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Recommend a reference book for inpatient?


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Hello wise ones,

I'm interviewing first week of April for a hospitalist position at Spartanburg Regional in Spartanburg, SC. Before you go "WHA?!**(&@", I actually want to live there! My dear friend and her five kids (2 of them my goddaughters) are there and I'm ready to do something else, so there you go. Actually it's a beautiful part of SC, very mountainous, clean air....

So, after 5 1/2 years in outpatient medicine and very little (almost none) inpatient med experience, how do I wow them? I'm looking for a good reference of how hospital care is done--the most current, evidence-based practices, M&M issues, etc.

I have good procedural skills and enjoy the few I do in family practice/urgent care but I am trainable and can learn more. I'm willing to read everything I can and am more than willing to be the new kid on the block for a year or so until I'm up to speed. My only inpatient experience has been a CT surgery rotation, mostly spent in the OR, a little on the CCU/ICU (not enough IMHO), and a bit during my IM/endo rotations six years ago.

I'm up for a challenge and want to do something different. I'm soooo ready to get out of the OFFICE. Sounds odd but it might be a nice change to see & help sick people (as opposed to the perimenopausal depressed women who dominate my practice).

Have at it!

Thanks in advance,

Lisa

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L, I'm sure you'll get some advice from people waaaaaay more qualified than myself - but I wanted to share a website with you that andersenpa referred me to prior to my taking a critical care course. It's www.ccmtutorials, 'ccm' being critical care medicine. According to the lead-in page, it was written for residents on their critical care rotation. It's an excellent set of tutorials on respiratory failure, renal failure, sepsis and much more.

 

And good luck at the interview! That's a beautiful area of the country (other than the big a$$ is the sky :D )

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This one has always been and always will be my favorite. I like the way it is organized and how practical it is. I have to confess, I have not seen the most recent version, though.

http://www.amazon.com/gp/product/0323023975/ref=pd_kar_gw_1/102-2381019-6405710?%5Fencoding=UTF8&v=glance&n=283155

 

This one is good for the ICU.

http://www.amazon.com/gp/product/0683055658/ref=pd_kar_gw_3/102-2381019-6405710?%5Fencoding=UTF8&v=glance&n=283155

 

 

Will keep my fingers (and toes) crossed for you! Good luck!

 

Melodie

 

P.S. The cake was awesome! Tasted just like a macaroon! Thanks again for your help.

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Dear Lisa,

 

Favorite is "Hospital Medicine" by Wachter, Goldman and Hollander

http://www.amazon.com/gp/product/shipping/0683304828/102-3637476-7704944

 

It’s been updated with the most recent edition displaying a table of contents at:

http://www.vonl.com/CHIPS/hospmed2.htm

Very readable is "Current: Critical Care Diagnosis & Treatment" by F. Bongard & D. Sue

http://www.amazon.com/gp/product/083851443X/102-3637476-7704944?v=glance&n=283155

Amazon will sell a very cheap, softcover copy.

 

Good luck,

 

-Tom

 

 

 

.

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The intern pocket survival guide is good.

Harrison's is the best but it won't fit in your pocket.

 

If you get the job study electrolyte abnormalities, ACS, CVA, DKA, COPD, Asthma, CHF, TIA.

Also brush up on procedures: lumbar puncture, arterial blood gas, peripheral and central IVs

 

Good luck!

Madeline

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L--

The ICU book by Paul Marino book recommended above is one of my all time favorites.

Other ICU books I like are:

 

Handbook of Evidence-Based Critical Care by Paul Ellis Marik.

 

It breaks the body up into systems and covers the pertinent subjects, like vent weaning, PE, fluid/pressor resuscitation, stress ulcer prophylaxis, etc. It also goes over info like how to write an h&p for the ICU, what to focus on in daily rounds, how to present your cases and "key point" to carrying for ICU pts.

 

Handbook of Critical Care by Kirby/Taylor/Civetta

Also hits major topics and highlights the key issues to assess, differential dxs and treatment plans. Easy to read. Good useful info.

 

IMHO, check out several texts and pick the one that you like the best, the way it reads, how it covers the information, the layout, etc. If you do that, you'll find it much more useful. For example, not everyone likes how the Marino book is set up. So, the other books listed above, may be considered more "friendly."

 

One of my SP's has this book in his office. It is excellent.

 

Hospital Medicine (Hardcover)

by Robert M. Wachter (Editor), Lee Goldman (Editor), Harry Hollander (Editor)

Amaon.com doe carry it

 

Another "quickie" reference I keep in my lab coat is:

tarascon internal medicine and critical care handbook.

