Scutsheets!

[deschutes]

At this late date in my Teams rotation, I came across Medfools.com's Downloads area yesterday and looked over the IM Scutsheets - which I liked better than my own.

Our CBCs are an upside-down tripod instead of a cross - where I am, we put down Hgb, Plt, WBC - so what's the fourth space for?

Lytes are Na/K/Cl/bicarb with the Cr/Gluc sticking out - what goes into the additional 2 spaces?

And what is P L M E B?

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[b&ierstiefel]

At this late date in my Teams rotation, I came across Medfools.com's Downloads area yesterday and looked over the IM Scutsheets - which I liked better than my own.

Our CBCs are an upside-down tripod instead of a cross - where I am, we put down Hgb, Plt, WBC - so what's the fourth space for?

Lytes are Na/K/Cl/bicarb with the Cr/Gluc sticking out - what goes into the additional 2 spaces?

And what is P L M E B?

PLMEB looks like the differential for the WBC count? Working on that assumption, P=PMNs, L=lymphocytes, M=monocytes, E=eosinophils, B=basophils. M could also stand for metamyelocytes, B could also stand for bands but these latter two cell types are not often reported on WBC differentials.

I kinda like filling out those skeletons and tripods, etc. It's kinda like playing tic-tac-toe and hangman...two things I should've done during my clinical medicine month,

 

[deschutes]

I kinda like filling out those skeletons and tripods, etc. It's kinda like playing tic-tac-toe and hangman...

It takes anal-retentiveness to heights of coolness I never thought possible.

I have no intention of carrying folded sheets like these in my pockets for the rest of my life. But I sure would like to know the designations!

 

[b&ierstiefel]

It takes anal-retentiveness to heights of coolness I never thought possible.

I have no intention of carrying folded sheets like these in my pockets for the rest of my life. But I sure would like to know the designations!

OK now you got me started
The annoying parts of scutsheets and internist white coat contents:
(1) First and foremost....those stupid little boxes. Yes, the internist call them checklists. But why do they have to be boxes? Why can't they be bullets or roman numerals? No they have to be boxes. Is there really a sense of satisfaction that comes with putting a slash or an X through one of those stupid little empty boxes? On my last week of subI's, I caught myself starting to make stupid little boxes on the stupid folded sheets.
(2) The countless little pocket books that cost a fortune to buy...yes those same books that we NEVER use! I had like 5 pocket books...hardly ever used them...sold em before my subI's ended....should've never bought them. Don't get me wrong, they CAN be useful but I'm too lazy to flip through them and strain my eyes reading 6 point type.
(3) Reflex hammer - useless. Use the head of your stethoscope as a reflex hammer and use a twig to do the Babinski test.
(4) Maxwell cards ... kinda useful, mostly useless. I only used it to write admit orders...and no, I never memorized that pointless mnemonic. And that thing cost me over $10! I could've bought a cheap DVD with that money!

Totally spurt of the moment here...did I miss anything?

 

[deschutes]

It's quite the full meal deal that we hate, isn't it.


I like the boxes. I haven't found another way of being able to tell which To-Do has been done and which hasn't. I could just draw a line through it, I guess, but the problem is that's what I do for errors as well. And then I just get confused.

I only bought ONE pocket book which I don't use - the Oxford mustard. It's not a great book. I think Pocket Medicine is much better - it has EBM quotes, for heaven's sake. But I am not buying any book at this point. I don't have a book allowance. I am testing the hypothesis that anyone ought to be able to make it through med school without buying a full set of books (or even one book) per subject/rotation. Socioeconomic status alone should not preclude one from entering and graduating from med school!

It takes a bit of ingenuity, but hasn't failed me (literally) thus far.

(UpToDate wins hands down. And it's free!)

Head of steth = EXCELLENT reflex hammer. If you can't elicit a reflex, there's something wrong with your technique. Keys for plantars work too. There are many things I have started to realize are stupid to carry because they make my neck hurt. My coat weighs a lot less now than 6 weeks ago.

