Hey readers, I hope you've been enjoying your new year. I'll have had a week on the Internal Medicine service as of Tuesday, and it's amazing how much I've picked up and how much of basic sciences I don't remember, haha.
Medicine is a great rotation to start on because it covers so many broad topics and exposes you to a lot of pathology. However, that also makes it a hard rotation to start on. How many people after winter vacation remember how to treat community acquired pneumonia off the top of their head? I got a lot of brushing up to do.
Tips:
1. On medicine rotation, your job is to know everything about your patient. Literally everything. Not just the labs for that day, but how they've been changing over time. It's really important, especially if you have a patient admitted by Medicine who is having a chronic disease/acute disease being managed and they need surgery soon.
2. Gel with your team. Unfortunately, the team you get is just luck and you can be rotating with a bunch of really cool, laid back people, or intense people. However, always be eager to help out and make it known, people will appreciate it.
3. Jump in it! Seriously. If you came into the hospital at 5am to work on things and evaluate your patients, when someone on your team is presenting that same patient, jump in at the appropriate time to bring up pertinent updates.
4. Jump in it! Again, be active about learning: when you get to the bedside with your team, glove up if your attending is, go feel pulses, go listen to heart and lung sounds. For some reason, I found that listening to heart sounds in COPD patient with a hyperinflated chest cavity to be easier with the bell of my steth.
5. If you are at a VA hospital: ask your patients about their military service. For many, it is the biggest achievement and biggest pride in their life.
6. Work through Step Up to Medicine, Pocket Medicine by Sabatine, and Goljan's Rapid Review Pathology. You won't have a lot of time, but you'll make it happen.
7. Get the vitals yourself! I can't emphasize this enough: the vitals will be more recent and you have more time than others on the team to be OCD about getting the right vitals and plenty of errors can be made by other busy staff.
8. Don't be afraid to ask nurses where to get disposable stethoscopes, EKG machines, vitals machines, etc. And be polite! I always ask if they are busy and since I grew up in Texas, say "Ma'am" and "Sir" all the time, haha.
9. Be comfortable with the physical exam and you'll make your patient comfortable. I don't say "Now we shall commence the physical examination" robotically. Instead after taking my history or getting the Subjective part of my SOAP note down, I say "Alright, let's have a look at ya. I'm going to start by listening to your heart." Depending on how busy you are, you can let your patient listen to their heart or lung sounds with your steth. It can make for a great moment if your patient is excited about medical things.
10. Teach your patients! Tell them their lab results if your team says its cool, and keep your patients updated. They are being hospitalized for days and only might see you or your team once a day and have to wait a whole other day wondering and possibly worrying.
11. Show up early to the hospital so you can spend more time with your patients. You'll get a better history and better idea of what happened overnight. Plus, if you're friendly and warm, they'll appreciate the company. I tend to take notes in front of my patients and I got a compliment by one of them saying I was really thorough and would make a great doc. Small things do a whole lot.
12. Be positive and have fun with your team: everyone is stressed out and working harder than you are and have many responsibilities. Do what you can to help out with the atmosphere (bringing in food never hurts!)
13. Always be willing to help! Sort of goes along my "jump in!" advice, which I personally am trying to work on more because I just don't know anywhere near as much as the members of my team and my clinical skills definitely aren't that of a doctor who has been practicing for years. The major upside to that is you get less anxious about getting put on the spot and you'll learn more. People are there to teach, and if you jump in and learn, they'll really appreciate it and give you a good eval likely.
14. Always check your inpatient's calves for redness, swelling, discomfort because you never want to miss a DVT in a patient!
15. Always ask an inpatient how they slept/how their night was. Fevers, shortness of breath, episodes of confusion, and new pain so far have been pretty common things mentioned in the morning on my rotation.
16. Obsess over a certain patient's relevant labs, but also know everything else! The pertinent labs are important to keep following, but remember that you don't want to miss a decreasing hemoglobin, or change in weight gain (like fluids in CHF pts), nor a decreasing platelet count in a patient scheduled for surgery.
17. Smile, shake hands, take a few seconds to talk with your patients about their military service if they're veterans, recent sports games, hobbies, or talk about family if they mention their kids or things like that. It will help them relax, they'll know there's someone in the big hospital they have a connection with, and they'll feel more comfortable discussing health/social history things. Also, teach your patients things about their condition, it shows you care and want to play a role in helping them take care of themselves.
18. I always use "Sir" or "Ma'am" when talking to patients, or their title and last name. I always say "Mr. [Name]" the first time I see a patient in the morning. I wouldn't use first names in a hospital, it just doesn't feel right and some patients might actually have the same first name, so yea. Also, I feel like older patients appreciate the show of respect.
Anyway, I'm off to read up on Pocket Medicine and get some things done. all the best!
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