L*****r
发帖数: 722 | 1 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
Intern: 。。。There is a patient for ID consult, his name is XXX, at room
2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
of right lower leg pain and swelling.We thought ID can help us.
ID consultant: Well, is his leg red, and warm?
- Intern: No
ID consultant: Has the pt had any fever and chills?
- Intern: No
ID consultant: What’s the wbc?
- Intern: Eh…8.5 thousand
ID consultant: What’s the neutrophil percentage?
- Intern: What?
ID consultant: The percentage of neutrophil among the white blood cells.
- Intern: Well…don’t you have a computor infront of you?
ID consultant: No I don’t. Sorry I am in a conference.
- Intern: (Took some time) the neutrophil percentage is 62
ID consultant: Well, the leg doesn’t feel like infected…what’s the reason
for consulting ID?
- Intern: The night float team signed out for me to consult ID
ID consultant: Well, this is not a reason for calling consult, usually the
reasons might be…(The telephone line was suddenly cut off, and the intern
never call back. Fortunately the ID consultant took the name of the patent
and went to see the patient. The result was really a surprise)
大家看问题在哪里，如何改进？ |
z******1
发帖数: 666 | 2 The intern has communication deficiency.
【在 L*****r 的大作中提到】
: 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
: consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
: Intern: 。。。There is a patient for ID consult, his name is XXX, at room
: 2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
: of right lower leg pain and swelling.We thought ID can help us.
: ID consultant: Well, is his leg red, and warm?
: - Intern: No
: ID consultant: Has the pt had any fever and chills?
: - Intern: No
: ID consultant: What’s the wbc?
|
A*******s
发帖数: 9638 | 3 Well, he/she is just an intern. ID should go ahead to see the patient. :) |
k********n
发帖数: 756 | 4 you should tell him you were going to call the attending for clarification..
.. |
A*******s
发帖数: 9638 | 5 haha, I hope you are just kidding.
I understand this is in academia. In private practice, more consults mean
more business. If you complain, fine, I'll find someone else.
That intern's behavior should be warned by talking to the senior resident.
..
【在 k********n 的大作中提到】
: you should tell him you were going to call the attending for clarification..
: ..
|
L*****r
发帖数: 722 | 6 Come on, big cows. All I want here is to help new interns improving
specifically in some important points.
Any new interns here? |
L*****r
发帖数: 722 | 7 You are right. Thank you. Can you specifiy the points, and how to improve?
Ther are some other problems in additon to communication deficiency.
【在 z******1 的大作中提到】
: The intern has communication deficiency.
|
a*********1
发帖数: 872 | 8 感觉这是个学习的好机会 瞎说两句
我觉得这个intern连为什么consult都不清楚，所以跟attending汇报病史时也抓不住重点
【在 L*****r 的大作中提到】
: You are right. Thank you. Can you specifiy the points, and how to improve?
: Ther are some other problems in additon to communication deficiency.
|
A*******s
发帖数: 9638 | 9 Dr.Liu, first of all, I'd like to welcome you to the new board.
On this case, I can not be on your side.
I think the reason for consult is for leg pain. A HIV patient could easily
develop leg pain due to HIV infection and side effects of medication
treatment.
The intern was scared by the ID consultant. When I was an intern，I was
scared of those fellows who do not want to work hard.
别拍我。 |
L****n
发帖数: 12932 | 10 Very good. Get to the point. Wordy but no point is the most frustrating way
of communication.
重点
【在 a*********1 的大作中提到】
: 感觉这是个学习的好机会 瞎说两句
: 我觉得这个intern连为什么consult都不清楚，所以跟attending汇报病史时也抓不住重点
|
|
|
s****p
发帖数: 1087 | 11 你说得对。
不过一个case,网上的人讨论很容易偏离你原来的目的的；网上的术语叫什么来着：歪
楼了。 :)
【在 L*****r 的大作中提到】
: Come on, big cows. All I want here is to help new interns improving
: specifically in some important points.
: Any new interns here?
|
k********n
发帖数: 756 | 12 I find it helpful to ask "what is the question for the consult."
Then ask risk factors related to the question, symptoms related to the
question , vitals,pertinent labs/medication
Most of us can narrate the H/P well but can't tell a story in 3~4 sentences.
【在 L*****r 的大作中提到】
: 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
: consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
: Intern: 。。。There is a patient for ID consult, his name is XXX, at room
: 2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
: of right lower leg pain and swelling.We thought ID can help us.
: ID consultant: Well, is his leg red, and warm?
: - Intern: No
: ID consultant: Has the pt had any fever and chills?
: - Intern: No
: ID consultant: What’s the wbc?
|
A*******s
发帖数: 9638 | 13 The first month is the toughest month for the interns. They have too much
to learn.
When ppl are busy, they are just not their normal forms, both intern and
fellow.
sentences.
【在 k********n 的大作中提到】
: I find it helpful to ask "what is the question for the consult."
: Then ask risk factors related to the question, symptoms related to the
: question , vitals,pertinent labs/medication
: Most of us can narrate the H/P well but can't tell a story in 3~4 sentences.