Did I tell you about the one neurology attending who strongly recommend that we each get ourselves an ophthalmoscope and practice using it...

 

[yaah]

Keys for plantars work too. There are many things I have started to realize are stupid to carry because they make my neck hurt. My coat weighs a lot less now than 6 weeks ago.

Yes, but then your keys are covered with grimy foot fungus or odiferous materiel or whatever else is on that person's feet. There are too many things on feet that are contagious. That is why I have never, and never will, understood anyone who has a foot fetish. Why don't you just lick the floor?

I hated the boxes too. I usually just remembered what I had or hadn't done. But then again I have a strange memory and don't recommend this strategy to others. I have trouble remembering what I have to do (thus I still write it down) but no problem remembering that I have completed it. Most clinical medicine tasks were odious. Thus, I had a strong memory of actually completing the task. Some people will seriously carry around highlighters and pens of different colors to "prioritize" their tasks and give them different stages of completeness.

You know what my path coat has now? A small notebook for writing down important phone numbers, passwords, etc (it's my palm pilot). And a couple of pens. And some loose change. That be all. And a lot of the time I don't even wear it.

Sorry if any of you have foot fetishes. But seriously, if you do, you need to be checked out.

 

[b&ierstiefel]

It's quite the full meal deal that we hate, isn't it.

It's more like a super-sized biggie meal deal.

I like the boxes. I haven't found another way of being able to tell which To-Do has been done and which hasn't. I could just draw a line through it, I guess, but the problem is that's what I do for errors as well. And then I just get confused.

During the first 7 of 8 weeks of the subI when I didn't use the stupid little boxes, I just put the To Do list up in my head. I figured...I want these malingering bastards discharged ASAP and I know in my mind, heart, and soul what to do to get them out. But then during my last week of medicine, I started using those boxes. But it didn't matter as I checked all of them off on the same day and D/C'd my patients and rode out the last of my days on IM with zero patients. I made sure to burn all the patient information I had in my backpack as I waved clinical medicine goodbye with my left hand with middle finger fully extended.

But I am not buying any book at this point. I don't have a book allowance. I am testing the hypothesis that anyone ought to be able to make it through med school without buying a full set of books (or even one book) per subject/rotation.

Again I totally agree with you. What I said before on some other thread about what type of student you're gonna be on rotations (student A, student B, etc) comes into mind. Buy 4 books and study your butt off...you get a pass. Buy no books, be a lazy bastard, and leave the hospital everyday prematurely, and bomb but still pass the shelf exams...still get a pass. With the latter option, you've saved money. You've also saved time and we all know that time is money.

My coat weighs a lot less now than 6 weeks ago.

On day 1 of my path rotation I came to the medical school with a white coat. It was empty. And very light. 30 minutes into the rotation, I take off my white coat, crumple it, and stuff it in my bag. Now it sits in the back of my car not to be worn again for the rest of this year. That thing is gonna get burned too.

Did I tell you about the one neurology attending who strongly recommend that we each get ourselves an ophthalmoscope and practice using it...

No you didn't...why don't you tell us about it?

How much longer you got left on infernal medicine?

 

[deschutes]

I agree - feet are smelly. I take the key suggestion back, unless one carries an unused key for the specific purpose of scratching people's feet and dutifully sani-wipes it after each exam. Having said that, I certainly don't remember seeing people sani-wipe their tendon hammers.

I also like a disposable tongue depressor, snapped longitudinally.

But why am I talking about this. My patients either withdraw from or give equivocal responses to the scratch test anyway.

Haha I remember the first day I shadowed in surg path. I walked in white-coated. The attending said, why don't you hang it up, you don't want to dirty it. Gown, glove and get in!

~
I got 2 hours last night, got home this morning, and slept from 10am to 7pm. And I am due back at the hospital in 12 hours.
I'm not even going to try to recover my original sleep schedule! And with Ob/Gyn and Gen Surg still on the cards, it's only going to get worse.

