Dr. Red Eagle

Internal Medicine Wards Expectations
Alexander Red Eagle

#    C O N T A C T    .     I N F O R M A T I O N :
##    Email: 
-    Alexanderredeagle(5)gmail.com
-    alexander.redeagle(ava.gov
##    P h o n e : 
-    5 6 2 - 3 4 2 - 3 2 7 2

#    S E R V I C E    .     R U L E S :
-    Treat patients how you would want your family member to be treated
-    Safety first no matter what
[_]    Learn something new every day    
[_]    Update patient/families daily.
[_]    Update nurses on the plan of care (they are carrying out all the work)
-    Please feel free to contact my anytime! 
-    Call me if 
---    you need to cap. 
---    there is an 
-----    AMA
-----    change in level of care
-----    death
-----    RRT
-----    code
-----    other unexpected changed in care.

#    DUTY HOURS: 
If you or your team is staying late consistently, please let me know so that we can figure out how to prevent this from happening.

#    Rounding: 
-    Flexible depending on the day

##    Preferred: 
-    Round starting at 9:30am after morning conference. 
-    Bedside rounding 
-    1 intern at atime.
-    Feel free to join rounds if you like though.

#    M E E T I N G S :
##    TEAM HUDDLE: 
-    Led by senior resident
-    focus on letting team know 
----    expected discharge date 
----    needs.
-    Optional for rest of team to be there but encouraged. 
[_]    Use pre-discharge order for every discharge.
##    DMS ROUNDS: 
-    Attending wiil attend this. 
-    Please raise system issue to attending prior to meeting.

#   Conferences: 
-    Patient safety always comes first. 
-    However, my expectation is that the whole team goes to morning report and noon conference on time every day. 
-    Medical students also have conferences in the afternoon.

#    Teaching: 
-    Will occur on rounds and is patient based. 
-    We will also do an EKG of the day everyday in the afternoon. 
-    I can teach in the afternoons as much as you wish on any topic you wish. 
-    I expect that the senior resident teach the interns and residents on the team. 
[_]    Medical students (not subinterns) should    give at least 1    talk of around 10 minutes in the afternoon during their rotation.

#    Feedback and evaluations: 

-    Expect that I will give you immediate feedback daily. 
-    This is not a value Judgement but just away to improve and for us to work together more efficiently. 
-    Please feel free to give me feedback anytime as well. 
-    I want to be the best teacher and clinician I can be and that can only happen you give me feedback as well. 
-    Medical students have to do mid-rotation feedback. 
[_]    Please bring those forms and do them with me in person, not after you have left the rotation.

#    Notes: 
-    All new patients require an H&P cosigned by myself. 
-    You must write adaily progress note on a new patient regardless of when the nocturnist wrote their note. 
-    Discharge summaries should be done the day of discharge. 
-    No exceptions. 
-    Copy the discharge summary to the notes section under "Discharge note". 
-    Senior residents should have a system for tracking completion of discharge summaries.

#    P r e s e n t a t i o n s :
-    The first day I will need a summary of each patient for context that will not be required in the future.
##    Established patient: 
-    5 minutes per patient
-    Overnight events 
-    (acute change in level of care or condition or major change in plans)
###    Subjective
###    Objective
-    Vital sign ranges for last 24 hrs
-    weights 
-    I/Os for heart failure patients
-    exam relevant to the active problems 
-    (JVP, lungs, heart, LE for heart failure for example). 
-    You need to know if there is a pressure ulcer or not on all your patients    but are not required to report it unless they have one.
####    Labs: 
-    Any important labs in last 24 hrs. 
-    Give baselines for BNP, troponin. 
-    Creatinine, hemoglobin if relevant.
####    Imaging
-    Any new or relevant imaging.
###    Assessment and plan
-    Most important of all.
-    Do not give me a "one - liner ".
-    Do address each active problem. 
-    For the most important problem or unclear problem, I want to hear
your key factors for the case. 
-    Give your assessment based on your key factors. 
-    Commit to adiagnosis or short differential diagnosis. 
-    Give a diagnostic plan and therapeutic plan for each problem. 
-    Address mobility, prophylaxis, and expected disposition every time.
#    New patient: 8-10 minutes
-    Traditional H&P format. 
-    Chief complaint first! 
-    Do not give "one liner". 
-    HPI
-    PMH
-    Important medications. 
-    Family history if relevant (unlikely to be relevant if >age    70), ect.
-    Social history.
-    Again, the assessment and plan as above is the most important.

#    Medical Students:
-    Expect to carry 2-3 patients. 
-    Quality    >    Quantity. 
-    Try not to take overnight patients but admit your own.
-    Otherwise you can pick up patients and present them the following day. 
[_]    Please write up one patient case focusing on the key clinical factors, differential diagnosis and management of their major presenting complaint so that we can review together during the week. 
-    Medical students CANNOT sign  over notes to interns/residents to take over
-    You can adopt their notes with revisions after they sign.
-    Medical students will obtain co-signatures from residents.