I admitted 10 patients last night

Back in med school, I wondered how the interns wrote so many notes so quickly. It took me hours to do a good H&P, and in the process of writing it I would always remember something I forgot to ask or elicit.

Luckily, I’m now an intern, so I know the secret to writing lots of notes quickly:

Intern notes suck.

Even the best notes are only technically ‘good’ because we spent a couple extra minutes synthesizing the assessment and plan. Because, hey – the bright side to notes that suck is that nobody’s going to read a 3 paragraph HPI or a 4 paragraph history of someone’s back pain, and everyone’s just skimming your ROS and examination anyway, so what the hell, it’s okay that your family history consisted of two words.

(I used to bold the pertinent positives and negatives of the ROS and exam, but then one of my preceptors told me to knock it off because she likes to use bold for her own addendum. Which, okay, fine – I guess this way, at least no one will notice I didn’t check for cervical adenopathy in the kid with mono.)

The downside to notes that suck is that your original note will be repeatedly quoted in every consultant and social worker’s HPI, word-for-sucky-word.

I really can’t get over the fact that people actually read my notes now. (Or at least, copy and paste them). After 4 years of medical school, having a consultant specifically reference aspects of my HPI or assessment feels… wrong. And guilt-inducing.

Don’t you want to do your own assessment? Are you sure you want to rely on mine? I wrote this H&P in-between a rapid response, 3 “urgent” pages, the surgical fellow tapping his foot impatiently at the door, and sign-out.

But anyway, there you go: It used to take me 4 hours to write my weekly H&P, which would inevitably get ripped apart by the preceptor for not including tactile fremitus, CVA tenderness, a gait exam, and fifty additional ROS questions. This H&P would never, ever be read, because I was an M2.

Now I can write 10 H&Ps in a night, all of which will be quoted extensively by consultants who are relieved they don’t have to take the history themselves!

Something, something… patient safety.

4 thoughts on “I admitted 10 patients last night

  1. I hate when you look back at a note and are just like “what did I say there?” Especially in those notes from the end of a busy night. I am normally so anal about my notes and so agitated when it is crazy busy and I have to just scrawl down the really pertinent stuff, especially when, like you say a bunch of people regurgitate it word for word and yet nobody really cares what it says. It does get better. But, you never have quite the time or quite the notes as you had as a med student.

  2. Yep . . . if you want that experience every day for the rest of your life, there are programs in emergency medicine near you . . . instead of ten notes a shift, you get to do twenty, secure in the knowledge that one misremembered fact or prejudiced conclusion can easily become the basis for important decisions multiple changes of hands down the line.

    I find the hardest part, besides remembering stuff, is really really listening once you’re tired. It’s easy to forget that there’s a story there and not just a shortest path to getting the answers to finish your note.

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