Thread: what not to do during clinicals........quick tip(s)

Tips 1 & 2 were posted in the WHO thread.

quick tip #3

Do not presume as a 3rd year student (or 4th year for that matter) that you fully understand the emotional implications of a diagnosis, for a patient. Thus please don't take the liberty of telling a patient they have cancer and not much time to live. That is usually the job of the resident or attending.



(all of these are deriving from rotational experiences)

If anyone else has tips................it would be great if you would post do's and don'ts during rotations.

Quick tip #4 ( some may disagree with this one but this is my experience)

Be nice to nurses.........no matter how catty.........how mean and insensitive they are to you. You are just a med student with barely any clinical experience........... they, however, have likely worked in that hospital for over 15 years and see new med students every 4 weeks, each thinking he/she is the awesomest stuff.......when, in truth, he/she doesn't know crapola. The nurses will eventually cool their jets when they get to know you over the course of the rotation (be patient with them) and they can be your best friends when you need something. They can even recommend your good deeds to residents and attendings (believe me.....I've seen nurses in action with this).

Quick tip #1: DO

When given a consult to see......please read up on the patient in the system beforehand, ask the nurse about the patient (if available)........and then go and see your patient. You will have a good background of how the patient presented to the nurse.......and if any major changes in presentation occurred in the interim; you will know if your patient is lying to you.............and you will have a good grasp of the overall background when presenting to your resident/attending.

Quick tip #2 do:

If the resident asks you to call in a consult.........please get as complete information as possible about the patient before you make that call. Below is not the complete list, but some major stuff the other consult resident will ask you to provide.
1. Name
2. gender
3. age
4. CC
5. Presentation
6. How long ago did they present?
7. Relevant medical hx
8. Medical Record Number
9. WHY you are consulting them? What do you want that team to do? (Very important)

Originally Posted by DWB

Bunch of this is in that thread about new 3rd years coming in...under clinicals

5) go to sleep without reading atleast 1 page of something - doesn't have to be something you saw cud just be a random page of whatever u want

difficult to do most of time..............but VERY essential. You won't be sweating bullets when shelf exams come nearer.

Originally Posted by tin_md

Quick tip #1: DO When given a consult to see......please read up on the patient in the system beforehand, ask the nurse about the patient (if available)........and then go and see your patient. You will have a good background of how the patient presented to the nurse.......and if any major changes in presentation occurred in the interim; you will know if your patient is lying to you.............and you will have a good grasp of the overall background when presenting to your resident/attending. Quick tip #2 do: If the resident asks you to call in a consult.........please get as complete information as possible about the patient before you make that call. Below is not the complete list, but some major stuff the other consult resident will ask you to provide. 1. Name 2. gender 3. age 4. CC 5. Presentation 6. How long ago did they present? 7. Relevant medical hx 8. Medical Record Number 9. WHY you are consulting them? What do you want that team to do? (Very important)

Be weary of consulting surgeons as a student... just let a resident handle it if u can.... this will take some sweet talking and quick thinking to get out of the situation... and if u have to call someone call the surgery intern.. if you call the senior s/he is going to rip u up 9 times out of 10 (i've been on the surgery side of those calls... they're hilarious but at the end of it the senior looked at me and said... don't ever call me, even if u know me, i'm busy working and that's what we have interns for).

DO:
1. iron your clothes. This annoyed me as a med student to see other students show up in shirts and pants that look like they cam out of the laundry basket. If you can't iron, dry cleaners will do just ironing.
2. Wash your white coat regularly. Showing up in a dirty white coat is not professional. Showing up in it wrinkled and dirty is even worse.
3. Learn to write so others can read it.
4. Do keep a positive attitude.
5. Do realize that lunch time is not at 12pm. It is when you have time to eat.
6. Get your fellow students lunch if they are tied up and the cafeteria is closing soon and they have not eaten. Students have to watch out for each other
7. Do let your resident know if you need to leave during the day for a personal or family matter (i.e. your husband calls in the middle of the day and tell you he wants a divorce). Most residents will understand, and if not, talk to your rotation education person or the hospital education person.
8. try to get sleep when you can. use the weekends to catch up on sleep.

Don't
1. just not show up. call your resident, education person, another student and let them know you are sick
2. don't skip and say another student in your group told to it was a holiday to cover your own rear. Be honest and say I thought it was a holiday and we didn't have to come.
3. Don't go and hide and leave the other students to do all the work and then try to claim you did it.
4. show up late all the time
5. don't read the attendings H&P and say how they left things out
6. Don't present a patient if you have never seen the patient
7. Don't tell a resident you can't see a patient because it is lunch time
8. don't miss the birth of your baby because you are at the hospital for a rotation. attendings will understand
9. don't act like you know more than the nurses.......you don't
10. don't argue with attendings about diagnosis or treatment. you can ask questions to see why they came to that dx or tx
11. don't throw your fellow students or residents under the bus. This can follow you to interviews.
12. don't have conversations with the residents and attendings in your native language or present patients during round it your native language even if most of the team understands. It is very annoying and rude to do this if you are the only one in the group who does not speak that language. This happened to me. all 3 residents, attending, and student spoke hindi and would do rounds speaking this language, i did not. I had to remind them almost daily they need to speak english.

Originally Posted by DWB

Be weary of consulting surgeons as a student... just let a resident handle it if u can.... this will take some sweet talking and quick thinking to get out of the situation... and if u have to call someone call the surgery intern.. if you call the senior s/he is going to rip u up 9 times out of 10 (i've been on the surgery side of those calls... they're hilarious but at the end of it the senior looked at me and said... don't ever call me, even if u know me, i'm busy working and that's what we have interns for).

