on the wards, how late is late?

Burrell College of Osteopathic Medicine
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Newyawk

Newyawk

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please spare me the "you're a med student you should be there 20 minutes before everyone else" rant.

if I show up for 8 o'clock rounds at 805, am I considered late enough for it to be noted?
if not, when would it start to raise flags/be noted on my MSPE if repeated several times?
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Newyawk said:
please spare me the "you're a med student you should be there 20 minutes before everyone else" rant.

if I show up for 8 o'clock rounds at 805, am I considered late enough for it to be noted?
if not, when would it start to raise flags/be noted on my MSPE if repeated several times?
Click to expand...

It depends on how much someone dislikes you or dislikes tardiness. All it takes is one occurrence for someone to put a permanent comemment about your inability to show up on time.

In terms of how late, honestly, if rounds start at 0758 because everyone else was already there except for you, then you are late. So yes, students really have to be there at least 5 minutes before rounds. Why aren’t you pre-rounding on your patients?
 
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oh I am prerounding. I'm there like 2 hours before rounds. I should have clarified that. sometimes I just show up to rounds a few minutes late cuz I lost track of time and stayed too long with a patient, etc.
 
Happened to me more than once on pretty much every inpatient rotation because of chatty patients. If it's because you were with a patient and you were only a couple of minutes late, people are understanding. Just don't make a habit of it, don't be 20 mins late, and prove you are prepared with the quality of your presentations. Always honored my rotations, timeliness was never brought up.
 
Newyawk said:
oh I am prerounding. I'm there like 2 hours before rounds. I should have clarified that. sometimes I just show up to rounds a few minutes late cuz I lost track of time and stayed too long with a patient, etc.
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If this happens once and your attending feels it's necessary to negatively comment on it in your evals they're a jerk, but they can still do it. If they warned you to never be late or this is a regular thing then that's on you and they probably should include it.
 
I mean I feel like you're ok as long as you were seen before you prerounded
 
DBV said:
I mean I feel like you're ok as long as you were seen before you prerounded
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This. If I know you're around and you seemed prepared for rounds, I'll let it slide. I know there are chatty patients out there, and sometimes it's difficult to redirect/disengage without coming across as a jerk, especially when you're new to the clinical game.

If you're half an hour late though, you better have a damn good explanation.
 
Newyawk said:
please spare me the "you're a med student you should be there 20 minutes before everyone else" rant.

if I show up for 8 o'clock rounds at 805, am I considered late enough for it to be noted?
if not, when would it start to raise flags/be noted on my MSPE if repeated several times?
Click to expand...

Not if you know where your team will start rounding and you can sneak into the group flawlessly.

Also, it helps if your attire matches the color of the walls.

Furthermore, don't be afraid to crawl, those floors get cleaned every day.

Lastly, if you can do this while holding coffee, more power to you.

Best of luck.
 
Newyawk said:
please spare me the "you're a med student you should be there 20 minutes before everyone else" rant.

if I show up for 8 o'clock rounds at 805, am I considered late enough for it to be noted?
Click to expand...

If rounds have started at that time and you arrive after, you will 100% be late and it will (in most circumstances) look bad. One time being late can be excusable, but if it happens again, that can start to become very very bad. Even if you show up at 8:05 and your senior is still waiting for your attending, they'll notice that you were there late and it will be mentally noted (unless you were doing something that they or your attending told you to do). Obviously, this can be service/attending/senior dependent, but in the absence of any signs that it's okay, do your best to be at rounds early. You shouldn't be the one that they are waiting on (or, if you know you're going to be late, text your resident and let them know why).

In your case of being late because of chatty patients, I get it, it happens on every service, but at the same time, one of the things you begin to learn 3rd year is how to be efficient in the mornings even if your patients want to chat for a while. You can always tell them that you'd love to talk to them more, but right now you have to meet with the attending to talk about their progress and their plan and that you would be more than happy to stop by later in the day. Then, in the afternoon when there's some downtime, drop back in and say hi.
 
