Clinical Medicine Rules

Generally: Be exceedingly polite to RNs/techs/aides. Introduce yourself, and then ask for their name. Some (esp. RN’s) will be mean/cold to you no matter what. Some will get nicer once you demonstrate at least marginal competence. Also, if you’re female, remember that there’s a substantial amount of female-on-female hate in medicine. Don’t take it personally.

CRUCIALLY, if you have to hand out an evaluation, make sure your intern/resident completes it *in front of you* and gives you real-time feedback. If you know you’re going to hand someone an eval in a set amount of time (say, at the end of a 2 week block), then ask them near the end of the first block to evaluate you (i.e. a week before your actual eval is due). Explain that your goal is to be an “X” level student (you can say “acting-intern or sub-I level” instead of honors if you don’t want to sound like a douchebag) and that you want to know if there are any areas you need to step up your performance in order to meet that goal.

DO NOT “fire-and-forget” by handing out an eval form and walking away, if at all possible. This is how you get screwed. Sometimes it will be unavoidable, but, beware the consequences. Also, don’t lose your evals or forget to hand them in …

1A. Giving normal saline, if an option, is NEVER the wrong answer.

1B. Getting a beta-HCG, if an option, is almost never the wrong answer.

2. For boards, only in family medicine is “refer to specialist” ever the correct answer. Even if you’re an ophthalmologist, you should still be an expert in DMARDs, indications for ORIF at every bone, and how to manage an acute abdomen.

3. Eat when you can.

4. Sleep when you can. [Corollaries: Go home when you are told to go home. Never stand when you can sit. Never sit when you can lie down.]

5. Anything in the abdomen or pelvis is common bile duct or ureter unless proven otherwise.

6. Don’t even think about the pancreas, much less fuck with it.

7. Trust no one, especially not the patient. Check everything yourself. Understand how data is generated on the floors (e.g. how are I’s & O’s estimated when a patient doesn’t have a foley? what size BP cuff was used with the patient?). Know trends, not just ranges (but DEFINITELY know the ranges for everything). Understand the reason for any changes in objective/subjective measurements.

8. If you didn’t document it, it didn’t happen [this rule is HIGHLY prone to abuse]. Conversely, if you did document it, you’d better freakin have done the exam (get ready to get grilled if you write “AOx3” without asking). Avoid subjective assessments in the objective data section: “appropriate tenderness”, “lungs clear”.

9. Conversational politeness to others must increase in inverse proportion to pay scale (see above). Make friends with the floor staff and they might save your butt.

10. The walls have ears. See #9

11. You’re always playing with someone else’s money (related to “The Patient is the one with the Disease.”). Meaning several things: firstly, if you screw up, your intern/resident/chief/attending gets the ultimate blame, secondly, if you screw up, the patient gets hurt, not you. Implications: people are trusting you, don’t let them down by taking shortcuts, and, the patient is ultimately trusting you and bears your failures, so do your best at all times.

12. If you don’t take care of yourself, no one else will (related to #3 and #4). Go to the gym. Eat well. Get a haircut. Have a hobby. Insist upon being human in whatever way you can.

13. Be aggressive. B-E aggressive. You have to ask for opportunities, or simply take them, and you cannot count on them being offered to you. Ask to cut, suture, and tie in the OR. Ask to do procedures and/or examine patients by yourself or under supervision instead of shadowing your resident/attending.

14. Work hard. One surgical textbook describes the ideal medical student as a “high-speed low-drag hammerhead.” While this is hyperbolic and hypermacho, it’s not that far from the goal in almost every field of surgery.

15. Please, for the love of god, never ask your residents/attendings “Is there anything I can help you with?” This statement reflects three things, all negative: 1. You don’t have anything to do. 2. You don’t know what you should be doing. 3. You are imposing on your resident/attending because if they wanted you to do something they would have asked you already. Instead, learn what they need and then do that thing, or, ask them if you can do a specific task “Would you like me to gather the vitals before PM rounds? Would you like me to pull Mr. Z’s JP drain with the intern supervising?”

16. If there isn’t anything for you to do, study VISIBLY near your team. Don’t text or surf the web or facebook. Do work – you are at work – and engage in leisure activities on your own time.

Also see the Fat Man’s Laws (and read the book if you haven’t).

2 Responses to Clinical Medicine Rules

  1. Pingback: Saturday Round-up | Action Potential

  2. Jim says:

    Love some of these rules.

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