s**********t
发帖数: 217 | 1 Just came back from the NYC CMG seminar, seeing a lot of old friends and
meeting a lot of new friends. Still feel very excited. Many thanks to KDs
organized this wonderful meeting, letting CMGs having this platform to share
information.
As a guy happened started my clinic career couple years earlier, I would
like to share some experience with my young friends. I hope this is going to
help you go through your transition period smoothly.
When an intern reports to me A NEW ADMISSION, what do I want to know?
All of you have passed the CS. You are good at taking HPI/PMH/PSH/Allergy/FH
/SH/ROS/medications list. I do not want to say too much about these. Only
one thing I want to emphasize is I want you to know your patient in details.
When you report a HPI, I want to hear the details, as a textbook HPI,
especially in the first couple months. This is the time for the attending to
evaluate new interns’ bedside skills. The other parts PMH/PSH, etc. kind
of standard. Not that much to say. But for surgical patient, you may need
to know the anesthesia history. For internal medicine patients, there is
some other information beyond HPI I would like to know as a new admission.
For chest pain, CAD, heart disease, heart failure patients:
Has any ECHO or CATH or stress test been done or not?
If it is yes, when, where, what are the results. What is the LVEF on last
ECHO or CATH?
If CABG has been done, when, where, how many vessels were involved.
For SOB, asthma, COPD patient:
Any PFTs was done in the past. What the result is. Any work up tests like CT
/HRCT, allergy test, IgE level, six minute work test, oxygen titration test
been done in the past. If any you need to know the result.
For GIB, anemia patient:
Is there any history of previous bleeding? Any EGD or colonoscopy has been
done. Any evidence on ultrasound or CT suggests cirrhosis or portal
hypertension. What is the patient’s baseline H/H. The treatment of
previous bleeding, history of transfusion, any interventional procedure has
been done or not. Any anemia work up has been done or not.
For DM patient:
When and how the patient was diagnosed. Any history of DKA or hypoglycemia.
What was the last HbA1C? Last neuro exam and eye exam.
For renal patient:
What is the patient’s baseline Cr? Is there any ultrasound of the kidney?
Are the doses of the patient’s medications are renal doses or not. Are
there any renal toxic medications?
If the patient is on HD, when did it start? The patient gets HD through
graft or catheter? Are there any complications of the graft or the catheter?
What is the patient’s dry weight?
For autoimmune disease patient:
How did the patient get diagnosed? What are the criteria for the diagnoses?
Are there any other system involvements? What is the history of treatment?
Are there any severe side effects from the medications?
For HIV patient:
When was the patient diagnosed? What is the viral load/CD4 counts? What
medications the patient takes? Does the patient have history of PCP
infection or not, if the patient comes with breathing problem.
Above are the most common patients we will see on daily basis as in patient
on medical floor. Thanks for the EMRs, you can get most of the information
from the computer.
When you report your assessment and plan, I want to hear a whole story about
what’s going on for this patient, starting from risk factors, current
presentations, positive PEs, and work up results to support your diagnosis.
Your work up plan for your DDX, the in patient treatment plan and out
patient follow up plan. Any consultations you would like to order? What are
the reasons for the consults? What are your specific questions for the
consultants?
These are some things I want to hear from my interns. Other physicians may
have other ideas. Welcome to share your information.
If you think it will help you, take it. If you do not like it, just ignore
it. Good luck in your new career. Wish you to shine on your first day. | D********r
发帖数: 119 | 2 Thanks!! Very helpful info | k********e
发帖数: 168 | | e****0
发帖数: 678 | 4 仔仔细细读了， 太谢谢了， 非常细致有效，马上就能上手的东东。 谢谢前辈！ | m******r
发帖数: 1904 | 5 雪原前辈这道菜非同凡响，色香味俱全，吃完以后唇齿留香。收藏先。 | s********o
发帖数: 3319 | 6 雪原主治威武！：）
share
to
FH
Only
【在 s**********t 的大作中提到】
: Just came back from the NYC CMG seminar, seeing a lot of old friends and
: meeting a lot of new friends. Still feel very excited. Many thanks to KDs
: organized this wonderful meeting, letting CMGs having this platform to share
: information.
: As a guy happened started my clinic career couple years earlier, I would
: like to share some experience with my young friends. I hope this is going to
: help you go through your transition period smoothly.
: When an intern reports to me A NEW ADMISSION, what do I want to know?
: All of you have passed the CS. You are good at taking HPI/PMH/PSH/Allergy/FH
: /SH/ROS/medications list. I do not want to say too much about these. Only
| s*****1
发帖数: 273 | 7 Thank you for the detail instructions!! | s****G
发帖数: 50 | 8 This is beyond helpful!
Thank you so much! | s**********t
发帖数: 217 | 9 As an intern, the other one most important thing is communication. You need
to keep your resident updated. You need to give good sign out to on call
interns. And you need communicate with the nurse inform them your plan for
this patient. You need to talk to the patient and patient's family, etc..