:
|
s****p
发帖数: 1087 | 14 :ID consultant: Well, the leg doesn’t feel like infected…what’s the :
reason
:for consulting ID?
:- Intern: The night float team signed out for me to consult ID
intern自己也没有figure out the reason.
我发觉汇报病情其实和写文章差不多。
写文章的时候要站在读者的角度来写。
汇报病情站在听者的角度。对方关心的是什么。
不过intern怎么挂电话呢，还是不小心挂掉了？
【在 L*****r 的大作中提到】
: 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
: consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
: Intern: 。。。There is a patient for ID consult, his name is XXX, at room
: 2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
: of right lower leg pain and swelling.We thought ID can help us.
: ID consultant: Well, is his leg red, and warm?
: - Intern: No
: ID consultant: Has the pt had any fever and chills?
: - Intern: No
: ID consultant: What’s the wbc?
|
A*******s
发帖数: 9638 | 15 So what is the surprise found by ID? |
z******1
发帖数: 666 | 16 This shows the intern's English is pretty bad.
===========================================
ID consultant: What’s the neutrophil percentage?
- Intern: What?
Very rude question.
====================
ID consultant: The percentage of neutrophil among the white blood cells.
- Intern: Well…don’t you have a computor infront of you?
ID consultant: No I don’t. Sorry I am in a conference.
- Intern: (Took some time) the neutrophil percentage is 62
The intern should not answer like this way. Correct answer should be "Yes"
============================================================================
and some more details.
=========
ID consultant: Well, the leg doesn’t feel like infected…what’s the reason
for consulting ID?
- Intern: The night float team signed out for me to consult ID
How wrong is the intern! I think he must be unhappy with the ID consult,
===========================================================================
which is bad to communication. He/she should call back if it is an accident.
============================================================
ID consultant: Well, this is not a reason for calling consult, usually the
reasons might be…(The telephone line was suddenly cut off, and the intern
never call back. Fortunately the ID consultant took the name of the patent
and went to see the patient. The result was really a surprise)
大家看问题在哪里，如何改进？ |
a*********1
发帖数: 872 | |
P********A
发帖数: 101 | |
P********A
发帖数: 101 | 19 1. the intern did not get good sign out from night float. The intern should
have asked night float: why we have to call ID? what specifically we need
from them?
2. before you speak to consult, the intern should have gathered all
important data about this pt. you may not have all the answers for the
consultant's question, thats fine as long as you know main story of the pt
and routine numbers, like Tmax, WBc, Cr etc. |
m*********6
发帖数: 609 | 20 觉得这个intern比我这两天做的还要好些，不过我的态度比他要好，而且我是在ER，病人太多了，周转太快了，昨天还被attending表扬了，有点飘飘然，今天的attending是个女的，关键是一点教学都没有，还很picky.和昨天的形成了鲜明的对比，今天我又掉到地上了。
今天夜班的attending也是男医生，人也很nice,交班后我在小声问夜班的另外一个resident一个note的小问题，他坐在resident旁边还伸过头来抢着回答填notes的小事。不知道是不是女attending都比较tough.
【在 L*****r 的大作中提到】
: 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
: consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
: Intern: 。。。There is a patient for ID consult, his name is XXX, at room
: 2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
: of right lower leg pain and swelling.We thought ID can help us.
: ID consultant: Well, is his leg red, and warm?
: - Intern: No
: ID consultant: Has the pt had any fever and chills?
: - Intern: No
: ID consultant: What’s the wbc?
|
|
|
A*******s
发帖数: 9638 | 21 你还有时间上网啊， 赞！
有很多好的attending， 也有很mean的。 Fellow也一样。
病人太多了，周转太快了，昨天还被attending表扬了，有点飘飘然，今天的attending
是个女的，关键是一点教学都没有，还很picky.和昨天的形成了鲜明的对比，今天我又
掉到地上了。
resident一个note的小问题，他坐在resident旁边还伸过头来抢着回答填notes的小事
。不知道是不是女attending都比较tough.
【在 m*********6 的大作中提到】
: 觉得这个intern比我这两天做的还要好些，不过我的态度比他要好，而且我是在ER，病人太多了，周转太快了，昨天还被attending表扬了，有点飘飘然，今天的attending是个女的，关键是一点教学都没有，还很picky.和昨天的形成了鲜明的对比，今天我又掉到地上了。
: 今天夜班的attending也是男医生，人也很nice,交班后我在小声问夜班的另外一个resident一个note的小问题，他坐在resident旁边还伸过头来抢着回答填notes的小事。不知道是不是女attending都比较tough.
|
m*********6
发帖数: 609 | 22 明天off,后天12pm-12am,再说上网也是放松嘛
attending
【在 A*******s 的大作中提到】
: 你还有时间上网啊， 赞！
: 有很多好的attending， 也有很mean的。 Fellow也一样。
:
: 病人太多了，周转太快了，昨天还被attending表扬了，有点飘飘然，今天的attending
: 是个女的，关键是一点教学都没有，还很picky.和昨天的形成了鲜明的对比，今天我又
: 掉到地上了。
: resident一个note的小问题，他坐在resident旁边还伸过头来抢着回答填notes的小事
: 。不知道是不是女attending都比较tough.
