Sunday, June 9, 2013
Sunday, June 2, 2013
PGY-2 almost done
I know that it has been some time since I wrote but I have been up to my head in residency. There are so many things that need to get done, that sometimes I even forget that I have a blog and there are people who are waiting for me to write.
I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.
If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.
Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.
I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.
For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.
Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.
Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC. www.oldpremeds.com
I am at the tail end of my second year of my residency. I have learned a great deal and learned what I really do not know and need to work on. But I have also learned about my strengths. PGY2 is a lot different that the intern year. You are considered a senior resident and there are many more expectations from you than before. For starters, you are the leader of your team. When I am on the general medical floors of hospital, I have 2 interns that report to me directly. It is my responsibility to not only make sure that they write all of their notes but that the patient is being properly taken care of. That the attending physicians have been communicated with and the interns come to me for advice on what should be done next. In addition, I am also responsible to teach the interns. It gets even more complicated when there are medical students as well.
If there is a 3rd year medical student, they typically report to the intern. However, this has been changed and now they report to the resident, me. I need to ensure that they see 2-3 patients, review their notes, cosign the notes and write the orders. In addition, they have to do only 4 admissions per call and I have to go over that entire history and physical with them. Not to mention that medicolegally they cannot write the assessment and plan but I have to do it. Finally teach them. If there is a 4th year medical student, they are considered a sub-intern and have always reported to the resident. These students, being senior medical students have a little more knowledge than the 3rd year but they are still students. I need to give them a larger patient load which means that I have more work to do.
Now most of the time this is not a problem. The issue comes in July when the new interns start. Because these are fresh interns right out of medical school or international medical graduates that are not familiar with how US medicine is run. On top of that being the senior resident all of the discharge dictations have to be done by me. But first I have to review the discharge instructions to make sure that the new interns did not miss anything. Luckily this coming July, I do not have that responsibility.
I have been doing a lot of admissions since I have been the admitting doctor at night and during the day. I have been reading all of the consults and the test results on the patients I have admitted to see if I was correct in my assessments. I have been doing a pretty decent job lately. But it is always a learning process. I am very lucky to be where I am as I get to see many pathologies that I may not have seen anywhere else.
For instance, I was able to see a gentleman with early stage Huntington's Chorea (a virtual death sentence if this is diagnosed), late stage multiple myeloma that is non secretory (very rare), and several incidental findings of renal cancer.
Currently I am preparing to apply to fellowship in critical care medicine. There are 4 programs in the area as we are not moving. If I get into one program, I will be thrilled. If I get into no programs, that is alright too as I will be able to practice medicine either as an internist or a hospitalist.
Hopefully I will have more time to write. In the meantime, come to the old premeds conference this weekend in Washington DC. www.oldpremeds.com
Tuesday, September 25, 2012
Location of the Old Pre Meds 2013 Conference.....
Drum Roll Please...............................
Washington D.C.!!!! Early June. Stay tuned for more information as it comes about.
Washington D.C.!!!! Early June. Stay tuned for more information as it comes about.
Sunday, September 23, 2012
2nd year of Residency
So here I am. It has been quite a long time since I updated this blog, mostly because I have been so busy that I am spent at the end of the day and was too tired to update anything and on the weekends, when I do have off, I am catching up on my sleep or family time. But I can tell you that it is great being a second year medicine resident.
To begin with, I have a lot more confidence in myself and my abilities to treat my patients. This all comes with experience. The more patients that you see, the more that you will understand things. Even more experience came when I was doing all of the admissions. During that rotation, I would be the one who would come up with the assessment and plan and then discuss it with the attending. Most of the time, my plan was right on. Other times, there could have been something better or something was added that should not have been. For example, Vancomycin to a patient who should have had a level first. However these things come with the territory. This is all in keeping with my goal this year.
Last year, my goal was to become a good intern and now this year my goal is to become a good resident. So far, the only thing that has been commented on by my attendings is that I have to read more. But then again, so does everyone. Once I am able to do that, then I will be golden. The issues is trying to come up with a schedule that works. What I am going to be trying is to read for about 1-2 hours per night after 9pm when the kids are in bed. This is not always achievable. Because of course, the kids do not always go to bed at the pre-determined time and of course there is always wife time that needs to be had.
My goal for this year is to really get more into a hobby. I am either going to work or I am at home and sleeping. One reason I am able to update this blog is because I am on vacation and since I have no boards to study for this time, I am able to really relax. So I did what any good doctor does, I played golf and fished. I have to work on both of these things. I am not ready for any PGA tour but I did have a lot of fun. And will not win any tournaments with my little large mouth bass that I caught but as they say, a bad day of fishing is certainly better than a good day at work. Even though I love my job, I love to golf and fish.