Communication, communication, communication, it is the key. | h**s
发帖数: 1757 | | | | S**********e
发帖数: 1325 | 11 啊，累死我了，总算抄完了。。。
别人的贴，收藏就可以了。师兄的贴，要吭哧吭哧一笔笔抄在pocket medicine后面的
笔记页上，然后装回白大衣兜兜里。。。 | s********o
发帖数: 3319 | 12 赞马屁精师妹！LOL
【在 S**********e 的大作中提到】
: 啊，累死我了，总算抄完了。。。
: 别人的贴，收藏就可以了。师兄的贴，要吭哧吭哧一笔笔抄在pocket medicine后面的
: 笔记页上，然后装回白大衣兜兜里。。。
| t***m
发帖数: 96 | 13 Good summary. Do you have any tips for neuro or neurosurgical cases? Thanks
in advance!
share
to
FH
Only
【在 s**********t 的大作中提到】
: Just came back from the NYC CMG seminar, seeing a lot of old friends and
: meeting a lot of new friends. Still feel very excited. Many thanks to KDs
: organized this wonderful meeting, letting CMGs having this platform to share
: information.
: As a guy happened started my clinic career couple years earlier, I would
: like to share some experience with my young friends. I hope this is going to
: help you go through your transition period smoothly.
: When an intern reports to me A NEW ADMISSION, what do I want to know?
: All of you have passed the CS. You are good at taking HPI/PMH/PSH/Allergy/FH
: /SH/ROS/medications list. I do not want to say too much about these. Only
| s**********t
发帖数: 217 | 14 Thanks. You make my day.
【在 S**********e 的大作中提到】
: 啊，累死我了，总算抄完了。。。
: 别人的贴，收藏就可以了。师兄的贴，要吭哧吭哧一笔笔抄在pocket medicine后面的
: 笔记页上，然后装回白大衣兜兜里。。。
| s**********t
发帖数: 217 | 15 Thanks.
Have you maken up your mind yet?
【在 h**s 的大作中提到】
: zan!!! 给雪原同志捐包包，冲！
| s**********t
发帖数: 217 | 16 For neuro patient, again, you need to know the risk factors. The details of
HPI, esp the sequences of the symptoms are very important in neuro patient.
If the patient has CVA in the past, you need to know the patient's function
status, the left over symptoms from last stroke. Are there any tests
doppler, MRI/MRA have been done in the past. Does the patient on any
preventive meds for recurrent stroke or not.
For neurosurgery patient, it depends on cases. Neruomascular or brain mass.
For neuromascular case, you need to know the progress of the disease, and
the indications for the surgery.
For brain mass, again indications for the surgery. And details of the
patient's comorbid medical conditions which may need preop clearance, like
card, pulmonary.
All there are from internal medicine stand points.
Thanks
【在 t***m 的大作中提到】
: Good summary. Do you have any tips for neuro or neurosurgical cases? Thanks
: in advance!
:
: share
: to
: FH
: Only
| f*******u
发帖数: 48 | 17 It is very helpful, even during observe. Thanks a lot. | S**********e
发帖数: 1325 | 18 走过路过的，如果觉得好，就请楼主吃包子吧？
我们CMG都是实在人。。。
★ 发自iPhone App: ChineseWeb - 中文网站浏览器
【在 f*******u 的大作中提到】
: It is very helpful, even during observe. Thanks a lot.
| d*****g
发帖数: 31 | | m*********8
发帖数: 292 | 20 支持! 咖啡好久没见啦
【在 S**********e 的大作中提到】
: 走过路过的，如果觉得好，就请楼主吃包子吧？
: 我们CMG都是实在人。。。
:
: ★ 发自iPhone App: ChineseWeb - 中文网站浏览器
| | | d******g
发帖数: 258 | 21 哇，感觉自己还有好多东西要学啊。谢谢前辈的指点。 | S**********e
发帖数: 1325 | 22 学step3哪！
从纽约玩回来，还没收心，又跑来灌水呵呵
你也好久不见，加油哈~
【在 m*********8 的大作中提到】
: 支持! 咖啡好久没见啦
| m*********8
发帖数: 292 | 23 是呀, 要加油赶我的step2. 但学习归学习, 下个月去纽约玩是不能耽误的. 到时候有
机会请你吃饭.
【在 S**********e 的大作中提到】
: 学step3哪！
: 从纽约玩回来，还没收心，又跑来灌水呵呵
: 你也好久不见，加油哈~
| s**********t
发帖数: 217 | 24 指点谈不上。有帮助就好。过来人一点经验之谈罢了。
【在 d******g 的大作中提到】
: 哇，感觉自己还有好多东西要学啊。谢谢前辈的指点。
| t***m
发帖数: 96 | 25 Thanks！
of
【在 s**********t 的大作中提到】
: For neuro patient, again, you need to know the risk factors. The details of
: HPI, esp the sequences of the symptoms are very important in neuro patient.
: If the patient has CVA in the past, you need to know the patient's function
: status, the left over symptoms from last stroke. Are there any tests
: doppler, MRI/MRA have been done in the past. Does the patient on any
: preventive meds for recurrent stroke or not.
: For neurosurgery patient, it depends on cases. Neruomascular or brain mass.
: For neuromascular case, you need to know the progress of the disease, and
: the indications for the surgery.
: For brain mass, again indications for the surgery. And details of the
|
|
