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Index

acetaminophen, 23, 28Acid-base algorithm, 84Acidosis. See metabolic gap acidosis;

metabolic non-gap acidosis; Renaltube acidosis

activities of daily living (ADLs), 105ADLs. See Activities of daily livingadmissions

prn orders and, 28routine for patient, 94–97

Adult Pain Management Guide (UCSF),81

advance directives, 133, 140Advanced Cardiac Life Support

(American Heart Association), 134advisor

deans as, 2, 3finding an, 1

air bronchograms, 87alcohol wipes, 10American Association of Medical

Colleges, 46American Family Physician, 43American Heart Association, 134American Medical Student Association,

44analgesia, 23, 81. See also

patient-controlled analgesiaantibiotics, ordering, 95arterial blood gas, analysis of, 84Aspiration precautions, 27, 94

assessmentdescriptors used for, 21global, 21intensive care units needs on, 21patient’s problems of, 22

assisted ventilation, 134atelectasis, 87attendings

cards disliked by, 40deflating treatment by, 51, 53filling out forms for, 61forgetfulness of, 51pimping by, 50reading of, 62reminders for, 51students hated by, 40suffering of, 54young, 49

baseline ECG, 29B&C. See Board and carebig sib networks, 2binder. See clerkship binderblack bag, 10Blackbourne, L., 42Blood

cultures, 96suctioning, 5

blood drawpractice procedure, 98–99steps of, 98–102

167

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168 Index

board and care (B&C), 106, 108bonding, student-patient, 67Books, 8, 11

ECG interpretation, 12ongoing, 12questions v. research in, 63for slight nerds, 12useful reference, 12website for ordering, 12

Boweldrugs, 79–80regimens, 79

bronchograms. See air bronchogramsBuffy the Vampire Slayer, 129butt kissing, 59

calculator, medical, 45Cardiac tests, unheard of, 90–91cardiopulminary resuscitation (CPR),

135Cards. See also Patients, data collection

cardsattendings’ dislike of, 40color coding of, 39, 111flip, 14Hemocult guaiac, 11labeling, 40philosophies about, 40physical examination record, 4pre-rounds usage of, 40presentations and, 40residents grabbing, 40sign-out index, 122–124Snellen test vision, 11using, 39–40

care options, post-hospital, 105career

goals, 1terrain, 2website for choosing, 2

cathartics, 26catheters. See Foley catheter; peripheral

intravenous central catheterCharles Schwab’s Guide to Financial

Independence, 158

chartscomputerized, 40timely notes on, 4

Checklist, Meg’s List, 43chest

compressions, 134x-rays, 29, 85, 86, 87

CHOPPED MINTS mnemonic, 48cimetidine, 24Cleaver, Ward, 1clerkship binder, 36. See also peripheral

braininformation in, 36lab test values in, 37organizing, 38–39sections of, 36, 38short-hand diagrams in, 38

clerkshipsdirectors of, 8, 36discounted meals during, 74evaluating students via, 7medicine, 39PB on first day of, 36–39people choosing, 1stress of, 73x-ray reading during, 85

clothes, 8professional, 9scrubs v. regular, 8, 9

code blue, 126–127, 133, 134, 144. Seealso Pseudo-code emergencies

code status, 134, 143. See also Notfull-code

code talkavoiding, 132–133finalizing, 137–138with patients, 131–137tenets of, 140–143vignettes, 145–151, 152–154vocabulary of, 133–137

codespager, 44patient self-designation,

138–139pseudo-emergency, 127–128






Index 169

communicationpatient, 26, 67team-related, 67

Competence, 135confidence, 55

ego v. projecting, 55shaking of, 58wards and, 55

connections, use of, 59constipation

cathartics for, 26prevention of, 25–26, 97treating, 97

consultacute renal failure, 32calling a, 32–33infectious disease, 32rehabilitation services, 64

conversions, pain medication dose,81

coronary artery disease, 91Corporations, physicians as, 75Corticosteroids, 81–82cortisol replacement, 82Courtesy, 58CPR. See Cardiopulminary

resuscitationcrib sheets, 88Current Medical Diagnosis and

Treatment (Tierney), 41, 42CXR (chest x-ray), 29, 85, 86, 87

Data collection cards, 4, 39, 111. Seealso Progress note

day health care services, 110D/C Planning. See Discharge, planningdeans, 2, 3debt, analysis of, 158deep venous thrombosis (DVT), 25Delaney, Matthew, 45dermatology, 3Diagnosaurus software, 45diagnoses