On the financial front, the plan is to keep our heads above water just long enough until I am done with residency and I can get an attending salary for a few years. Give us some breathing room. But always remembering to take advantage of discounts and there is nothing wrong with refurbished products, especially if they come from the factory. There is nothing wrong with the products and they are usually cheaper. Besides, there is no reason to get it right away and hold off until all of the hype dies down and then the prices will follow.
I hope to update more often but I cannot promise anything since I know do 24 hour shifts.
Hasta.
To begin with, I have a lot more confidence in myself and my abilities to treat my patients. This all comes with experience. The more patients that you see, the more that you will understand things. Even more experience came when I was doing all of the admissions. During that rotation, I would be the one who would come up with the assessment and plan and then discuss it with the attending. Most of the time, my plan was right on. Other times, there could have been something better or something was added that should not have been. For example, Vancomycin to a patient who should have had a level first. However these things come with the territory. This is all in keeping with my goal this year.
Last year, my goal was to become a good intern and now this year my goal is to become a good resident. So far, the only thing that has been commented on by my attendings is that I have to read more. But then again, so does everyone. Once I am able to do that, then I will be golden. The issues is trying to come up with a schedule that works. What I am going to be trying is to read for about 1-2 hours per night after 9pm when the kids are in bed. This is not always achievable. Because of course, the kids do not always go to bed at the pre-determined time and of course there is always wife time that needs to be had.
My goal for this year is to really get more into a hobby. I am either going to work or I am at home and sleeping. One reason I am able to update this blog is because I am on vacation and since I have no boards to study for this time, I am able to really relax. So I did what any good doctor does, I played golf and fished. I have to work on both of these things. I am not ready for any PGA tour but I did have a lot of fun. And will not win any tournaments with my little large mouth bass that I caught but as they say, a bad day of fishing is certainly better than a good day at work. Even though I love my job, I love to golf and fish.
On the financial front, the plan is to keep our heads above water just long enough until I am done with residency and I can get an attending salary for a few years. Give us some breathing room. But always remembering to take advantage of discounts and there is nothing wrong with refurbished products, especially if they come from the factory. There is nothing wrong with the products and they are usually cheaper. Besides, there is no reason to get it right away and hold off until all of the hype dies down and then the prices will follow.
I hope to update more often but I cannot promise anything since I know do 24 hour shifts.
Hasta.
Sunday, April 8, 2012
Old Pre Meds National Conference June 7-10; Orlando Florida
| Cecil B. Wilson, MD (keynote address) Immediate Past President American Medical Association |
| David W. Kelley, DO Assistant Professor of Anesthesiology SUNY Upstate Medical University Founding Member of OldPreMeds |
| Judy Colwell, MA Former Assistant Director of Admissions Stanford University School of Medicine presenting "The Nuts and Bolts of Applying" |
| Dawn K. Aldrich, MD Founder/CEO of Solutions Health & Wellness Center author of the audio book series "The Day That Changed My Life, Cancer: an uncertain journey" |
| Trena Gologan, MBA Admissions Coordinator/Recruiter Philadelphia College of Osteopathic Medicine (Georgia campus) presenting "Professionalism and Admissions: a viewpoint from the other side" |
Conference Registration
And COMLEX is all done!!! I PASSED STEP 3!!!!
Hello there my friends out in cyberspace. I have just finished my time on nights, which was not that bad. It was a lot of learning that I had actually done even if it was just a few things here and there. For example, one of the biggest things I learned was to steadfastly say no to people who were manipulative in trying to get their narcotics. It is very hard to say to someone who says that they are in pain that they cannot have medication for it. However, I did learn to differentiate between people who are truly in pain and who will benefit from powerful pain medicines and someone who is an addict and is there for you to be their personal drug dealer.
But you can then argue to me "Well, addiction is also a medical condition so you are treating them aren't you? And by withholding the narcotics are you not forcing them to go through withdrawl?" And to these questions I say Yes and No. Yes, addiction is a disease that needs treatment. However, you do not go see a Chiropractor for your heart attack. If the patient truly wants to get off of the junk, they need to be properly treated in a detox unit by a medical staff that is properly trained to handle it. I am not one of them. And yes, I can learn but that is more of a specialty and one that I am not interested in pursuing. And No, you are not treating them by giving them the narcotics that they are addicted to. You treat the withdrawl symptoms and make the personal comfortable. Besides, you can tell when these people are lying because they embelish everything. From the amount of pain they are in (a person who tells me that their pain is 10/10 but when I see them as I walk in the room and they are sleeping or watching TV or talking on the phone without missing a beat). I have seen people in severe pain and they cannot stay still long enough to answer any of my questions let alone talk on the phone.