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Anti-PD1 said:
Lol, imagine strolling in at 7:59 for 8:00 am rounds. That attending life tho.
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Haha ...if only.
Half the time people don’t know what’s going on or what happened overnight. I check xrays and notes for things like medical clearance long before rounds, after I wake up, and often from home (definitely a bonus to just log in from my comfy bed!) Ultimately I’m the attending of record, and I can’t just go “well I never looked at his knee xrays myself so I had no idea he also had a fracture there”... PAs and residents are there to help you, but they can’t substitute for you.


Sent from my iPhone using SDN mobile
 
If you just lose track of time, you need to set a cell phone alarm or something to go off shortly before rounds (5 min? 10?) that will give you enough time to get there. Simple. If you're with a patient at the time, you can tell them you're being paged/called/are needed elsewhere but will be back with the team later. Patients are generally concerned that you get where you need to be and will let you get on your way.

I find it easier to get out of an inpatient's room than in the office setting because inpatients know there is a lot going on in the hospital and that emergencies happen; as you get more comfortable with patients, you'll find ways of redirecting a patient or excusing yourself from a room without it being rude or obvious. Even some of those overhead pages can be a reason to step out of the room: "was that a rapid response? I'm sorry, I need to listen to your heart and lungs and then go check on that, but will be back later with the team to go over things again".
 
Newyawk said:
please spare me the "you're a med student you should be there 20 minutes before everyone else" rant.

if I show up for 8 o'clock rounds at 805, am I considered late enough for it to be noted?
if not, when would it start to raise flags/be noted on my MSPE if repeated several times?
Click to expand...

I just can't even with this attitude right now

Check yourself before you wreck yourself
 
Time management is my weakness.

Organization. I did this in residency, even.

Say I had 5 patients and 1 hour to round on them. Well, let's make that 50 minutes. That's about 10 minutes per patient.

I got to where I would have *two* timers on my phone for every room. One was for when I needed to leave the room, and one was for 2 minutes before that.

But remember, that 2 minute warning, you might go past that. Also, you need time to gown glove and walk around.

So, allot 8 minutes per patient, and the timer goes off at 6. Your goal is to actually be ready to leave the room at the first alarm, to stack up the 2 minutes for the other patients/situations were you can't cut off more time.

If you're not done by the first alarm, you're not on time. If the second one goes off, you're late. Because even if you keep going at that rate, you're likely to end up late.

If you yak too much and have to bust out a "do it for the notes/checklist" type exam, 2 min is long enough to listen to the heart and lungs, push on the belly, and squeeze the ankles. If the exam you need to do is more important than that, than you don't leave it last like this. Also, as a patient talks and concern grows, you can immediately exam those parts of the body.

(eg, someone is in for MI r/o, but now they are complaining of what could be very concerning belly pain. You were going to push on his belly before leaving the room of course, but if something in the short S of the SOAP you're collecting that morning demands more data, then you get more data when you need it).

Every room I would go into, I would start off by apologizing for being in such a rush that morning. Then open ended question like "how were you overnight?" Then after that pleasantry off to really pointed questions, and if I seem like a dick, "Sorry if I seem rude, I just really need the answers to *these* questions to take back to the team to get you the best care."

You just have to get used to this idea that every room you're going into, you are on a recon mission. There is intel you need to discover, you need to get in, and get out. The clock is ticking. This isn't the military but the analogy isn't bad.

You're not going in blind, either. For every admitted patient, there is a CC. There are going to be the questions that matter for addressing how that is coming along, screening for the most common problems that might arise related to that, their other conditions, this hospitalization, and how they are progressing towards dispo.

Before you go in, you have questions. Some answers lead to predictable follow up questions. You go in and already have some idea of what exam you'll do. You can add more as indicated by the subjective.

This might sound inhumane, and it sorta was, but as a resident it was the only way to mow over the patients fast enough, ask all the right questions, get an honest exam done, and if I was lucky have 5-10 minutes to sit down and maybe organize it, or at least NOT be late.
 
Even if you learn how to get out of a room, you have to learn to direct the conversation. Think about transactional communication (a senior taught me this, look it up), the way that an interrogator asks questions vs Oprah.

I'm touchy feely but we're not talking about a miscarriage or something here.

