A few thoughts to keep in mind as you are seeing patients:
- During the Clerkship, you will have close daily contact with patients and families. You will be learning medical facts and developing problem solving skills as well as refining equally important interpersonal skills. Although it may sound trite, please remember that patients are sick and families are worried. Think about what you are going to say before you say it.
- Always discuss issues regarding diagnosis, prognosis and management with your housestaff and attending before talking with patients and families.
- The central focus of your experience during the Medicine Inpatient Clerkship will be your patients.
How many patients should I follow? Students should discuss with the housestaff and attending how many patients they should follow. This will vary depending on Clerkship timing (early vs. later in Clerkship and in 3rd year) and complexity of patient issues. Remember, students are required to submit six complete H&Ps (including one for formal grading) to the Clerkship Office by the end of the Clerkship. All students will admit and follow many more patients than this minimal number, usually admitting at least one patient per call night. Each student should be following at least one patient every day.
For each patient you admit:
- Perform a complete history and physical examination on the day of admission. Most of the time you should perform the history and physical separate from the housestaff. Although at times a student might "tag along" and observe/participate in the examination done by the resident team, this experience does not match the learning experience inherent in performing the information gathering personally.
- Review the labs, EKG and x-rays. Do not just read the reports. Learn how to interpret the actual studies yourself.
- Use the information from the history, physical examination and initial laboratory data to create a complete problem list.
- Prioritize the issues in the problem list that need attention and generate a differential diagnosis for each active problem.
- Discuss the patient with the housestaff and be involved in ongoing decision making about patient care. You might try writing the admission orders under the supervision of the housestaff. Do not miss out on important patient care activities by running off to the library or to your computer too early.
- Then go read. Read with two objectives. First, read to get some background information and to acquaint yourself with the current knowledge on a subject. Second, read to understand and analyze your patient's specific issues.
Patient write-ups (H&Ps):
- For each patient you admit, you should write a complete H&P. This should iinclude a problem list, differential diagnoses and a patient-oriented assessment that includes a diagnostic and therapeutic plan for each of the patient's active problems. You should assess the literature and support your rationale your assessment and plans.
- Give a copy of your complete H&P to your attending (and to your residents if you wish) for feedback, constructive criticism and signature.
- More information on writing H&Ps is available here.