Sub-I

The structure for medicine at San Francisco General Hospital is a little different than that for Moffitt. We have overnight call every six nights, which is really good. Every six day cycle, we also have a "short call" when we admit hold-overs and patients before noon. That is, each day, there is an overnight call team that admits patients until 3 in the morning or until they "cap" at 10 admits. Anyone left over or admitted after 3 goes to the "short call" team the following day (which caps at 4). It's not a bad system and I appreciate only having to stay overnight once a week.

Being a sub-intern comes with all the administrative baggage. I have to call for outside records, fax prescriptions to the pharmacy, dictate. Dictations are really hard for me. I had to do them in surgery, but those dictations were more straightforward. On medicine, patients come with an extensive problem list and figuring out how best to communicate them is difficult but very educational.

The other new thing is doing sign-out. Sign-out is an immensely important process by which a patient's care is transferred from one person to another. At the end of each day, I have to sign out my patients to the night float (who's in the hospital overnight) or the cross-covering intern (harder to explain). I need to anticipate any problems the patient might have and put down any to-do's for the covering resident. This requires thinking through all the patient's problems and anticipating the worst case scenario. What should the night float do if the patient spikes a fever or drops his blood pressure or becomes combative? After participating in this process of sign-out, I realize how critical it is to efficiently transfer information about a patient to someone who has to learn about dozens of people in a short period of time.