Question about clinic

[nope80]

So I had a few questions about clinic Any advice in general about things to keep in mind, to do, not to do for residents clinic? Also, another question, when we have clinic do residents typically go back to the wards when clinic is over or no? Especially when you are on call or having a busy day? The reason I ask is because if your clinic happens to be far from the hospital you are rotating is it general practice that you are expected back inhouse at the end of the day to tie things up? For some reason I totally did not pay attention to what our residents did for this issue while I was on the wards

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[Law2Doc]

So I had a few questions about clinic Any advice in general about things to keep in mind, to do, not to do for residents clinic? Also, another question, when we have clinic do residents typically go back to the wards when clinic is over or no? Especially when you are on call or having a busy day? The reason I ask is because if your clinic happens to be far from the hospital you are rotating is it general practice that you are expected back inhouse at the end of the day to tie things up? For some reason I totally did not pay attention to what our residents did for this issue while I was on the wards

I'm sure different places have different policies, but my experience I that you usually are going to be coming back to the hospital after clinic unless you chief tells you otherwise. And you aren't going to get out of call because of clinic.

 

[IMdocT]

my experience in my program:

yes you go back to the floors after clinic. even on call. it's kind of tough because you try to write all your discharge notes and orders before clinic. it's even harder trying to discharge and admit all your work before noon. after clinic, you see the rest of the patients who came up before you capped. the senior will usually see the patient and write skeleton orders.

during clinic people page you bugging you about the nursing home wants a printed script for a narcotic and the patient can't leave unless you go up and sign one. or a patient's family showed up and wants to talk to you. if you have a nice senior, senior will help you out. you're screwed if the senior has clinic on the same day as you, but usually the schedules are made to avoid that. if you have a hospitalist for the attending, nice ones will help out too if they know you have clinic that afternoon. private attendings are never around except in the morning.

you have to go back to electives too, to round on the consults. hopefully, there's more than 1 intern on your service, and you can get the early consults and staff them before clinic.

in the beginning it will be hard to finish clinic on time, but towards the end, it gets easier. but it's always going to be tough trying to multitask between clinic and the rotation. clinic pages always interrupt your inpatient work-day too. some patients expect you to call them back right away, others will wiat till the end of the day. some of my co-interns tell all their patients to wait until the end of the day. i usually answer within the hour, or i call them back and tell them i'll call them at the end of the day, especially if they have a complex question that doesn't need to be handled right away.

 

[nope80]

wow, what you described sounds really stressful The reason why I asked was because several months of the year we have to rotate at a hospital that is about 30 minutes away. And from what I understand our teams are 1 intern and 1 senior. So yeah, that is going to be really really hard on clinic days running back and forth with only 1 intern...where I went to med school there were two interns so at least when one has clinic, the other can keep things afloat.

 

[jdh71]

So I had a few questions about clinic Any advice in general about things to keep in mind, to do, not to do for residents clinic? Also, another question, when we have clinic do residents typically go back to the wards when clinic is over or no? Especially when you are on call or having a busy day? The reason I ask is because if your clinic happens to be far from the hospital you are rotating is it general practice that you are expected back inhouse at the end of the day to tie things up? For some reason I totally did not pay attention to what our residents did for this issue while I was on the wards

Clinic. Unless you LOVE out-patient medicine will be the turd that floats in the punchbowl that otherwise is your awesome intern life.

No real advice about clinic itself. Show up, do your best. Out-patient management of chronic medical conditions is nuanced and complicated, and no one will expect you to know what to do for every patient early on. Take a good history. Do a good and thorough focused exam (always listen to heart and lungs - billing ).

You are expected to come back for clinical duties if there are duties to be had. At my program we tried to help each other out on clinic days, and if you're work could be covered by another so you didn't have to come back, that's what we did, with the expectation that the same would occur when the other intern on the team would be gone. Some days things get busy. It's best to just come back and see what's going on and check in with your senior early on. They'll let you know.

 

[jdh71]

wow, what you described sounds really stressful The reason why I asked was because several months of the year we have to rotate at a hospital that is about 30 minutes away. And from what I understand our teams are 1 intern and 1 senior. So yeah, that is going to be really really hard on clinic days running back and forth with only 1 intern...where I went to med school there were two interns so at least when one has clinic, the other can keep things afloat.

Then things will probably be VERY senior resident dependent. And unfortunately, not every senior is created equal, some think not being an intern any longer provides them the excuse to be lazy and useless. I always helped out my interns on clinic days - plus I get a buzz from discharges, so if I have to do them myself I will.

 

[Buzz Me]

I think our (surgical) clinics are different - typically once or twice a week, usually 8-4, once the work is done we return to the floors to catch up with the rest of the team. You can't just "go home."

 

[IMdocT]

in the programs i've seen, you're also usually excused from clinic when you're on long call/overnight call if you are at a different facility. seniors aren't excused though.

1 tip i have is: write your clinic notes as early as you can, because you'll forget most of the details within a few days, and when you write a crappy note and when the patient comes back to see you, it's hard when you have no idea what your previous plan was.

ps. i'm in internal medicine

 

[jdh71]

in the programs i've seen, you're also usually excused from clinic when you're on long call/overnight call if you are at a different facility. seniors aren't excused though.

1 tip i have is: write your clinic notes as early as you can, because you'll forget most of the details within a few days, and when you write a crappy note and when the patient comes back to see you, it's hard when you have no idea what your previous plan was.

ps. i'm in internal medicine

who waits days to write a clinic note?

 

[IMdocT]

seen it happen a lot to the other previous 1st years. and as an intern i picked up patients that had blank but signed clinic notes, i'm guessing because the previous residents couldn't remember anything to write about

 

[smq123]

and as an intern i picked up patients that had blank but signed clinic notes, i'm guessing because the previous residents couldn't remember anything to write about

How does that even happen?? And who in their right mind thinks that that's acceptable?

 

[jdh71]

How does that even happen?? And who in their right mind thinks that that's acceptable?

Agreed

Our clinic notes always had to be finished the day we saw the patient, sometimes that meant staying until 7pm, but that's just what you do. Of course we weren't used or abused (5 patients per half day of clinic, with a 6th slot first thing in the morning for use at our discretion, mostly for discussion of serious lab/test/scan results or joint injections I didn't have time for, though sometimes I'd squeeze a quick visit in there if the patient needed it) and most days I'd finish patient notes immediately after seeing them.

 

[Buzz Me]

We have to dictate our clinic notes that same day.