Remote access to EMR

[Wardles888]

Hi everyone,

for those who have remote access to your EMR, how often do you check on your patients when you are off (weekends)? I’m curious what others feel is an appropriate balance when it comes to time off and responsibility to patients?

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[Ladholyman]

Never. Your time off is your time off. If your program is anywhere halfway decent, then you should have proper handoffs to different teams when you are off.

 

[Dr.LeoSpaceman]

Hi everyone,

for those who have remote access to your EMR, how often do you check on your patients when you are off (weekends)? I’m curious what others feel is an appropriate balance when it comes to time off and responsibility to patients?

I would usually chart check them once a day as a mid-level/chief resident (surgery). If I knew they were getting some specific test, I might check on that later in the day. As an attending, I do the same.

The reason is two-fold. First, while there are other people covering, no one "knows" the patient like you do, and it's essentially impossible to convey all relevant information to someone else on a signout. Second, I didn't like to walk into surprises on Monday morning.

 

[Redpancreas]

Hi everyone,

for those who have remote access to your EMR, how often do you check on your patients when you are off (weekends)? I’m curious what others feel is an appropriate balance when it comes to time off and responsibility to patients?

There is probably a large variability in resident practice.

I personally checked on patients I was curious about in the evenings on inpatient. I probably will avoid this in the future or check at a structured time where I have time to sit down and focus. A pitfall I ran into while doing that was that I would read notes less thoroughly at home since it was my leisure and would miss details or stuff that was added later. The advice I'd give would be that when you review something, do it once, completely and thoroughly and preferably the latest possible (counterintuitive) because that's when the most addendums, etc. will be there. For example, if you read a consult note at 7pm from Gen Surgery and the PGY-2 resident is saying nothing to be done, but tomorow at 6AM the attending thinks the patient needs to go to the OR and the General Surgery resident changes his note at 7AM, you'll look like an idiot for reporting at 8am on rounds the patient doesn't need surgery when the attending prerounded at 730 and knows the patient needs surgery.

I also relied on my remote access a lot to get tasks done at home that didn't necessarily need to be done before 5pm that day. I recommend avoiding this at all costs. The more you blend the work to be done at work with home life, the more control you lose in your life. You also don't adapt to the fast pace your colleagues work at because you think you can do XYZ at home and adopt a put-off-till later attitude. You will start piling these massive lists of To-Dos that you intend to do when you get home. At the beginning, that can be feasible, but eventually you'll burn out. One day, you'll decide to lay down and the next thing you know it's 4AM and you didn't do your to-dos meant for yesterday evening. God forbid you forget 1 or 2 things out of XYZ on your list and have to explain that to the attending the next morning.

The one exception where I think I will continue using EMR remotely is the day before service. Again this is highly variable, but I'm just the type of person who wants to be aware of every little detail prior to entering an always-chaotic medicine service. On hand-off items, the residents will give you only the information they think you need based off their plan with their attending. One thing you need to do (or else your attending will call you out on it if he/she is new) is to re-think the plans on the patients who're not nearing disposition. Could this be something else, is there anything the other team missed? Why did the patient really get XYZ? (sometimes resident reports are wrong, sometimes the notes are wrong). I think doing this work up front makes the week run a LOT smoother especially if the service contains a lot of old patients. The first day taking over a service is chaotic regardless of whether you've reviewed everything or not, but I feel I provide better patient care when I do it so I spend at least 6-8 hrs (I'm may be an outlier) looking into this before I start a service.

 

[HemeOncHopeful19]

I certainly don't have to for handoff-related issues, but sometimes I do. Usually it's a situation where I'm worried about the patient for whatever reason and knowing how they're doing helps me not perseverate on it all day long. E.g. instead of stressing all day about how the family meeting went for Mr. Smith who's SAS in the unit or whether he's still on 3 pressors or how his cath turned out, I spend 5 min taking a look, and then I feel like I can put it aside and enjoy my day off.

Pretty much this 100%.

