September 10, 2008

• Sub-I

  Whew…apparently the Sub, in sub-I stands for subjugated. But I am getting ahead of myself…

  For those of you unfamilar to the med school meat grinder, The Subinternship, or SubI for short is the one rotation that all 4th year med students are required to go through, in comparison to the remainder of the year, which we pretty much plan ourselves. It is a month spent acting like a real honest to goodness licensed intern on the medical floor, with the caveat that any orders we write still must be cosigned.

  My team consists of two senior residents, three sub-I’s aside from myself, and one medical student.I flew back in to Chicago on Sunday. Monday (my first day) I was on call..trial by fire learning at its finest. Our team caps at 6 patients each, and since it was the first day, me and one other subi decided to split the call, so we only admitted 3 patients each. And when i say admitted, I dont mean 3rd year med student admitted, where all you are basically responsible for is the history and physical. No sirree, we also get introduced to the wonderful world of medical paperwork, writing admissions and orders.

  Not too worry, laypeople. The final say on what orders are actually carried out is dependent on the senior resident. Other than that though, the patients I admit are mine-I am responsible for following them during their hospital stay, writing the daily notes, ordering consults, ensuring all tests are performed and the results followed up on…its just like being a big boy real doctor.

  Following the call, we presented our patients in morning rounds, and just like the real interns our post call day, which is supposed to end at 1:00PM due to those workweek regulations in fact ended somewhere around 4PM. The post-post-call day is short call, meaning we still admit patients until 4PM, then we sign out and it becomes the on-call teams problem responsibility.

  One of the things that is new to me is the sacred important necessary duty of dictating any patients who have been discharged. This entails punching a special code into the phone and then summarizing the patients hospital entire hospital stay, including admit diagnosis, discharge diagnosis, all treatment given, any and all procedures done, and of course the history and physical along with any significant developments. It doesnt sound that difficult until you think about how some patients remain in the hospital for weeks on end and SOMEBODY has to dictate that.

  The dictation reports eventually get transcribed and placed in the electronic medical records so for any future admissions the other doctors will know what went down, and if the admission is for a similar problem, they can see how effective the previous treatment was. Whoever actually transcribes the dictation though must have had a grand old time listening to mine though. It was filled with such pearls as

  “44 year old woman admitted with diagnoses of chestpain for 4 days and, oh wait, I mean this is almost drj dictating the discharge report…”

  “MRI of the brain was performed without contrast and the uh erm brain scan came back negative”

  and the best, after dictating the whole history and course treatment then thinking I forgot to say something, rewinding and dictating the whole thing again on the principle that it would record over and realizing that in fact it didnt-” Oh wait, I totally didnt need to say this…nuts”

  Hopefully future dictations (and there will be future ones) will go somewhat smoother, but all in all, not bad for a first couple of days. On call again Saturday, and according to the schedule this month, it looks like I get a total of 3 whole days off! w00t!

  Future posting may be sporadic for a while, given my responsibilities, my attempt to finish up and submit my residency applications, and studying for the Step2 ck.

  -Almost Dr J

  • 9:41 pm
  • 4 Comments