 

A great mnemonic for hospital medicine:

"FAST HUG" (Critical Care Medicine. 33(6):1225-1229, June 2005) for Feeding, Analgesia, Sedation, Thromboembolic prophylaxis, Head-of-bed elevation, stress Ulcer prevention, and Glucose control

 

 

RC actually made an addition to "Fast HUG" which I've been using since.

He added an extra "T" making it "FAST THUG" the second "T" stands for Tubes and lines.

 

This is a webiste that is on our hospital computer. it is called Up to Date.

It has the most up to date info on diagnosis, work-up, research trials, follow-up and treatment recommendation. I love looking info up on this site. Check to see if it is on your system on the new job. It really is awesome.

http://www.uptodate.com/

 

Or

 

You can check out the website thru this link to get an idea of what it is like:

 

http://patients.uptodate.com/tocmain_prof.asp

 

My other recommendation would be to see if you can spend some time with the billing coder for your SP or the group. They can give you valuable info on what to include in your daily notes and how to write billable diagnosis.

For example, I just found out that for billing, there are 6 types of malnutrition codes. Writing "malnutrition" is not billable. So, until we can our inservice, I've been writing "Pro/Kcal malnutrtion" for our pts with low prealbumins. Written this way, they can bill for it. Would have been nice to know that a year ago!!:eek:

Anyhow, once you get settled, IMHO, that would also be time well spent.

 

All I can come up with at the moment.

 

Good luck to you! I'm sure you'll do an excellent job.

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I suggest hospital medicine by Wachter. He is one of the father's of hospital medicine and the SHM. Before all of that, the Washington Manual of Medical Therapeutics is the most helpful book for the wards. I see it sticking out of the pocket of most first year IM residents on the floor. It is really good and concise.

 

Learing on the fly is what you do when you start a hospitalist position. At first, you read tons. While at work, I use up to date for that stuff. You also use more consults. As time goes on, you need to "cram" less and call less consults.

 

By the way, I love hospital medicine. This is my 4th year on the wards.

 

Good luck,

 

Pat

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Hands down:

Marino's is the bible, read it and learn. It will get you thinking "right".

 

Watcher's also is essential

and, for your first few days, the "scut monkey's guide" to help you with orders (remember nutrition, decub prophy and weights!)

 

Please take the job L,

you will SHINE

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Ditto Marino for the ICU, Ferri's for the floors. Also used (occasionally) Washington Manual.

 

In the coat:

A pocket "survival guide" (most brands are adequate) for orders/daily care stuff

The Maxwell spiral book, if it is still made, has a lot of useful day-to-day info- until you get it all in your head

Tarascon Pharmacopoeia or equivalent (Taracon also makes survival guide type handbooks)

 

 

although, if you're so inclined, they fit all this stuff into a PDA now. I seem to find it faster in the book, though, and never use the volumes of Harrison's or whatnot that you can load onto a palm pilot.

 

Enjoy the wards!

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I'm amazed no one's said Up-to-date yet. It's what Mrs Toolman uses. It's what every doc on our floors (who can tell sh*t from shinola) uses. Concise, always updated, completely evidence based. When other docs see you reading it on some screen on the floor...there's some reverance.

http://www.uptodate.com/

 

"damn...Tool man's reading Up to date. He must not be as dumb as he looks."

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Do I like it? Depends what time you ask me.

 

The wonders of modern medicine have people living MUUUCCCHHH longer than they should have, and they lose what ever part of them made them human.

Much of Hospital medicine is just nursing home medicine. Endlessly admitting the same gomer you admitted last month...and the month before that...and the month before that. Endlessly filling out forms. And all the discharge nurses and social workers are also enlessly filling out their forms. Now that we've got people living longer....we don't know what to do with them.

 

You're job.......is to take what you learn from the gomers.....and not be so braindead....that when 35 y/o father of 3 comes in clinging to life....you know what to do from your Internal Medicine skills you've developed.

 

When you actually end up saving someone, who is actually save-able...it's a rush...and makes the next gomer more palatable and makes you love your job.

 

Clinic... people are there and gone in 15 minutes. ER... there and gone in 2 hours, but in hospital medicine you actually get time to know your patients(some say that's a bad thing). There are some pts that you grow to love but you know they're gonna die, and there's nothing you can do about it but try to give some comfort. And when they die, it's a strange feeling. You feel like you actually did something, but lost, but still you feel some kind of satisfaction that you did something important. I don't know how to explain it. It can be very satisfying.

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I'm amazed no one's said Up-to-date yet

 

Toolman--you must have missed it in my post.

This is a webiste that is on our hospital computer. it is called Up to Date.