BUT!! I have only one call night left on Teams, and it ends Friday at noon! I'm so happy I could weep!

 

[Primate]

Two days of long call left, sweet merciful beefcake, that is all. I just keep praying for rocks in my little garden - sit on my service and keep me capped, baby!

Gotta run and check off some boxes. (Sample of boxes to be checked: Practice Ophthalmoscopic skills; make new boxes; check on poop; check off poop boxes 1-37; make more boxes)

Honestly, though, I have a great team for my sub-I. Man, that makes this a much better experience - even fun at times. I would be well and truly miserable if I had some of my classmates' residents this month.

P

 

[b&ierstiefel]

Two days of long call left, sweet merciful beefcake, that is all. I just keep praying for rocks in my little garden - sit on my service and keep me capped, baby!

Gotta run and check off some boxes. (Sample of boxes to be checked: Practice Ophthalmoscopic skills; make new boxes; check on poop; check off poop boxes 1-37; make more boxes)

Honestly, though, I have a great team for my sub-I. Man, that makes this a much better experience - even fun at times. I would be well and truly miserable if I had some of my classmates' residents this month.

P

I'm with ya on that man! My 2 months of sub-I's were quite deplorable but tolerable considering that my teammates were really cool folks (both months).

I like your boxes...it's hard to remember poop boxes x37. If I was a senior resident and I was evaluating you...you would get an A+ for the month

Hope your last two long calls don't suck as bad as mine did...if you're capped, you're golden!

 

[deschutes]

Since it seems to be the week for asking stupid deschutes-style questions, I no longer have fear in my heart My question is - what does "capped" mean?

~
I had a good day today. Weaselled all the credit for carrying 4 patients (I admitted 3 of them on the long weekend when no one else who came back today knew what the hell had been going on) and proceeded to discharge the short-stay while the attending phoned interventional radiology.

Bounced out the door yelling "THREE DAYS MORE, BABEEEEEEEEEEE!!!"

 

[b&ierstiefel]

Since it seems to be the week for asking stupid deschutes-style questions, I no longer have fear in my heart My question is - what does "capped" mean?

~
I had a good day today. Weaselled all the credit for carrying 4 patients (I admitted 3 of them on the long weekend when no one else who came back today knew what the hell had been going on) and proceeded to discharge the short-stay while the attending phoned interventional radiology.

Bounced out the door yelling "THREE DAYS MORE, BABEEEEEEEEEEE!!!"

unfortunate...2 days ago you could've posted on the Five More Days thread. oh well...you still have some more clinical medicine rotations coming up (sorry).

OK so "capped" means that your census is maxed out. The pros of capping? No more new admits...no more admit H&P notes...no new workups. The cons of being capped? You got lots of paperwork and BS to do.

 

[deschutes]

How does one achieved a maxed-out census? Beds full?

 

[b&ierstiefel]

How does one achieved a maxed-out census? Beds full?

For instance, when I was a sub-I, our maximum census was 6 at any given time (maximum # of admits per call night = 3). our team total cap was 20.

I never reached the cap of 6 as my highest census at any given time was 4. Anyways, there will always be beds so if that was the criteria behind capping, then we'd be in a world of [expletive]. The cap rule is some arbitrary rule set by the person who's in charge of medicine teams.

 

[deschutes]

Cannot begin to imagine carrying 6 patients. If I had a full day (8-5) to work with, maybe. But instead there's morning case rounds and run-the-list rounds and dammit-even-I-have-to-pee rounds.

But why am I complaining - they provide sustenance.

 

[b&ierstiefel]

Cannot begin to imagine carrying 6 patients. If I had a full day (8-5) to work with, maybe. But instead there's morning case rounds and run-the-list rounds and dammit-even-I-have-to-pee rounds.

