July 24, 2007

• Clerking my way back to you babe, part 2

  Going from the classroom to the hospital can basically be boiled down to white socks and black socks. I came to a realization yesterday that I now have an incredible surplus of white socks at my disposal, while my black sock supply just keeps depleting. I’ve gone from a student, wearing messy clothes in local coffeeshops, seen only by my peers, to a professional, seen only by my team and my patients. It’s very yin and very yang: the intellectual pursuits of the first two years; the practical, hands-on management of the last two. The goals are very different: first came memorization of detailed facts and pathways. Now comes dealing with a real human.

  The two are without a doubt complimentary, but the two require incredibly different thought processes. In preclinical, you’re looking at disease with 20/20 hindsight: you’re memorizing the symptoms, the complications, the treatments, and the physiology. Here’s the disease, what are the symptoms? In clinical work, you’re looking at… the patient. He or she comes to you with a couple symptoms, you try to ask questions to get a couple more hints, and then try to use that information to figure out the disease. Here are the symptoms, what is the disease?

  With the end of the first month, my grace period is finally up. I’m no longer completely new to the routine. I’m expected by now to be able to contribute to the team without major goofs. To make on average more correct guesses than mistakes. However, even when i dont, my team is still incredible and does not make me feel bad about it.

  So what is a typical day for me? Get to the hospital by 7, pre-round on my patients. This means going in, waking them up usually, finding out how they did during the night, if they had any new problems, examing the pertinent systems (if they were admitted for a hear problem, check the cardio system. A muscular problem, check reflexes and muscles strength, etc) and check their labs to look for any changes there. Of course the labs usually arent available until 10am, but i look anyway. Then i have to go write up a note about my findings and put it in the patients chart so anyone else following the patient can know the most up to date information about them. As a med student i carry 1-3 patients. Most interns carry 6-10. Most actual doctors see like 30-40 in a day. puts things into perpsective, doesn;t it?

  I can usually finish my pre-rounds in an hour, then it is off to morning report at 8am where physicians from other teams will discuss patients they have seen. After morning report, the team will go on rounds. DUring rounds, our entire team will report to the attending on each of the patients we have been seeing, then the attending will go in talk to the patient for 5 minutes, perhaps teach us something about their condition, then we will come back outside the patients room, write a little note, and perhaps pimp us on their condition. This can take anywhere from 30 minutes to  3 hours depending how many patients there are.

  Then it is time to write more progress notes on our patients or finish up any work until noon conference. Noon conference is a lecture on some topic in medicine by a specialist, usually with lunch provided by a drug rep. There are many conflicting opinions about this i am sure. One could argue all drug reps are evil and i am selling my soul to them by accepting anything they offer. One could also argue that they are providing me with LUNCH and medical supplies i can not obtain on my own given my student budget. I leave you to ponder which view i take.

  Afte that, there may be another lecture, then i finish up any other work i didnt do in the morning and go home. UNLESS it is a call day. Call days are every 4th day, and that means I stay in the hospital until i have admitted a couple patients from the er. This may be done by 6pm, or it may take til 3am. The rest of the team stays overnight, but i am usuallu allowed to go by midnight if i have admitted a few patients.

  So that is the medicine clerkship in brief, and why i am so rarely online now for thos of you trying to contact me by the usual routes of communication. Thos of you just on xanga, i am sure you never realized i was gone.

  -J

  One of the most challenging and humbling parts of clerkships is how often I find myself having to say “I don’t know.” On anything from things that I do know but can’t recall on the spot, to things I truly have no clue about. Some things are even obvious but I’m just nervous thinking on my feet.

  • 10:55 am
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