very least, you'll be awesome during your next rotation.

 

[bioteach]

Wow. Isn't that normally the resident's job? I've never done any more than pre-round, write a SOAP note and present my patient to the attending. The resident seeing that patient then fills in any gaps and then the attending sees the patient while we watch. Afterwards the resident will scribble orders that the attending verbalizes. The attending writes a few lines about management on the resident's note and then we move on.

 

[nlax30]

I agree with the others in that this is a strange way to do things and honestly I don't see how it benefits you to have basically try and rush through scribbling notes for 30 patients. Even interns are usually capped at 10/each.

And if I was in that situation I'd be concerned about how much management/learning experience I was actually getting out of it if I was just rushing through writing down info from the team, unless I spent a fair bit of time going back after rounds to really take it in.

I think most places have the "typical" ward setup of some sort of morning signout where new patients are assigned, then pre-rounds where we can usually get all our notes done and go over management decisions with intern/resident, then attending rounds.

What time does your attending round? How big is the team? Is this an academic center or smaller community center? Is they way they've always done things in regards to students?

Depending on those things maybe speaking with your clerkship director/coordinator would be an option to improve things as I just don't see how this is ideal.