God, surgeons are the worst, and resident-surgeons are the worst of the worst. I'm sorry, but that advice is disappointing in its entirety. I don't care who you are calling, you state your piece (as described above; history, findings, etc.), and that's that. No surgeons are "busy working and that's what we have interns for" in any capacity busier than interns, internal-med residents, peds residents, critical care fellows, em residents, family med residents, etc - ad nauseum. We all work for the same patients and we all work our assess off, senior to junior and everyone in between.

Your anecdote is the perfect example of why surgeons have possibly the worst rep of all the specialties, and its too bad they instilled that value in you as a student. The senior is no more busy or more important than the intern who is taking all those crappy RN-calls in the middle of the night. And if the intern is busy, scrubbed, or whatever, you had better believe I'm gonna page the senior next and the attending right after that until I get a response and someone sees the damn patient!

Sorry, this just irks me to no end when one resident thinks his or her job is SO MUCH more important than the work everyone else is performing...

Originally Posted by PaddyMelt

God, surgeons are the worst, and resident-surgeons are the worst of the worst. I'm sorry, but that advice is disappointing in its entirety. I don't care who you are calling, you state your piece (as described above; history, findings, etc.), and that's that. No surgeons are "busy working and that's what we have interns for" in any capacity busier than interns, internal-med residents, peds residents, critical care fellows, em residents, family med residents, etc - ad nauseum. We all work for the same patients and we all work our assess off, senior to junior and everyone in between.

Your anecdote is the perfect example of why surgeons have possibly the worst rep of all the specialties, and its too bad they instilled that value in you as a student. The senior is no more busy or more important than the intern who is taking all those crappy RN-calls in the middle of the night. And if the intern is busy, scrubbed, or whatever, you had better believe I'm gonna page the senior next and the attending right after that until I get a response and someone sees the damn patient!

Sorry, this just irks me to no end when one resident thinks his or her job is SO MUCH more important than the work everyone else is performing...

I totally appreciate everyone's input........ this is great.

If i was told to call in a consult..........I called in the consult. Residents are sharp and they know when a student is trying to skip out on a situation. Just do the best you can............and you will learn what not to do next time.........if you get yelled at.

Quick tip # (lost count)

Just because you don't want to do FM or surgery or pediatrics...............whatever it may be...........does not mean you should not be on your best behavior for all rotations. The reason why......is b/c all your evals from every rotation are eventually compiled into your dean's letter which program directors and residency committees read during the interview season. I was in an interview in which the PD was impressed with my evals from other rotations in addition to my surgery ones.........and he pointed that out in the interview, proceeded to ask me a question regarding the evals (to which I gave an awesome answer). He was also the same one that called me right before rank lists were being made to encourage me to their program.

All this because of good evals from OTHER rotations .......that were not in my field of interest. So please keep this in mind

DO:

try your best, be polite, don't throw students under the bus, smile, act interested, STUDY, and be a very very compassionate person to your patients. No matter how fake you are being. Your patient will love that you have made the effort (will often tell your resident/attending how great you were to them) and people around the hospital DO notice and this can often make you stand out a lot. Plus, we are all here to help people, right? So just be a good person no matter how tough your day is. Make someone else's day by smiling and listening. It's a pretty simple method that hardly anyone follows... although most people will say they do.

DON'T

Ever think that because "that's how it has been in medicine, traditionally" then that is OK. It's not. And the atmosphere of medicine is the number 1 reason I went into pathology.
What am I referring to? Every single time you feel abused, you are made to feel like you are less than someone else, less important than someone else; basically anything that your mom would disapprove of someone doing to you.

For those that know me I'm a very easy going, social person. But there's no way that I am going to spend my life (and yes, you spend more hours of your life at work than doing anything else, including being with family) in a profession that condones abuse. Quite frankly it's pathetic and embarrassing that our profession that preaches help, healing, and kindness, is at its core, abusive.

A great example of this is from the movie Breast Men, in a scene near the beginning of the movie where the attending surgeon verbally assaults another resident. I just shook my head and laughed... let's see how tough that attending would be outside of his precious OR.

Of course this does not apply to every physician but it applies to enough that it requires a change.

So what should you DO?

Be the change. Quite simply. Just because other people do something doesn't mean you have to. When residents are laughing about some patient who is "crazy" or a patient who is wildly overweight, or whatever the reason... don't support that behavior. You don't have to call them out on it (and often doing that will just put you in their bad books), but don't support it. When you are a resident, remember all of the residents and attendings that were abusive to you and do not do that to other people. Do not think that just because you are a resident you have some God-given right to put down other people just because people have put you down in the past. You are a doctor, so act like one. Or perhaps better put, act like how you saw yourself as a doctor when you were growing up.


After re-reading my post it may sound like I endured extreme hardships as a medical student but I really did not. However I have seen and heard enough to realize that many students do. And it's about time it ended.

Originally Posted by Crispy

12. don't have conversations with the residents and attendings in your native language or present patients during round it your native language even if most of the team understands. It is very annoying and rude to do this if you are the only one in the group who does not speak that language. This happened to me. all 3 residents, attending, and student spoke hindi and would do rounds speaking this language, i did not. I had to remind them almost daily they need to speak english.

This is so absurd and inconsiderate it's ridiculous.