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What an M3 should keep in White Coat during rotations?

Discussion in 'Clinical Rotations' started by Dextrocardia, Aug 1, 2011.

  1. Dextrocardia

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    Searched for similar thread, but found very little. Hopefully someone can shed some wisdom as to what an M3 should carry around. I am beginning my medicine rotation this week and would love to have some suggestions on some pocket reference guides/apps.

    Thanks!
     
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  3. WashMe

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    I'm 2 months into my third year and I carry:

    stethoscope
    white coat clipboard (folds in half)
    maxwell pocket reference
    3 pens and a pencil (always 1 nice pen and 2 I'm willing to lose if I lend them out)
    blank 3x5 notecards, cut in half for random use (3x2.5 essentially)
    safety scissors
    little pocket books relevant to rotation
    marking pen (for surgery)
    gauze, alcohol pads, packaged sterile gloves, telfas, 1" silk tape, 3" paper tape, sealed basic tray
    extra AA battery for my pager
    paperclip (for pain + 2-point discrimination)
    2 protein bars

    I also have a smartphone, but I don't currently use any medical apps on it. Good for constant connection to email/wikipedia though.
     
  4. turkeyjerky

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    tape and scissors can be useful depending on the rotation. Reflex hammer on neuro only. Kept pocketbooks on my iphone for reading. Patient list w/ notes for rounds written on it. Stethoscope around neck (looks ******ed stuffed in your pocket).
     
  5. Wilf

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    I carry my stethoscope, pen, and a couple sheets of folded up paper to take notes about the patients on.
     
  6. RySerr21

    RySerr21 i aint kinda hot Im sauna
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    amen. a pen light comes in to handy if you are checking out a pt at 5 in the morning and they are still sleeping and all you need to do is look at their rash or something to see if its improved. Better than turning on the light and waking everyone in the room up. That maxwell pocket book has come in handy too tho.
     
  7. Mr hawkings

    Mr hawkings Senior Member
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    All of the above plus an energy bar in case i dont have time to get lunch at my regular time or if i need a mid-morning snack
     
  8. High Roller

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    Funny... I was thinkin' the opposite...
     
  9. Rollo

    Rollo Renowned Wolf
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    Haha, I thought the same thing...around the neck screams "I look more important than I really am"....

    Stuff that bad boy in your pocket, your neck will thank you later.
     
  10. Jolie South

    Jolie South is invoking Domo. . .
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    I find that I have more issues when I carry too much crap in my pockets. I hunch over a lot more when it's in my pocket vs. around my neck.

    Thus leading to the next point about what I carry in my pockets:
    - blank white paper
    - team list of patients
    - pens
    - my cell phone
    - gum
    - Pocket medicine (if on medicine)
    - mini hand sanitizer

    Any more than that and I think you look like a sherpa. Also, your posture/back will suffer.
     
    #9 Jolie South, Aug 6, 2011
    Last edited: Aug 6, 2011
  11. badasshairday

    badasshairday Vascular and Interventional Radiology
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    Dude some of you carry way too much ****. Your neck and back is going to hurt big time. I carry as little as possible. Right now I just carry 2 pens, a pen light, protein bar, stethescope (in the pocket), mini hand sanitizer and rounding list. Anything more is becoming over kill. If you are going to carry any books, leave it in the work room, it's not like you are going to use it all the time, so it just ends up being extra weight. The only exceptiond be Pocket Medicine because it is so light weight.
     
  12. WashMe

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    :laugh:

    Most docs at my hospital who aren't IM refer to stethoscopes around the neck as flea collars :p
     
  13. username456789

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    I'm with TJ on this one. I know it's trendy to knock people for wearing it around their neck for some reason, but putting it awkwardly in your pocket seems even stupider to me. And less convenient having to take it out/put it back in. Enough people do wear it around their neck (IM and otherwise) that it definitely doesn't make you look "out of place" doing so.
     