I check on patients occasionally - BUT - I would say never because I felt it was my RESPONSIBILITY. I usually checked only if I was personally curious what a lab/imaging result that we had ordered the day before, or if it was a patient I was particularly worried about. I would NEVER feel like you HAVE to keep tabs on people on your day off, especially when you're a resident and don't get enough days off as it is.

I totally disagree about checking up on patients for hand-off related issues. If something comes up that people have questions they have my cell phone, which probably happened occasionally but never interrupted my day. In IM though it is rare for everyone on the team to have the same day off, so if I was off then the interns on my team still knew all the patients pretty well.

 

[rokshana]

I would usually chart check them once a day as a mid-level/chief resident (surgery). If I knew they were getting some specific test, I might check on that later in the day. As an attending, I do the same.

The reason is two-fold. First, while there are other people covering, no one "knows" the patient like you do, and it's essentially impossible to convey all relevant information to someone else on a signout. Second, I didn't like to walk into surprises on Monday morning.

Those “covering” are just as involved with the pt...bit presumptuous to think someone else on the team is not as responsible or invested in the pt.

 

[Dr.LeoSpaceman]

Those “covering” are just as involved with the pt...bit presumptuous to think someone else on the team is not as responsible or invested in the pt.

It's not presumptuous. It's reality. I'm not saying they don't want what's best, aren't capable, or aren't going to be appropriately engaged. It's the simple fact that if you've rounded on someone for 3 days and made most of the decisions, you will know more about them than someone who hasn't. There's a reason that hand-offs receive a fair amount of attention as it relates to patient safety, adverse events, etc.

EDIT: Furthermore, I made no value judgement about those who do something different. The OP asked what others did, and I answered.

 

[VA Hopeful Dr]

I'm outpatient only so take this with a grain of salt, but outside of the rare labs that I order on Friday that I don't want to wait until Monday I don't check anything on weekends.

When my wife was a hospitalist, she never checked anything when she wasn't scheduled to work either.

 

[VA Hopeful Dr]

It's not presumptuous. It's reality. I'm not saying they don't want what's best, aren't capable, or aren't going to be appropriately engaged. It's the simple fact that if you've rounded on someone for 3 days and made most of the decisions, you will know more about them than someone who hasn't. There's a reason that hand-offs receive a fair amount of attention as it relates to patient safety, adverse events, etc.

So if you're off on the weekend and you notice something off in the chart, do you call the covering person about it?

Maybe I have a bigger ego than most (given that we all work in medicine I highly doubt it, but its possible), but if I were working on the weekend I'd get kinda irritated if you called me and basically second guessed my decision making on a patient unless there was something particularly odd with a very specific patient.

 

[Dr.LeoSpaceman]

So if you're off on the weekend and you notice something off in the chart, do you call the covering person about it?

Rarely. Only if I see that something is being ordered that was duplicated, or it seems that something is happening based on what seems like a miscommunication during signout.

 

[rokshana]

It's not presumptuous. It's reality. I'm not saying they don't want what's best, aren't capable, or aren't going to be appropriately engaged. It's the simple fact that if you've rounded on someone for 3 days and made most of the decisions, you will know more about them than someone who hasn't. There's a reason that hand-offs receive a fair amount of attention as it relates to patient safety, adverse events, etc.

EDIT: Furthermore, I made no value judgement about those who do something different. The OP asked what others did, and I answered.

So , by that logic, the person that was assigned to that pt the 3 days before you was really the person involved in that pts care and you are only covering them... maybe it’s different in surgery but in medicine, it’s more of a team effort and a single intern/resident isn’t the only person involved in a pt’s care.

 

[rokshana]

Rarely. Only if I see that something is being ordered that was duplicated, or it seems that something is happening based on what seems like a miscommunication during signout.

Wow... you must have been popular being that guy.

 

[Dr.LeoSpaceman]

Wow... you must have been popular being that guy.

I don't know if it made me popular. But people generally seemed happy if they didn't waste time digging through the chart or duplicating a conversation I'd already had with the patient/family.