commonly missed, 96differential, 5

directorsadministrative assistants to, 36clerkship, 8, 36

dischargepatient’s, 33, 104–105planning, 104–105

diseasecoronary artery, 91end stage renal, 21infectious, 32

disposition (dispo), patient’s, 103DNI. See Do not intubateDNR. See Do not resuscitateDo not intubate (DNI), 135, 144Do not resuscitate (DNR), 136doctorese, translating, 69–70Doctors. See Physiciansdocusate, 79dose conversions, 81DPOA. See Durable power of attorneydrugs

anti-coagulant, 25bowel, 79–80interactions of, 95side effects of, 95

Dubin, Dale, 12Durable power of attorney (DPOA),

136. See also Living willDVT. See deep venous thrombosis

ECGapproach to, 88–90baseline, 29interpretation books, 12questions about, 88–90

ECG Interpretation Cribsheets (Evans),12

EctopicBrain website, 44ego

confidence v., 55physician’s problems with, 75

emergenciescode blue, 126–127, 133, 134, 144coping with, 125–126pseudo-code, 127–128






170 Index

Emergency room (ER), 94emotional intelligence

defined, 52evaluations and, 52peers displaying, 59

empathizing up/empathizing down, 54end stage renal disease (ESRD), 21Epocrates software, 45ER. See Emergency roomER television show, 139ESRD. See end stage renal diseaseevaluations

emotional intelligence and, 52insecurity regarding, 58shoes and, 10

Evans, Thomas Jr., 12, 88examination

performing of, 6pre-rounding, 15

exercise, 73expectations, team’s, 62

Factor V Leiden, 25falls, precautions for, 27fanny packs, 10feedback, 62“FEN, 8P’s, and D/C” mnemonic, 22fentanyl patch, 81Ferri, Fred, 13Ferri’s Clinical Advisor (Mosby), 41,

48financial literacy, 157. See also

Microsoft Excel; MicrosoftMoney; MoneyDance

debt and, 158emergency funds and, 158income knowledge for, 157insurance and, 159investing and, 159student’s need for, 155

flirting, 59fluids

adult maintenance, 93determination of, 93Lactated Ringer’s, 92

management of, 91–94NS, 92resuscitation, 93

Foley (urinary) catheter, 974-2-1 rule, 93Friedman, H. Harold, 41

gastritis, 82gear, categories of, 8Get a Financial Life: Personal Finance

in Your Twenties and Thirties(Kobliner), 158

global assessment, 21goals

career, 1rotation, 62

Golden Rule of Procedures, 99. See alsoProcedures

grades, UCSF’s system of, 7, 52, 76grand rounds, 14gunners

defined, 57–60problem with, 58

HandsHigh Software, 37, 45Harrison’s Principles of Internal

Medicine (Kaspar), 42, 45HCO3

excessive loss of, 84liver’s conversion of, 92

Health Insurance Portability Act(HIPPA) of 1996, 45–46

health systems, 75hemocult guaiac cards, 11heroin, 24HIGH PH mnemonic, 85. See also

Metabolic alkalosisHIPAA. See Health Insurance Portability

and Accountibility Act of 1996history

taking of, 6thoroughness of, 4

Home-based rehabilitation, 105, 109homeless patients, 97–98Hospital Handbook (Shah), 12






Index 171

hospitalscare options post-, 105computerized charts at, 40hierarchical organization of, 67infections acquired in, 104patient’s first time in, 67SNF’s in, 106–107

How to Choose a Medical Specialty(Taylor), 2

Hughes, Ellen, 71humor, sense of

importance of, 53screwing up and, 56

hydrocortisone, 82

ICF. See intermediate care facilityIDUs. See injection drug usersignorance, patient’s, 139–140IHSS. See in-home support servicesindex cards, sign-out, 122–124infections, hospital-acquired, 104infectious disease, 32in-home support services (IHSS), 107,

109injection drug users (IDUs), 24injuries, 6inner child, whining of, 58inpatient

rotations, 71services, 5, 8, 24

insomnia, 28insulin, 80Intelligence. See emotional intelligenceintensive care units, 21intermediate care facility (ICF), 106interns

medical student v., 121psychological survival for, 128–130scuts and, 31

internships, choosing of, 1intravenous drug users (IVDU), 98investing, 159IV lines, 96IV pain medication, 23IVDU. See intravenous drug users

