当前在线人数15332
首页 - 博客首页 - 美国医学教育博客 - 文章阅读 [博客首页] [首页]
yf: How to survive those malignant program, especially in NYC?
作者:USMedEdu
发表时间:2009-03-10
更新时间:2009-03-20
浏览:1845次
评论:7篇
地址:10.
::: 栏目 :::
现代医学vs“中医”
社会、艺术与医学
住院/FELLOW单位
中外医学网站精选
国内外医学交流信息
生物医学人物
力刀美加医学教育专
临床见习/实习/义工
医学生理学诺贝尔奖
医生助理(PA)职业
医学书籍照片及图谱
社会与医学瞬间定格
医学典故/医史杂谈
USMLE复习和考试
申请和面试住院医生
住院医生生活和工作
FELLOWSHIP
医生就业、工作及生
医学科普及问题解答
美加医学院申请/MCA
中美医学临床教育比
医学新进展及新闻
社会医学伦理

发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: How to survive those malignant programs especially those malignant programs in NY-1
发信站: BBS 未名空间站 (Tue Mar 10 22:04:25 2009)

Match结果快要出来了,我打赌有很多朋友们会到一些Malignant program去,还有很多
可能已经拿到了这些program 的prematch.还有4个月我就要结束第一年residency,不
敢说已经survive了,但是至少已经签了又一年的卖身契,所以在这里提供一些经验。希
望有些经验对大家有用。

纽约的很多医院都是很malignant的,有很多医院医院关门了,有很多医院即将关门。
所以survive 的第一条就是:不要去那些医院!!!

但是但是,如果不得已,match还是比match 不上好,如果你不幸像我这样稀里糊涂去
了这样的医院,那么请先把态度端正好,不要把自己当根葱,其实我们连扫地的都不如
,因为他们是permanent employee, 他们还有工会,我们是IMG,还要担心身份,即使拿
到了绿卡,我也没觉得有什么区别,就是要夹着尾巴做人。第二第三年的residents,
program director,chairman,attendings固然是我们的老板,护工,护工,秘书,case
manager,social worker, technician, etc etc 都不能得罪,什么事都得会干,什么
抱怨都不可以有,什么责任都得但,最重要的patient和family member得伺候好了。
引用我们的一个brilliant cardiolgist 的名言:

You are not here for education! You are here because nobody else is willing
to do whatever you are doing. You are here because I want to sleep at night.
You are here because you are cheap labor. So if there is any education
opportunity, grab it and precious it, it\'s like a bonus.
啊,累死了,今天先写态度,明天继续写技术问题。
--

all series address:

http://www.mitbbs.com/article_t/MedicalCareer/31244640.html
http://www.mitbbs.com/article_t/MedicalCareer/31244640.html
http://www.mitbbs.com/article_t/MedicalCareer/31244959.html
http://www.mitbbs.com/article_t/MedicalCareer/31245397.html
http://www.mitbbs.com/article_t/MedicalCareer/31245962.html
http://www.mitbbs.com/article_t/MedicalCareer/31246859.html
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]

[上一篇] [下一篇] [发表评论] [写信问候] [收藏] [举报] 
 
共有7条评论
1   [USMedEdu 于 2009-03-20 23:29:48 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Survival guide-7: Who is sick?
发信站: BBS 未名空间站 (Fri Mar 20 20:56:54 2009)

There are still a lot more to talk about communication. But these days, I am
thinking about a very interesting topic becaus I got so many sick patients
on my postcall day, and looking back I found that the difference between a
more experienced and an average intern is to figure out who is sick at the
very beginning.
On my postcall day, I had total of 11 patients(usually we will have 13-14
patients on post call day, sometimes, we can get 20+ patients when it is
very crazy). So I was initially very happy that I didn't get a lot.
But when I got the sign out, I became more and more worried.
Patient A: 32 years old female with HIV/AIDS, ESRD on hemodialysis,
uncontrolled hypertension(220/135)Utox positive for coceine and opoids was
sent here by neighbour for sudden change of mental status. The patients was
walking talking several hours ago, but now she can't recognize her brother,
and when she was in the room, she jumpped on the other patient in the same
room. She does not have fever though.

Patient B: 40 years old female with ESRD S/P kidney transfusion, DM-II and
hypertension came for blood glucose of 900, anion gap of 29, Potassium of 2.
5. She does not have changed mental status though.

