Which resource is better for a new intern?

[HalcyonDays]

Okay, so I'm really strapped for cash but would like to buy something to help me along when I begin work next week. I'm debating between 5 Minute Clinical Consult from Skyscape for my Palm or Washington Manual (the book) to carry in my white coat. Skyscape's 5 Min Consult is a step above the rest b/c it has actual algorithms of symptoms that you check off and it gives you a list of differentials. I almost don't want to use it because I'll just turn my brain off completely and not think.

I was hoping some residents could give their opinions on these 2 resources and hopefully give a little advice and which of the 2 would be better for me. (I'm starting IM btw)

Thanks!

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[doc20]

get uptodate from your instuition or from an attending its just as good if not better

 

[Winged Scapula]

While I am tempted to agree with Tired that you should save your money and buy neither, I know how you medicine types like to have such things at hand. Therefore, I agree that you don't need to buy anything except maybe a Pharamcopeia and a Maxwell's for your pockets and then use whatever on-line sources your hospital has. It will be quicker than using your PDA.

 

[Gastrapathy]

Okay, so I'm really strapped for cash but would like to buy something to help me along when I begin work next week. I'm debating between 5 Minute Clinical Consult from Skyscape for my Palm or Washington Manual (the book) to carry in my white coat. Skyscape's 5 Min Consult is a step above the rest b/c it has actual algorithms of symptoms that you check off and it gives you a list of differentials. I almost don't want to use it because I'll just turn my brain off completely and not think.

I was hoping some residents could give their opinions on these 2 resources and hopefully give a little advice and which of the 2 would be better for me. (I'm starting IM btw)

Thanks!

For IM, you should carry 3 pocket books (you can 2 of the 3 on Palm, but I prefer the real thing cause its so much faster to look stuff up).
1. A drug reference (pharmacopia, epocrates, whatever), probably epocrates if you have a palm
2. Sanford Guide (a must have, you are an internist so unlike Tired you can't say "Ancef" to any question and make your attendings happy)
3. The latest Pocket Medicine ed Sabatine (then write notes in the flowsheets as you learn your institution's practice patterns).

Good luck, and don't worry, you can always subspecialize later.

 

[radslooking]

Good luck, and don't worry, you can always subspecialize later.

haha, way to toss that one in there at the end. reflects what many feel in IM these days

 

[HalcyonDays]

I went with the Pocket Medicine. But truthfully there is no time to even open the damn thing. It's so freakin' busy it's not even funny. I use my Epocrates more than any other program. The pharmacy also gave us 3 little booklets for general/abx/pain killer meds that are in the formulary which is very helpful and semi-negates the need for Sanford.

 

[DrDre311]

Please, it's way more complicated than that in Ortho.

Preoperative prophylaxis --> "Ancef"

Postoperative infection --> "Vancomycin and ID consult"

I'm currently looking for a publisher so I can make some cash off this system, but no luck so far.

Don't forget Keflex.

As an attending I plan only to write the following drugs: Ancef, Keflex, Cefzol, morphine, Percocet, Vicodin, and Tylenol #3.

 

[DrDre311]

We don't write for Keflex.

Mainly because it is completely useless.

F*** that. Keflex is f***ing awesome and you know it.

 

[San_Juan_Sun]

Don't forget Keflex.

As an attending I plan only to write the following drugs: Ancef, Keflex, Cefzol, morphine, Percocet, Vicodin, and Tylenol #3.

Why Percocet, Vicodin, and T3? Perc has better street value, just give that and keep the people happy.

 

[DrDre311]

Why Percocet, Vicodin, and T3? Perc has better street value, just give that and keep the people happy.

I like a little variety in my pain meds. Plus, some people insist on having a certain pain med because they've had it in the past.

 

[elwademd]

2. Sanford Guide (a must have, you are an internist so unlike Tired you can't say "Ancef" to any question and make your attendings happy)

i've found john hopkins antibiotic guide (unfortunately no longer free) to be more user friendly than the sanford guide.

 

[Blade28]

I use OxyIR almost exclusively when staff will let me.

Whoa, hardly ever see that around here!

Percocet and Vicodin comprise the vast majority of narcotics here. Occasionally we'll have variants like Demerol, Dilaudid or Lortab elixir (for the kids). Or fentanyl patches.

 

[Winged Scapula]

Whoa, hardly ever see that around here!

Percocet and Vicodin comprise the vast majority of narcotics here. Occasionally we'll have variants like Demerol, Dilaudid or Lortab elixir (for the kids). Or fentanyl patches.

Really?

We used (on Trauma) OxyContin or MS Contin and OxyIR all the time.

 

[DrDre311]

I never bought that nonsense about the "synergistic effect" between Tylenol/NSAIDs and narcotics. But even if I did, the downside of the acetaminophen-containing compounds is pretty clear: acetaminophen is ubiquitous in OTC drugs. Why risk the overdose?

Fun way to f*** with the medicine docs.

 

[DrDre311]

They always call if they readmit our patients.

OxyIR: Because you hate it when those IM f***ers call!

I like to envision myself as a particularly obtuse brick wall in these situations.

"Wait, yeah, we operated on him/her, I think...you want to do what? Huh? Is he/she infected? No? Well, why would he/she have to come to our service for that? No, I don't think Dr. [Infamous Plastic Surgeon] would like that. We're not going to operate again. You can't take that person to the OR for that; I'm pretty sure it'd be best if the patient came to your service...yeah, yeah, just seems like your area of expertise...not a surgical issue, better off on your service. Thanks. Let me know how he/she does."

Usually works.

 

[Gastrapathy]

Saw a spate of surgical readmissions to medical services during a ward month a couple years ago as a junior staff. Had the residents put together a list of cases that particularly pissed them off, went to our M&M coordinator and she emailed the various surgical PD's. The surgeons got to present the cases, the IM residents got to explain why they came back in and how we managed the surgical complications. Happened a lot less for a while.

Don't forget this one Tired. I might admit that some Ortho patients should be on an IM service from the get-go, but this was a wonderful learning opportunity for all sorts of folks.