Posts Tagged ‘internship’

A huge part of your training is getting feedback – constructive feedback. Too often you will come across upper level residents, attendings, and supervisors who give useless feedback. And you should not settle for feedback that is useless.

Here’s what I mean…

Let’s say you go and ask your attending, “Dr. BossMan, I was just wondering how I’m doing. Am I doing okay?”

You will see, the problem lies in how you asked the question. Invariably, the answer will be “Fine. You’re doing fine.” Or, “You’re doing great. You have nothing to worry about.”

Useless. Completely and utterly useless.

This kind of “feedback” will not help you improve. It will not help you to form good habits, nor will it alert you to bad ones.

Here’s a better question for your attending… “Dr. Advisor, can you take a moment to look over this H&P and tell me how I can make it better?“

You can do this with any particular area you want to improve in. Note writing, history taking, presenting patients, introducing yourself, signing out patients, running codes, etc. Whatever it is.

I just added more to the feedback portion to the RookieDoc Orientation Mastery Program to help you optimize your feedback – templates and scripts – exact phrases to try for yourself. You really need to form good habits now.

Learn more about the pearls available in this program that one person called “an oyster farm”. This is the RookieDoc Mastery Orientation Program for interns, residents, and 4th year students who want to get a jump on internship.

Go read this letter I drafted… it’s a little long though, and a little salesy, but with good reason. There’s a ton of stuff – so it’s long. And I’m really, really excited about the program. I wish there was something like this around when I was feeling my way through the darkness of the first few months of internship. I still don’t know why this stuff is not taught (I’m rambling), but you get the point.

I posted a survey where you can ask me anything about internship and residency. I’ll answer some questions on the RookieDoc FAQs – these are occasional phone conferences for RookieDoc fans and members where I discuss a hot topic or answer questions.

Ask Me About Internship or Residency

I may not get to every question directly, but may be able to post important answers here, in special RookieDoc reports (PDF), on the RookieDoc Squidoo lens, or in the Audio Tips series.

Okay, I just spent almost the entire day putting some finishing touches on something that will really help you out… but indirectly.

It’s really cool, but in a way, it’s sad that I had to do it.

The fact is that because of your career path, and because of the current stage in that path, your relationships are in for a change – a shake-up. You are going to face stress from angles you never really thought of. Although it is all manageable, it is not easy. And unfortunately, our family and friends are usually the ones that bear the brunt of it.

So, I created tips and strategies for them – for your friends and family. No charge, no gimmick, no catch.

Very simple… They sign up with their name and email. Then every so often, I send them a little message – audio and written – only a few minutes long – but full of great info and ideas for maintaining your relationships (and sanity).

They can sign up here:

Or, better yet, send them to the main RookieDoctor.com site, to the Family & Friends section. Here’s the direct link: Audio Tips for Loved Ones and Friends of Interns and Residents.

Having an excellent bedside manner is ultra important. If you master having a good bedside manner, you stand to make your patient feel better, potentially heal quicker, and certainly complain less. Your patient will trust you more, and you’ll be able to extract a better history.

If you have a good bedside manner, your patient will tell other people. Your patient’s nurse will tell other people. And guess what? It will absolutely impact how your attending evaluates you.

You will be sued less, get paged less, and be respected more.

And it is so simple to start. Here are three quick tips from the Rookie Doc Squidoo lens:

1 – While sitting a patient up to listen to their lungs, just say, “Hey. While I have you up, let me flip your pillow to the cool side.”

2 – When you plan to order some medications, don’t just tell them you’re ordering them. Explain that it will take a little while for them to come up from the pharmacy.

3 – When you’re all done in the room, put things back the way you found them. Put the call bell in reach, move the phone closer, and, if their allowed to eat/drink, move their tray closer to them.

There are many, many more little things you can do listed at the Rookie Doc Membership Site.

If you don’t have a handheld device, you should get the following: 1 general pocket reference, 1 on-call pocket reference, and 1 drug pocket reference. Avoid having too many sources. That type-A, lay all the books out on the table when your studying move doesn’t work in internship or residency. So, don’t do it. It’s way too distracting.

Money Saver Tip – If you don’t have a handheld device (Palm, Pocket PC, Blackberry, etc), you should probably wait until your stipend kicks in from your internship or residency program. (Make sure they cover it)

Until I bought my PDA, I had…

Mass General Pocket Medicine – I scrapped the Washington Manual after about a week. I like Ferri’s better. But nowadays, I’d recommend this one… The full title is Pocket Medicine: The Massachusetts General Hospital Handbook of Internal Medicine

Tarascon Pocket Pharmacopoeia – I kept this one in my pocket even after getting a PDA.

The Sanford Guide – I pretty much only used 6 pages (the charts in the middle), but I used them almost everyday.

This is also available on the Rookie Doc Squidoo Lens. I’ll update that, since it is more like an article, whereas, this is a timestamped blog post.

This excerpt comes (with permission) from GiggleMed.com‘s Book of Lists

Whether you’re a patient, a surgeon, or any hospital staff member working in the OR, there’s enough stress as it is. It can certainly become a lot scarier if you hear any of these “Things You Never Want to Hear During Surgery.”