Patient C: 38 years old male with HIV/AIDS came for gum bleeding, found to
have platelet of 4.

Patient D: 80 years old male with CHF(Left ventricular ejection fraction of
18%) Afib(rate controlled by pacemaker), Hypertension, respiratory failure
on ventilation. S/P PEG placement on Monday. Was started on Fragmin and
coumadin on Tuesday. Now is having massive bleeding from the Gtube site. INR
2.0, APTT 33.7. Hemoglobin dripped from 11.4 to 7.5.

Patient E. 52 years old female with chronis pancreatitis, chronic colitis,
Hypertension, Klatskin tumor S/P liver lobectomy in Dec, 2008, S/P
pseudocyst drainage 3 weeks ago, 14 days of levaquin and flagul usage, came
for non-stopping vomitting and diarrhea, potassium of 2.6.

Patient F. My old patient waiting for discharge and suddenly platelet
dropped from 168 to 20.

Others are asthma exacerbation, CHF decompensation, etc, etc. Only one less
sick patient who is a psych patient and he comes to you every one minute
asking for food, or just to curse you out.

My brain stopped running. I thought I was lucky to get only 11 patients, but
now I am having panic attack. This is not ICU, we can't take vitals every
30 minutes. So many sick patients, who is the sickest one that I should
attend first?

As interns, we are easily stressed out. But the crucial thing is to know
which patient needs most attention. Forget about your progress notes,
breathe deeply. Run to the sickest patient. Sometimes, you don't even know
who is sick, and that is dangerous. If you see your patient one by one
according to the order on you patient list, then you may see your sickest
patient last. Then you are in trouble, you really don't want the nurse to
tell you " Doctor, I think we need to run a code because the patient seems
to stop breathing."

I leave the question to you, what will you do to deal with those patients,
in what order are you going to attend the patient? And what treatments will
you start, what diagnostic tests will you order?

Tomorrow I will have 24-hour call. I hope I will not get so many sick
patients.
I'd rather get 20 not so sick patients than getting 1 really sick patient.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]

 
2   [USMedEdu 于 2009-03-19 21:43:09 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Survival guide-6 communication with attendings
发信站: BBS 未名空间站 (Thu Mar 19 21:35:13 2009)

These days there are so many good news from the forum. Very happy for all of
those matched and pray for those who are not matched, hope that they can
get matched next year.
Today I will continue to share some experience of communication.
First, communication with attendings.
Attendings are your big boss, any major decisions should be made by them.
When patients comes to the hospital, first thing you need to know whether
they are private patients or service patients. Private patients means they
have their own primary care doctors and their doctors also come to this same
hospital. If a patient doesn't have his/her own doctor, or his/her own
doctor doesn't come to your hospital to take care of the patient, then he/
she becomes service patient, the attendings who are on service of the floors
will take care of the patient. To an intern who comes from China, it is
extremely confusing in the first several months, and clarification of
attending doctor is very very important. Some hospitals only have service
attendings, which makes life much much easier.
So, when you get a sign out from your senior that a patient is going to be
admitted, first thing to ask is who is the attending, does the attending
know the patient is in the hospital. If there is any doubt, page the
attending, make 100% sure that the patient is under the care of the right
attending.
After informing the attending that his/her patient is admitted, you should
ask him/her about the treatment plan, which consult to call, etc. Some
attendings are very serious and cautious, they will give very very detailed
plan, and they want you to call them when any new situations take place,
some attendings are 死人不管的,随便你们怎么整。And they don't want you to
bother them for every little thing. I have one attending who never opens the
computer to check the patient's lab result, whose note is always 2-3 lines,
and who will never give you a hint of discharge plan. I have another
attending who doesn't allow the resident to write any order, everything he
does by himself.
But the bottom line is to confirm with attendings whenever you are going to
make any major decision, es[ecially discharge plan, Never ever discharge a
patient without the knowledge of his attending. Even though some attendings
never discharge any patients, and you are pushed by case managers, social
workers everyday for discharging, you can never discharge a patient by
yourself. You can present the case to attendings, saying that pt is making
such and such improvement, and all the lab results are within normal range
or back to his baseline, could you please consider discharging the patient?
Before discharging, if there is any abnormal lab result, page the attending
to update him, and ask for further planning.
Private attendings are usually not very eager to teach, because they are so
busy, and they come to the hospital at some weired time. I have one
attending who comes to the hospital at 12:00am and writes one note for two
days. So it's hard to catch them, it becomes more important to call them
whenever you need plans. Senior residents can help you with some detailed
treatments, but attendings give major directions.
Never argue with attendings, if they complain about you to the department,
it's serious.
The best attendings are humble and nice and eager to teach and have sympathy
for interns, but those attendings are rare. Most of the attendings have
some shortcomings, learn the good parts only. Always be respectful. Make
friends with some good ones, you will learn a lot from them.