So , by that logic, the person that was assigned to that pt the 3 days before you was really the person involved in that pts care and you are only covering them

Recency plays a role. And yes, I suspect medicine and surgery are different, which is why I specified. It's a team effort in surgery...the teams are just much smaller. The weekend coverage can be cross-coverage by people who are on a "sister" service, but who really don't have direct responsibilities for those patients during the week.

 

[LucidSplash]

I don't know if it made me popular. But people generally seemed happy if they didn't waste time digging through the chart or duplicating a conversation I'd already had with the patient/family.




Recency plays a role. And yes, I suspect medicine and surgery are different, which is why I specified. It's a team effort in surgery...the teams are just much smaller. The weekend coverage can be cross-coverage by people who are on a "sister" service, but who really don't have direct responsibilities for those patients during the week.

I agree this may be a surgery vs medicine quirk. In general I like to say that when I am off, I am off, but I definitely do chart check some of my patients selectively. I have only one resident at a time and generally the resident knows my patients better than my partner would, and my partner and I call each other freely when covering to clarify anything that might come up, but it still happens pretty rarely.

Surgeons who have operated on a patient frequently feel an extra responsibility/bond/sense of ownership of care towards that patient than I think may be common in medical specialties on a hospital service. Maybe closer to what primary care physicians may feel regarding their patients. It is ingrained in us from the beginning in residency to approach patient care this way. If something went wrong with a patient unexpectedly over a weekend when a different attending was covering, it would not be unusual at all for either the covering attending or the senior resident to call the person who operated and let them know and go over a plan. And I would not want to be the resident on a Monday morning who did NOT call the attending who was off over the weekend and let them know about a complication their patient was having.

I’m not saying this is “better” than any other way of looking at things, just explaining why most surgeons would not feel that Dr.LeoSpaceman’s approach is atypical.

 

[Mass Effect]

Hi everyone,

for those who have remote access to your EMR, how often do you check on your patients when you are off (weekends)? I’m curious what others feel is an appropriate balance when it comes to time off and responsibility to patients?

Never. Boundaries are important. Day off means day off. Stop checking the EMR.

 

[Mass Effect]

I don't know if it made me popular. But people generally seemed happy if they didn't waste time digging through the chart or duplicating a conversation I'd already had with the patient/family.

I don't know, I think you're opening yourself up to liability. When you're off work, you're off work. The inability to create and stick to boundaries is one reason so many doctors have mental health (and family) issues.

 

[Dr.LeoSpaceman]

If I'm caring for them during the week (or whenever), I'm already liable. When someone files a suit, I think it's unlikely I'd be dropped because X event happened on a day I was off. Sure, if it comes out that I changed the plan of the rounding team or put in an order without them being aware, then it could be a problem. But I don't do that.

As for work life balance, it takes 15 minutes when I'm drinking my coffee and has zero impact on the rest of my day. I don't sit around and compulsively check vitals, and if I'm truly out of pocket (traveling, etc) then I don't feel compelled to do it.

EDIT: And running contrary to what you suggest, I think that (as @LucidSplash insinuates), most surgeons would tell you that remaining involved is a way of potentially mitigating legal issues. If I have a complication and a patient needs to go back to the OR, I will absolutely be the one coming back to do it unless I'm out of town. Not only is it potentially better since I know what happened in the first procedure, but it's beneficial that the patient feels you are there to deal with the issue.

 

[hallowmann]

Chart review the evening before I'm coming on service, but unless I'm worried about someone, as in I'm that I'm actively thinking about what happened, I don't touch it. The frequency with which that occurs has significantly reduced over training.

 

[Candidate2017]

And yes, I suspect medicine and surgery are different, which is why I specified. It's a team effort in surgery...the teams are just much smaller. The weekend coverage can be cross-coverage by people who are on a "sister" service, but who really don't have direct responsibilities for those patients during the week.

