.First off… Windows Vista is a recurrent thorn on my side... as it was the reason I could not participate in the live chat arranged by SDN . However... we could try a thread..
.I'll try to answer the days questions all together late tonight..
.I want everyone to feel at ease and comfortable with asking anything they want. .
.I am a Hospitalist at West Hills Medical Center in Southern California… loving inpatient disease diagnosis and treatment. I figure that one good way to start off our chat is with a kind of primer to the typical morning on the Internal Medicine wards. .
.Always show up on time! Always! You need to be a team player, as well as make your personal mark during the clerkship. One way to show that you are mature and serious about the responsibilities you will be given is to be there on time. The morning flows as follows:.
.6-7am:.. Arrive at the hospital to pre-round on your patients. .
.The term pre-rounding is used to denote the fact that formal rounding with your team and attending will occur afterwards. You will typically be responsible for following an average of 3 patients alongside the interns, who will usually be responsible for 8 to 12 patients each. The teams are typically comprised of 2 interns (sometimes 3), 1 resident (sometimes 2), 1 attending physician… along with perhaps a pharmacist, nutritionist, social worker, and 1-2 medical students. .
.Pre-rounding consists of you obtaining your patients' overnight information, current status, and to some extent… plan for the day. Prior to seeing each patient at bedside… get the information regarding:.
.Imaging results:.. CXR, CT, MRI, PET, Echocardiogram.
.Invasive Procedures:.. Endoscopy, Surgery.
.Medications:.. Know the reasoning behind each medication being given.
.Nurses assessment:.. Always…. always… always befriend the nurses, and ask them to fill you in on their overall assessment of the patient. Nurses can be a great source of ‘insider' information – as they typically know the patient best..
.Then go and see the patient..… being armed with all the background information needed. Go over overnight events… ensuring to review possible issues about the chief admission complaint, pain, appetite, ambulation, bowel-bladder movements..
.Then meet with the intern(s)..… and exchange information. Just let them know the overall picture. Give them the short and sweet about what's going on with their patient(s). If something is concerning (ex. vitals, labs, imaging, etc..) LET THE INTERN KNOW so that they can assess the situation… after which they will report to the resident..
.Then meet with the team resident.., who will typically have a mini-rounds session of their own in order to get an idea of what's happening with the patients in general. .
.Then meet with the team attending.., who will then do formal rounds with the entire team… expecting:.
.- Full History and Physical presentations on new patients.
.- Full SOAP note presentations on old patients.
.Formal rounds may last several hours. Sometimes until lunch. Then you break off to do the days work… .
.Now ask away!!!!!!!!!!!!!!!!!!!!.