I forgot to mention another important ponit. If you have a service patient
but he has a private doctor outside, it is a great idea to get the doctor's
number and to give the doctor a call. First to clarify the commorbidities
the patient has and the medications the patient is taking. Second is to
update the primary care doctor the new findings of the patient and tell him
to follow up with the patient when he is discharged. A 10 minute's call will
save a lot of effort.

I just discharged a patient who came with platelet of 4. He said he is HIV/
AIDS, and is taking combivir and sustiva. The next day the primary care
doctor called me. He said the patient is mentally retarded, has HIV/AIDs,
and later developped Hodgikin's lymphoma which was treated by radiation, he
then developpend ITP in 2007 and responded very well to steroids, his last
CD4 count was 125 on Tuesday. And he gave me the number of the patient's own
hematologist. He also told me that the patient is not compliant with AIDS
medication, he is not taking any AIDS meds actually, and the doctor doesn't
want to start any AIDS meds before knowing that the patient is resistant to
those meds or not.
If the ER doctor would have called the PMD earlier, the patient would not
have been transfuse with 3 units of platelets(which is not a good thing to
do to an ITP patient), instead, steroids might have been started earlier if
the patient bled. And we can also save a lot of redundant work ups, tests,
and consults.

If a patients has been worked up for some disese extensively in anouther
hospital, it is better to get the record before ordering anything, unless it
's emergent.
--


--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]

 
3   [USMedEdu 于 2009-03-16 21:41:33 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Survival guide-5 education
发信站: BBS 未名空间站 (Mon Mar 16 20:06:36 2009)

First congratulations on those who matched. Especially for one of my old
friend Dr. Lu who matche to Pathology. Very happy for all of you!

I was plannning to talk about another very improtant point, communication,
but found the topic too big. I need some time thinking about it. So today
Iwill talk about education.

Education for residents is a required by ACGME. so every program has its
conferences for residents. But as an intern, often time you are overwhelmed
and cannot concentrate on studying, or you don't have any time for studying.
So what can you do?

In our program, everyday, we have morning report, noon conference. And every
Mon Wed Fri we have additional teaching conferences 1 hour in the morning,
1 hour in the afternoon. For each of those conference, attendances will be
taken, and we have to be very punctual, CMRs go to every floor to make sure
that nobody is late. So we left with little time to work, and whenever the
time come to conferences, we are so unwilling to leave floor. It's dilemma,
we want to have education, but it's also taking a lot of time. My tips are:

1. Try to be on time, because this is part of professionalism, part of your
evaluation is based on it. Only when you have very sick patients or when you
have emergencies, can you be late or skip the conferences. These
conferences are bonuses for residents as cheap labour, grab the chances and
precious them.

2. Try to take some notes. But first concentrate on listening. A lot of
topics are repeated, so even you can't grasp the whole topic, next time you
have another chance.

3. Take one step further if you can, try to volunteer to present or teach.
Practice makes perfect, It is the person who involves most benefits most.

4. Be more efficient with your patient care so that you can arrange
everything well.

5. Take every chance to study, when see the consultant, discuss with them
about the case, so that you don't have to read there unrecognizable note and
also at the same time you can have teaching.
6. When you see a medicine that you are not familiar with, don't copy, take
several seconds to check epocrates, make sure you know what the medicine it
is.

7. Ask questions. Some attendings are eager to teach, you can learn so much
from them. For those attendings, they love you more when you appear curious,
and also serious about patient care.

8. Avoid those teachings that sounds like "Protocol". Every patient is
different, you can't have a general protocol for each one. Make sure you don
't get the wrong teachings.

