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Internal Medicine Clerkship: 150 Biggest Mistakes and How to Avoid Them

by: Desai, Samir P.

Internal Medicine Clerkship: 150 Biggest Mistakes and How to Avoid Them

by: Desai, Samir P.

ISBN 13:
9780972556125
ISBN 10:
0972556125
Edition: 1st
Format: Paperback
Copyright: 01/01/2004
Publisher: Md2B

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Summary

Did you know that most medical students begin doing their best work at the end of the Internal Medicine clerkship? Wouldn't it be great if there was a book available that could speed up the learning curve so that students were performing at a high level right from the get-go? Now with the Internal Medicine Clerkship: 150 Biggest Mistakes and How To Avoid Them, there's absolutely no reason to save your best for last. It will offer you ways to: Effectively and efficiently preround Deliver outstanding work rounds presentations - the kind that will make your resident and intern wonder if you are really just a student Work-up newly admitted patients thoroughly and efficiently allowing you more time to spend reading about the patient's illness Deliver polished oral case presentations to your attending physician, ones that will make them sit up and take notice Develop thorough, comprehensive write-ups that will be returned to you with fewer red marks/corrections Create well

About the Authors

xii

Preface

xvi

How to Use this Book

xviii

PART I: COMMONLY MADE MISTAKES DURING---Prerounds

Setting aside too little time for prerounds

(1)

Not knowing what to do during prerounds

(1)

Information gathered during prerounds is not written down

(1)

Chart is not reviewed for new progress notes

(1)

Chart is not reviewed for new orders

(1)

Not talking with the cross-covering intern

(1)

Not having the vital signs information

(1)

Focused physical exam is not performed

(1)

Forgetting to see if lab or diagnostic test results have returned

(1)

Not giving yourself enough time to gather your thoughts before work rounds

(1)

PART II: COMMONLY MADE MISTAKES DURING---Work Rounds

Not knowing your resident's expectations for you during work rounds

(1)

Showing up late for work rounds

(1)

Not being brief

(1)

Being unfamiliar with the order of the work rounds presentation

(3)

Not bringing the EKG or x-ray with you

(1)

A to-do list is not made

(1)

Tasks that need to be completed are not prioritized

(1)

Orders are not written during work rounds

(1)

The plan is not understood

(1)

Not paying attention during work rounds

(2)

Going to morning report when there is unfinished business

(1)

PART III: COMMONLY MADE MISTAKES WHILE---On Call

Being unfamiliar with your on call responsibilities

(1)

Not being adequately prepared for your call

(1)

Essential patient information is not obtained before the patient is seen

(1)

Patient is not seen in a timely fashion

(1)

Not knowing the approach to evaluating a new patient

(2)

Patient's medical records are not obtained or reviewed

(1)

ER or clinic notes are not reviewed

(1)

A complete history and physical exam is not performed

(1)

Forgetting to gather information from studies done on admission

(1)

Not thinking about your assessment and plan after evaluating the patient

(1)

Relying on your intern to write the patient's admission orders

(1)

Not notifying your resident when the patient is seriously ill

(1)

Discussing with the patient or family issues you are unsure of

(1)

Not obtaining patient information from other potential sources

(1)

Not offering to help the team before leaving

(2)

PART IV: COMMONLY MADE MISTAKES ON---Write-Ups

Not understanding the importance of the write-up

(1)

The write-up is not turned in on time

(1)

The write-up is not complete

(1)

Not knowing what to include in the write-up

(1)

Not being familiar with the order of the write-up

(1)

The write-up does not include the date and time of the patient assessment

(1)

Chief complaint or reason for admission is not listed

(1)

The source of the history is not included

(1)

The first sentence of the history of present illness (HPI) does not include the necessary information

(1)

The history of present illness (HPI) is not presented chronologically

(1)

Not knowing what to include in the body of the HPI

(1)

The last sentence of the HPI is not worded properly

(1)

Drawing conclusions or making judgments in the HPI

(1)

HPI is not written in full prose

(1)

Not knowing where to include the emergency room information

(1)

The past medical history (PMH) is not complete

(2)

Medication list is not complete

(1)

Inpatient medications are included

(1)

Medications are not listed by their generic names

(1)

Dosage, route, or frequency of the medication is not listed

(1)

Patient's medication allergy is not described

(1)

The social history is not complete

(2)

The family history is not complete

(1)

The review of systems (ROS) is not thorough

(1)

The physical examination is not complete

(1)

No comment is made about the patient's general appearance

(1)

Vital signs are not listed

(1)

Vital signs are listed as ``afebrile and stable''

(1)

Orthostatic vital signs are omitted

(1)

Making judgments about the physical exam findings

(1)

Lab test results are not reported

(1)

Basic lab test results are not reported first

(1)

Results of other studies are not reported

(1)

Summary is not included

(1)

Problem list is not complete

(1)

Problem list is not prioritized

(1)