Surgeons who have operated on a patient frequently feel an extra responsibility/bond/sense of ownership of care towards that patient than I think may be common in medical specialties on a hospital service. Maybe closer to what primary care physicians may feel regarding their patients. It is ingrained in us from the beginning in residency to approach patient care this way. If something went wrong with a patient unexpectedly over a weekend when a different attending was covering, it would not be unusual at all for either the covering attending or the senior resident to call the person who operated and let them know and go over a plan. And I would not want to be the resident on a Monday morning who did NOT call the attending who was off over the weekend and let them know about a complication their patient was having.

I’m not saying this is “better” than any other way of looking at things, just explaining why most surgeons would not feel that Dr.LeoSpaceman’s approach is atypical.

This is definitely the one thing that sets surgeons apart. Maybe it's just narcissism, but the vast majority of surgeons take definitive ownership of their patients. God bless them, and that is admirable, which makes surgery a true profession/calling as opposed to the clock in and clock out widget making employees in other medical specialties.

I'm not saying physicians need to be checking the chart and be available 23/6, 364 days a year. But if it's a life or death matter, then do the right thing.

OP, seems like you are a psychiatrist and are anxious, as psychiatrists are wont to be. Checking the chart just to reduce your anxiety is really not in the true interest of the patient. Anyway, in psychiatry, there's no need to check the chart on weekends if you do your job: tidy everything up by 5 pm (orders in, important labs followed up, etc) and then give good sign out to the weekend person (life threatening things to look out for, potential violence etc).

 

[Candidate2017]

Never. Boundaries are important. Day off means day off. Stop checking the EMR.

I'm not a Walmart employee, I don't punch the clock. I don't check the EMR for petty matters, but my colleagues know they can contact me with a quick text or call if the have any questions. My outpatient panel knows they can call me and I will call them back nights, weekends, holidays... IF their call is legitimate. Ironically, patients knowing they can call me and I will call them back is why they rarely call me.

 

[Mass Effect]

I'm not a Walmart employee, I don't punch the clock. I don't check the EMR for petty matters, but my colleagues know they can contact me with a quick text or call if the have any questions. My outpatient panel knows they can call me and I will call them back nights, weekends, holidays... IF their call is legitimate. Ironically, patients knowing they can call me and I will call them back is why they rarely call me.

Ok? That isn't what the thread is about. It's about checking the EMR for patients that aren't yours over the weekend.

Also, I'd strongly encourage you to also create boundaries. Unless you're seeing the worried well in a concierge practice, telling patients you will call them back nights, weekends, holidays isn't healthy for either you or the patient, especially in psych.

 

[dpmd]

Those “covering” are just as involved with the pt...bit presumptuous to think someone else on the team is not as responsible or invested in the pt.

This is sort of a surgery specific thing. If you weren't involved with the surgery (or the decision to manage something nonoperatively) you aren't as invested in the patient and you don't "know" the patient as well. I bet you wouldn't expect some endocrinologist from another practice in town to know you patient as well as you do. If the person covering was also in the case that is a different story but many times you have someone on a different team or different service entirely covering on the weekend. For the run of the mill patient that might be fine, but for those with more complex issues then checking the numbers even though someone else is going to be laying hands on them isn't presumptuous. I am in private practice so I am never really "off" or "on", I round on any inpatients myself unless I need to leave town and even then I check the chart and answer phone calls while having a colleague available to go see the patient if needed most of the time. If I have a planned trip that will take me out of cell phone contact and I have a patient that needs daily rounding then I will defer to my covering surgeon to handle it all but I hate doing that so I try to avoid getting into that situation. As for calls from outpatients I take them 24/7 unless I am going to be unreachable by phone then I make arrangements for someone to cover. I let my patients know to request to speak to me directly so the operator puts them through which I feel makes them more likely to call during waking hours. Most of the things they call for are able to be managed quickly because I know what would be concerning and what is expected based on what I saw intraop while it would be impossible to sign out every possible outpatient to a covering doctor and they might get too concerned about someone and send them to er needlessly (not that bad) or not be concerned enough and miss something (pretty bad). But I don't have to sit at work or be tethered to a computer to be this involved so my work-life balance does not suffer.