9. Put a pocket book inside your pocket, and also your bag. So that you can
a few lines whenever you can. I take trains to go to and back from work, on
the train, I read books, 20 minutes total every day is not too bad.

10. The most important thing about teaching is to take care of a real
patient. You will never forget. I met a lot of questions in the in service
exam that I can answer instantly, because I have taken care of similar
situations.

11. In programs like mine, interns are bombarded by tons of patients. Day
after day, all the repetance make you learn. If you take care of 10
pneumonia patients in a week, you will know how to manage pneumonia.

12. When you have intersting cases, go to uptodate and print out some papers
to read, also try to present the case. Last wekk, I met a possible Behcet
syndrom, I read a lot of it, and I am much more familiar with the disease. I
also went to pathology department and review the biopsy slides with the
pathologist. When I have time, I go with pulmonologist to review CT or CXR
if intersting cases. Don't just copy the report from computer, and don't
always trust the report either. Once I was given a case of PE, the CT report
said patient has PE, fragmine and coumadine was already started. But when
the pulmonologist saw the film, there was NO PE at all. Sometimes you were
told that patient has pneumonia, all kinds of antibiotics were started, but
there was no pneumonia! Pt still coughes. He/she may have asthma, or
pulmonary edema.

13. Do some MKSAP questions whenver you can, when I was doing night float, I
install MKSAP software on the computers I use, so whenever I have time in
between admissions. So even with 9 admission each night, I can still do 5 or
10 questions per night. Add together, I did quite a lot.

14. If you aim a fellowship, try to get in touch with somebody who can give
guidance of research. There are GI, Card, Hem/Onc, Geriatric, Nephrology
fellowships in our hospital,and I am interested in Hem/Onc. SO I try to get
in tough with Hem/ Onc guys. Somebody else are contacting other guys. Even
if interns don't have time to do any research, quite a bit of interns of my
batch have written up case reports and submit to ACP regional or national
meetings, one of them even won first prize. I admire them very much. They
really tried their best. Even for some reason they can't get fellowships
right after graduation, they will get in an ideal program later on. As IMGs
in a malignant program, we need to pay more price, but never lose hope.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]
 
4   [USMedEdu 于 2009-03-14 22:30:32 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Survival guide-4 Documentation
发信站: BBS 未名空间站 (Sat Mar 14 21:14:46 2009)

