“Go forth and do great things.”
No one gets into medical school without a considerable dose of ambition. We want to be involved, to make a difference, to save lives. In short, we want to do great things. We spend years waiting in the wings, our enthusiasm funneled into pre-med activities, o chem exams, and countless hours of studying in the first two years of medical school. Like a horse that has been held tightly in the starting gate that suddenly swings up at the sound of the starter’s bell, we spring forward with unbridled enthusiasm into third year, dirt flying. Having spent nearly a decade in prep (if you start counting in undergrad), we are eager to actually do something and start making a difference. And yet, so much of third year can be sitting around, waiting for the action, and, when the action happens, standing in the back of the room.
As a third year, I found myself repeating over and over, “Anything I can do to be helpful?” Often, however, I would be met by the shrug of a resident, too busy accomplishing his or her own infinite check lists to delegate something to me. Part of the problem was I didn’t know what I could do. What really can a third year medical student do that actually contributes to the team? It wasn’t until the end of third year that I felt I had a handle on how a medical student can make herself useful rather than burdensome. Below are half a dozen ways to make yourself useful to the team, from admission to discharge.
1. Obtaining collateral: On admission, patients often come with an extensive medical history, having traversed the halls of many an outside hospital. Frequently, they are in no state to give a thorough or even simply accurate history and thus much of it needs to be clarified and verified. For a resident, it’s easy to spend far too much time tracking down this collateral, calling outside providers and faxing ROIs to get medical records. They will be incredibly thankful (or they should be), if you do this for them. If you will be calling a physician for collateral, be sure to clarify with your resident the most pertinent information if you’re not sure. In addition to being helpful, obtaining collateral will also give you a better understanding of the patient’s other medical problems and other factors that can influence his or her hospital stay.
2. Getting results: For better or worse, in the hospital it is often the squeaky wheel that gets the grease. If you need the results of a test, a quick call to the lab or to the radiology suite can speed things along. Similarly, sometimes even getting a test done can be facilitated by a few quick calls. Need an MRI? Calling can make it happen much sooner than just placing the order (which you likely can’t even do without your resident to cosign). And, you can often find out an approximate time for when they think the test will be performed, information that can relieve anxiety for both the patient and the rest of the medical team.
3. Reviewing medications: Often, our patients are so sick, that they come in on a potpourri of medications, frequently prescribed by a number of different prescribers and never quite how they are documented in the electronic health record. It can be all too easy for a home medication to be overlooked when admitting a patient. You can serve a critical role in ensuring patient safety by reviewing the medication list with the patient and clarifying what each is for, if they are able to tell you. If the patient is a poor historian, consider calling the patient’s pharmacy to confirm the current medication regimen. Similarly, on discharge you can greatly help the patient better understand his or her own care by taking time to go over any medication changes and explaining their role in the patient’s health and well-being. Patients are far more likely to take a medication if they understand why they need to do so!
4. Calling consults:Calling a consult can be difficult. On the surface it seems deceptively easy. All you do is place a phone call and ask for the help of another service in the care of your patient. And yet, the first time I tried this as a medical student, I ended up with two very annoyed residents – both the resident who took the call and my resident who was probably thinking, can’t she do anything right? However, with proper preparation, calling a consult is definitely within the medical student repertoire. Follow these basic steps and you’ll be fine.
· First, unless specifically asked, it’s best to only offer to call consults on your own patients, as you’ll need a good understanding of the patient’s story to answer any questions the consulting team may have.
· Have the basic information including the patient’s name, MRN, date of birth, and hospital location. Ideally, be in front of the patient’s chart when you make the call so you can refer to it.
· Have a brief, relevant summary of the patient. This should be no more than a few sentences giving a barebones overview. Why is the patient hospitalized and what is the current situation?
· Have a question. This is likely the most difficult part. Why is the consult being called? The more specific the better – simply “We’re having trouble with Mrs. Smith, can you help us?” won’t cut it. You should try to formulate the question yourself, but if possible go over it with your resident beforehand.
· When you actually place the call, be sure to introduce yourself and what team you’re calling from. Also, try to get the other person’s name as well, in case your resident asks.
· Don’t forget to say thank you!
5. Preparing for discharge: As soon as a patient is admitted, the team starts thinking about discharge, and there are definitely ways a medical student can help. Typically, this includes creating a discharge summary. Everywhere I have worked, these documents tend to include a significant amount of cut and paste (why, with today’s technology, it can’t just all auto-populate is beyond me. . .), which is a great way to kill time and be useful while waiting for something more exciting to happen. More importantly, you can put your writing skills to work by detailing the hospital course. This is likely the main part of the document that will be useful to others, both outside providers who will receive a copy and to providers within the hospital the next time the patient is admitted. This should be a summary of what happened over the course of the stay. Ask your residents for advice on how they like to do theirs, as styles vary significantly between specialties. Surgery and Ob-gyn tend to be oriented to post-operative day or post-delivery day (“Patient was stable on POD#1 but spiked a fever to 39C on POD#2 and vanc/zosyn was started. . .”) whereas psychiatry and medicine tend to be organized around problems. Keeping the hospital course up to date rather than waiting for the day of discharge is a good way to ensure you understand the ups and downs of your patient’s stay.
6. Setting up future appointments: While working on an inpatient team it’s easy to focus only on the inpatient issues, but, in order to be safely discharged, most patients will need to have follow-up care. While sometimes establishing follow-up appointments falls to the social worker, often it’s up to the medical team to arrange these. Before making the appointment, ask the resident for what timeframe you want the patient to be seen in (within 2wks/4wks/etc.). Be sure to include the name of the physician, location, date, time and contact information in the discharge summary.
While third year can feel competitive, medicine isn’t a horse race. It’s a team sport. By learning to be part of the team and contributing in a meaningful way, you can make a difference, both for the team and for patient care. By getting more involved in all components of your patients’ hospitalization, you develop a better understanding for all aspects of their care. You will better understand their stay and be in a better position to advocate for their needs. In third year, our days may not be filled with doing great things. Instead, consider the words of author Napoleon Hill who said, “If you cannot do great things, do small things in a great way.” By contributing in these small ways, you can make a big difference.
Megan Riddle, MD PhD, is a psychiatry resident at the University of Washington. She is a graduate of the Weill Cornell/Rockefeller/Sloan-Kettering Tri-Institutional MD-PhD Program.
“Go forth and do great things.”