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Posts Tagged ‘on-call’

Med Students & Interns – How To Keep Your Pager Out of the Toilet

Med School & Internship Answers No One Ever Tells YouNow that everyone has switched over… 2nd year med students have started their clinical rotations, 3rd year medical students have become 4th years and are beginning the countdown to graduation, and new interns have started their stress-year…

I thought it appropriate to cover something you will never be taught about your pager… at least not formally, anyway. So here it is:

How To Avoid Having Your Pager Fall In The Toilet

It’s really quite simple. When wearing scrubs, you only have this semi-thin drawstring that doesn’t really hold a pager too well.

SCRUBS: If you wear your pager on your scrubs, it will flop around and sometimes unclip itself depending on your position.

WHITE COAT (side pocket): If you put it in your white coat side pocket, you will leave it on during conferences or you will not feel it vibrate. You also run the risk of it slamming into a door or wall as you walk.

WHITE COAT (top pocket): If you put your pager in your top pocket of your white coat or of your scrubs, well, that’s just inexcusable… it will fall out when you bend over & it will be impossible to reach if you wear a gown.

So here’s what you do (see the video at http://youtube.com/RookieDoc):

1. Tuck in your shirt – all the way – even in your underwear
2. Face your pager in towards you (not outward like you would if you were using a belt)
3. Clip the pager around your scrub bottoms drawstring AND your underwear

That’s it. I hope it helps :)

Residency Horror Stories – Why Stories?

Lessons from RookieDoc's Residency Horror Stories

I’ve started a Residency Horror Stories series. The point is not to get you nervous about your training or being on-call or anything like that… In fact, it’s quite the opposite.

Most people think they learn best through experience. That’s true, for the most part… but there’s another piece of “experience” that is even more important than the experience itself… and that’s “the story”. We remember things as stories. We further ingrain the memory by retelling that story. And each time we retell it, there’s an opportunity to extract new insights from it and an opportunity for the listener to benefit from your story.


==> Tell Us Your Residency Horror Story <==

Now some of the medical establishment (the Old Boys Network) may be a little upset with me for saying this, but… the dry, factual version we often present on rounds is not always optimal.

Which one are you going to remember?:

THIS?:

49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, hypotension, and diaphoresis. Her EKG demonstrated 3mm ST segment elevation inferiorly. Cardiology was consulted and she was emergently taken to the cath lab. After a brief Vtach arrest requiring 260 Joules for return to sinus rhythm, her right coronary artery was successfully stented with two Taxus stents with good angiographic results. She was transferred to the CCU in stable condition with an intra-aortic balloon pump, IV heparin, Plavix, and aspirin.


OR

THIS?:

It was my first week as a second-year resident and I was on-call in the CCU. I was called stat to the ER for a CCU admission that was described as a “49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, shortness of breath, and diaphoresis.” I was told that cardiology was consulted via phone & they recommended transfer to CCU after a VQ scan.

I went to see the patient & there’s a morbily obese lady lying in Trendelenberg, IV fluids wide open, heart rate in the 40s, and huge “tomb stone” STs on the monitor. I introduced myself and told her that we would take good care of her. She looked up at me and said, “Son, I’m gonna die tonight if you don’t do somethin’.”

I went to the ER doc and said, “This lady’s clearly having a huge RCA MI! She’s bradycardic, hypotensive, complaining of chest pain, & her EKG… well, look at it! We can’t send her to the unit with a VQ scan.”

He responded, “Well, I talked to the cardiologist on-call.” And I asked, “Well, are sure he understood what we’re looking at here? I mean, no offense, but sometimes it’s all in how we say it. I think you should call him back.”

Well, he did… the ER doc called back the cardiologist on-call and got screamed at… loud enough for me to hear it through the phone from about 4 feet away. “I said!… Admit to CCU and get a VQ scan!”.

He hung up. There I am, a new second year, one of my first nights with any kind of real responsibility and I’m disagreeing with the ER attending and the subspecialist. What should I do?

Well, there was no question… that lady said to me, “Son, I’m gonna die tonight if you don’t do somethin’.” So I did… I firmly asked the ER doc, “I’m not comfortable with this! Are you comfortable with this?!” He said, “No… No, I’m not.” So, I asked, “Well, how about TPA?” He paused… so I snatched the EKG out of his hands and ran 3 floors up to the telemetry floor. There was a cardiologist (from a competing group) and I shoved the EKG in front of him and said, “49 year old lady in Room 8 in the ER, tons of risk factors, heart rate in the 40′s, telling me she’s going to die… no labs back yet.”

He said nothing to me. He picked up the phone and called the cath lab. Together he and I wheeled her into the lab. While we were lifting her to the table, she arrested….

So which one are you going to remember? Which one will give you strength to do the right thing when the time comes. Both of those versions are true. I lived through it. More importantly, so did the patient, but not before her night got much, much worse. I’ll tell you the full story and the lessons learned in the second video for “Residency Horror Stories”… the first video will be in the next few days.

Do you have a story we can all benefit from? Tell us. Here’s the link again:


==> Tell Us Your Residency Horror Story <==

Limiting Resident Work Hours

Even though a blog is often the writer’s soap box… that’s not what I’m going to do with this particular subject. I’m just pointing it out for med students, interns, and residents… just to be aware that there are even more changes being discussed in resident work-hour reform. I want to suggest that you reserve judgment. Here’s why…

It’s easy to think about yourself in the short-term and think, “Heck yeah! I want to limit my work hours!” But be careful, there are definite pros and cons. And we are talking about a dynamic system here.

Part of being remarkable in your profession is your ability to “see systems”. You should know that one tweak in one part of the system may have profound implications in other parts of the system. And in this “me world” you might miss the effects on other parts. And in this “right now world” you might miss, even, the longer-term implications for yourself.

But I’m not going to go there right now. (RookieDoc members – I’ll teach you how to overcome the cons with a whole separate bonus module…) Just keeping you informed here by linking to an interesting article and an interesting blog post. Check them out.

By the way, if you’re on Twitter, you may want to follow “kevinmd” too… he’s got a lot of great insights.

Avoid the Caller ID When Calling the ER

You’re on-call and it’s three in the morning. You get called from the ER and you call them back from your call room, because you had just laid down. You’ll find that it’s almost like they have a direct connection to your pillow. As soon as your head hits that pillow, they’ll call you.

You call back and they see the in-house caller ID “resident call room” and the ER doc says, “Whoa! Dr. Tori, trying to get some sleep? Trying to rest your head? Why don’t you come on down? I have a few admissions for you.”

Great. That kind of stuff starts to tick you off after awhile. The first few times you’re like sure and you head on down. The next few times you start to get the idea that people think you’re a slacker because you’re in your call room.

Well, here’s the thing… (more…)

On-Call Hours Study States the Obvious

Ready for this?… It’s a shocker… A study published in the Vol. 300 No. 10, September 10, 2008 issue of JAMA concludes,

“increased on-call workload was associated with more sleep loss, longer shift duration, and a lower likelihood of participation in educational activities.”

You can see the article abstract here: Association of Workload of On-Call Medical Interns With On-Call Sleep Duration, Shift Duration, and Participation in Educational Activities

3 Things I Kept In My White Coat Pocket

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.