The most important two things of survival: Documentation and communication.
Today I will talk about documentation. From today on I will talk about
survival guide in general and also share some stories accordingly.
Remember, a patient's whole chart is legal documentation, so write in a
professional way, and don't write any thing indicating different opinions
and arguments from different doctors. It look very very bad. All chart are
being reviewed and every single word stays permanent. This is very serious.
You think nobody can recognize your writing? wrong, some specialist can read
any note.
How to write progress note efficiently?
If you take care of the patient from admission, then make an index card from
day 1, put a patient's label on the corner, write the possible diagnosis,
past medical history, medications that patient takes at home, medications
that have been started. For antibiotics, write the satarting date. It's also
good to write the abnormal labs on admission. The index card is very
important, you use this card to present case, to write progress note
anywhere( even in the elevator).
Use SOAP method to write progress note.
S: subjective complaint
O: Objective findings
A: Assessment
P: Plan
At the beginning of each note, write like this: Mr so and so is a 57 years
old male came from community(or nursing home) for shortness of breath...
Today he complains of..., overnight what happened.
Then write the vitals
Then physical examination findings
The the lab results, circle the abnormal findings
Then Assessment and plans.
Address the abnormal findings
At the end, at least for one time document advance directive(DNR or Not DNR,
or Health care proxy, or living will)
Don't forget to write DVT prophylaxis
It is best to write the medication everyday, but if you don't have time, at
least mention how many days patient is on what antibiotics.
if patient is diabetic, you need to write finger stick and lispro coverage.
You can see that a lot of information come from the index card, you can grab
a progress note sheet and write note anywhere. In the early morning, when
you first visit the patient, write down the vitals, ask about their
complaint, for stable patient, you don't have to examine them from top to
bottom everyday, when you in the round, write down your assessment and plan
according. Or in the other way, you can write your own assessment and plan
by yourself, and discuss with your attending. Some patients come with tons
of commorbidities, you need to address the acute situation in detail, and
all the other stable problem, just copy everyday, eg.Hypertension: Blood
pressure controoled, c/w so and so medications.
So you can see each note is a variation of one template. You can make
template early on, and fill in labs, physical examination findings later on.
But don't write same mote everyday, you can write short note, but don't
write nonsense note, at least yor note can reflect your thinking process.
Even though most of time especially in the first month, we don't know who is
who and we are so much confused.
Don't lose track of the antibiotics, patient can not be on Zosyn forever.
Not to say tygercycline or polymixin.
And don't trust anybody, I will say it again. If there is major change of
treatment or discontinue some meds or change of IV fluid, like change of
antibiotics, tell the nurse, don't only write the order. Fax the improtant
order yourself, make sure the pharmacy send the medication in time, and make
sure the bag is actually hanging there!
I have so many bad experience. Sometimes I discontiued Zosyn, or I changed
some antibiotics, and on the third day, during the round, attending found
Zosyn is still hanging there, it really look bad. When you ask the nurse,
she seems so innocent, and she always tells you that she has this patient
for the first time, she knows nothing. But when you check the order, your
order was indeed picked up. Nobady can solve the mystery. Nurses have their
medex, for each given medication, you sign their names. You need to check
medex. Some very good nurse will remind you to renew IV fluid, or reassess
some orders. And even diet is very important, everyday, you should spend 30
second thinking about what diet the patient is on. If tube feeding, what
kind of feeding, at what rate.
Once I had a patient, he ws on soft pureed food, but after speech and
swallow evaluation, he was found to have impaired swallow function, and high
risk of aspiration. He came with fever, and even on antibiotics, he still
spikes fever from time to time, panculture and chest x ray multitimes were
all negative. ID consult suggest Lumber punction, but the patient didn't
have meningeal signs. Family member refuse LP. So we higly suspect that
patien has aspiration pneumonia, and microaspirations would not always show
on x ray. So we discontinued his diet, put him on aspiration precaution,
head of bed 30 degree, all kinds of order. But after three days of these
order, family member found a whole tray of SOLID food on bedside, patient
was lying flat, IV fluid was hanging, but nobody cared about wheter the
fluid was running or not. The family was a speech and swallow specialist
herself, she got angry and went directly to the customer service. The the
nursing superviser was on top of the whole thing. On the order sheet, it
showed every order was picked up. Though it was mostly nursing problem, I
was blamed hard. And I learned lesson from it.
My chairman told us his story, he had a patient came with break through
seizure, dilantin dose was raised again and again, but dilantin level in
blood was low everyday. Albumin was checked again and again. Order was like:
Hold food 1 hour before and after dilantin. After ordering another high
dose of dilantin, he suspect that the nurse was not giving dilantin or not
giving properly. He called the nurse aside, said"the dilantin level of this
patient is always low, I don't know why, please look into it." And the next
day dilantin level spiked. He had to decrease dilantin.
In this story we can also see the importance of communication. Never be
harsh to anybody, use the art of talking. I will talk about communication
later on.


发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Re: Survival guide-4 Documentation
发信站: BBS 未名空间站 (Sat Mar 14 21:30:26 2009)

I forgot to say that anything was not documented did not happen. So make
sure document everything that is important. And document wisely. When order
IV fluid or antibiotics, don't write indefinte length. You will forget about
it, and patient will suffer. Everytime you see IV fluid running or
anything running at bedside, always ask yourself why the patient is on that.
Sometimes it's the admitting resident's order from long time ago. It's very
easy to say what you should do, but in realitly, when you are so stressed
out, you don't remember everything. And multiple times when attendings ask
about this and that, I stared with blank look. So our attendings always say
interns don't have brain, there are kidneys in ther heads.
When you become senior residents, you have more time to think, besides
reading papers, patients care is the most important, don't say " Aha, now I
am second year, I don't have to do anything, I have suffered enough in my
first year." Instead, be on top of everything, have sympathy for your intern
, cover them for their ignorance and teach them in a nice way.
Interns: Never argue with second year, not to mention third year or
attendings. Even though you were PGY 40 or chief of medicine back home.
Residency system is just like army. You can only ask questions, make wise
suggestions. But be obdient. When you are an intern, never play hero. In the
first several months, always confirm with your second year before order
something. CMGs always flunk at this point.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]



 
5   [USMedEdu 于 2009-03-14 09:40:28 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Re: Re: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Fri Mar 13 23:35:36 2009)

