I'm doing my sub-i this month and a week in, am feeling underprepared, which I can't stand. I did my M3 medicine rotation early in third year and took Step 2 in July. I haven't been on the wards for a long time.
A lot of clinical stuff has come back but quite frankly it's been unhelpful for "what's the next step" when managing my patients. For example, a patient with serious CHF-related issues had elevated SGOT but otherwise normal LFTs, and isolated elevated CK-MB with no history of immobility: I know how the basic steps for managing the pulmonary/cardiac issues but addressing these isolated lab values is where I don't feel confident. (Before anyone chimes in, I do know how to handle these two issues now. I honestly think I must have skipped over elevated SGOT secondary to CHF during third year reading.)
So far I have been asking my senior resident or the interns for help understanding pathology and what is the normal management. It's a very busy ward and I can tell that I am taking up too much of their time (they have been amazingly nice about it). I do not have time/computer access to UpToDate everything and Step Up is mostly useless for management issues. I have Pocket Medicine but have found it's too general.
Can anyone suggest a reference book that I could use? I am looking for something that focuses on hospital management of patients and not just a regurgitation of pathophysiology like Step Up. Harrison's is a little long considering I have only three weeks left. If what I should know will only come from experience, I don't mind hearing the ugly truth. I didn't expect to be playing catch-up and want to be a competent intern next year.
A lot of clinical stuff has come back but quite frankly it's been unhelpful for "what's the next step" when managing my patients. For example, a patient with serious CHF-related issues had elevated SGOT but otherwise normal LFTs, and isolated elevated CK-MB with no history of immobility: I know how the basic steps for managing the pulmonary/cardiac issues but addressing these isolated lab values is where I don't feel confident. (Before anyone chimes in, I do know how to handle these two issues now. I honestly think I must have skipped over elevated SGOT secondary to CHF during third year reading.)
So far I have been asking my senior resident or the interns for help understanding pathology and what is the normal management. It's a very busy ward and I can tell that I am taking up too much of their time (they have been amazingly nice about it). I do not have time/computer access to UpToDate everything and Step Up is mostly useless for management issues. I have Pocket Medicine but have found it's too general.
Can anyone suggest a reference book that I could use? I am looking for something that focuses on hospital management of patients and not just a regurgitation of pathophysiology like Step Up. Harrison's is a little long considering I have only three weeks left. If what I should know will only come from experience, I don't mind hearing the ugly truth. I didn't expect to be playing catch-up and want to be a competent intern next year.
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