  14. badasshairday

    badasshairday Vascular and Interventional Radiology
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    I don't like the steth around the neck. Doesn't look as clean and organized. It works for IM docs who use it all the time. But for other doc's, it doesn't like as nice.
     
  15. virie

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    Whatever you choose to carry, empty everything except for your patient papers and stethoscope for rounds. You don't want to be standing for 4 hours w/ several books in your pocket.
     
  16. Bacchus

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    I'm on medicine

    1) Steth around my neck (use it too much to keep in my pocket)
    2) Patient list
    3) Notecards
    4) No PDA/Smartphone so I carry:
    *Tarascon's
    *Pocket Medicine
    *Sanford Guide to Microbiology
    *Maxwell
    5) Pens
    6) Reflex hammer (just to rule out some neuro stuff)
    7) Lecture schedule/calendar
    8) Large gloves bc they always tend to be out
     
  17. Mr hawkings

    Mr hawkings Senior Member
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    Doesnt that defeat the purpose if you're going to carry it around with you in your pocket?
     
  18. Bacchus

    Administrator Moderator Physician 10+ Year Member

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    Maybe its a NE colloquialism, but when things are out it means they're empty ;). I blame my parents and hometown for this one.
     
  19. officedepot

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    Good for all rotations:
    2 pens
    paper (get from printers to keep notes on)
    pocket reference depending on rotations (always maxwell's; pocket med; surg recall; I actually like carrying around case files to read on down times when I didn't have too much stuff)
    stethoscope
    trauma shears (never know when you'll need them and they are light)
    reflex hammer (I think it's a good light tool)
    smartphone
    pager if your school gives you one
    gum

    If you are cool:
    otoscope/ophthalmoscope - if you have a small, light one you'll look like a champ for certain cases; otherwise you don't really need one for most rotations - I think it's good for medicine, neuro, peds, and family med


    dressing supplies can easily be obtained when needed/ just think ahead or make an effort to get them while rounding ahead of time

    you probably won't need anything on psych
     
  20. Rollo

    Rollo Renowned Wolf
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    Maybe replace the reflex hammer with an actual hammer for psych for a little self-defense??
     
  21. ussdfiant

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    An attending here, just peeking in. Years from now you guys are going to look at a post like this and wonder "What did I even need a white coat for?" Any Internist who is carrying more than a stethescope, a pen, a beeper, and a pt list is overloaded!
     
  22. Bacchus

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    Probably, haha. I picked my whitecoat up today after not wearing it over the weekend and can't believe the weight of it.
     
  23. Pembleton

    Pembleton Senior Member
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    Cyanide pill
     
  24. officedepot

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    that's because, from what I've noticed, you guys for the most part don't do jack for a physical exam. As a result lots of stuff is missed initially and then picked up later because you're so worried about going quickly and only listening to the patient's heart and/or lungs. I've seen some attendings who are super amazingly good at the physical exam and they can diagnose some difficult stuff on that alone (or at least have a very narrow differential). So it's not worthless... even though you are all just going to get a scan anyway.
     
  25. turkeyjerky

    Physician 7+ Year Member

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    Lol, you really want to sit there and wait for 20 min while the attending checks the all the reflexes on every patient? Or looks in the ears to pna patients to check for bullous myringitis?
     
  26. ussdfiant

    Physician Moderator Emeritus 10+ Year Member

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    Ahhh, to be a medical student. See how thorough your physical exam is on your 20th pt of the day while you have 2 admissions waiting for you in the ER
     
  27. isoquin

    isoquin Allopathetic
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    rubber ducky.
     
  28. 410322

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    Thorough != efficient. He wasn't claiming to be the best at admitting and the quick diagnosis -- he's an MS3 and learning, not a resident.
     
  29. Jolie South

    Jolie South is invoking Domo. . .
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    I don't think a new MS3 is capable of a thorough OR an efficient physical exam.
     
  30. 410322

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    I wasn't the one that originally used thorough, and I only mentioned efficiency because ussdfiant was talking about admit backlogs.
     
