Time Flies in Pediatrics
I. The Write Stuff
You hear so often how little time physicians spend with their patients, and now I'm living it. I get to spend the most time with my patients during their initial workup, which involves taking a comprehensive medical and social history, plus a physical exam (usually focused). If done thoroughly, the history & presentation (H&P) can take over an hour. This is unrealistic no matter the setting - inpatient, outpatient, free clinic, whatever. As a rule of thumb, taking a relevant medical history, performing the physical exam, and composing an assessment and plan should take the clinician about 15 minutes. That doesn't seem like much, does it? Believe me that the medical community tries to optimize their time to enhance patient satisfaction as much as possible. Really. Go to PubMed and type in 'patient satisfaction' and see how many hits turn up. There's a study out there which I've not found yet, that says something to the effect: out of the 15-minute visit, if the patient spends at least 7 of those minutes talking, he or she is more likely to walk out of the doctor's office with more satisfaction. Yeah, I think that level of analysis is pretty cold, too.
Anyway, if we spent more time with our patients we'd never get anything done. And that thing we're doing when we're not interacting with our patients is writing writing writing. We're writing the H&P or writing orders or writing progress notes or writing discharge summaries. And now that I'm a young (stop chortling you out there. Young-ish. I'm at least young-ish) physician-in-training, I'm trying to figure out why this paperwork takes so darn long to write. At any one time, I'm only carrying two or three patients. Last time I was on call, the intern handed me two patients in the early evening in the hopes that I could get cranking on the paperwork and hopefully get out early. But noooooo...I started writing their H&P's around 8pm. I didn't get out of the hospital until 2am. (I got home at 2:30am, trying to decide whether I should risk grabbing some sleep and having to fight waking up, or just pulling the all-nighter. My neighbor was still playing his horrible house music, making the choice easy for me). Anyway, I think the problem is this:
To those of you who read through my experiences writing my thesis, this comes as absolutely no surprise. Somewhere in the near future I need to draw up some third-year medical student rules a la Fight Club. "The 1st rule of Third Year is....you DO NOT piss off your intern! The 2nd rule of Third Year is....you DO NOT piss off your intern! The 3rd rule of Third Year is....learn to write FAST" and so on.
Same problem, different context - the record keeping in the medical field is crucial when there are multiple caregivers, so you need to write as efficiently as possible - and I really like the narrative to flow smoothly. The patient's hospital course is a story, after all, with a beginning, some mystery in the middle, a conclusion, and the denouement. If the reader is in tears by the end of one of my discharge summaries, then I've done my job.
II. 'Tis the Season for Bronchiolitis...
cough-cough-cough-cough-cough...hack-wheeze-wheeze-cough
I've had the great privilege of taking care of two toddlers who have lower respiratory tract infections, one of them a joyful little guy with diastrophic dysplasia. It's winter, so we get quite a few admissions where we have to closely monitor respiratory function of babies. I'm able to steal a few minutes with the babies just to play with them and get them to smile. I guess I'm 'okay' at this...some med students you just look at and there's this word 'PEDIATRICIAN' in neon lights over their heads. Me, probably not so much, but I'm enjoying this clerkship enough to consider it as part of my residency training.
Self-assessment in Pediatrics:
You hear so often how little time physicians spend with their patients, and now I'm living it. I get to spend the most time with my patients during their initial workup, which involves taking a comprehensive medical and social history, plus a physical exam (usually focused). If done thoroughly, the history & presentation (H&P) can take over an hour. This is unrealistic no matter the setting - inpatient, outpatient, free clinic, whatever. As a rule of thumb, taking a relevant medical history, performing the physical exam, and composing an assessment and plan should take the clinician about 15 minutes. That doesn't seem like much, does it? Believe me that the medical community tries to optimize their time to enhance patient satisfaction as much as possible. Really. Go to PubMed and type in 'patient satisfaction' and see how many hits turn up. There's a study out there which I've not found yet, that says something to the effect: out of the 15-minute visit, if the patient spends at least 7 of those minutes talking, he or she is more likely to walk out of the doctor's office with more satisfaction. Yeah, I think that level of analysis is pretty cold, too.
