PATIENT CARE EXPECTATIONS

Patient care is the central focus of the Internal Medicine Clerkship. 

The following guidelines and expectations apply to every patient you admit and follow.

You are required to work up a minimum of 18 patients during the clerkship. You should work up each patient and present them to your team.  This is an average of approximately 2.25 patients per week.

Admitting a Patient

  • You should acquire one patient on the first day with your ward team.  This patient can be an existing patient on the service if the team is not admitting new patients that day.
  • You will do full physical exams on your patients unless a condition or patient precludes you from doing so.  This includes rectal exams and pelvic exams when indicated.  This also includes manual blood pressures in both arms.
  • Review the labs, EKG and X-Rays and practice interpreting them on your own and with the housestaff.  Do not rely on the printed reports.

Inpatient Follow-Up

  • Pre-round on your patients before work rounds with the team each day.
  • Participate in rounds with the team.
  • Present patients to your Attending Physician during team rounds.  It helps to practice these presentations with your resident and interns beforehand. (see Tips for Presentations)
  • Write progress notes (SOAP notes) on your patients each day and have them cosigned by a licensed physician (Resident, Intern, or Attending).
  • Write orders on your patients under the supervision of the housestaff and have the orders signed by a licensed physician.
  • If the opportunity for a bedside procedure arises, you may perform procedures on patients under the direct supervision of the housestaff or faculty.
  • Discuss the patient with your team and be involved in ongoing decision making about your patient’s care.
  • Follow all aspects of your patients’ care.  You should be up-to-date on the clinical status, lab data, medications, and diagnostic tests of your patients at all times.

Patient and Family Communication

  • It takes practice to achieve patient and family communication that is respectful, informative, and clear.  
  • The following activities are designed to help you practice.
    • Ask the patient if s/he would like for you to call someone to update them on the patient’s status in the hospital.  This can be a family member or friend who the patient identifies for you to contact.  Then make the call and give an update on the patient’s admission.*
    • Call each of your patients after discharge at least once to learn of patient progress, help answer questions, and facilitate follow-up.*
    • You should notify your team and attending that you are calling the patient and inform them of the outcome of the call.

* Exception: you are not allowed to call anyone on behalf of a prisoner, or if the patient declines this communication.