  31. officedepot

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    that's no excuse for not doing a good physical. I never said you need to do that whole thing. I only point out that most attendings I have worked with just completely blow it off (not neuro people though). A thorough focused exam can/should be done on every patient. Just listening to the heart and lungs is not enough.

    for example, pt comes in with alcohol withdrawal and ED notes a soft systolic murmur. What's your exam? look to make sure he isn't shaking, listen to heart, listen to lungs, then get labs (which were probably already obtained by the ED). Well you could go ahead and do a waaay better cardio exam to see if that murmur really is just a innocent murmur or a complication of some other issue.


    But whatever. I actually hope more attendings stay lazy like you because you'll keep people like me who are going to go into radiology in business. Just leave the diagnosing stuff to us.
     
  32. officedepot

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    false. It has been shown (though I don't have the study) that medical students actually do the best physical exams. Attendings are the worst. Gives us some pride. Can't tell you how many times I've read an ED note or the intern's note and then go to the exam (not long after their note or after I talked to them) and find stuff completely different or find tons of stuff they missed.


    For example, how many of your attendings even bother to look at a patient's eyes? I have seen so many issues with eyes that were just completely overlooked by everyone. It doesn't take that long to look at the pupils, sclera, and EOMI...
     
  33. Jolie South

    Jolie South is invoking Domo. . .
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    I think new third years go through the motions of a thorough physical exam, but don't have the experience to appropriately interpret or describe findings. Heck, I as a fourth year don't always have that ability.

    The only way the student discovers things is when they fumble through an exhaustive list of exams from your first or second year "doctoring" course and are like "um, what is this?" Half the time it's a normal benign finding.

    And I do have pride in my skills. Most of which is in my ability to select which exams are indicated for a particular chief complaint and what findings I should be hoping to elicit on a thorough exam of those areas, as that's what I will be expected to do as a resident. Do you think as a general surgery intern that people would give two craps if I checked pinprick sensation or tympanic membranes on all my patients? No, I need to evaluate what's critical and move on.

    If you could cite that study, that would be great.
     
    #32 Jolie South, Aug 10, 2011
    Last edited: Aug 10, 2011
  34. ussdfiant

    Physician Moderator Emeritus 10+ Year Member

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    In my 10 years on SDN through medical school, residency, and beyond, this is the most disrespectful post I have ever had directed towards me, and from a medical student. Being called lazy by someone who manages what, 10 pts on a medical service while being overseen by an intern, resident, and an attending...priceless. I am seriously wondering if I have been sucked in by a troll.
     
  35. Rollo

    Rollo Renowned Wolf
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    I'm actually glad that he's going into radiology otherwise he would've been kicked in the face by a patient sooner rather than later for being such a douchebag.
     
  36. officedepot

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    ok I will admit I was being a douche and probably trolling some. I was directing that statement more at attendings and even residents in general, not you specifically.

    Regardless a focused thorough physical does not take that long, especially at your level. Again, you don't need to look at the tympanic membranes if the patient clearly has a UTI or something simple. But even taking a good history is lacking in many circles and often times the underlying cause of common issues are not caught early because not enough questions are being asked and a good physical isn't done (a physical finding can easily change a differential or add to it what common tests ordered might not pick up). But this is just my opinion and experience over the last year working on many different teams. Lots of docs just go straight to tests and scans... though I guess that is necessary nowadays because that is the standard of care. And time constraints just make docs want to take care of the acute issue and an underlying dx or even another separate problem can be overlooked. Oh well.
     
  37. ArcGurren

    ArcGurren only one will survive
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    Speak for yourself, I'm an M3 and my school does one hell of a good job training us.

    It also depends on your own confidence in your ability - if you practice, practice, practice, you get good at it, and you do pick up stuff. I picked up a murmur my attending was unable to hear initially (this is an established patient with a good doctor) because of my thorough exam. Also it doesn't take me THAT long to do a moderately thorough exam... maybe 10 minutes max in an office. Obviously if it's an initial physical visit it would take longer but the attendings do have to do full exams then as well. I agree knowing what to do with a focused exam is key.
     