Anyway, if we spent more time with our patients we'd never get anything done. And that thing we're doing when we're not interacting with our patients is writing writing writing. We're writing the H&P or writing orders or writing progress notes or writing discharge summaries. And now that I'm a young (stop chortling you out there. Young-ish. I'm at least young-ish) physician-in-training, I'm trying to figure out why this paperwork takes so darn long to write. At any one time, I'm only carrying two or three patients. Last time I was on call, the intern handed me two patients in the early evening in the hopes that I could get cranking on the paperwork and hopefully get out early. But noooooo...I started writing their H&P's around 8pm. I didn't get out of the hospital until 2am. (I got home at 2:30am, trying to decide whether I should risk grabbing some sleep and having to fight waking up, or just pulling the all-nighter. My neighbor was still playing his horrible house music, making the choice easy for me). Anyway, I think the problem is this:
I. Write. Sloooooooooooooooooooooowly.
To those of you who read through my experiences writing my thesis, this comes as absolutely no surprise. Somewhere in the near future I need to draw up some third-year medical student rules a la Fight Club. "The 1st rule of Third Year is....you DO NOT piss off your intern! The 2nd rule of Third Year is....you DO NOT piss off your intern! The 3rd rule of Third Year is....learn to write FAST" and so on.
Same problem, different context - the record keeping in the medical field is crucial when there are multiple caregivers, so you need to write as efficiently as possible - and I really like the narrative to flow smoothly. The patient's hospital course is a story, after all, with a beginning, some mystery in the middle, a conclusion, and the denouement. If the reader is in tears by the end of one of my discharge summaries, then I've done my job.
II. 'Tis the Season for Bronchiolitis...
cough-cough-cough-cough-cough...hack-wheeze-wheeze-cough
I've had the great privilege of taking care of two toddlers who have lower respiratory tract infections, one of them a joyful little guy with diastrophic dysplasia. It's winter, so we get quite a few admissions where we have to closely monitor respiratory function of babies. I'm able to steal a few minutes with the babies just to play with them and get them to smile. I guess I'm 'okay' at this...some med students you just look at and there's this word 'PEDIATRICIAN' in neon lights over their heads. Me, probably not so much, but I'm enjoying this clerkship enough to consider it as part of my residency training.
Self-assessment in Pediatrics:
- Play-fu: 6/10
- Tickle-fu: 9/10
- Cooing-fu: 0/10. SUUUUUUUUUUUUUUUUUUUUUUCKS!!!! I attribute this to the fact that I have two sisters, neither of whom has been considerate enough to provide me with nieces and/or nephews to practice on. Come on people what are you waiting for????
posted by Mikey at 6:02 PM
5 Comments:
You're the oldest. You're supposed to be first.
And anyway, I'm busy working on a graduate degree of my own, to substantiate any claims I might have to self-esteem. Since that whole process has served you so well.
vwpttqmc
↑
Single, no prospects. Hello?
And careers are no way to build one's self-esteem. Offspring - that's the answer. Live through your kids, I say.
I tested a bunch of kids today for:
vflpprlr
Jeez Mikey, no pressure on the sisters, eh? As someone who has been hounded (not pressured, HOUNDED) for almost twelve years to replicate my genes, I have sympathy for the sisters. Sometimes you (read: me and the wife) just want to freakin' wait!
Incidentally, say the word and we'll work on improving your prospects. I met a really cute Italian woman this week through a mutual friend who likes to dance to techno. She could come over to your house and you guys could get ya swerve on to the neighbor's beats.
cdsgy
What are sisters for? If they're not targets for pressure, then I am.
Ah, playing matchmaker, huh? Wait right there, let me check my schedule...
* runs away *
blfys
She was awfully cute (the words, "bug's ear" spring to mind) and she had this sexy little Milan accent. But she wasn't a redhead, so I'll keep looking.
aawado
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