The SMR pager, this is like the hot pager – when this thing goes off, I go running. *Beeps* Code Blue Level One, Lobby Main Entrance Code Blue Level One, Lobby, Main Entrance Morning guys, I’m Siobhan, a second-year medical resident. I just got to the hospital, 6:30 in the morning and today you’re gonna see what it’s like to be a senior medical resident on an in-patient service. So, on a Monday, gotta learn all the new patients and get a sense of what happened over the weekends, I feel like I missed a lot. And right now I’m just heading to the emergency department to meet up with my staff physician – so the main boss – and we’re gonna be reviewing and seeing all the new patients that came in overnight that the residents on-call admitted. *Violin playing* Okay, so done seeing those patients, it’s just about 8:00 a.m, so which means I need to go to teaching now. But I’ve got a couple of minutes so I’m just gonna tell you what my role and what the CTU is. So, it’s the Clinical Teaching Unit, and as you can imagine, there’s a big emphasis on teaching and it’s teams *laughs* So you’ve got residents and medical students, we all work together to take care of in-patients. And you can kind of imagine it’s like Dr. House, like, we actually try to figure out medical mysteries, sometimes we are admitting basic things like pneumonia and other times you’ve got new diagnoses of cancer and then sometimes you have a… something that no one has any idea what’s going on and we’re there to try to do all the tests and figure it out, so it can be quite exciting but it’s a busy service. So like right now we have 30 patients on the team, there’s a lot to do. So, as the senior medical resident, my role is managing the team, teaching the medical students and junior residents, and then overseeing sort of all of the patient care, so I need to be aware of all the patients, know what’s going on. It’s sort of… getting us ready for rather than just seeing five/six patients a day. I should have the bigger picture of all the patients So…it’s a lot of pressure! Now it’s time to go from morning teaching – today is a case based learning experience. So, we’re given a scenario and as a team, we have to come up with the diagnosis and write admission orders. So, as a senior resident though, it’s more about providing feedback and then filling in knowledge gaps within my team. So, just done with teaching and it was actually on infective endocarditis – it was just that I did a video on that, so I was super ready for it! *laughs*
I bet you guys would have been too! Anyways, now we have multidisciplinary rounds or “bullet rounds” where we quickly go through all of our patients with occupational therapy and physical therapy and social work and the coordinators of the hospital and it’s a way to try to streamline patient care, so…what are we still waiting for? Are we trying to get people moving? Or are we are trying to get a CT scan? Or what’s sort of holding things up? And.. yeah. Anyway, I bring the medical side of that. So I usually talk about that, so I should probably get going, so I’m not late and don’t make everyone wait. Next we meet up with the medical student and resident who were on call last night, and hear about any patient issues that came up. So now that we’ve divided up the team each of the medical students and residents are gonna be going and seeing each patient, writing notes on them and really diving into detail What I do is then I go – and I’m going on a computer right now – I’m looking at the bloodwork for each of the patients, checking out first the sicker ones. So I always like to see the sicker patients first and the ones that are planning to go home. And then I like to make my own plan and then when the junior residents come to me, then we can see if our plans match up and if there’s something that I picked up or they picked up that was different, we can collaborate on it. With 30 patients on the team, there’s always a medication to clarify, a critical test result to interpret, or a family to update – there’s never a dull moment or a quiet moment as a senior resident. – Hey Siobhan, do you want to go for that family meeting now? Yeah! Okay let’s go do it Unfortunately, this patient has been having many falls at home alone, and this meeting is to explore the possibility of long-term care with the patient and his family. Honestly, we’re so fortunate to have amazing social workers to help facilitate meetings like this. *beeping* Code Blue Level 1, Lobby, Main Entrance So it turns out it was a “fake code,” meaning patient just fainted in the lobby, so the heart didn’t stop, they didn’t stop breathing but we still made sure they went to the emergency department and got the care they needed, and um yeah, I just got a little jog in, that’s all. *laughs* Okay, heading over to the surgical unit. Now, there’s two patients that we’re following along with, so no, we’re not their main doctors, but we’re following along for their medical issues. For one of them it’s cancer, for another one they have a big clot and we’re managing that part, so, going to see them now. Back to the medicine unit now. One of the medical students just let me know that they’ve got the paperwork and everything ready for one of the patients to get discharged, so I want to go through that with her, make sure everything is teed up and we can get this patient home. Okay, one discharge down, sounds like there’s another patient who may be able to go home, but I actually just see this patient, make sure they’re walking, make sure they don’t have a full catheter in, and make sure they understand their instructions and are ready for home. So I’m going to touch base with the patient’s nurse and physical therapist to get a better sense of how he’s doing today, compared to yesterday. Oh boy, that really shows you the importance of seeing patients yourself – that person is not ready to go home; breathing still really fast, I’m not comfortable with that. So, try to get him feeling better before going home. Okay, it’s just about noon and I’m heading for noon-hour teaching. Usually it’s like a lecture or something like that, like a subspecialty, but today it’s jeopardy! So, the different team, I’m on Team A, we’re all gonna be competing – I think – I don’t think they’re actually any prizes, but it’s sort of like medical trivia. Things can get pretty competitive, so I don’t want to be late. The chief medical residents created this and came up with really creative categories like “Don’t Bug Me” for infectious disease questions and “Do it in the Dark” for x-ray spot diagnoses. Oh my gosh, time flies by – it’s crazy, I don’t even know how this happened, so it’s already 2:30 and it’s time to meet up with the team and run the list, meaning we’re gonna talk about all the patients that we saw throughout the day. Each of the residents, medical students will present their ideas, what they think and then we’ll also do some teaching around each of the patients and make it a learning point what we end up deciding to do, so, I’m gonna go meet them now. Okay, so I’m done the day stuff and now technically I’m on “bridge”, which basically just means I’m bridging the day and the night shift, that means we have an SMR who’s on from 4:00 to 8:00 p.m. to help out with consults. So I’m heading to the Emerge to do one consult and then I could probably home after that. Okay, so I’m just down in a room and just next to the emergency department and I’m seeing a patient who..is coming in for a completely different reason that I’m worried about, so they’re coming in with what looks like shortness of breath, It seems actually like a pneumonia – but then, I’m taking a look at this patient and their eye is super red and they’ve had this H headache on this side and it’s getting worse, and their vision’s a little bit blurry and so there’s actually a lot of things this could be, but I’m worried about something called Acute Angle Glaucoma and that’s a medical emergency, so I’ve already called the ophthalmologists to come and take a look, because they come with their special pressure and check the eye and everything, so I’m just waiting for them to come right now and once they get here and tell me what they think, then I can I can head home. So for now, I’m just gonna update the list. I just go on the computer and update all the things that happen today and then it’ll be ready for tomorrow morning. So it’s 8:30, I just finished, I’m definitely ready to go – turns out that patient does not have acute angle glaucoma, yaaay! I can sleep easy tonight, but I’m glad we ruled it out. And if you want to see more videos like this, don’t forget to subscribe check out these videos, So you can see more what it’s like on call and as a doctor, but otherwise, I’ll be telling you guys next week, so… Bye for now!