Advice for the Wards

The only source of knowledge is experience.”
– Albert Einstein

Guidelines

  • No question is a stupid question.
  • If you do not know, ask someone who does – and don’t be afraid to do so.
  • Do not believe everything you read or hear. Think critically.

Principles of Clinical Medicine

adapted from Care of the Medical Patient by Fred Ferri, MD

  • Common things occur commonly.
  • When you hear hoof beats, think of horses, not zebras.
  • If what you’re doing is working, keep doing it.
  • If what you’re doing is not working, stop doing it.
  • If you don’t know what to do, call someone who does.

Know that you are NEVER alone and that help is always a phone call away.

Pearls for the Wards

Time Management is Essential

  • DO NOT BE LATE. This has always been true; but now that you are near the bottom of a very tall totem pole, one of the quickest ways to fall out of favor with your attendings and residents is to start poorly.
  • The better you know Ochsner’s multiple computer applications, the faster you will be able to find information, the more valuable you will be to your team.

Pre-Rounds

  • Ask your resident to assign you patients with a variety of complaints, e.g. with pathologies in various systems. You may opt to follow one short-stay patient and one long-stay patient, or one “straightforward” case and one complex case, at a time.
  • Check vitals, labs, and imaging reports.
  • Find your patient’s chart to check progress notes and check orders written since you last saw your patient.
  • See your patient with your resident, if possible.
  • Discuss your patient’s plan for the day with your resident.
  • Know if your service has a Spectralink phone assigned to it. This may be the best way to catch up with your service when you get separated.

Morning Report / Conference

  • Attend morning reports and conferences with your service unless you have a faculty-approved overriding engagement.
  • These conferences are to a resident what PBL was to you in Years 1 & 2: It is what you make of it.
  • Observe how the residents present their cases. You will be in their place in two years.
  • Actively develop your own differential diagnosis and management plan.
  • Don’t be afraid to ask questions. Rest assured, there’s a resident in the room who also doesn’t know the answer.

Rounds

  • A good medical student prepares!
    • Know your patient.
    • Rehearse your presentations before you give them to your attending. If you are crisp, concise, and organized, your attending can concentrate on your medical knowledge and management skills as opposed to your presentation skills.
    • Anticipate questions you may get from your attending.

Post-Rounds

  • Be sure your patient’s orders are obvious in the chart and put in the correct place.
  • Offer to help your resident with tasks pertaining to your patient.
  • Read up on topics discussed during rounds, especially those pertaining to your patient. A sharp attending will remember to quiz you later – even days later.
  • Check in with resident for post-round discussion.

End of the Day

  • It is courtesy to let your resident know that you’re leaving for the day.
  • Reflect on the day your patient has had. Good? Bad? Busy? Slow?
  • Consider what tomorrow will hold for your patient.
  • If you want to impress the right people, find out what tomorrow’s morning report topic is and read up on it ahead of time. Having the right questions is just as impressive as having the right answers.