 

[Apollyon]

I think back to my prelim IM year, so, 19 years ago. When the golden weekend was at present, there were two flavors of residents: one was the patients that were very well managed, and the resident said, "here's my pager, call for any problems or questions", but, you never, ever, needed to call. The second was those that couldn't leave soon enough, left everyone in a lurch, and couldn't be raised by any means, including calling their parents, and the patients were a mess.

 

[VA Hopeful Dr]

I'm not a Walmart employee, I don't punch the clock. I don't check the EMR for petty matters, but my colleagues know they can contact me with a quick text or call if the have any questions. My outpatient panel knows they can call me and I will call them back nights, weekends, holidays... IF their call is legitimate. Ironically, patients knowing they can call me and I will call them back is why they rarely call me.

I did the same thing when I was in solo practice. The call/text volume wasn't bad, but it was guaranteed at least a few every single day. That gets old pretty quickly.

 

[dpmd]

I did the same thing when I was in solo practice. The call/text volume wasn't bad, but it was guaranteed at least a few every single day. That gets old pretty quickly.

I think having the exchange as a go between including the option for them to just leave a message for when the practice opens cuts down on call a bit. It is extremely rare that I give my cell phone number out to patients and when I do I explain that it is my private cell phone and that I need sleep so only use in emergencies and the ones I have trusted to have it have been worthy of that trust.

 

[Mass Effect]

I did the same thing when I was in solo practice. The call/text volume wasn't bad, but it was guaranteed at least a few every single day. That gets old pretty quickly.

And keep in mind, you're in FM. I believe the poster you're speaking to is in psych. As an attending psychiatrist, I would never tell patients they can reach me day, night, holidays or weekends (unless I had a concierge practice). Many, if not most, psych patients don't consider "medical" urgency when making calls, especially the personality disordered ones. They sometimes call because of a breakup or because someone was rude to them. I tell my patients to call me if they need me and I generally return phone calls the same business day. If they need something outside of business hours, there is an on-call psychiatrist only for emergencies (and that person knows how to get a hold of me if needed, but I don't tell patients this part). If they're in crisis or unsafe, they need to go to the ER, not wait for me to call them back. The ER will notify me if necessary.

But psych is generally different in that depending on patient population, it can actually be harmful to the patient's treatment plan for me to be at the patient's beck and call. I see a lot of personality disordered patient. No easier way for a borderline or dependent personality to decompensate when I am out of town or legitimately unreachable than if I set the precedent that I will always be there for them.

 

[VA Hopeful Dr]

And keep in mind, you're in FM. I believe the poster you're speaking to is in psych. As an attending psychiatrist, I would never tell patients they can reach me day, night, holidays or weekends (unless I had a concierge practice). Many, if not most, psych patients don't consider "medical" urgency when making calls, especially the personality disordered ones. They sometimes call because of a breakup or because someone was rude to them. I tell my patients to call me if they need me and I generally return phone calls the same business day. If they need something outside of business hours, there is an on-call psychiatrist only for emergencies (and that person knows how to get a hold of me if needed, but I don't tell patients this part). If they're in crisis or unsafe, they need to go to the ER, not wait for me to call them back. The ER will notify me if necessary.

But psych is generally different in that depending on patient population, it can actually be harmful to the patient's treatment plan for me to be at the patient's beck and call. I see a lot of personality disordered patient. No easier way for a borderline or dependent personality to decompensate when I am out of town or legitimately unreachable than if I set the precedent that I will always be there for them.

I was concierge-ish FM at the time which didn't exactly help.

 

[Candidate2017]

And keep in mind, you're in FM. I believe the poster you're speaking to is in psych. As an attending psychiatrist, I would never tell patients they can reach me day, night, holidays or weekends (unless I had a concierge practice). Many, if not most, psych patients don't consider "medical" urgency when making calls, especially the personality disordered ones. They sometimes call because of a breakup or because someone was rude to them.

My boundaries are pretty strong. I let patients know when (weekdays, business hours), how (I don't check EMR messages), and why (specific dangerous side effects etc) to call me.