But why am I complaining - they provide sustenance.

you forgot wipe-my-ass rounds

still can't get past those stupid little boxes!

 

[deschutes]

Today was also New Scutsheet Template Day! I am so damn organized. I am beginning to like the idea of carrying my patients around in my pocket. After all, what are they but collections of lab values, med lists and nursing notes.

You are up late! I am going to sup and to bed.

 

[b&ierstiefel]

Today was also New Scutsheet Template Day! I am so damn organized. I am beginning to like the idea of carrying my patients around in my pocket. After all, what are they but collections of lab values, med lists and nursing notes.

You are up late! I am going to sup and to bed.

Wow...Canadian patients must be tiny if you can fit them in your white coat. How tall are you? 5'1''? And since you're a student, you would be wearing a short white coat. So yeah, you've got some lilliputian patients

Oh damn...look at the time. I gotta get to the hospital now at 7 a.m. just to get parking with my new parking pass cuz the lot fills up shortly thereafter. Our days on the path rotation starts at usually 8 am or 9 am depending on if there is conference and we go to it. I guess I'll go to the 8 am conference since I'd rather sit around for 1 hour instead of 2....which means...good night for me too. Ciao!

 

[yaah]

Wow...Canadian patients must be tiny if you can fit them in your white coat. How tall are you? 5'1''? And since you're a student, you would be wearing a short white coat. So yeah, you've got some lilliputian patients

Oh damn...look at the time. I gotta get to the hospital now at 7 a.m. just to get parking with my new parking pass cuz the lot fills up shortly thereafter. Our days on the path rotation starts at usually 8 am or 9 am depending on if there is conference and we go to it. I guess I'll go to the 8 am conference since I'd rather sit around for 1 hour instead of 2....which means...good night for me too. Ciao!

I get here at 6:30 and there are no parking problems. I love showing up early, getting things done, and seeing people stress about showing up ontime for conferences. I couldn't live like that. Always rushing everywhere, chronically late, depending on things to go perfect to arrive on time, accepting being 10 minutes late as "on time" etc. Oh well. Guess I'm anal retentive.

 

[JattMed]

(3) Reflex hammer - useless. Use the head of your stethoscope as a reflex hammer and use a twig to do the Babinski test.

Will the end of my crack-pipe work?

 

[deschutes]

I love showing up early, getting things done, and seeing people stress about showing up ontime for conferences. I couldn't live like that. Always rushing everywhere, chronically late, depending on things to go perfect to arrive on time, accepting being 10 minutes late as "on time" etc.

I once aspired to that ideal. I could see it - wake up just half an hour earlier, and my life would be in order.

I've since given up. You lark, me owl. We deal.

The classic owl story is George Bernard Shaw?s invitation to a breakfast meeting during his first visit to the United States. He inquired what time this would be, and on learning that it could be at any time between 7.00 and 8.30 a.m., politely declined the invitation explaining that he would have gone to bed by then.

 

[b&ierstiefel]

I once aspired to that ideal. I could see it - wake up just half an hour earlier, and my life would be in order.

I've since given up. You lark, me owl. We deal.

The classic owl story is George Bernard Shaw?s invitation to a breakfast meeting during his first visit to the United States. He inquired what time this would be, and on learning that it could be at any time between 7.00 and 8.30 a.m., politely declined the invitation explaining that he would have gone to bed by then.

It's funny...I saw yaah at 8 am conference this morning. I asked him what time he got to work today and he said six something (don't remember the exact time...I'm really beat and can barely think). I then proceeded to ask him why he got to work that early. If I had remembered what he wrote on the forum, I wouldn't have had to even ask that question.

Long day for me today but a good one. 8 am conference was the absolutely best lecture I've ever been to in my whole life! Well no not really...but I did pick up some useful and practical information. Being the only student there though I kinda felt out of place. Saw some cool stuff in the surg path room today and then got to do some grossing in the afternoon. Usually on long days, I sometimes think, "I'd rather be dead" (see other thread)...but today that was not the case. Path is an awesome field...it's great that we're going into it!