JAMA. See Journal of the AmericanMedical Association

Janeway, Kathryn, 1job

basic description of, 7not your, 5performance, 7rest of, 4

Journal of the American MedicalAssociation (JAMA), 49

Kaspar, D. L., 42Kerley’s B-lines, 87kidney disorders, 95Kobliner, Beth, 157

Lab results, gathering, 15, 97Lactated Ringer’s fluids, 92limbs, injuries to, 6living will, 137. See also Durable power

of attorneyLo, Bernard, 144loafers, 9lung densities, types of, 87

managed care, 75Medi-Cal, 107medical center, hierarchical

organization of, 67Medical knowledge, 7medical myths, 80medical school. See also Third year

competition within, 76financing, 158student support groups at, 73wards v., 53

Medicare, 107medications

acetaminophen-containing, 23, 28checking, 15docusate, 79dose conversion for pain, 81double-checking, 61IV pain, 23oxycodone, 24






172 Index

medications (cont.)pain, 22, 23, 81, 97pressor, 134sleeper, 28stool softeners, 79

medicolegal events prevention, 26–27MedLine online, 43Meg’s List checklist, 94–97mentors, 1–2metabolic alkalosis, 85metabolic gap acidosis, 84metabolic non-gap acidosis, 84methadone, 24Microsoft Excel software, 157Microsoft Money software, 157mission, student’s, 6mnemonics

CHOPPED MINTS, 48FEN, 8P’s, and D/C, 22HIGH PH, 85MUDPILERS, 84

Moffitt Hospital, 25–26mojo, parental, 1MoneyDance software, 157morphine, sustained-release, 24Mosby, C.V., 41Mother-Father being, 1MUDPILERS mnemonic, 84. See also

Metabolic gap acidosisMulholland, Gerry C., 12Mvelopes Personal finance program,

157myths. See medical myths

needlesbutterfly type, 100inserting, 100removing, 101

needlestick hotline, 101networks, big sib, 2neurosurgery, 3neutropenic precautions, 28New England Journal of Medicine, 50,

74Newman, Meg, 94

“no idea” person, 2nodules, 87normal saline (NS) fluids, 92not full-code, 138–139notes

format of, 102pre-rounding, 14

NS. See normal salinenurses

befriending, 64PCAs and, 23physicians compared to, 76talking to, 15ward, 64

Obi Wan Kenobi, 1occupational therapists, 65online references

EctopicBrain website, 44Medline, 43Mvelopes Personal finance program,

157PubMed, 43, 162, 163–165UpToDate, 41, 43–44Yale Wards Handbook, 41, 42

opioids, 23, 79orders, writing, 61Orient, Jane M., 41Oto-opthalmoscope, 11outpatient rotations, 8outpatient services, 9oversleeping, 56oxycodone, 24

pagerscodes for, 44etiquette of, 43team member’s, 61

painchronic, 24medication, 22, 23, 81, 97ongoing, 23prn order for breakthrough, 23syndromes, 23

PalmPilots, 44






Index 173

pancreatitis, 39parents, mojo of, 1patient-controlled analgesia (PCA),

23patients

admission of, 94–97assessment problems of, 22baseline function of, 65card flips and, 14changing status of, 65code self-designation by, 138–139code talk with, 131–137communicating with, 26, 67competence of, 135court-appointed surrogate for, 137data collection cards, 4, 39, 111decision-making capacity of, 135discharging, 33, 104–105disposition of, 103DNI declaration by, 135, 144ER’s influence on, 139feeding, 97first presentation on, 50first-time hospitalization for, 67flagging, 33as “guinea pigs,” 68home-bound, 105, 109homeless, 97–98ignorance of, 139–140information gap of, 69labs for, 97learning about, 4mini-presentation about, 33misapprehension of, 70MS3s and, 31MS4s and, 32non-boring, 6post-hospital care options for, 105pre-rounding and, 14professional treatment of, 9shepherding of, 103sickle cell, 23signing out patients, 122–124special subjects related to, 50steroid taking, 82

student’s bonding with, 67team-based care of, 69terminal illness, 26

PB. See Peripheral brainPCAs. See patient-controlled analgesiaPDA. See personal digital assistantsPDR. See Physician’s Desktop ReferencePE. See Pulmonary emboluspeers

courtesy to, 58emotional intelligence displayed by,

59ward behavior by, 58

pen light, 10pens, black ink, 10peripheral brain. See also clerkship

binderdefined, 37first day of clerkship and, 36–39mega-genius outcome of, 39pancreatitis notes in, 39professionalism and, 52, 76resident’s, 36

peripheral intravenous central catheter(PICC), 69, 96

personal digital assistants (PDAs), 37,44

American Medical StudentAssociation overview of, 44

brands of, 44doctors using, 44EctopicBrain website articles about,

44fear of, 44hazards of, 46medical calculator software for, 45software for, 37

Personal Finance for Dummies (Tyson),157

pharmacology, tips on, 79PHI. See protected health informationphlebotomists, 99physical examination, 4

record cards, 4physical therapists, 65






174 Index

physicianscorporate identity of, 75ego problems of, 75nurses compared to, 76self-determination of, 75

