Length of time for H&P, write-up, and orders

[sebsvenmdc]

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Hey Guys,

I'm just wondering how long it takes you vs. what you have heard it should take a ms3, ms4, and an intern to do the following in internal medicine:
1) H&P
2) write up the H&P
3) write orders for pt

Ob GYN and surgery are faster and less detailed.

 

[werd]

ms3 - there's a lot of variability. usually over an hour to do and then write an h&p. third years don't put in most of a patient's orders where i trained and did my medicine intern year.

ms4 - i'd shoot for 30 minutes each for h&p, writeup, and orders

intern - you get a lot faster as the year goes on. by the end of my intern year, i could do an h&p in 10-25 min (depending on the pt), good writeup 15-20, and make a plan/put in orders in 10 or so... and have them all tucked in in less than an hour. at the beginning of my intern year, my admission to tucked-in time was more like 90 minutes.

 

[sebsvenmdc]

ms3 - there's a lot of variability. usually over an hour to do and then write an h&p. third years don't put in most of a patient's orders where i trained and did my medicine intern year.

ms4 - i'd shoot for 30 minutes each for h&p, writeup, and orders

intern - you get a lot faster as the year goes on. by the end of my intern year, i could do an h&p in 10-25 min (depending on the pt), good writeup 15-20, and make a plan/put in orders in 10 or so... and have them all tucked in in less than an hour. at the beginning of my intern year, my admission to tucked-in time was more like 90 minutes.

WOW! 30 mins is so fast for a ms4! I'm not that fast yet! I guess it's because I'm taking too long to read through the patient's chart in the database or paper chart in addition to writing it. I can take the actual H&P in 30 mins, but that's excluding writing it and doing orders. Any advice on how to speed up? I guess I'm trying to pick up too much info and not honing in on the major problem well enough. Are there good pocket books with techniques or other aids to improve in this area? I know that practice will help improve efficiency, but it would be good to go in with some pre-read format or style to ensure completion.

 

[smq123]

Any advice on how to speed up?

Practice.

 

[cpants]

Practice.

Definitely comes with practice. A tip is to make sure you focus onto the problem at hand. If a patient is being admitted for a COPD exacerbation, you probably don't need to go crazy with her GYN history, for example. It's hard to figure out what's important and not important at first, and you want to be extra thorough to impress residents/attendings. The secret is that they will barely read your note, and they will be a lot more impressed with your efficiency than your thoroughness.

 

[BigRedBeta]

The only thing that's going to make it faster is practice. Over time you simply learn what's important, and you also learn ways to phrase questions so that you get the answers you want while minimizing the amount of extra irrelevant information the patient gives you. As an M3, you don't have that filter developed and so you end reporting on everything, because you're unsure what data is going to matter.

 

[sebsvenmdc]

The only thing that's going to make it faster is practice. Over time you simply learn what's important, and you also learn ways to phrase questions so that you get the answers you want while minimizing the amount of extra irrelevant information the patient gives you. As an M3, you don't have that filter developed and so you end reporting on everything, because you're unsure what data is going to matter.

Nice comments. Yeah, I'm a MS4. I've come some way, but I still have a long way to go regarding efficiency. My filter needs more refinement. I guess it helps having people page you constantly about patients too - helps in the sense that you are constantly reminded about issues relating to diagnosis, mgmt, and tx of patients - this probably helps keep patients more clearly delineated from e/o. Still, intern year seems very formidable!