Diabetic patient followups make up a huge majority of primary care stuff that both residents and medical students gotta handle, here's a ABCD style mnemonic to remember what to keep tabs on for diabetics:
A - A1c : Target A1cHb Less than 6.5
B - Blood Pressure target Less than 130 /80 in Diabetics to slow renal failure! Start off with ACE inhibitors , and remember annual microalbuminuria checks
C - Cholesterol Check: LDL less than 100 is target, less than 70 recommended
D - D Vitamin ! Low Vit D levels in DM increases atherosclerosis risks
E - Eye exam, annual, by an opthalmologist or optometrist
F - Foot exam with every visit
G - Gonadial Hormone --> Testosterone levels in Males - Why ? 1/3rd of Diabetic men have low testosterone levels which worsens insulin resistance & obesity - Read this
H - Holistic Health advice including Lifestyle, exercise, smoking cessation, Diet education and weight goals
Emailed to me by a reader who recently started his residency - and here's a real cool "prescription pill" bottle that their residency program gave all incoming interns:
Here's the medicine label ;):
And here are the contents !!
And here are intructions...
Sweeeet...
Just started my second year of residency and my first rotation is a relaxed primary care clinic rotation..lovin it ! The last week, Mr. Z, a jolly white man showed up for his 6-month followup with his very pleasant wife. I went over his notes, problem list, labs and meds on the Electronic Medical Record, which all looked fine and optimal. On the vitals screen, I saw that his blood pressure reading today was @ 156/94, and a similar one in the previous 2 visits, but he wasn't on any medications. I brought this up and he said, "Oh yea, doctors told me it was a doctor coat hypertension or something, because my pressures run perfectly fine at home, in the 120s and 80s"
This is how it works at the VA Hospital inpatient rotations where I am currently at. In the first year, we spend about 4 month-long VA hospital slots scattered in the first year. The other two hospitals we do not take any calls and spend 3 months doing that. The rest of the 5 months of the first year were relaxing elective rotations with weekends off and fixed work times anywhere from 8 /9am to 4 / 5 pm
***
6 am: Wake up !
7am - 8:30am:
- Drive & Report to work
- Newly admitted patients from previous call are distributed
- Gather Patient data on old and new patients
8:30am to 9:00am: Morning Report
- Post-call resident presents new admissions to residents, medical students and clinical pharmacists
- Discussions with peers and attendings on management and differentials
9:00 am to 11:00am: Morning Rounds
- Multidiscipline rounds with attending, medical students, social worker, nurse & pharmacy students
- Bedside discussions on updates, management changes, discharge plans
11:00pm - 12:00pm:
- Putting in new orders into the EMR as discussed on rounds
- Typing in Progress notes on the EMR
12:00pm - 1:00pm: Noon Conference
- With Lunch, get to socialize with peers :-)
1:00pm - 3:00pm:
- Non-call residents Take new Admits
- Perform pending procedures like ascitic taps, thoracentesis, etc.
- Resident on call for the day takes any new admits after 3:00 pm
3:30 to 3:30 pm: Sign-out rounds
- All residents update the on-call resident about their patients and what labs need to be followed up
Post-3:30:
- Go Home whenever done with updating progress notes, admissions. I typically get done by 4:30 to 5pm, then go for a run / work outs / library / movies
- On Call resident stays back
3:00pm - 7:00am next day: Call Time
7:00am: New Day begins
- Post-Call resident gets to finish rounds first and go home before 12:00pm
Resident Takes Call on every 4th Day i.e. Q4 (7 calls in a month)
New @USMLEtoMD
