Botswana-upenn handbook [13. 13]
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- Daily Intake
You and the FirmsUniversity of Pennsylvania students and residents are each assigned one of firms. You may or may not be rounding with a Penn specialist. In many cases you will be asked to function more independently then in the United States. In general the students function at the level of an intern and the residents are expected to function as a specialist. As stated before this is an elective where residents will have a great deal of independence, however, you will always have a Penn specialist available for advice about and help with patient care. You will (should) never feel “exposed” or abandoned. There will always be a Penn specialist available for help, advice, consultation but much of the day you will be making decisions on your own. Unlike the medicine team system most people are accustomed to coming from UPHS, the work on the firms at PMH closely resembles a surgical team. Instead of house officers/students owning/caring for individual patients the firm operates on a team-based model where everyone sees every patient. This does not preclude individuals, especially students, from taking on the daily work of patient care and presentations on rounds for particular patients. In fact this is encouraged. It is merely to stress that we all must work together to care for a large service that usually includes many extremely ill individuals. In addition, the roles you play back home on the wards are much more flexible while you are working here. Of course, there is a hierarchy but to date everyone has done their fair share to get the work done. There are no phlebotomists, blood culture teams, IV teams or PICC teams. Even transport is a problem. Therefore, one must be not only a doctor but be ready and willing to play all of these other roles as well. It will take days to adjust to the “foreign” diagnoses, testing available, formulary, charting, hospital geography, language, personnel, etc. One of the most difficult things to adjust to is learning to prioritize what to work up and what to leave. Coming from a culture at Penn where virtually no abnormality is ignored (even if it should be) this takes some time. So…prepare for a difficult orientation (we will take care of you), be opened minded (crucial). Be prepared for the frustration of dealing with a new system, inefficiencies (they go at a different pace in Botswana), lack of accountability, items being “out of stock”, inability to get the lab tests you are accustomed to getting, and deaths that would not occur in the US. All of this is superimposed on jet lag. This is one of the reasons we require people to spend at least 6 weeks on the rotation. Most people require about two weeks to get past the frustrations and inefficiencies that are part of our work in Botswana. At some level we have to accept it. We are working to change it by evolution not revolution and many things are, indeed, much better than when Penn started in Botswana. Certainly but the middle of your rotation you will feel in pretty good control and by the end regret that you are leaving. Daily Hospital Experience and Schedule Schedule Overview The day begins with Intake where house officers (or students) who were admitting the preceding day present a brief summary of each admission (about 15/shift) and then a few are chosen for a more detailed discussion. These sessions are followed by ward rounds, which continue until lunch. After lunch additional work is done and in most cases physicians who are not on call are out of the hospital before 5. A number of procedures are regularly performed including: lumbar punctures, thorocenteses, paracenteses, bone marrow aspirates, pericardiocenteses, and FNA of masses and lymph nodes. Despite the prevalence of AIDS in the hospital there are many other diagnoses including: tuberculosis in all varieties and locations, cryptococcal meningitis, pyogenic meningitis, rheumatic carditis, renal failure, diabetes, hypertension, CVA, MI, snake bite, organophosphate poisoning, tetanus, suicide ingestions, and vitamin deficiencies. One will rely heavily on history and physical diagnostic skills and there are many interesting physical findings. This is not just an experience for someone interested in infectious diseases. Daily Intake:Every morning at 7:30 the entire department meets in the small conference room at the end of the Male Medical Ward for a daily intake meeting. During this meeting the previous day’s admissions and deaths are listed by the admitting house officers and sometimes specialists (for consults resulting in transfer). Several cases are chosen for a more detailed discussion. In addition, to the daily roster of admissions being presented the meeting is supposed to function as a source of education and learning for the staff. The house officers are questioned about their thoughts, diagnoses, and plans. In addition, there usually are several announcements at the beginning or end. The quality of the presentations and the meeting in general is fairly low by our standards, but much improved from several years ago. You are encouraged to ask questions of the admitting doctor. Of course please use tact and consideration, as we are there to help and educate not to ridicule. It is important that you explain why you are asking a specific question, as many people there probably will not understand the relevance. For instance if a patient is presented with chest pain and it’s not clear from the presentation if it could be pericardial in origin you might want to ask “does the chest pain improve while sitting up or sitting forward suggesting that it might be pericarditis”. You may think its clear why you are asking a question but it may not be apparent to everyone else in the room. Take you cues from the Penn people who have been there for a while When you, as residents or medical students take call, you will be presenting those patients at intake. You should not go through an in-depth case presentation, as usually there are many other patients that need to be presented. Be focused and as brief as possible. Never forget to include your impression and the diagnostic possibilities. Once you see intake for the first time you certainly will get the hang of it. Directory: medicine medicine -> John Tyndall, Science and Man medicine -> Applicant information medicine -> Previous id grand Rounds medicine -> Education 1977 1980 ba microbiology, Southern Illinois University, Carbondale, IL 1980 1982 ms medicine -> Medical Journal of Babylon-Vol. 12- no. 1 -2015 medicine -> Faculty who have mentored residents in the Research in Residency Program medicine -> Subcutaneous fat Adipose tissue anatomy Download 398.13 Kb. Share with your friends:
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