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Thread: Clinical Applications

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    Sphinx43 is offline Newbie 510 points
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    Clinical Applications

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    Hey guys, curious as to when and if we will do any actual hands on practice? Are the AMSA workshops the only exposure we are going to get to phlebotomy / etc.? Or will we learn some of the more basic procedures in ICM eventually? Curious as to what we should be proficient in by the time clinicals roll around.

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    Macgyver1MD's Avatar
    Macgyver1MD is offline Senior Member 535 points
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    U will never hardly ever have to draw blood as a med student or resident. The rare exception is the odd patient who requests the "doctor" do it because they have difficult veins. Why would u want the least experienced person the stick u? The important skills you should learn is how to put on sterile gloves and gown. How to place an arterial line, central line (fem and Juglar) procedure. Suturing and biopsy techniques would be ideal.

    It's good to know what u do in drawing blood and how to apply EKG leads in case ur asked to help staff in hospital. But this is rare.

    There is usually a phlebotomist in the class, so make an announcement for anyone wanting to lead a class.

    See if Dr S*** icm fellow would have time. He may be able to give some insight.
    PGY-Attending Hidden Content FP

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    devildoc8404 is offline Ultimate Member 12699 points
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    Quote Originally Posted by Macgyver1MD View Post
    U will never hardly ever have to draw blood as a med student or resident. The rare exception is the odd patient who requests the "doctor" do it because they have difficult veins. Why would u want the least experienced person the stick u?
    Yup. I worked as a hospital phleb tech for a good while, and that always used to crack me up... people would come into the lab all serious-faced, moaning "The DOCTOR couldn't even get my blood, so I don't know why they bothered to send me here."

    Hmmmm. Maybe because the doctor never-ever-ever draws blood, and this nice, middle-aged woman in the Winnie-the-Pooh scrubs could probably coax a full set of ER tubes out of a desiccated turnip? Maybe that's why?

    Ahhhh, good times. Thanks for the memories on that one.

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    ds_in_tx is offline Senior Member
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    Several of the hospitals I rotated at didn't even allow med students to draw blood or cannulate. Did plenty of centrals, ABGs, a few chest tubes, para/thoracenteses and skin biopsies, closed up in the OR, etc. Remember: you are in training to be a doctor, not a nurse or a phlebotomist or EKG tech or rad tech or whatever else. While those skills *might* be useful if you are on a medical mission or practicing in rural middle-of-nowhere, you won't ever be doing that stuff day-to-day.

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    rokshana is offline Member Guru 11644 points
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    the funny thing is that the ABIM requires venipuncture and NGT placement, but no longer requires central or a lines...

    and guess ya'll never rotated in some of the NYC hospitals...there lab draws are routinely done by the interns (and of course that rolled down to the med student).
    Endocrinology, Diabetes and Metabolism Attending
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    BrianB4837 is offline Member 530 points
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    Wow you guys are all VERY spoiled. Rockshana is correct, in NYC nurses have an unwritten rule where they don't do phlebotomy, and the phlebotomy service is only available at certain times. So if you have to draw q6h ptt or q6h CBCs or cardiac enzymes, the residents are sticking the patients, then you are signing out the next one to on call, then the 3rd to night float.

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    cms
    cms is offline Member 514 points
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    Quote Originally Posted by BrianB4837 View Post
    Wow you guys are all VERY spoiled. Rockshana is correct, in NYC nurses have an unwritten rule where they don't do phlebotomy, and the phlebotomy service is only available at certain times. So if you have to draw q6h ptt or q6h CBCs or cardiac enzymes, the residents are sticking the patients, then you are signing out the next one to on call, then the 3rd to night float.
    Sounds like the NYC nurses are the ones who are spoiled (why does this not surprise me).

    It simply makes sense for the nurses/techs to do it given both their experience and simple laws of economics. Part of the problem with the system is doctors do way too much stuff that is better done by a nurse, a tech, a PA, etc. Assign the most logical (and least expensive) person to do the task, freeing up valuable time to deal with things that require a doctor's expertise.
    RfisherMD likes this.

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    RfisherMD is offline Senior Member
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    Quote Originally Posted by cms View Post
    Assign the most logical (and least expensive) person to do the task
    I agree with you 100%. However, the least expensive person in a teaching hospital would be the Med Student right??
    AUC c/o 2013
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    Slaol is offline Elite Member 7164 points
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    If you go to the UK, you will get the opportunity to practice clinical skills on a daily basis. I once rounded with a phlebotomist when I was in IM and she let me take blood from close to 20 consecutive patients. It was awesome.

    There is a rule here for any procedure (not sure how things are in the US) - it's "First you see one, then you do one, then you teach one".

    If you show up on any ward and ask to practice venipuncture, cannulation, ABGs, etc... the nurses and doctors are more than happy to pass the work on to you. In fact, medical students are expected to do these things. Nurses don't usually take blood here.
    Last edited by Slaol; 02-18-2011 at 08:27 AM.
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    cms
    cms is offline Member 514 points
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    Quote Originally Posted by Rfisher View Post
    I agree with you 100%. However, the least expensive person in a teaching hospital would be the Med Student right??
    Dont disagree with that particular point and its something we should know how to do, but Rok was saying residents which I do disagree with. Now if the techs are gone for the night and the nurses/etc are busy doing actual work then we should be able and willing to do it but its not an ideal application of resources under normal circumstances.

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