Just got back from on call and finished the last history and physical. I
will share more tomorrow. Today too late. The purpose of this poster is to
prepare for those who don't have choice at all. Match is really a MACTH, not
everbody has many choices, you can't find a better place, the program can't
find a better person. So you MATCH. I tried to transfer to another place
actually. Got several interviews. I got very nice recommendation letters
from chief of some subspecialty. One nice university program loves me very
much, but they ask for Director's letter, any they interviewed tons of AMGs
also for only two positions. I didn't get in. Another program is not as good
as my current one, interviewed 8 people for one position, all of the other
interviewees are prilim with H1 or J1 visa, if they can't find a spot, they
have to go back home. They told me " At least you have green card, and no
matter how bad your program is, you have 2 more years' contract. But we have
nothing." So I think it's inhumane to compete with those poor guys who
worry about their status and have families relying on them.

I have a second year, who was interviewed 2 years ago by 16 programs, many
of them were saying very good words to him, he didn't accept our program's
prematch, waited for match, but all those nice programs filled their spots
with AMGs, He ranked our program very low but still he matched to our
program and he said he almost cried on match day.

Another second year, went into match twice, first time he refuse the
prematch of our program, didn't get matched to anywhere. Second time, he was
again interviewed, and again matched to our program.

A lot of us have high scores, but not everybody has double 99s, a lot of
Indians and Europeans are freshly graduated or they have strong clinical
background. But somehow we matched here. I want to say, this forum is a
little biased, a lot of non 99 holders only read but not speak, it looks lke
that it's easy to get 99 scores, it's easy to get into very good university
programs. But the reality is most of us are average Joes, we need to see
the whole picture, we need to know the true stories, we need to get well
prepared, I didn't mean to discourage anybody, on the contrary, I want more
and more CMGs to survive those kind of programs and thrive in the end. To be
honest, a lot of CMGs will end up in those "IMG friendly" programs, and
they can have a very successful career from then on.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]

 
6   [USMedEdu 于 2009-03-13 16:43:57 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: {请勿置顶}Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 19:17:20 2009)

I had a very very bad day today. CMRs blasted us for not filling DVT
prophylaxis forms and advace directive forms and problem lists and they told
us to quit program if we don't want to obey the rules.
Last year August when I got my green card I really wanted to quit and be a
cashier in Target. But now after being tortured for 9 months, I am a little
hesitated.
Ok lets talk about how to survive.
Today I will talk about the technical part.
In our program, blood works are seldom done by the Nurse assistants(we call
them PCA, they should do blood works, change patients gowns, clean patients,
weigh the patients and take vital signs, do finger sticks)
to be continued.


#########################
#二月征文:“最坚强intern”奖#
#########################


--
※ 修改:·soaplover 於 Mar 13 13:01:58 2009 修改本文·[FROM: 70.143.]



发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 20:10:26 2009)

So the PCAs usually are not willing to draw the blood. Every morning, there
is a list of morning labs, they will sign their names under the patients
from whom htye draw blood, 9 out of 10 patients they will write" Patient
refused" or "Unable, hard stick". Even though the patient is demented and
nonverbal, they wtill write refuse blood work, which is very funny.
Every morning, interns should come to the floor very early 6:00am at least,
then print out the patient list, print out the labels of the morning labs,
take an empty box, put butterfly needles, tubes, sample bags, gauzes,
alcohol swabs in the box, then you go to your patients' room to draw blood
one by one, at the same time, write down the vitals on your list, eyeball
the patient(maybe this is the only time you check the patient in the whole
day), briefly ask what the new complaint is, any overnight event. in the
first several months, I spent a lot of time trying to get blood, because I
never did that before. Some patients are very combative, you need to find a
way to stablize their hand, be very careful of needle stick, many people get
stuck and the hospital doesn't pay the insurance for HIV.According to NY
law, you need to get consent from patient to check HIV status, so if you get
stuck by the needle, it's a disaster, the way to get around is to check CD4
cell count to have an idea if the patient is HIV positive, but you never
know whether patient is hep B or C positive, you can check though. Some
patients are really hard stick.It's so hard to find a vein.
For the demented patients or unconsious patient, you don't waste time on
finding veins, just go directly to artery, much easier.
Then after the blood work, take blood to lab, it will the transporters for
ever to send blood. Then go to morning conference, then have breakfast, then
go to floor, have pre-round with second year. Then have conference for one
hour. Then it's the 'length of stay
' discussion. You need to present all your patients to social workers and
charge nurse and case managers, who will be discharged, who will not be.
They will push you to discharge as many as possible. You have to justify the
stay of the patients.
Then it's the round until noon, some rounds take forever, depend on the
attendings. Then it's the noon conference for one hour. Then take a quick
lunch. Then follow all the labs, and write your notes, but usually,
everybody is calling you to do something(The nurse will call you for putting
heplock, the pharmacy will call you for correction of orders, blah blah),
the conference again, then senior round, then sign out. So you barely have
any time to wirte notes and take care of the patients. After 6 oclock, you
start to write note and see the patient until very late.
The tricky part is that during the round, some attending will not allow you
to leave to call consults or write orders, and all consults should be called
in the morning, otherwise the consultants will not come to see. When the
round ends, it's alreay afternoon, then the attending will ask you why you
didn't call the consults in time. He will never think about what time we can
call the consult. So sometime we page ourselves by cellphone so that we can
have excuse to leave to call consults or write orders. And also during the
round, you can take the chart with you so that you can write orders right
away.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 71.183.]


