When to speak on rounds?

[All4MyDaughter]

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Did a full SOAP on a patient today, took me an hour because the charts are all handwritten and disorganized. As I was wrapping up my work getting everything put away to leave for the day, I hear the nurse at the monitors go "Oh... the patient in ICU Isolation 2 just flatlined, call the family to inform."

Patient was DNR/DNI.

Should I just toss this workup out or are workups on patients who end up dying allowed?

I don't see why you'd throw it away. Do you need it for your portfolio or to meet requirements for your school? If so, the outcome of the patient's treatment shouldn't matter. It's the process you went through doing the workup and SOAP note that is relevant to your educational outcomes.

 

[Farmercyst]

Did a full SOAP on a patient today, took me an hour because the charts are all handwritten and disorganized. As I was wrapping up my work getting everything put away to leave for the day, I hear the nurse at the monitors go "Oh... the patient in ICU Isolation 2 just flatlined, call the family to inform."

Patient was DNR/DNI.

Should I just toss this workup out or are workups on patients who end up dying allowed?

I've included deceased patient work-ups before. I would usually work up two cases to present to my preceptor and tried to choose the ones I thought were most interesting to me. Easier to remember them that way.

 

[Farmercyst]

So I started my Internal Medicine rotation yesterday. Most of my responsibilities will be on the patient floor and rounding, with some presentations to residents and whatnot.

So my question, when should I speak? The team I'm on consists of the Attending Physician or Chief Physician, 2-3 residents, 2-3 nurses, social worker, physical therapist, and me. For example, today we were on a patient with MRSA bacteremia. Chief physician asked what the trough level should be? (He knows what it should be, but I think he was asking the team because he likes to teach while he is conducting rounds.)

Is it okay for me to jump in and say the answer or should I wait for the residents to say an incorrect answer first and then correct them? The thing is, this chief physician is always looking at the residents and I'm usually standing next to the chief physician: so I don't really know who he is directing questions to unless he directly asks me a question.

I'd go with it varies. My first rotation was with a 5th year Cardio thoracic surgery fellow. My preceptor was not on rounds with me either. We had 1 resident, 2 med students and a PA student. It was made clear to us that his main responsibility was to teach the med students. We were more along for the ride. I think I was asked a total of 6 questions in 6 weeks on rotation by him. Mostly he'd ask questions of the the med/PA students. I'd have only had this directed at me after the others tried and failed, and while Z's answer is most thorough, I'd have been cut off after the trough and follow-ups would have been asked of the med students to try and dig out the rest of the information. On my peds rotation I would have been allowed to give Z's full answer, provided I was able to. The dynamic was that different. As for access, we were given access after 1 week at my first rotation (fortunately I still had access from a previous elective, so I didn't have to wait.) My peds rotation, access was setup during my drug info rotation, so I also didn't have to wait. I've been lucky that way.

 

[Sparda29]

I'd go with it varies. My first rotation was with a 5th year Cardio thoracic surgery fellow. My preceptor was not on rounds with me either. We had 1 resident, 2 med students and a PA student. It was made clear to us that his main responsibility was to teach the med students. We were more along for the ride. I think I was asked a total of 6 questions in 6 weeks on rotation by him. Mostly he'd ask questions of the the med/PA students. I'd have only had this directed at me after the others tried and failed, and while Z's answer is most thorough, I'd have been cut off after the trough and follow-ups would have been asked of the med students to try and dig out the rest of the information. On my peds rotation I would have been allowed to give Z's full answer, provided I was able to. The dynamic was that different. As for access, we were given access after 1 week at my first rotation (fortunately I still had access from a previous elective, so I didn't have to wait.) My peds rotation, access was setup during my drug info rotation, so I also didn't have to wait. I've been lucky that way.

Hmmmm.

At this hospital it seems like the attending is there to teach the residents. (Although, I've heard one attending saying, "when I conduct rounds, there will be no teaching, I want the information quick and concise.") The med students seem to just stand there on rounds and then they go follow the residents the rest of the day.

 

[koldun]

That's because your program sucks too...and you probably couldn't answer it that way any ways.

Hi! I'm from the Nobel Prize committee, and I'm here to present you with the award for the "Most Pompous Ass on the Internet" category. Your first post in this thread had made you a serious contender, but this addition sealed the deal beyond any reasonable doubt.


Anyway, I'm almost finished with my 4th year, and at this point I've been in about a dozen distinct hospital systems, and if someone (especially a student) tried to answer a question in such a didactic and condescending manner at any of them, it's not "respect and trust" that you'd earn. There's a thin line between knowledgeable and a show-off douchebag. You probably didn't realize it since you left that line miles behind you.