 

[yaah]

Yeah well Dr G is one of the new authors/editors of the Sternberg surg path book. So there is needless to say a lot to learn from him. That conference was pretty focused though...I learned quite a bit too.

 

[b&ierstiefel]

Yeah well Dr G is one of the new authors/editors of the Sternberg surg path book. So there is needless to say a lot to learn from him. That conference was pretty focused though...I learned quite a bit too.

I didn't know that about Dr G. I remember him lecturing to my class 5 years ago. He does come across as a very knowledgable guy but a cool guy as well. Maybe I'll be able to spend a day or two in a room with Daddy G.

[ ] eat dinner
[ ] watch tv for a bit
[ ] sleepy time

 

[deschutes]

[ ] eat dinner
[ ] watch tv for a bit
[ ] sleepy time

Sounds like a good plan. I started to check off #2 - then I decided that posting was less annoying than Frasier and a lot more recreational.

Sleep is good! Now if only those elephants upstairs would stop clomping around in their high-heels.

And if you're trying to keep us on-topic, you'll have to try harder than that

 

[b&ierstiefel]

[x] eat dinner
[x] watch tv for a bit
[x] sleepy time

Wow it's been a long time since I got 10 hours of sleep but damn that feels refreshing.

 

[deschutes]

Sleep is a necessity, not a luxury. We tend to forget that by final year.

 

[b&ierstiefel]

Sleep is a necessity, not a luxury. We tend to forget that by final year.

Yes...and that's why I'm not gonna be a surgeon

 

[deschutes]

I agree - it was effortless to rule out surgery as a career. I only ever shadowed once - and that was before med school.

The Teams countdown - EIGHTEEN HOURS LEFT, BABEEEEEEEEE!!!!!!! *boingg boinngggg*
And I'm post-call so I don't have to present at the afternoon "clerk grand rounds".
I don't even have to turn up.
So very Woohoo!!

 

[b&ierstiefel]

I agree - it was effortless to rule out surgery as a career. I only ever shadowed once - and that was before med school.

The Teams countdown - EIGHTEEN HOURS LEFT, BABEEEEEEEEE!!!!!!! *boingg boinngggg*
And I'm post-call so I don't have to present at the afternoon "clerk grand rounds".
I don't even have to turn up.
So very Woohoo!!

You're essentially done deschutes. Congratulations!

 

[deschutes]

Not quite. I still have to get my evaluation form filled out.

What will the night be like, I wonder.... I have quite accidentally neglected to add my name to the "CC on call" field on the board - the nurses usually do it anyway...

 

[b&ierstiefel]

Not quite. I still have to get my evaluation form filled out.

What will the night be like, I wonder.... I have quite accidentally neglected to add my name to the "CC on call" field on the board - the nurses usually do it anyway...

hmm...when I had 18 hours left, I considered myself done...didn't do squat after that. Still got 8's and 9's out of 9 on my subI evals. BUT, I did do the subI's at an outside hospital (a joke hospital too) so I'll probably end up with a Pass anyway.

 

[deschutes]

hmm...when I had 18 hours left, I considered myself done...didn't do squat after that.

There is still one patient (not one of mine) that the attending didn't round on before 6. I got arm-twisted into doing it. I guess I should go do it.

[ ] Round on ectopic patient at 8pm
[ ] Read up on "an approach to eosinophilia" *
[ ] Steal lots of club soda and ginger ale in my last hours on the unit.

*Eosinophilia is so important and significant a laboratory finding that UTD has no "approach" article on it.

~
My poor friend on Peds. She is telling me that one of the rotation requirements written up in the clerkship guide is for clerks to "be enthusiastic".

 

[b&ierstiefel]

you will be adding vodka to that ginger ale and club soda right?

ahh...this 2001 cabernet sauvignon is treatin me pretty good right nyah!