I don't tell patients to contact me day and night. But I call back if they have a legit message/question. Sometimes it just happens to be night/weekend/holiday when I call them back. That's all.

 

[Mass Effect]

My boundaries are pretty strong. I let patients know when (weekdays, business hours), how (I don't check EMR messages), and why (specific dangerous side effects etc) to call me.

I don't tell patients to contact me day and night. But I call back if they have a legit message/question. Sometimes it just happens to be night/weekend/holiday when I call them back. That's all.

That wasn't the impression you gave with your previous post. Hence my response. But ok, glad to hear it.

 

[rokshana]

This is sort of a surgery specific thing. If you weren't involved with the surgery (or the decision to manage something nonoperatively) you aren't as invested in the patient and you don't "know" the patient as well. I bet you wouldn't expect some endocrinologist from another practice in town to know you patient as well as you do. If the person covering was also in the case that is a different story but many times you have someone on a different team or different service entirely covering on the weekend. For the run of the mill patient that might be fine, but for those with more complex issues then checking the numbers even though someone else is going to be laying hands on them isn't presumptuous. I am in private practice so I am never really "off" or "on", I round on any inpatients myself unless I need to leave town and even then I check the chart and answer phone calls while having a colleague available to go see the patient if needed most of the time. If I have a planned trip that will take me out of cell phone contact and I have a patient that needs daily rounding then I will defer to my covering surgeon to handle it all but I hate doing that so I try to avoid getting into that situation. As for calls from outpatients I take them 24/7 unless I am going to be unreachable by phone then I make arrangements for someone to cover. I let my patients know to request to speak to me directly so the operator puts them through which I feel makes them more likely to call during waking hours. Most of the things they call for are able to be managed quickly because I know what would be concerning and what is expected based on what I saw intraop while it would be impossible to sign out every possible outpatient to a covering doctor and they might get too concerned about someone and send them to er needlessly (not that bad) or not be concerned enough and miss something (pretty bad). But I don't have to sit at work or be tethered to a computer to be this involved so my work-life balance does not suffer.

I’m not the example for that...I work locums so don’t usually see a pt long term...so I have a habit of doing a pt summary of previous evaluations and treatments and pretty detailed about my plan for the pt short and long term... and have learned that I don’t have control over what will happen with the next clinician but make sure they know what I was thinking and planning... but I get it... and attending life is different where there is more of a solo aspect to pt treatment... but in IM at least, in residency, the pt is more a team responsibility... even overnight with the same night float team for a good portion of the admission... decisions on care isn’t just left to the intern or even just the resident...we round for long periods of time for a reason! we are supposed to know all the pts!!

 

[dpmd]

I’m not the example for that...I work locums so don’t usually see a pt long term...so I have a habit of doing a pt summary of previous evaluations and treatments and pretty detailed about my plan for the pt short and long term... and have learned that I don’t have control over what will happen with the next clinician but make sure they know what I was thinking and planning... but I get it... and attending life is different where there is more of a solo aspect to pt treatment... but in IM at least, in residency, the pt is more a team responsibility... even overnight with the same night float team for a good portion of the admission... decisions on care isn’t just left to the intern or even just the resident...we round for long periods of time for a reason! we are supposed to know all the pts!!

Yeah, we don't do marathon rounds

 

[rokshana]

Yeah, we don't do marathon rounds

I remember one attending would round from 9a-1p and then come back at 4p to round again for another hour or 2!
I would send the interns to noon conference to give them a breather and actually get some work done!

 

[dpmd]

I remember one attending would round from 9a-1p and then come back at 4p to round again for another hour or 2!
I would send the interns to noon conference to give them a breather and actually get some work done!

See in surgery rounds are under an hour and sign out is under an hour (to a person who was likely not at rounds). So you see how the person who operated on the patient would have more info than anyone else.

 

[dpmd]

Plus maybe another 30 minutes or so of running through the list again to figure out what got done and what still needs doing. I liked to do this over lunch.

 

[Giovanotto]

Not very far along, but not once.