The time pressures, the responsibility, the speed with which you must do every task, the efficiency, AND the need to be on time goes up exponentially.

If you can't manage to be on time or early at this stage, intern July will eat you alive. Even with the best time management skills you will be swimming with all your might to keep your head up, and will still feel like you are falling behind. And you probably will be to some extent, as you won't be able to read as much as you need to, and your seniors and attendings absorb some of your overall slack. Normal amount of falling behind/hardly keeping your head up, and you'll be expected to catch up. If your time management skills are not on lockdown and you have anything else at all holding you back, and you can't catch up, you drown.

There are so many skills you won't even get a stab at until that intern July. But time management, patient interview, and redirection, are ones you can master now. A stitch in time really does save nine. Do it now. Save time later. Time saved later will be spent saving more time. Then you get better at swimming.
 
I'm trying to break down solutions to you, what transitioning from med student --> doctor is like, and why this is a much bigger deal than comments on your MSPE.

This wasn't a typical "med student be on time" rant. I could give a rat's ass what time anyone does anything, I'm not a timekeeper sort (hence the two alarm system for all patient interactions). I'm not standing on principle here.

Late doctors get ass-reamed at any stage of the game, not because they're "late" necessarily, but because there ain't no time for that shyte, there's seriously never enough time - and that's a fact. That's why the time obsession exists even when it seems like it's pointless, like as a student. But seriously, you don't have any incentive for being on time as a student?

How about not looking like a future dingus to the time pressured docs standing around you questioning your fitness to walk the tightrope? Walking in late you're being eyed by hungry angry tigers. How about, you are early and you get to eat a muffin?
 
OrthoTraumaMD said:
Haha ...if only.
Half the time people don’t know what’s going on or what happened overnight. I check xrays and notes for things like medical clearance long before rounds, after I wake up, and often from home (definitely a bonus to just log in from my comfy bed!) Ultimately I’m the attending of record, and I can’t just go “well I never looked at his knee xrays myself so I had no idea he also had a fracture there”... PAs and residents are there to help you, but they can’t substitute for you.


Sent from my iPhone using SDN mobile
Click to expand...
I was gonna say, the best attendings are the ones that already know about all the patients while rounding and have obviously already chart reviewed the patients.
 
Brorthopedic said:
Show up at 0801 for 0800 rounds and start pimping your attending on relevant minutiae pathology you recently learned for Step 1
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Assert your dominance over the attending, I like it.

I mean, be prepared for a severe ass-kicking, but I still like it.
 
For time management, I recommend to invest more time in the patient on day 1. Then on day 2 or 3 or 4 when u do a rushed in and out in the morning they are much more understanding. Investing in the patient early makes your life easier and the patient happier.
 
this is a pretty silly thread because obviously it will depend on the team, so there's not really any useful advice anyone here can give you. the other variable is how on top of your **** you are. if you're 5 mins late all the time but your presentations are great and you know your patients well, you will probably get cut some more slack

you should also probably just practice redirecting patients, it can be uncomfortable at first but it's an important skill. and it's very easy to deflect blame so you don't make yourself look bad in front of the patient -- for example "thanks so much for talking to me -- I'd really love to finish this conversation a little later, but I have to make sure I'm on time for our team meeting. the head doctor is old-school, and he doesn't like it when we're late!"
 
um, actually, there is pretty good advice we can give

seriously don't think because your performance is otherwise great that you will ever get a pass for being tardy

you know how I know this????? July interns still get in trouble for being a few min late when it's their first week on ICU with 7 all new patients. Ask me how I know.

at my program, being late to morning report and lunch conference was noted and could get you in trouble
at minimum you'd have to make a pretty good case for why if you were called on it

If the attending and senior aren't OK with the fresh intern who's in way over their head (they know this about every early year intern) literally a few minutes late even a handful of times, what makes you think they'll be OK with a med student doing it? from their POV you have less responsibilities and being on time is one of them, so why should they give you a pass on it?

You get more of a pass as a resident depending on overall performance. Not as a med student.

The difference is, while it's not OK for a medical professional in training to be late, the resident will get a pass on it when it is occasional, and you typically get trusted that it was hard to avoid. If it's too much, you are still expected to improve to where you are not running late for rounds or clinic. Period. The resident may have it in their eval and then nothing happens. Or you are told to shape up.