Problems in the problem list are not as specific as possible

(1)

The assessment is not included

(2)

The plan is not included

(3)

PART V: COMMONLY MADE MISTAKES WHEN---Presenting Newly Admitted Patients

Not understanding the importance of the oral case presentation

(1)

Not realizing the type of presentation the attending physician is looking for

(1)

Not knowing how much time you have to present the case

(1)

Oral case presentation goes beyond the allotted time

(1)

Oral case presentation has too little or too much detail

(1)

Oral case presentation is a verbatim reading of the patient's write-up

(1)

Oral case presentation is read

(1)

Not practicing your oral case presentation with your resident or intern

(1)

Not paying close attention to how the resident and intern present patients

(1)

Letting the awkwardness and discomfort of the first few oral case presentations get to you

(1)

The information is not presented in the proper order

(1)

Patient is not adequately identified

(1)

Chief complaint or reason for admission is not expressed in the patient's own words

(1)

The source of the history is not included

(1)

The first sentence of the history of present illness (HPI) does not include the necessary information

(1)

The history of present illness is not presented chronologically

(2)

Not knowing what to include in the body of the HPI

(1)

The last sentence of the history of present illness is not worded properly

(1)

Not knowing where to put the ER information

(1)

Too much time is spent on the past medical history (PMH)

(1)

Medication list is not complete

(1)

Medications are not listed by their generic names

(1)

Dosage, route, or frequency of the medication is not known

(1)

Inpatient medications are included

(1)

Not knowing details regarding the patient's medication allergies

(1)

Too much time is spent conveying the social history

(1)

Too much time is spent conveying the family history

(1)

Too much time is spent conveying the review of systems

(1)

Review of systems duplicates information already conveyed in the history of present illness

(1)

Too much time is spent conveying the physical exam findings

(1)

Not following the appropriate order

(1)

No comment is made about the patient's general appearance

(1)

Vital signs are not mentioned

(1)

Medical student states that the patient is afebrile and vital signs are stable

(1)

Making judgments about the physical exam findings

(1)

Lab test results are not reported

(1)

Basic lab test results are not reported first

(1)

Results of other studies are not reported

(1)

Summary is not brief

(1)

Plan is discussed before assessment

(2)

Not seeking feedback about your oral case presentations

(1)

PART VI: COMMONLY MADE MISTAKES ON---The Daily Progress Note

Not reviewing how to write the progress note with the intern or resident at the beginning of the rotation

(1)

Not writing legibly

(1)

Not listing the date and time of the note

(1)

Not identifying the type of note you are writing

(1)

Not following the proper order

(1)

Not knowing what to include in the subjective statement

(1)

Not including the medication list

(1)

Not including the general appearance of the patient

(1)

Not including the vital signs

(1)

Physical examination is not focused

(1)

Not including the results of laboratory and diagnostic studies

(1)

Assessment and plan are not properly done

(1)

Not knowing whether to use a problem-based or systems-based approach to present the assessment and plan

(2)

Forgetting to sign your name

(1)

Scribbling out errors in the progress note

(1)

Not seeking feedback on the quality of your progress notes

(1)

Delaying the writing of the progress note

(1)

PART VII: COMMONLY MADE MISTAKES DURING---Attending Rounds

Not knowing how to present patients to the attending physician

(1)

Differential diagnosis of the patient's chief complaint is not known

(1)

Not having a differential diagnosis for a sign

100

(2)

Differential diagnosis of an abnormal lab test result is not known

102

(1)

Clinical significance of an imaging test abnormality is not understood

102

(1)

Not being well read on your patient's primary problem

103

(1)

Not being well read on the patient's other problems

104

(1)

Indication for obtaining the chest x-ray is not known

105

(1)

Chest film is not systematically interpreted

105

(1)

Chest film is not brought to rounds

106

(1)

Chest film is not reviewed with the radiologist

107

(1)

Not knowing how to interpret a chest film you have never seen

108

(1)

EKG is not systematically interpreted

108

(1)

EKG is not brought to rounds

109

(1)

Not knowing how to interpret an EKG you have never seen

110

(1)

Not bringing in an article

110

(1)

Not grading yourself after attending rounds

111

(2)

Appendix A: Presenting Established Patients

113

(3)

Appendix B: Ward Etiquette

116

(2)

Appendix C: TIPS (General Pearls)

118

(2)

Appendix D: Basic EKG

120

(6)

Appendix E: Basic Chest X-Ray Interpretation

126

(3)

Appendix F: Common Abbreviations

129

(3)

Appendix G: Important Numbers

132

(1)

Appendix H: Patient Data Template

133

(3)

Books by the Author

136

Amazon no longer offers textbook rentals. We do!

Internal Medicine Clerkship: 150 Biggest Mistakes and How to Avoid Them

Internal Medicine Clerkship: 150 Biggest Mistakes and How to Avoid Them

9780972556125

0972556125

Summary

Table of Contents

Supplemental Materials

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