 

[dpmd]

Not very far along, but not once.

I wouldn't expect a junior resident to feel like doing this even for curiosity reasons because I don't expect them to be as invested and knowledgeable about the patient. Not meant as an insult. Junior residents are rarely making the big decisions on patients and their seniors ought to be keeping tabs on them carrying out plans.

 

[Redpancreas]

So if you're off on the weekend and you notice something off in the chart, do you call the covering person about it?

Maybe I have a bigger ego than most (given that we all work in medicine I highly doubt it, but its possible), but if I were working on the weekend I'd get kinda irritated if you called me and basically second guessed my decision making on a patient unless there was something particularly odd with a very specific patient.

Looking back, I have called for ultimately inconsequential things in the past and you're right that it's not received very well. You're basically implying the person who you're calling needs hand-holding OR you didn't tell them something you should have. Either way it's a bad look for you. That said, patient safety is the #1 concern and if you really think the attending, residents minus you, +/- pharmacists, RNs, and medical students are missing something only you know, I suppose you can make a brief call and I suppose a weekend is the time where things are short staffed and orders miss the scrutiny they usually receive.

I would recommend taking yourself out of that conundrum entirely by not checking in the first place especially as a resident. On a day off, I plan to check things at the very last moment at 10-11pm the day before I am back. If you keep compulsively checking, you will throw yourself off. You won't read notes carefully, things may change later, and also you're actually not on the ground talking to the nurses/patients, etc. and your perception could be entirely off base. If this wasn't the case, then all of us would be zoom-calling into the hospital and working from home. Virtual hospitalists are a thing, but in a very limited capacity and they existed before the pandemic too.

 

[mvenus929]

Those “covering” are just as involved with the pt...bit presumptuous to think someone else on the team is not as responsible or invested in the pt.

You don't get the consults that I do then. I start asking questions about the patient's history: "oh, I don't know, I'm just covering". Which is a huge pet peeve of mine (because the covering person SHOULD know the patient).

With regards to the original question--I will occasionally check my inbox on days off if I have to log into the EMR for another reason (finishing notes, doing research, whatever). I will absolutely chart stalk during the week, especially if it's my patient admitted, even if I'm not on service. Otherwise, the night before my service week, I spend time reviewing all the patients' charts and figuring out if the handoff I received was reliable or not (turns out, I'm much more type A than my colleagues, so it's usually not updated to my standards). Makes the first day go much more smoothly.

 

[Redpancreas]

You don't get the consults that I do then. I start asking questions about the patient's history: "oh, I don't know, I'm just covering". Which is a huge pet peeve of mine (because the covering person SHOULD know the patient).

With regards to the original question--I will occasionally check my inbox on days off if I have to log into the EMR for another reason (finishing notes, doing research, whatever). I will absolutely chart stalk during the week, especially if it's my patient admitted, even if I'm not on service. Otherwise, the night before my service week, I spend time reviewing all the patients' charts and figuring out if the handoff I received was reliable or not (turns out, I'm much more type A than my colleagues, so it's usually not updated to my standards). Makes the first day go much more smoothly.

This is everyone's pet peeve! I absolutely hate that. You're at work, you're qualified, you should be able to call a consult. You should have the SBAR ready to go and exactly what you need to go right off the bat in addition to a short summary of why the consult is needed. Now I get it if the patient's had a long history and you're covering and you don't have everything on you which is why you should be next to an EMR to verify anything you're not sure about.

Agreed that anytime someone gives me this excuse it's pure laziness. I usually am in the patient's chart and can figure out, but if it's so egregious like not knowing why the patient was admitted, I'll usually just say I can wait or request they call me back when they know what they’re talking about so I know that the person knows what they're doing.

It sounds rude but it’s literally necessary because as a consulting team I need to be able to tee it up for my attending and explain what exact question we have to ask. A lot of consultants come off as ass****** to interns because it seems like they’re pimping you but in all honesty, if you don’t get the information as a consultant, you’re going to waste a load of time and potentially answer the wrong question for the patient and create a lot of confusion.