The med student will get less of a pass AND they can write it in your eval AND effect your grade.
 
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it is one thing to be late as well with a new admit, those take longer

if most or all of your patients are follow up on service, this is going to look like a failure to direct the interview and time management, neither of which is considered acceptable

the only times I felt I got a pass on being late for rounds were sick patients that I had to assist on and off the toilet
we all know how long those older folks can take doing that

(I once had a patient that didn't want to be seen while on the can, and they were there for 3 hours. The attending gave me a pass on that one when the patient refused to see him too)
 
seriously, you need to never assume that tardiness will be given a pass, and do all you can to never be late at all times

this is not realistic of course, so if you can manage to only be late for rounds say 2x out of the month, you'll probably look good

even once a week is going to be a once a week failure
 
If you guys want to live in some fantasy land that your performance as a med student is going to excuse tardiness, that's fine. Maybe it never bites you. It could.

If I have 2 students, and one is doing "stellar" but consistently late, and another that is struggling, say they miss some important stuff during the interview, while the first one is late but checking all the boxes, I'm going to be more peeved by the late student.

One, depending on how rounds are structured, we could be waiting on you, in which case you are wasting my time, and that is worse because the amount that either student really saves me time, or the "stellar student" does, is basically nil.

You think the attending and resident are going to give you a pass for wasting even a minute of their time because you otherwise look good as a student? Then you have another thing coming to you.

Two, even if we don't wait on you for rounds, the interruption is still annoying and unwelcome.

Three, you are also missing out on learning. It might not feel that way to you, doesn't mean that's not how the attending and resident feel about it.

Four, med students can actually take some pressure off the residents NOT BY THEIR AMAZING WHATEVER THEY DO, but by showing up to get pimped on rounds. Some attendings are also nicer when the student is there. Some attendings will take it out on the residents when students are late.

Five, I actually expect a med student to miss things and be on time. I don't expect them to be stellar in every way but be late.

Six, maybe it's not rational, but residents and attendings, who have way more on their shoulders, don't see why you get an excuse to be late. They may even resent a little bit that you have less responsibility and think you can be late. Your presence might not matter, but the resentment can be there nonetheless.
 
As I said earlier, I'm not the impatient sort that generally cares about time.

But not every doc is like this.

I ride a student's ass hard about time because I know what happens. If you struggle with it in med school it's not getting better as a resident. It doesn't do anyone any favors to let it slide.

Besides issues of patient safety, emergencies, do no harm, the most important thing is efficiency.

Safe, fast, pleasant, in that order, is my mantra for being a good resident. Med students struggle on fast and may need to focus more on pleasant than speed than the resident.
 
Crayola227 said:
As I said earlier, I'm not the impatient sort that generally cares about time.

But not every doc is like this.

I ride a student's ass hard about time because I know what happens. If you struggle with it in med school it's not getting better as a resident. It doesn't do anyone any favors to let it slide.

Besides issues of patient safety, emergencies, do no harm, the most important thing is efficiency.

Safe, fast, pleasant, in that order, is my mantra for being a good resident. Med students struggle on fast and may need to focus more on pleasant than speed than the resident.
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Thanks for the book!
 
Pathdocmd said:
Being on time is the easiest, most objective criteria they can evaluate you on. Also it speaks volumes about professionalism. Be on time.
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Could you shed some light on what what prerounding techniques you suggest to med students? Thank you!!
 
RinShanKaiHo said:
Could you shed some light on what what prerounding techniques you suggest to med students? Thank you!!
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*just a student.....

You need to do 3 things if possible before rounding with the doc...
1)see the patient
2)see all the overnight/morning labs/notes/vitals etc
3)hear from your nurses, preferably at shift change hand off if possible

Yes, wake your patient to see them, try to do this as late as possible but do it.
Yes, look at every image. Try to look at them before reading the radiology report to see how close you get to the radiologist.
Actually ask your nurses their opinion on how the patient is doing, any concerns they have, questions the patient was asking, etc etc
 
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