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*How to round with Paul Williams*
Tips for medical students, interns, and the curious - a thread
Just in case this might be helpful. Your mileage may vary with other attendings, who may violently disagree with these. (1/16)
Tips for medical students, interns, and the curious - a thread
Just in case this might be helpful. Your mileage may vary with other attendings, who may violently disagree with these. (1/16)
Before we start together, it& #39;s really helpful for me to know what things you& #39;re trying to improve on. This will help me know how to best tailor my feedback for you as we go through the rotation together. (2/16)
You& #39;re in charge of coming up with the assessment and plan. I will do my best to agree with your plan, but please tell me why you’re thinking what you’re thinking.
If I ever dictate the plan, it’s because I’m worried we are drifting into oncoming traffic. (3/16)
If I ever dictate the plan, it’s because I’m worried we are drifting into oncoming traffic. (3/16)
For me, the history is the thing. There is nothing more important to me than the story.
A brief history can be a marker for premature closure. (4/16)
A brief history can be a marker for premature closure. (4/16)
Nothing makes me happier than intellectual curiosity. If a patient is anemic, we should be asking why. If a creatinine bumps, we should wonder why. Same goes for VTEs, MIs in young patients, and so on and so on.
(5/16)
(5/16)
This is basic stuff, but please report vitals, and please address trends.
Please tell our night floats that PRN antihypertensives will result in great anger and furious vengeance. (6/16)
Please tell our night floats that PRN antihypertensives will result in great anger and furious vengeance. (6/16)
If there is a leukocytosis, please be prepared with a differential. If there is an anemia, please be prepared to tell me the morphology (microcytic, normocytic, macrocytic) and what the hemoglobin trend has been; please follow the bouncing creatinine. (7/16)
If we ordered an EKG, I will want to see it, and will ask someone to interpret it. If there is a student with us, it will probably be them. Same goes for imaging. (8/16)
Shorter, more up-to-date notes are preferred over the metastatic monsters I see with every imaging study ordered since conception and a plan for chronic gout that has been quiescent since 1973. (9/16)
Please revise and re-order your assessments and plans on a daily basis, with the most important problem listed first. I know that you know this, but it’s sometimes good to repeat it.
For your daily progress notes-if there was an acute event overnight, please document it. (10/16)
For your daily progress notes-if there was an acute event overnight, please document it. (10/16)
We should know where the patient is coming from, and where they are going. Who do they live with? Are there stairs? Are they going back there? Do they need a physical therapy consult? These are questions I will be asking often. (11/16)
I am not advocating for intellectual laziness, but patients are owed the standard of care, and the best care we can give them. As long as we have a concrete, reasonable question that we have been unable to safely or promptly answer, we should be thinking about a consult. (12/16)
If you are thinking about calling an ICU consult, call the ICU consult. (13/16)
Please let our night floats/nighttime coverage know that I need to be called about deaths, premature discharges, elopements, and ICU transfers. I do not mind being called. I do mind finding out on rounds the next day. (14/16)
Length of stay is important, but a good general rule of thumb is to not discharge patients who have been febrile in the past 24 hours, or who have a dropping hemoglobin or rising creatinine. (15/16)
Despite all of this proscriptive and prescriptive stuff, we should be having fun. I tend to give feedback on the fly, both positive and negative. Please give me feedback as well. I would like to be good at my job. (16/16)
I was not expecting this thread to get quite so much traction. Thanks for the nice comments. Since the HTN thing generated the most conversation, here& #39;s an excellent review: https://www.journalofhospitalmedicine.com/jhospmed/article/176615/hospital-medicine/acute-treatment-hypertensive-urgency">https://www.journalofhospitalmedicine.com/jhospmed/...