It has the most up to date info on diagnosis, work-up, research trials, follow-up and treatment recommendation. I love looking info up on this site. Check to see if it is on your system on the new job. It really is awesome.

http://www.uptodate.com/

 

Or

 

You can check out the website thru this link to get an idea of what it is like:

 

http://patients.uptodate.com/tocmain_prof.asp

 

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Thanks Toolman for your insight. I suspected something along those lines. Still, I'm intrigued. Probably more so for the opportunity to stretch the limits of my learning and do more than I have done.

Many of you know I've struggled with whether I should go back to med school. The truth is, unless somebody pays me to do it, it's not financially worthwhile. So I realize it's just time for me to learn more in a different way--on the job, getting paid. This can't be a bad thing.

Also it's a teaching hospital so I think that will be great. There are FP, IM and transitional year residents who come through. I love teaching but often feel like I don't know enough to be a really effective teacher. This could be a great opportunity to gain confidence there.

Any other perspectives? Fire away!

L.

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Sorry MaryFran

still reading at a forth grade level.

 

The other good thing about experience in Hospital Medicine/Critical Care is it looks great on your resume. You're regularly managing CHF, ACS, COPD, DM, CRF, GIB's, s/p surgery, PNA....

 

If you can do all that, it's a lot easier to get another job

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Sorry MaryFran

still reading at a forth grade level.

 

No Toolman, it likely has more to do with my posts being a tad verbose.:rolleyes:

 

L--

I love practicing in the hospital setting, particularly in a teaching hospital. I enjoy recognizing who the really bright specialists are that also like to teach and going over the details of pt care with them, always learning something along the way.

Many residents and students are floored when they work on our service and realize how much IM/hospital medicine we do on Trauma.

Just in the last week I have managed one of our pts that developed HHNK, dx'd 2 of our young pts, <30yo, with metablic syndrome, another pt in which we are doing a syncope work-up, has no traumatic injuries, am treating for CAP, and have found that she has ovarian CA as well as grave's disease.

The other great thing about teaching hospitals is the variety of disease processes you are exposed to including the occassional zebra. in my experience, no 2 days in a row are the same. When your pt goes bad--hemodynamically unstable, new afib with RVR, acute onset SOB, or just plain crumping-- you are the one that gets the call to the bedside to care for your pt. Unlike oupt medicine where you send them to the ED to be cared for by someone else. I love having that type of "ownership" of my pt's care.

 

If you typically round on the same floors, as I do, it enables you to develop good, friendly relationships with the nurse's, case managers, PT/OT, RT's and other anciallary staff that can help make your job easier. Many love to be educated about their pts. When I have a chance, I try to show them interesting abnormalities of their pts. Now, when they have questions about a disease process or a lab, sometimes not even on a trauma pt, they ask me because I don't mind taking the time to answer the question.

Plus, when they have their little parties you get invitied to have free food!:D

 

So, as you can see, I love being in a hospital setting. I couldn't imagine being happier somewhere else.:)

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  • 4 months later...
Guest mjamieson

Lisa:

 

I am a hospitalist in St. Croix, actually the only hospitalist/intensivist in the hospital. I am also from York, SC. Two books I recommend are Manual of Intensive Care Medicine, Lippincott, Williams and Wilkins. ISBN 0-7817-1986-0 and Emergency Proceedures and Techniques, Williams and Wilkins. ISBN 0-683-07738-4. Both are excellent.

I am efforting information on salary expectations for this program and would appreciate any info you can provide. Also any sample or representative " Scope of Practice".

 

Thanks

Mark

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Guest lisnek
Thanks Toolman for your insight. I suspected something along those lines. Still, I'm intrigued. Probably more so for the opportunity to stretch the limits of my learning and do more than I have done.

Many of you know I've struggled with whether I should go back to med school. The truth is, unless somebody pays me to do it, it's not financially worthwhile. So I realize it's just time for me to learn more in a different way--on the job, getting paid. This can't be a bad thing.

Also it's a teaching hospital so I think that will be great. There are FP, IM and transitional year residents who come through. I love teaching but often feel like I don't know enough to be a really effective teacher. This could be a great opportunity to gain confidence there.

Any other perspectives? Fire away!

L.

 

you were, by far, the best lecturer (and PBL instructor) we had last year at PU. so, NO WORRIES - pahleese!

 

lk

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Wow, thanks for that. I needed it.

Actually I took a job in EM...the hospitalist job just didn't seem like a good fit for me. I probably would have liked the work but I didn't like the docs...that's important to me. I head back to Portland next week for my brother's wedding (@#(*&$& the price of flights now :eek: ) then back to SC to start work.

Best to you and all my PU buddies,

L.

 

you were, by far, the best lecturer (and PBL instructor) we had last year at PU. so, NO WORRIES - pahleese!

 

lk

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  • 8 months later...

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