Random tips for new interns

The following are my opinions only.  As I have done ward attending rounds since January 1980, I have developed some thoughts about helping new interns.  Some practicing physicians may enjoy this list also.  The list is not inclusive, but rather what comes to mind today. 1. CKD is not a diagnosis without providing the stage.  If you do not know the staging system and the implications of that system, this Annals of Internal Medicine summary article is free – Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline 2. CKD staging cannot occur when the patient’s creatinine (or cystatin C) is changing, it requires a stable creatinine. 3. CHF is not a diagnosis in 2013.  Patients have systolic dysfunction (specify the eject fraction), or diastolic dysfunction, or valvular disease or right sided heart failure (usually from pulmonary hypertension), or something else.  The CHF label does not help us develop a management plan. 4. If the patient has type II DM (or type I), the number of years matters and should be stated in the PMH or HPI.  We have differing diagnostic concerns with new DM than with 20 years of DM. 5. If the patient has syncope you (the intern or medical student or resident or attending) should perform orthostatic BP evaluation – it is not something to be ordered.  You should see what the patient looks like when they stand. 6. The first response to hyponatr...
Source: DB's Medical Rants - Category: Health Medicine and Bioethics Commentators Authors: Tags: Medical Rants Source Type: blogs