Another thing I learned was how to handle sleep problems in the hospital. Yes, it is very easy when the nurse calls about the patient not sleeping to give a verbal order for sleeping pills, but are you really doing the patient a service or a disservice by giving them that pill. For starters, it is a hospital and not a hotel. The beds are not the most comfortable thing in the world. Second, there are other people around making noise. Third, you are not in your own environment and maybe warmer or colder than you normally are and finally, you are in the hospital because you are ill for one reason or another. So your sleeping patterns will also be affected. What I started to do was to look at why the patient is here, what other medicines they are on and more importantly talk to the patient. Most of the time, the patient is not on a sleeping pill at home and there is no reason for them to be on one now. They have the TV on or the light on. So I suggest that they create a better sleep environment by turning off the TV, turning off the light and closing the door. There is no reason why the door to the hospital room has to be open. Most of the time, they understand.
Finally, I started to learn how to really put out fires and life endangering problems. While I do need to learn some more, I feel a lot more comfortable doing it or even just starting it.
I was thinking about adding a video every now and again. But only if my readers would like it. Please tell me what your thoughts are about that.
And to close, the NonTrad tip of this posting: One of the greatest assets that us non traditional students have is our maturity and our experience in previous careers. Take your knowledge of office politics and what not to do, and your customer service knowledge about selling your product and apply it to the nurses and the patients. Never say anything that you will regret, and always acknowledge the concerns the families have. And always follow through with what you said you will do. Even if the answer is no or if the news is not positive, the fact that you followed through is enough for the families and the patient.
But you can then argue to me "Well, addiction is also a medical condition so you are treating them aren't you? And by withholding the narcotics are you not forcing them to go through withdrawl?" And to these questions I say Yes and No. Yes, addiction is a disease that needs treatment. However, you do not go see a Chiropractor for your heart attack. If the patient truly wants to get off of the junk, they need to be properly treated in a detox unit by a medical staff that is properly trained to handle it. I am not one of them. And yes, I can learn but that is more of a specialty and one that I am not interested in pursuing. And No, you are not treating them by giving them the narcotics that they are addicted to. You treat the withdrawl symptoms and make the personal comfortable. Besides, you can tell when these people are lying because they embelish everything. From the amount of pain they are in (a person who tells me that their pain is 10/10 but when I see them as I walk in the room and they are sleeping or watching TV or talking on the phone without missing a beat). I have seen people in severe pain and they cannot stay still long enough to answer any of my questions let alone talk on the phone.
Another thing I learned was how to handle sleep problems in the hospital. Yes, it is very easy when the nurse calls about the patient not sleeping to give a verbal order for sleeping pills, but are you really doing the patient a service or a disservice by giving them that pill. For starters, it is a hospital and not a hotel. The beds are not the most comfortable thing in the world. Second, there are other people around making noise. Third, you are not in your own environment and maybe warmer or colder than you normally are and finally, you are in the hospital because you are ill for one reason or another. So your sleeping patterns will also be affected. What I started to do was to look at why the patient is here, what other medicines they are on and more importantly talk to the patient. Most of the time, the patient is not on a sleeping pill at home and there is no reason for them to be on one now. They have the TV on or the light on. So I suggest that they create a better sleep environment by turning off the TV, turning off the light and closing the door. There is no reason why the door to the hospital room has to be open. Most of the time, they understand.
Finally, I started to learn how to really put out fires and life endangering problems. While I do need to learn some more, I feel a lot more comfortable doing it or even just starting it.
I was thinking about adding a video every now and again. But only if my readers would like it. Please tell me what your thoughts are about that.
And to close, the NonTrad tip of this posting: One of the greatest assets that us non traditional students have is our maturity and our experience in previous careers. Take your knowledge of office politics and what not to do, and your customer service knowledge about selling your product and apply it to the nurses and the patients. Never say anything that you will regret, and always acknowledge the concerns the families have. And always follow through with what you said you will do. Even if the answer is no or if the news is not positive, the fact that you followed through is enough for the families and the patient.
Sunday, February 26, 2012
Night Float
Well my vacation has been over. During that "staycation" I pretty much tried to catch up on some projects that I have been meaning to do at home. I am now in my 2nd week of nights. Boy is my system off. Right now my main job is to help with admissions. Once I finish at 5 admissions I am done for the night. The earlier this happens, the sooner I go home. But if it happens later, then I tend to go back to the residents quarters and go to sleep so that I can get home safely.
Part of my job is to be the night float intern on Friday nights. Basically for practically anything I get called. This past Friday was especially busy. But not with acute problems, mainly a lot of busy work. Checking up on labs, putting in IVs when the nurses could not, putting in a nasalgastric tube. Every time I went to lay down and get some rest, my beeper went off. I probably got a good 1 hour of decent sleep that night. But that is what I signed up for right. But the cool thing was that I was confident in my abilities. The only time I called my resident was to confirm my plan in a case that I was sure about but need to confirm my suspicions. It is just like they say, time and experience.
Still waiting on the COMLEX results. Less than 2.5 years to go before I make a descent salary. In the meantime, lets take advantage of any and all programs we qualify for.
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