发信人: DTMB (WusMatterU), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 21:14:40 2009)

sigh, what a shitty program you got yourself in.
But you made your own choice, now you have to swallow it.
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 76.190.]


发信人: knockingdown (KD), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 22:18:26 2009)


yf,看不出你小小的身躯里面藏着这么一颗坚强的心,你一定会做出来的。我很佩服你

--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 72.80.]


发信人: usatravel (usatravel), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 22:55:56 2009)

你这话怎么这莫难听!
FanFan能诚恳的将一些医院的真实黑暗面告诉大家, 我们心存感激。
没在这样的医院里工作过, 就凭面试,谁也看不透真相。 现在大家知道了, 今后可
以少走弯路。
I agree with FanFan: Matched is Better than non-Matched! It is definately
better than being a postdoc doing labwork forever!
FanFan, you have a bright future ahead after residency. And I am sure you
will learn more than most of us.


【 在 DTMB (WusMatterU) 的大作中提到: 】
: sigh, what a shitty program you got yourself in.
: But you made your own choice, now you have to swallow it.



--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 99.188.]


发信人: whisper2010 (麦地轻语), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 23:07:16 2009)

想当年我做住院医生时,也是天天早上要自己抽血,查体,然后跟主治查房。而且不是
一年,是五年!

往事不堪回首!

其实抽血习惯了就好,就是千万别扎着自己了!
--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 98.154.]





sdmd08

进入未名形象秀
我的博客
[回复文章] [回信给作者] [本篇全文] [进入讨论区] [返回顶部] [修改文章] [删除文章] [转寄] [转贴] [ 15 ]

发信人: sdmd08 (Beyond the sea), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Thu Mar 12 23:49:48 2009)

Re


【 在 knockingdown (KD) 的大作中提到: 】
: yf,看不出你小小的身躯里面藏着这么一颗坚强的心,你一定会做出来的。我很佩服你
: !



--

※ 来源:·WWW 未名空间站 海外: mitbbs.com 中国: mitbbs.cn·[FROM: 127.0.]



发信人: DTMB (WusMatterU), 信区: MedicalCareer
标 题: Re: Malignant program survival-3, techicals
发信站: BBS 未名空间站 (Fri Mar 13 00:12:10 2009)

I know you guys are throwing bricks to me, come on, I don't care.
The purpose of training in residency is not get yourself trained with scut
work. This is so obvious. Even YF herself called her program malignant. I
guess you all know what is the opposite to maligant. If every program is
like that, then there's no need to call it malignant, right?
I feel so lucky I'm in a good program, got lots if chances to see and to do
meaningful things, lots of education, but never scut work.
When you have chance to make choice at prematch or match, you are making
some decisions that you are going to be responsible for. You make the
decision, you swallow the result, quite simple.
I guess if someday after graduation I have to work in a ghetto hospital with
daily load of scut work, you might be right that I probably would not do as
good as yf. But no so sure otherwise, hehe.
Good luck buddies.