Physician’s Desktop Reference (PDR),79

PICC. See peripheral intravenouscentral catheter

pimpingattending’s, 50defined, 47etiological approach to, 48examples of, 47–48JAMA on, 49key to, 47organ/system-based approach to,

48P-MIBI test, 91Pocket Guide to 12-Lead ECG

Interpretation (Mulholland), 12Pocket Medicine: The Massachusetts

General Hospital Handbook ofInternal Medicine (Sabatine), 12

Practical Guide for the Care of MedicalPatient (Ferri), 13

precautionsaspiration, 27, 94for falls, 27neutropenic, 28seizures, 27

preparationemotional, 72mental, 72

pre-rounding, 14cards for, 40examination, 15patient information gathered during,

14progress note, 17–20task, 15timing of, 15

Presentationsgiving, 4–5, 6memory v. cards for, 40

mini-, 33, 50patient, 33, 50“presentations” v., 4, 50rounds and, 14, 21self-editing during, 21types of, 5warnings about, 51

pressor medications, 134prevention

constipation, 25–26, 97DVT, 25medicolegal events, 26–27stress ulcer, 24, 25

PRN ordersadmissions and, 28breakthrough pain, 23common, 28

Problem-Oriented Medical Diagnosis(Friedman), 41

proceduresnote format for, 102suturing, 5

professionalismclothing and, 9impact of, 52, 62patient’s treated with, 9peripheral brain and, 52, 76punctuality as, 56

progress note. See also Data collectioncards

pre-rounding, 17–20template for daily, 117

prophylaxis, 24protected health information (PHI), 45proton pump inhibitors, 24, 82

gastritis and, 82ulcers and, 82

pseudo-code emergencies, 127–128psychological survival, 1, 128–130PubMed, 43

Boolean modifiers with, 163–165defined, 162–165using, 162

pulmonary embolus (PE), 29punctuality, 56






Index 175

questionsECG, 88–90stupid, 62–63textbook research v., 63

Quicken software, 157

radiology, 3Rapid Interpretation of EKG’s (Dubin),

12RBBB. See right bundle branch blockreflex hammer, 10regimens

bowel, 79SSI, 80

rehabilitation servicesacute, 107consultations, 64–66contacting, 65day health care, 110home-based, 109

renal dosing, 95Renal tube acidosis (RTA), 84residents

cards grabbed by, 40deflating treatment by, 51, 53filling out forms for, 61guidance from, 24PB of, 36providing information to, 21reading of, 62suffering of, 54

Resolving Ethical Dilemmas (Lo), 144resuscitation. See also Do not

resuscitatecardiopulminary, 135fluid, 93

resuscitation fluids, 93retractors, 5right bundle branch block (RBBB), 29rotations

inpatient, 71outpatient, 8personal goals for, 62surgical, 48tools for, 10

rounds, 4attending, 14defined, 14flavors of, 14grand, 14presentations at, 14, 21work, 14

RTA. See Renal tube acidosisrude treatment

bouncing back from, 55impersonal nature of, 53

Sabatine, Marc S., 12Sapira’s Art and Science of Bedside

Diagnosis (Orient), 41SCDs. See sequential compression

devicesschmoozing, 59scintigraphy, 91screwing up, 56

anxiety about, 57sense of humor about, 56war stories about, 56–57

scrubs, 8, 9scuts

defined,interns and, 31organizing, 34other, 33–34sheets, 32

seizure precautions, 27sensory deficits, 28sequential compression devices (SCDs),

25services. See also rehabilitation services

inpatient, 5, 8, 24outpatient, 9

Shah, Sanjiv J., 12shoes

comfortable, 9Ecco brand, 9evaluations and, 10loafer-type, 9selection of, 10

sickle cell patients, 23






176 Index

sign-out, 122–124skilled nursing facility (SNF), 66

free-standing, 107–109hospital-based, 106–107

skin care, 97SkyScape’s Archimedes software,

45sleeper medications, 28sliding scale insulin (SSI), 80. See also

insulinefficacy of, 80regimens, 80studies on, 80

sliding scales, 81snellen test vision cards, 11SNF. See skilled nursing facilitysocial workers, 64Software. See also HandsHigh Software

