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First Aid for the Medicine Clerkship

First Aid for the Medicine Clerkship

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Published by squeakycrows

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Published by: squeakycrows on Nov 03, 2010
Copyright:Attribution Non-commercial


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Be on Time
Most medical ward teams begin rounding between 7 and 8
.If you are ex-pected to “pre-round,” you should give yourself at least 10 minutes per patientthat you are following to see the patient and learn about the events that oc-curred overnight. Like all working professionals, you will face occasional ob-stacles to punctuality, but make sure this is occasional. When you first start arotation, try to show up at least 15 minutes early until you get the routine fig-ured out. If the morning vitals are not yet recorded, take them yourself. Also,look at the chart to update yourself on any developments.
Dress in a Professional Manner
Even if the resident wears scrubs and the attending wears stiletto heels, youmust dress in a professional, conservative manner. Wear a
white coatover your clothes unless discouraged (as in pediatrics).
should wear long pants, with cuffs covering the ankle, a long col-lared shirt, and a tie. No jeans, no sneakers, no short-sleeved shirts.
should wear long pants or knee-length skirt and a blouse or dressysweater. No jeans, no sneakers, no heels greater than 1
inches, no open-toed shoes.
Both men and women
may wear scrubs occasionally, during overnightcall or in the operating room. Do not make this your uniform.
Act in a Pleasant Manner
The medical rotation is often difficult, stressful, and tiring. Smooth out yourexperience by being nice to be around. Smile a lot and learn everyone’s name.Don’t be afraid to ask how your resident’s weekend was. If you do not under-stand or disagree with a treatment plan or diagnosis, do not “challenge.” In-stead, say “I’m sorry, I don’t quite understand, could you please explain. . . .”Show kindness and compassion toward your patients. Never participate in cal-lous talk about patients.
Be Aware of the Hierarchy 
The way in which this will affect you will vary from hospital to hospital andteam to team, but it is always present to some degree. In general, address yourquestions regarding ward functioning to interns or residents. Address yourmedical questions to attendings; make an effort to be somewhat informed onyour subject prior to asking attendings medical questions. It’s always good tomake your residents look good on rounds (...“Dr. Smith was nice enoughto teach me about ...”). Make sure the resident knows new patient develop-ments ASAP.
Address Patients and Staff in a Respectful Way 
Address patients as Sir, Ma’am, or Mr., Mrs., or Miss. Try not to address pa-tients as “honey,” “sweetie,” and the like. Although you may feel these names
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are friendly, patients will think you have forgotten their name, that you arebeing inappropriately familiar, or both. Address all physicians as “doctor,” un-less told otherwise.
Show Initiative
Often, residents are busy with work and neglect their teaching responsibili-ties. Read up on your patient’s condition, find an article, and offer to summa-rize in a few minutes what you learned. Give a copy of the article to your resi-dent. This kind of initiative goes a long way in evaluations.
Take Responsibility for Your Patients
Know everything there is to know about your patients: their history, test re-sults, details about their medical problem, and prognosis. Keep your intern orresident informed of new developments that they might not be aware of, andask them for any updates you might not be aware of. Assist the team in devel-oping a plan; speak to radiology, consultants, and family. Never give bad newsto patients or family members without the assistance of your supervising resi-dent or attending.
All patients have the right to have their personal medical informationkept private. This means do not discuss the patient’s information withfamily members without that patient’s consent, and do not discuss anypatient in hallways, elevators, or cafeterias.
All patients have the right to refuse treatment. This means they canrefuse treatment by a specific individual (you, the medical student) orof a specific type (no nasogastric tube). Patients can even refuse life-saving treatment. The only exceptions to this rule are if the patient isdeemed to not have the capacity to make decisions or understand situ-ations, in which case a health care proxy should be sought, or if thepatient is suicidal or homicidal.
All patients should be informed of the right to seek advanced direc-tives on admission. Often, this is done by the admissions staff, in abooklet. If your patient is chronically ill or has a life-threatening ill-ness, address the subject of advanced directives with the assistance of your attending.
Be self-propelled, self-motivated. Volunteer to help with a procedure or a diffi-cult task. Volunteer to give a 20-minute talk on a topic of your choice. Volun-teer to take additional patients. Volunteer to stay late. If the answer is “Youdon’t have to,” do it anyway.
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Be a Team Player
Help other medical students with their tasks; teach them information youhave learned. Support your supervising intern or resident whenever possible. Never steal the spotlight, steal a procedure, or make a fellow medical studentlook bad. Making other people look good always helps you, too.
Be Honest
If you don’t understand, don’t know, or didn’t do it, make sure you always saythat. Never say or document information that is false (a common example:“bowel sounds normal” when you did not listen). This can get you into serioustrouble.
Keep Patient Information Handy 
Use a clipboard, notebook, index cards, or PDA to keep patient information,including a miniature history and physical, and lab and test results, at hand.
Present Patient Information in an Organized Manner
Here is a template for the “bullet” presentation:
“This is a [age]-year-old [gender] with a history of [major history such asHTN, DM, coronary artery disease, CA, etc.] who presented on [date] with[major symptoms, such as cough, fever, and chills] and was found to have[working diagnosis]. [Tests done] showed [results]. Yesterday, the patient [state important changes, new plan, new tests, new medications]. This morn-ing the patient feels [state the patient’s words], and the physical exam is sig-nificant for [state major findings]. Plan is [state plan].
The newly admitted patient generally deserves a longer presentation followingthe complete history and physical format.Some patients have extensive histories. The whole history should be presentin the admission note, but in ward presentation, it is often too much to ab-sorb. In these cases, it will be very much appreciated by your team if you cangenerate a
good summary
that maintains an accurate picture of the patient.This usually takes some thought, but it’s worth it.
First, confirm that the CXR belongs to your patient.
If possible, compare to a previous film.Then, present in a systematic manner:
Rotation, anteroposterior (AP) or posteroanterior (PA),penetration, inspiratory effort.
Bony structures:
Look for rib, clavicle, scapula, and sternum fractures.
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