 
7   [USMedEdu 于 2009-03-12 08:28:55 提到] [FROM: 10.]
发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Malignant program survival guide-2
发信站: BBS 未名空间站 (Wed Mar 11 18:58:52 2009)

继续昨天的话题。
中文大字太慢,我就用英文了。
First things first:
What is the definition of "malignant"?
1. A LOT of scutwork!(drawing blood everyday, getting urine or stool samples
sometimes, transporting patients, doing secretary jobs, pushing all kinds
of medications,ETC)
2. Very very nasty nurses, NY hospital is notorious for its nurses. They don
't pick up the orders, when you ask them to do something, they usually
shouted back"why don't you do this?". They give wrong meds to wrong patients
and then said it's your fault. They are very lazy. They know little, paging
intern every minute for temperature of 99, blood sugar of 250. They forget
about things easily. They are very defensive, anything happens, they always
find a way to blame you.
3. Very bossy senior residents. There is a tradition that second year can't
help first year even calling a consult. Because they have had enough suffer
when they were first years. But I have some very nice second years in our
program.
To be continued.
________________

Continue:
4. Very awful patient population: Nearly 100% elder patients are demented,
from nursing home, very badly managed.
Nearly 100% young patients are either drug seeker, HIV or mad or rude. 90%
no insurance, homeless or only medcare or medcaid.
5. Many Indians in program. I am not a racist, but I have to say this is not
a good sign.
6. Very bad schedule: My schedule:
7:00-8:00am morning report, 8:00-9:00am conference, 9:00-9:30am legth of
stay discussion, 9:30am-12:00pm rounds, 3:00pm-4:00pm conference,4:00pm
senior round 5:00pm-6:00pm sign out You have no time to read or work, after
6:00pm you start to write progress notes of 11 patines or even more.
7. Huge patient volume and rapid turn over. 11 patients precall or 17
patients post call is like nothing, there is no such thing as CAP or
violation of the rule "not more than 27 continuous working hours" You are
just stuck in the hospital.

_________________________

Preparation for residents:
First you nee to understand the meaning of "MATCH":
That means you can't find a better place, and they can't find a better
person.
Second you need to understand what is the meaning of "RESIDENT"
That means you "reside in the hospital". You are no longer available for
your family, all you will do at home is either sleep or stare(with a blank
look of course)
Ok, before you join the program do these:
1. Pass Step 3
2. Read through Washington manual one time, you will never have time to read
it again in quite a long time.
3. Spend as much time as you can with your family, say "I love you" to your
wife or husband, take them to travel. Kiss you kids, cut your hair short.
5. Move near to your hospital.
4. Take a deep breath, another deep breath, another deep breath. Then on
July 1st, you are GONE.

风啸啸兮易水寒,壮士一去兮不复还.

To wives and husbands of those poor interns:
Hang on there, don't divorce them yet.
__________________________

发信人: diarrhea (二餅), 信区: MedicalCareer
标 题: Re: Malignant program survival guide-2
发信站: BBS 未名空间站 (Wed Mar 11 20:01:20 2009)

Great job!!!

Would you tell us the percentage of private patients?
What is the most common reason for admission?
How many patients do you have everyday on floor?
How many hours do you work every week?

___________________________

发信人: yf (麦地fanfan), 信区: MedicalCareer
标 题: Re: Malignant program survival guide-2
发信站: BBS 未名空间站 (Wed Mar 11 20:18:05 2009)

Private and service patients are half /half
Reasons for admission, some are very funny: Abdominal pain from constipation
, then call a cardiology consult because of tachycardia
Hip fracture(why medical floor? I don't know. Rule out MI, troponis three
times, Holter and ECHO. Why? Well, people fall for a reason, maybe they
syncopized)
Etc, Etc.
How many patients? Oh boy, I've never had more than 20 in a day.
How many hours a week? I didn't count, all I know is that I spend most of my
time at home sleeping.


--
※ 修改:·knockingdown 於 Mar 11 21:31:41 2009 修改本文·[FROM: 72.80.]

 
用户名: 密码:
发表评论
评论:
[返回顶部] [刷新]  [给USMedEdu写信]  [美国医学教育博客首页] [博客首页] [BBS 未名空间站]
 
Site Map - Contact Us - Terms and Conditions - Privacy Policy

版权所有BBS 未名空间站(mitbbs.com) since 1996