  38. ArcGurren

    ArcGurren only one will survive
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    You know what, even if I agree that M3s can do a good thorough exam and that anyone can learn to do one quickly... this is by far the most douchey, rude statement I've ever seen... not because the person is an attending but because the bull**** statement of "leave the diagnosis stuff to us" is the dumbest thing I've read in my life.
     
  39. Jolie South

    Jolie South is invoking Domo. . .
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    There's no amount of practicing that you can do on classmates with normal findings that will prepare you for the experience of the abnormal findings on wards when you get there. You can theoretically know what the abnormal findings are but that's not the same as knowing that's what you're seeing.

    I was unprepared for the subtlety of most abnormal findings despite "knowing" what rales, rhonchi, wheezes, murmurs, etc were supposed to sound like and the terms that were used to describe them. Those are things that can only be gained with experience. That doesn't mean that MS3s won't say "I think I heard something off here and this is what I think it is." That definitely happens, but that doesn't mean the description or characterization is right.
     
    #38 Jolie South, Aug 10, 2011
    Last edited: Aug 10, 2011
  40. Doctor4Life1769

    Doctor4Life1769 **tr0llin, ridin dirty**
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    Followed by...

    "Clinical correlation required..."

    :laugh:
     
  41. badasshairday

    badasshairday Vascular and Interventional Radiology
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    Actually you did direct your comment to ussdfiant. You said "you". Plenty of douchebaggery in that post. Plus with that attitude of "keep the diagnosing to us" will not take you very far in radiology, a consultant and service based specialty.
     
  42. Telencephalon

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    The interwebs are amazing. I only hope one day I can see a medical student lecture a board certified internist on the importance of the history and physical in person.
     
  43. dozitgetchahi

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    Yep. The subtleties of physical exam findings are much trickier to get a handle on than I'd figured. Murmurs especially often sound nothing like how they're "supposed" to sound and are generally fainter than the recordings you were introduced to as a 2nd year.

    This said, to act as if there are no sloppy attendings whatsoever is patently ridiculous. I'm not nearly arrogant enough to act as though I know better than attendings at this point in my training, but even after just one rotation I'm surprised to see how broad the range of clinical skill and acumen can be among residents and attendings.
     
    #42 dozitgetchahi, Sep 1, 2011
    Last edited: Sep 1, 2011
  44. bioteach

    bioteach MSIV
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    QFT.

    There is quite a bit of ego on this thread. Seriously people, I don't care how many standardized patients you've played with...you don't have the diagnostic skills to do squat yet during 3rd year.

    Back to the topic at hand....

    1. Stethescope
    2. 2 pens, 1 highlighter
    3. Patient list
    4. Ipod touch/cellphone (epocrates, etc, usually a pretest qbank app to do questions during down time)
    5. small notepad
    6. hand sanitizer, tiny travel advil bottle, chapstick
    7. granola bar
    8. credit card/cash
    9. Maxwells (even though I rarely used it and could have found the same info online just as quickly)


    Any time I ever look anything up on rounds its on my ipod, never actually in a book.
     
  45. Vision100

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    :)
     
  46. tco

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    Has to be a troll. He mentioned, "diagnosing," and "radiology" in the same sentence. There aren't many radiology reports that read shorter than a 15 option differential diagnosis.
     
  47. meister

    meister Senior Member
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    The answer to this thread is nothing, because you should never wear your white coat.
     
  48. gmsquid

    gmsquid Member
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    Now that's my type of med student! [i absolutely hate that thing]
     
  49. poorracerkid

    poorracerkid Life is short, be happy
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    No coat attending style would be nice. Not going to happen at most teaching hospitals though..
     
  50. 45408

    45408 aw buddy
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    Have you done a surgery rotation yet? We always do a thorough physical exam on the relevant body part.

    The med student keeping it real for all of us. Thanks, man.

    Let's see the study.

    Man, just think what would have happened if you hadn't caught that coloboma!
     
  51. 45408

    45408 aw buddy
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    [​IMG]
     

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