Inpatient wards are run very differently here. The day team arrives at 8:30AM. The attending is present for the signout given by the night team. After signouts, the team rounds and the SHOs and consultant see the patient for the first time that day. We all go into the patient's room and the consultant picks which SHO will take the history and do the physical, and outline the plan. Then the attending reiterates the main paoints. During this time, another SHO is documenting the history, exam and plan in the chart.
Some of the pros I see with this system is that it is great for the patient. The patient is woken up once, if that, since we came to seem them at around 9:30 AM and most of the parents are already awake at this time. Also there is no confusion with the resident telling the patient one thing and then the attending seeing the patient later and telling them something else. Then of course there is no prerounding! Your day starts at 8:30. All the documentation is done in the room so you don't have to go back and write notes. It seems very streamlined and efficent. And what an amazing concept to actually have the attending there during signouts instead of the incredibly redundant system in the US where the night team signs out to the dayteam, who then examines the patient, and then tells the attending, who then examines the patient again.
So now the cons. In the US system, the intern sees all the patients and the resident see all the patients. Here, each resident/SHO saw 3-4 patients. No wonder they have to train for 8 years after medical school! With the floor divided up among the SHOs, each sees a third of the number of patients a intern or resident would see in a day. This is the trade off. Get in at 6AM and be stressed out trying to see every patient and write every note, or get in at 8:30, see 1/3 of the patients and write 1/3 of the notes. So it also sucks for medical students becasue the whole morning I felt like I was shadowing. I was so bored just standing there. On peds in Harlem everyone on the team listened to the patients lungs and heart.
Today was a very unorganized day since the house officers were all new. We rounded until 1:30pm, then went to a peds radiology conference, when that was over went for lunch, and then continued rounding at 2:30pm. Today I saw reflux, 2 cases of questionable pertussis, bronchiolitis, constipation (hahah, its so funny to me when patients are admitted for severe abdominal pain and xray shows constipation, lool), and eczema herpeticum. Also we have a very intriguing case of a young girl who keeps on spiking fevers. She had a group B strep positive joint, then got chickenpox, and keeps spiking fevers. We don't know if its a septic joint, (MRI is nl), chickenpox (fevers don't usually reach 39F like hers are), antibiotic fever (no good test), or an infected line. I feel so bad for this poor girl. She screamed so much when we tried to get blood on her Friday and her affected knee is twice the size of her unaffected one.
I really love watching my consultant interact with the patients. She is so sweet. Shes motherly and childlike at the same time. Its really amazing. I feel like the way she expresses what is going on with the patient and the plan for the day is really reassuring to the parents. E, an SHO5 is also so amazing with the kids. She bends all the way down on her knees by the patients bed to talk to them.
I was also suprised at how causal lunch was today. After the conference, the consultant, 2 of the SHOs and I went across the street to a cafe and my consultant bought my lunch so I wouldn't have to go back and get my purse. And then we all chatted and had a very normal conversation. It was so less awkard than when my medicine attending decided to invite himself to come out to sushi when I went out with the residents at Stamford .
I joined an SHO who does the PASSU which is the admitting service. So instead of one team being on call and admitting for the day, one of the SHOs does the admitting the whole day. Its been so confusing here trying to understand how things work. I saw a pt in the resusitation room who was found to have meningoencephaltis, and an 11 yr boy with seizures. I didn't do any of the history or exam though. So in that way, today was a bit boring for me.
I hope tomorrow will be better now that the doctors had a day to settle.
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