Residency Program
Residency Handbook
III. Clinic
Dr. Walton, Clinic
Director
Hours
and Operation
Clinic
starts at 1:00 PM, with a 15 minute lecture at the beginning, and
then patients start at 1:20 PM. First year residents are to see
3-5 patients per afternoon spaced 30 minutes apart from 1:20 to
3:45 PM. Second year residents will see 4-6 patients per afternoon
spaced 30 minutes apart from 1:20 to 3:45 pm. Third year residents
will see at least 4 patients with no maximum scheduled 15 minutes
apart for returns and 30 minutes for physicals.
The
clinic is your opportunity to develop habits and learn how best
to run (or not to run) an outpatient practice. Patients are to be
treated respectfully. For example, do not talk about the patients
in the hallway. Please discuss each patient in the chart room or
at the nurse’s station. Professional behavior and dress is expected.
Please dress up and look clean and neat for your patients and do
not wear scrubs. The clinic is to be considered your personal office
practice for the next three years.
Patients
are expected to be on time for appointments. If a patient has not
shown up after ˝ hour, we usually assume the patient is not coming
to the appointment. There are circumstances when a patient will
be late. You should make every effort to see your patients. However,
when there are circumstances when you cannot do so, please discuss
these situations with your attending. Patients with scheduled pain
medications are required to sign a pain contract and will be seen
on a regular basis for their refills. (Patients will be expected
to abide by the pain contract and will be dismissed for failure
to do so.)
Number
of clinics expected
Residents
are required to have 108 clinic sessions during their three year
tenure. This is an average of 36 clinics a year. There is no clinic
the day following night call or during the ICU rotation. Traditionally
the R2 and R3 have not had clinic the day of call. You will be assigned
to one day of clinic a week and a back-up day which will become
your clinic day if you are post night call or on housestaff call
as a senior resident. You can only make up clinic in the same week
as the missed clinic, as the 108-week clinic requirement counts
2 clinics/week as one week. You will be responsible for keeping
track of these clinic weeks. There are those in the 2nd and 3rd
year that may need to have added clinic days when in the ICU.
Number
of patients expected per clinic
R1
– 3-5 patients/ session
R2
– 4-6 patients/session
R3
– > 4 patients/session
How
to see patients
Please
review the chart including lab and radiological studies, then see
the patient, perform a history and physical. Next, list the diagnosis,
differential diagnosis, conclusions and your recommendations. With
this information in hand, check out to the attending. The next step
is to explain your plan and any side effects to the patient either
with the attending or individually, guide the patient to check-out,
and complete a progress note. The notes should be a complete
SOAP note. Please update preventive care forms and medication lists.
Clinic
is to run on a timely basis. Patients currently check-in at outpatient
hospital registration and then come to the office. We make every
effort to schedule people so that our clinic ends at 4:30PM. Please
make sure to make every effort to stay on task so that we all can
finish by 4:30 .
Checking
out to the attending
For
the first 6 months of residency, all first year residents must have
the attending see every patient after their initial evaluation.
Beyond 6 months, first year residents, must review each patient
with the attending after the patient is seen and the attending will
use his/her discretion about which patients to see. Second and third
years are should discuss most cases with the attending. All patients
with Medicare insurance must be discussed with and be seen by the
attending.
Writing
notes/dictation
Notes
should be completed after seeing each patient. You may dictate the
history and physical, but write the assessment and plan so the attending
can see your thought process and conclusions.
Charts
Please
come by clinic and check charts daily. You will each be assigned
a nurse who will help you. If you are unable to do so, please have
someone do it for you, but tell your nurse who is covering for you.
Procedures
We
encourage procedures. This can be one of the most gratifying components
of Internal Medicine. We can teach you many types of procedures
including: joint injections, skin tag removal, skin biopsy, freezing
seb. keratosis, toenail removal, and abscess I&D. There are
several attendings that like procedures and are comfortable teaching
them. If you would like to schedule a patient for a procedure and
your attending is not comfortable with that particular procedure,
you may meet the patient in clinic on another day. Please make sure
the attending you request for supervision will be in clinic. We
have a procedure tray for skin lesions and a liquid nitrogen canister.
You will need to fill out a consent form and appropriate paperwork
for any procedure.
Cross
coverage when on vacation
You
must arrange coverage when on vacation. You will need to inform
the nurse supervisor, Claudia Adomat, in writing about who is your
coverage person.
After
hours and weekend coverage
The
on call resident covers after hours phone calls including nights
and weekends. The resident receiving phone calls is to fill out
a patient phone call record with complaint and action taken. At
the end of the call please give this record to the staff who will
place it in the chart. There will be no narcotics given after hours.
I would recommend that you limit phone call antibiotic use and encourage
the patients to be seen the following day for outpatient type infections.
If a patient sounds too sick to wait until the next day, he/she
should be referred to the ER.
Signing
off on labs, radiological studies, procedures
Every
sheet of paper that goes in to the chart needs to be signed off
with the action taken before being placed in the chart.
Clinic
lectures
A
short lecture/ question session will occur at the beginning of each
clinic. You are expected to be present and on time. Occasionally,
residents will present these lectures.
Billing
Part
of your training should include how to bill. You may discuss this
with your attending at the end of each visit.
Insurance
The
clinic accepts the same insurances as the hospital. If you want
a patient to follow-up with you after hospitalization, you may do
so.
Patient
Dismissal
Patients
are expected to show up for appointments. You may dismiss patients
who are “no shows” three times, those who abuse their pain contracts
or those patients who are abusive to our staff. If there are other
reasons you would like to dismiss a patient, you will need to discuss
these with your attending. A letter will need to go to the patient
by certified mail and the patient will be given 30 days to find
a new physician. The clinic director needs to be informed of patient
dismissals. Patients are encouraged to stay with the same physician,
but are permitted to change physicians if a day is inconvenient
for them.
Have
fun learning!
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