Saturday, July 2, 2011

TIPS 8 : Internal Medicine in UKMMC

I was either very lucky or unlucky to have medicine as my first posting. Its been 3 weeks in internal medicine (IM). In my opinion, in IM there is not much variation of the things you need to do, but because medicine itself is a cocktail of all the basic things in medicine, the heaviness lies on the things you need to know, rather than the things you need to get done.The first week is the coffee and lectures week, where there will be lots of coffee to make sure you can stay awake for the long lectures. It might be a little too much to have lectures from 8am-5pm, but some of the lectures really got you thinking of how inadequate your knowledge is. So you will either become motivated to study even harder, or end up getting depressed or a mixture of both (most of the time), but then you need to stand up no matter what to get yourself ready for the real stuff.

My first ward work was at UKMMC. You either start at UKMMC, HKL or HTI. I don’t know about the rest yet, but here’s my very own tips to make sure you can stay, well at least, organized, during IM in UKMMC. Now IM in UKMMC is a lot heavier (from what I heard). It’s a compulsory to be present during ward rounds everyday and to present your case. So even though I say there is not much variation of the things you need to do, but covering the beds and preparing for the ward rounds sometimes takes up half of your life in medicine. Since there will be 4-5 person per ward, one person must cover 6-7 beds. What makes it more heavier is when you ward is very “active” despite being the “active ward” at all. Being in Medical 5, there will be 4-6 new cases every day, that’s right, EVERY DAY, and I don’t know about other ward rounds, our ward rounds will and always start at 9am and ends at 12pm, minimum. Oh yes, the second week is a good week for you to make sure your musculoskeletal system is up to the 3 hours round. So what should you keep in mind during IM? Here’s my tip

For new cases
  1. Arrive at the ward at 7am because most new cases came after midnight. You only have 1 hour then to clerk new case and do reviews. At 8.00am till 9.00am you have to attend either lectures, grand ward rounds, CME, or CPC. Right after the lecture finishes, you'll be expected to be ready for the rounds.
  2. Clerk the history and present in a way you are trying to arrive to a diagnosis, maybe not necessarily the full history. This is where you sell your stories to the specialist during rounds. Sometimes, there is not much time, so at least try to get the chief complaint and background history right. But come back later to try to get the full history too. Add up investigations and physical examination if you manage to do it in time.
  3. If patient could not give history (stroke patients, too tired, refuse, etc), no excuse, clerk the notes (last resort). At least you know your case. Spend time to clerk the case other times if possible.
  4. Don’t waste the presence of family members, catch them as soon as you see them, get the history from them too, not the other way around (refuse to take history because don’t want to disturb patients with their family member.)
  5. Get involve with the patient’s investigations, especially blood taking and branula. You will have the privileged to take the patient’s blood if he or she is your patient. But don’t get too greedy; make sure your friends get a chance to fill their log books too.

Follow up-ing patients / review patients

What to Review:

About yesterday:
  • Had the plan yesterday been carried out?
  • What was the result of the recent  investigations or procedures done to the patient? (In pertaining to the patient’s problem)
  • Who else had seen the patient yesterday? (Example: in referred cases/ physiotherapy/dietitian)

About today:
  • Is the patient well today? Any acute complaints?
  • What are the vitals? (BP, HR, RR, T, SpO2, etc..)
  • What are the physical findings today? (In pertaining to patient’s problem, eg: lungs clear, no more abdominal pain)
  • Is the patient plan for anything today?
  1. If possible, came at night to review your patients, at least get to know what happen to the patient yesterday. Usually too many new case to cover the next day, you have to give time for that in the morning. But almost every time, blood result will only be ready in the morning. So if you can come earlier than 7.00 am, you can get everything done quite magnificently good.
  2. If you have the time, help the HO to fill in the reviews so that you will not be questioned so much. Oh yes, don't forget to get really friendly with the HO. They gonna help you out quite a lot.
  3. To keep your reviews organized, make a table of the patient’s , vitals and important investigations so that you can update and see the trend of the result too. For example:

So that’s all I can think of in terms of taking care of the ward and ward rounds. But there are other things to keep in mind during IM, the on calls, procedures to do, procedures to observe, lectures, teachings, oh, and of course the study groups. But basically, those stuff aren’t new, so try to manage time efficiently so that you have adequate time to do all (and I’m not so good at that, so you should ask other people for the tips, hohoho…)So all the best, I’m off to HTI! Chaiyok!