Diagnosaurus, 45Epocrates, 45free, 45medical calculator, 45Microsoft Excel, 157Microsoft Money, 157MoneyDance, 157Mvelopes Personal, 157Quicken, 157SkyScape’s Archimedes, 45ThoughtManager, 37, 45

special work needs, 34specialty

choosing of, 3surgical, 3

speech therapists, 66sphygmomanometer, 11SSI. See sliding scale insulinstage fright, 5steroids, 81

intermediate-acting, 83long-acting, 83patients taking, 82prolonged use of, 82short-acting, 83side effects of, 82stress-dose, 82–83

stethoscope, 10stool softeners, 79stooling, 97stopwatch, 10stroke management, 43students, medical. See also American

Medical Student Association;Financial literacy

attendings hatred of, 40as “caddy” of team, 10clerkships and, 7evaluating, 7financial literacy for, 155grading of, 7, 52, 76ignorance of, 32intern v., 121interns v., 121intimidating, 51, 53, 55job of, 4–6mission of, 6MS3, 31, 34MS4, 32, 34orders written by, 61patient’s bonding with, 67psychological survival for, 128–130refusing calls from, 32school support groups for, 73self-feeding by, 97sub-intern v., 121team role of, 66types of, 1

studies, ordering of, 33subintern, medical student v., 121support groups, 73surgery

assisting in, 5neuro-, 3rotations, 48specialization in, 3

Surgery Recall (Blackbourne), 42, 48surrogates, 137survival

psychological, 128–130third year, 1

suturing, 5






Index 177

tapemeasure, 11micropore, 10

tasks, non-boring, 6Taylor, Anita, 2team

communicating with, 67expectations of, 62gauging of, 62introducing self to, 61members of, 63pager codes of, 61patients cared for by, 69soliciting feedback from, 62student’s role on, 66

television. See ER television showTemple of Healing, 9terminal illness, 26tests

baseline ECG, 29CXR, 29prerequisite, 29UA, 29

therapistsoccupational, 65physical, 65speech, 66

third year. See also clerkships; medicalschool

exercise possible during, 73isolation of, 73marshaling support for, 72–73not waiting for, 3preparation for, 72, 73–74stress of, 72, 73surviving, 1

ThoughtManager software, 37, 45Tierney, L. M., 42time management, 71–72

“same day” bill paying policy as,71

weekends and, 71tools, 8

black bag for, 97–98black ink pens, 10

labeling of, 11medical calculator, 45neuro exam, 11not needed, 11ongoing, 10oto-opthalmoscope, 11pen light, 10reflex hammer, 10retractors, 5rotation, 10for slightly nerdy, 11sphygmomanometer, 11stethoscope, 10stopwatch, 10tape measure, 11tuning fork, 11

tourniquets, 100, 101treadmill stress test, 91Tuesdays with Morrie, 1tuning fork, 11Tyson, Eric, 157

UA. See urinalysisulcers

prevention of, 24, 25prophylaxis for, 24proton pump inhibitors for, 82

University of California at SanFrancisco (UCSF), 2, 71

Adult Pain Management Guide from,81

grading at, 7, 52, 76UpToDate online, 41, 43–44urinalysis, 29urology, 3

Vacutainer test tubes, 98Varosy, Paul, 88veins, evoking, 99ventilation. See Assisted ventilationvignettes, code talk, 145–151,

152–154Visors, 44vitals, gathering, 15Vitamin C. See confidence






178 Index

wardsconfidence on, 55medical school v., 53nurses on, 64peers behavior on, 58truth about, 53–55

The Washington Manual, 45websites

books ordered from, 12career, 2EctopicBrain, 44free software, 45Medline, 43Mvelopes Personal finance program,

157PubMed, 43UpToDate online, 41, 43–44

weekends, 71white coats

advantage of, 8nonrequired times for wearing, 8pockets of, 10required times for wearing, 8

wills. See living willWillyard, Kent, 45Wolff-Parkinson-White syndrome,

88

x-rayschest, 29, 85, 86, 87clerkships and learning, 85

Yale School of Medicine, 41Yale Wards Handbook, 41, 42






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5 x 9 Threelines - Assets - Cambridge University Pressassets.cambridge.org/97805216/76755/index/9780521676755_index.pdf · Dubin, Dale, 12 Durable power of attorney (DPOA), 136. See