ZT老年科病房轮转经历（第一次到病房）

ZT老年科病房轮转经历（第一次到病房）


Spent the past two weeks in Geriatrics ward. I was really scared before I
started as this was my first rotation on the floor. There are two residents
in geriatrics, each resident supervises one intern. When I was there, I had
no intern but two sub-interns. Sub-interns are fourth year medical students
doing rotations on the floor. Their responsibility is same as those of
interns, except they only carry half amount of patients. When on call they
are on call together. Therefore 2 sub-Is equals 1 intern. I was even more
nervous when I heard I will have sub-I since I will need to cosign all the
orders entered by sub-Is.

A day in geriatrics ward is like this:
I arrive at the hospital at 7am. At that time my sub-Is already finished
rounding and notes for their patients (They arrive at 5:30am). Each Sub-I
carries 7-8 patients at most (during the 2 weeks I was there, patient number
can vary). So I carry around 15 patients on average. If it’s my turn to
pick up night float admission, I would go to medicine dept to meet the night
float resident at 7am. The other resident on the floor and I take turns to
pick up night float admission. These patients were admitted from 7pm to 7am
next day by night float PGY-3. Usually patients are still in ER waiting for
a bed on the floor. When I pick up these patients, I basically get sign out
from the residents who admitted them. Then I will go to see these patients
with my Sub-Is and put in orders if necessary. After seeing these new
patients, I will round with my sub-Is.

At 8:30am we have attending round. One service attending in the ward. We go
over all service patients in the conference room with the attending. Then
attending will see the new patients with us. For the old patients attending
will see them by herself later in the day. Some patients are private which
means their attending for hospitalization is their own doctor in the clinic.
These private attendings are associated with our hospital and has privilege
in admission. So they will come by and leave a note for us to carry out. If
we have questions we will also call them. When I was there, about 20% were
private patients.

At 9:50am to 11am we have morning report. That’s only for PGY-2 and PGY-3.
Interns don’t get to go since they need to finish the work on the floor
after attending round. Interns have intern’s report every Friday noon.
Morning report is very good learning opportunity. Usually we will go over
two or three cases presented by residents. Discussion is great and we will
also get some mini lecture from the chief of medicine or program director or
other attendings. Morning report is one thing that always reminds me I need
to learn more.

From 11am to 12pm I usually return to the ward and touch base with my sub-Is
. Usually put in orders or talk to patients. If I wasn’t able to finish
rounding all my patients before 8:30am, I will usually do so during this
time.

From 12pm to 1pm is noon conference. Everyday has a different theme. Most
noons are lectures. Thursdays are M&M. Fridays are house staff meeting. Free
lunch is provided for noon conference but I don’t always get to attend.
Sometimes it’s just too busy on the floor. Those are fantastic lectures so
I will try to go everyday from now on.

From 1pm I just work on my patients. I don’t need to write long progress
notes. But I do need to write chart review everyday. It’s usually a summery
of what’s going on with the patient and key issues need to be addressed.
Could be two sentences, could be much longer.

Geriatrics is not a big service. So for on call we take turns with
nephrology house staff. Since there are two residents from each service, I
am on call every fourth day. Same for intern/sub-I. Interns take 24hour call
. They will admit throughout the call. Admission cap for intern is 6. (They
stop adimitting when they did 6 already). No cap for residents so basically
resident keep admitting until they are off. As a resident I don’t need to
take 24hour call. It’s 7am to 7pm. Night float resident will admit from 7pm
to 7am next day. During my call, I admit Geriatrics patients the whole time
, then Nephrology patients from 4pm to 7pm with nephrology intern. (I am
always on call with a nephrology intern) When my sub-Is are on call (always
different date as my call) I need to admit patient with them from 7am to 4pm
. That is we both see new patients in ER and both write admission notes. So
for each cycle, 2 of 4 days I need to admit new patients. Although our ward
is on 10th floor, when we have new patients they can be in any ward as long
as there is a bed available.So there is no limit for patient number we carry
.

In reality, when I am not on call I get home at around 10-11pm. On about two
or three occasions I went home at 8:30pm. When I am on call I get home much
later. The longest call I had was from 7am to 3am next day (that was my
first call, second day on the floor. So I was slow in doing everything too).
Then I had to show up for work at 7am the same day. The reason I ended up
staying late is because sometimes patients on the floor are very sick and we
end up sending them to MICU or surgery. Although I have night float
resident to cover my patients from 7pm to 7am next day, I can’t really
count on them to take over from 7pm sharp. Night float are busy admitting
patients. I have to finish most work ups for sick patients if needed before
I leave. That’s why even when I am not on call I need to take care of
patients till much later than 7pm.

On average we can have 1 day off per week. I happened to have “rotten
weekend” during my two weeks there so I only got one day off after working
there for 12 days. My co-resident had “golden weekend” during the first
weekend so he got Sat and Sun off. I had to cover his patients for those two
days which kept me busy. For the second Sunday I was also covering BMT ward
. Basically hematology fellow signed out the list of bone marrow
transplantation patients to me at around 10am. I needed to respond to nurse
’s page and deal with issues from those patients until 7pm. (Essentially I
was the intern for BMT that day)

For interns, they can sign out at noon or earlier after call. We have
physician assistant to cover their patients when they are post call. So it’
s a lot easier for me and the intern of the other team. PA is very good and
a great resource for me too.

We have a lot of old and demented patients on the floor. I thought the
rotation would be boring but to my surprise I met some great women and their
spirit really inspired me a lot. They used to be quite famous. Although
sick I can see they are still strong inside. Also I saw a lot of spouses
taking care of their loved ones. Most of them have been married for 50 years
or more. Their love and care made me realize there are true love in this
world after all. I feel sad seeing them so reluctant to let the other half
go. I met all kinds of people: from super rich to very poor. But they
received same care on the floor.

A lot of social issues for our patients. So talking to social workers is
important part of our daily work too.

Overall I enjoyed my first rotation on the floor. Getting used to the system
takes time but not so bad. My attending said to me “no matter how
uncertified you feel about yourself, you are actually doing fine” Some
people I worked with didn’t realize I am new until later. I guess it’s a
good sign when they couldn’t tell. My two sub-Is are very smart and
enthusiastic. I learned a lot from them too.

There are still a lot of new things for me to learn. I did do quite a number
of silly things during the two weeks such as forgetting to pick up night
float once or not putting in the service pager number into chart when admit
new patients etc. I felt stupid although people understood. Overall I think
I am getting there and this should be the case for everyone on this BBS.

Now I am doing a rotation in another subspecialty hospital. Things are much
slower here so I can have time to write this down. Good luck everyone.