1. I’m kind of excited, the last time I performed one of these I was a resident.
2. What the heck is that?!
3. Ooops!
4. We have to hurry, my flight leaves at 3.
5. Has anyone here used one of these before?
6. Wait a minute! That’s not her gallbladder!
7. Now which side did we say? Left or right?
8. I’m starting to think that this whole thing is just a waste of time.
9. In about 2 minutes, we might need to charge up those paddles.
10. Is this lady a full code?
11. It’s alright… Go ahead… He’s asleep.
12. What a minute! Did I even scrub for this case?
13. I had a bad feeling about this case, but that tarot card reader made me feel much better.
14. We’re technically not supposed to smoke in here.
15. I’m gonna need one of you guys to start whispering in her ear. Tell her to “Move away from the light“.
16. Welp, I guess there’s a first time for everything.
17. Hi, I’m Bill, one of the OR techs, are you the new surgeon?
18. I don’t understand … This didn’t happen in the video.
19. Would someone please swat those flies!
20. Righty tighty, Lefty loosey.
21. Why do I feel like this patient is surrounded by a bunch of assassins?
22. Of course this is ethical!
23. I see dead people.

Copyright, GiggleMed.com, LLC. All rights reserved. Used with permission.

For other cool medical humor sites, check out the links section in the sidebar. If you want to view/download a pretty PDF version (although with only 21 items) go here.

Have you ever thought about who looks at your charting? Too often, what is written in the chart is thought of in real time only. When we write down our history, our exam, lab values, etc we’re thinking about providing good care to the patient right now. We may, at times, realize that a little later down the road a consultant might need what we’ve written, or something, but rarely are we thinking much further down the road.

You need to change that, and do it now. If you think about the full context of what you’re writing now – in your training – you will form good habits that will stay with you throughout your career. Check this out…

I once received a note I had written 4 years prior (from when I was a resident). It was faxed to me for my review. It turns out that another hospital was being sued by a patient they transferred to my hospital on a night I was on-call. I wasn’t being sued, but they needed my deposition, since I was the first doc to see the patient after transfer was initiated. And even though I wasn’t being sued, I felt nauseated seeing a note I had written years ago come across the fax… from Dewey Soo Em and Howe.

Here’s an incomplete list of (potential) eyeballs on your hospital charting. Please add more in the comments if you think of others…

• Attending physician
• Covering attending physicians – usually on weekends
• Nurse – usually a new one every 12 hours
• Consultants
• Pharmacists
• Pharmacy techs
• Unit secretaries
• Interns and residents
• On-call coverage, moonlighters, etc
• Coding department
• Billing department
• Utilization review personnel
• Social workers and case managers
• Insurance company reps and reviewers
• Other hospitals’ staff/docs (on future hospitalizations)
• Lawyers
• Patients, themselves (Google and Microsoft are both have patient-directed health care records)
• ChartFarts.com (medical charting funnies – whatever you do, don’t end up here)

Be careful with what you write or enter into the computer.

Don’t shoot yourself and everyone you work with in the foot!

If you’re a doc, then you shoot others in the foot when you tell patients in the hospital that you’re going to order a certain medicine or a certain test – without telling them that it’s going to take some time.

If you’re a nurse, you’re shooting the doctor in the foot when you say, “I paged the doctor, but they never called back.”

The fact is that both may be true… but you need to give more information. Think about it from the patient’s point of view…

“The doctor just now told me that pain medicine is ordered. Why doesn’t the nurse get it right when I ask for it?”

“Why isn’t my doctor calling back? I’m sick enough to be in the hospital, you’d think they’d call back. He comes in for 5 minutes a day, at least call back when the nurse has a concern!”

It takes less than twenty seconds to change the way you say things, and in the process you can save the patient, other nurses, other doctors, patients’ family members, etc a lot of grief.

It’s all about managing expectations…

Many patients have never been in the hospital before. Many family members have never had someone so close to them in the hospital. Listen to what you say with their ears. See what they see.

They see the doctor in their room for 5 minutes a day… They don’t see the doc

1. Checking labs
2. Discussing things with consultants
3. Reviewing old records
4. Discussing the dispo with the case managers and social workers
5. Arguing Advocating for the patients with the insurance companies
6. Writing progress notes
7. Dictating consults
8. etc.

If you’re a nurse, you can change all of that if you just say something like, “Behind the scenes, we’ve all put our heads together and the doctor has reviewed your labs. Although she’ll be by a little later, she’s up to date on everything that’s been going on. She has some pretty sick patients on another floor.”

Likewise, the patients don’t know that when the you (Doc) write an order that…

1. The secretary has to take that order off
2. The secretary faxes it to the pharmacy or enters it into the computer
3. The secretary alerts the nurse or flags the chart
4. The nurse reviews the order
5. The pharmacy checks for duplicate orders, drug interactions, therapeutic substitutions, etc
6. The pharmacy sends the med up
7. And, finally the nurse brings the med to the patient

All it takes is saying something like, “I’m going to order a stronger pain medicine for you. But, I apologize, it’s going to take a little while for it to come up from the pharmacy.”