|
L*****r
发帖数: 722 | 23 谢谢大家热情而中肯的回复! 我也说不出太新的了，回头替大家做个小结。感慨ing，
如果我在做Intern时候看到这些建议，肯定会少走很多弯路。
我个人最喜欢的是这两段：
Dr. Aplusplu, 不是拍你，也不是因为你欢迎我，而是因为in this aspect, I am on
your side. Intern 的第一个月，最需要的是体谅和宽容、teaching and helping. If
there is any problem, the problem is on his/her senior resident. :-)
明天要早起查房，且容后续。
【在 A*******s 的大作中提到】
: 你还有时间上网啊， 赞！
: 有很多好的attending， 也有很mean的。 Fellow也一样。
:
: 病人太多了，周转太快了，昨天还被attending表扬了，有点飘飘然，今天的attending
: 是个女的，关键是一点教学都没有，还很picky.和昨天的形成了鲜明的对比，今天我又
: 掉到地上了。
: resident一个note的小问题，他坐在resident旁边还伸过头来抢着回答填notes的小事
: 。不知道是不是女attending都比较tough.
|
A*******s
发帖数: 9638 | 24 欢迎刘医生常来。 我本来准备的头盔没用了。
By the way, what is the surprise?
on
If
【在 L*****r 的大作中提到】
: 谢谢大家热情而中肯的回复! 我也说不出太新的了，回头替大家做个小结。感慨ing，
: 如果我在做Intern时候看到这些建议，肯定会少走很多弯路。
: 我个人最喜欢的是这两段：
:
: Dr. Aplusplu, 不是拍你，也不是因为你欢迎我，而是因为in this aspect, I am on
: your side. Intern 的第一个月，最需要的是体谅和宽容、teaching and helping. If
: there is any problem, the problem is on his/her senior resident. :-)
: 明天要早起查房，且容后续。
|
L*****r
发帖数: 722 | 25 且容后续。。。:-))))
【在 A*******s 的大作中提到】
: 欢迎刘医生常来。 我本来准备的头盔没用了。
: By the way, what is the surprise?
:
: on
: If
|
m*********6
发帖数: 609 | 26 请Dr.Liu花您宝贵的时间多写点，给我们这些在苦海中的intern指点指点，让我们能少
走些弯路
【在 L*****r 的大作中提到】
: 且容后续。。。:-))))
|
z*******2
发帖数: 2643 | 27 下面是我的看法(from the point of view of a phd supervisor)。
1。 这个Intern的准备工作作的不充分。在他打电话以前，他应该把该计算的数据
搞清楚，从而回答consultant的问题，做到有问必答。
2。这个consultant不应该说：“this is not a reason for calling consult,
usually the reasons might be”。原因是consultant不知道什么时候intern会有问题，consultant应该在conference以后给intern回电话或者赶去见intern. Conference is not the reason for denying the intern's phone call because the intern does not know the consultant's schedule.
3. Intern's answer "The night float team signed out for me to consult ID" is a proper reason to call Consultant, especially when the intern is a new intern.
【在 L*****r 的大作中提到】
: 上周我做ID consult，接到一个 page, 电话打过去，是个新Intern call for a new
: consult。我感觉这个新Intern请会诊的说话方式存在一些问题：
: Intern: 。。。There is a patient for ID consult, his name is XXX, at room
: 2046. This is a 39 YO AAM, with history of HIV, admitted yesterday because
: of right lower leg pain and swelling.We thought ID can help us.
: ID consultant: Well, is his leg red, and warm?
: - Intern: No
: ID consultant: Has the pt had any fever and chills?
: - Intern: No
: ID consultant: What’s the wbc?
|
s****p
发帖数: 1087 | 28 下边没有啦？
【在 L*****r 的大作中提到】
: 且容后续。。。:-))))
|
A********9
发帖数: 375 | |
m*****y
发帖数: 1652 | 30 难得一见的好贴啊。。。什么时候示范一下怎么算中性百分比？
题，consultant应该在conference以后给intern回电话或者赶去见intern. Conference
is not the reason for denying the intern's phone call because the intern
does not know the consultant's schedule.
is a proper reason to call Consultant, especially when the intern is a new
intern.
【在 z*******2 的大作中提到】
: 下面是我的看法(from the point of view of a phd supervisor)。
: 1。 这个Intern的准备工作作的不充分。在他打电话以前，他应该把该计算的数据
: 搞清楚，从而回答consultant的问题，做到有问必答。
: 2。这个consultant不应该说：“this is not a reason for calling consult,
: usually the reasons might be”。原因是consultant不知道什么时候intern会有问题，consultant应该在conference以后给intern回电话或者赶去见intern. Conference is not the reason for denying the intern's phone call because the intern does not know the consultant's schedule.
: 3. Intern's answer "The night float team signed out for me to consult ID" is a proper reason to call Consultant, especially when the intern is a new intern.
|
