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

by Desai, Samir P.

• ISBN13: 9780972556125
• ISBN10: 0972556125
• Edition: 1st
• Format: Paperback
• Copyright: 2004-01-01
• Publisher: Md2B

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

Table of Contents

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	(1)
Not knowing what to do during prerounds	2	(1)
Information gathered during prerounds is not written down	3	(1)
Chart is not reviewed for new progress notes	4	(1)
Chart is not reviewed for new orders	4	(1)
Not talking with the cross-covering intern	5	(1)
Not having the vital signs information	6	(1)
Focused physical exam is not performed	6	(1)
Forgetting to see if lab or diagnostic test results have returned	7	(1)
Not giving yourself enough time to gather your thoughts before work rounds	8	(1)
PART II: COMMONLY MADE MISTAKES DURING---Work Rounds
Not knowing your resident's expectations for you during work rounds	9	(1)
Showing up late for work rounds	10	(1)
Not being brief	11	(1)
Being unfamiliar with the order of the work rounds presentation	11	(3)
Not bringing the EKG or x-ray with you	14	(1)
A to-do list is not made	15	(1)
Tasks that need to be completed are not prioritized	15	(1)
Orders are not written during work rounds	16	(1)
The plan is not understood	16	(1)
Not paying attention during work rounds	17	(2)
Going to morning report when there is unfinished business	19	(1)
PART III: COMMONLY MADE MISTAKES WHILE---On Call
Being unfamiliar with your on call responsibilities	20	(1)
Not being adequately prepared for your call	21	(1)
Essential patient information is not obtained before the patient is seen	21	(1)
Patient is not seen in a timely fashion	22	(1)
Not knowing the approach to evaluating a new patient	22	(2)
Patient's medical records are not obtained or reviewed	24	(1)
ER or clinic notes are not reviewed	25	(1)
A complete history and physical exam is not performed	25	(1)
Forgetting to gather information from studies done on admission	26	(1)
Not thinking about your assessment and plan after evaluating the patient	27	(1)
Relying on your intern to write the patient's admission orders	28	(1)
Not notifying your resident when the patient is seriously ill	29	(1)
Discussing with the patient or family issues you are unsure of	29	(1)
Not obtaining patient information from other potential sources	30	(1)
Not offering to help the team before leaving	30	(2)
PART IV: COMMONLY MADE MISTAKES ON---Write-Ups
Not understanding the importance of the write-up	32	(1)
The write-up is not turned in on time	33	(1)
The write-up is not complete	33	(1)
Not knowing what to include in the write-up	34	(1)
Not being familiar with the order of the write-up	34	(1)
The write-up does not include the date and time of the patient assessment	35	(1)
Chief complaint or reason for admission is not listed	35	(1)
The source of the history is not included	36	(1)
The first sentence of the history of present illness (HPI) does not include the necessary information	37	(1)
The history of present illness (HPI) is not presented chronologically	38	(1)
Not knowing what to include in the body of the HPI	39	(1)
The last sentence of the HPI is not worded properly	40	(1)
Drawing conclusions or making judgments in the HPI	40	(1)
HPI is not written in full prose	40	(1)
Not knowing where to include the emergency room information	41	(1)
The past medical history (PMH) is not complete	41	(2)
Medication list is not complete	43	(1)
Inpatient medications are included	43	(1)
Medications are not listed by their generic names	44	(1)
Dosage, route, or frequency of the medication is not listed	44	(1)
Patient's medication allergy is not described	45	(1)
The social history is not complete	45	(2)
The family history is not complete	47	(1)
The review of systems (ROS) is not thorough	47	(1)
The physical examination is not complete	48	(1)
No comment is made about the patient's general appearance	49	(1)
Vital signs are not listed	50	(1)
Vital signs are listed as ``afebrile and stable''	50	(1)
Orthostatic vital signs are omitted	51	(1)
Making judgments about the physical exam findings	51	(1)
Lab test results are not reported	52	(1)
Basic lab test results are not reported first	52	(1)
Results of other studies are not reported	53	(1)
Summary is not included	53	(1)
Problem list is not complete	54	(1)
Problem list is not prioritized	54	(1)
Problems in the problem list are not as specific as possible	55	(1)
The assessment is not included	55	(2)
The plan is not included	57	(3)
PART V: COMMONLY MADE MISTAKES WHEN---Presenting Newly Admitted Patients
Not understanding the importance of the oral case presentation	60	(1)
Not realizing the type of presentation the attending physician is looking for	60	(1)
Not knowing how much time you have to present the case	61	(1)
Oral case presentation goes beyond the allotted time	61	(1)
Oral case presentation has too little or too much detail	62	(1)
Oral case presentation is a verbatim reading of the patient's write-up	63	(1)
Oral case presentation is read	64	(1)
Not practicing your oral case presentation with your resident or intern	65	(1)
Not paying close attention to how the resident and intern present patients	65	(1)
Letting the awkwardness and discomfort of the first few oral case presentations get to you	66	(1)
The information is not presented in the proper order	66	(1)
Patient is not adequately identified	67	(1)
Chief complaint or reason for admission is not expressed in the patient's own words	68	(1)
The source of the history is not included	69	(1)
The first sentence of the history of present illness (HPI) does not include the necessary information	69	(1)
The history of present illness is not presented chronologically	70	(2)
Not knowing what to include in the body of the HPI	72	(1)
The last sentence of the history of present illness is not worded properly	73	(1)
Not knowing where to put the ER information	73	(1)
Too much time is spent on the past medical history (PMH)	74	(1)
Medication list is not complete	74	(1)
Medications are not listed by their generic names	75	(1)
Dosage, route, or frequency of the medication is not known	76	(1)
Inpatient medications are included	76	(1)
Not knowing details regarding the patient's medication allergies	77	(1)
Too much time is spent conveying the social history	77	(1)
Too much time is spent conveying the family history	78	(1)
Too much time is spent conveying the review of systems	78	(1)
Review of systems duplicates information already conveyed in the history of present illness	79	(1)
Too much time is spent conveying the physical exam findings	80	(1)
Not following the appropriate order	80	(1)
No comment is made about the patient's general appearance	81	(1)
Vital signs are not mentioned	81	(1)
Medical student states that the patient is afebrile and vital signs are stable	82	(1)
Making judgments about the physical exam findings	82	(1)
Lab test results are not reported	83	(1)
Basic lab test results are not reported first	83	(1)
Results of other studies are not reported	84	(1)
Summary is not brief	85	(1)
Plan is discussed before assessment	85	(2)
Not seeking feedback about your oral case presentations	87	(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	88	(1)
Not writing legibly	88	(1)
Not listing the date and time of the note	89	(1)
Not identifying the type of note you are writing	89	(1)
Not following the proper order	89	(1)
Not knowing what to include in the subjective statement	90	(1)
Not including the medication list	90	(1)
Not including the general appearance of the patient	91	(1)
Not including the vital signs	91	(1)
Physical examination is not focused	92	(1)
Not including the results of laboratory and diagnostic studies	92	(1)
Assessment and plan are not properly done	93	(1)
Not knowing whether to use a problem-based or systems-based approach to present the assessment and plan	94	(2)
Forgetting to sign your name	96	(1)
Scribbling out errors in the progress note	96	(1)
Not seeking feedback on the quality of your progress notes	96	(1)
Delaying the writing of the progress note	97	(1)
PART VII: COMMONLY MADE MISTAKES DURING---Attending Rounds
Not knowing how to present patients to the attending physician	98	(1)
Differential diagnosis of the patient's chief complaint is not known	99	(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