Clerk

In the old days, third year medical students were called clerks; hence the word clerkship for our rotations. Indeed, notes by third year medical students are the most thorough and complete. I remember arduously writing up 4 or 5 page admissions notes on medicine, a task that seemed impossible at the time and a feat that seems unimaginable now. Partly, this stems from our inexperience at understanding what is important and what is not; hence, we ask about and document everything, no matter how trivial. We also feel like writing perfect notes is one thing we can do as a medical student and worry that it is the only way we'll be evaluated. After all, we don't have clinical judgment or answers to all the patient's questions; all we can do is record things beautifully. And there is an educational component in writing the note; it reinforces the importance of the history and physical exam, the thought process in decision-making, and the interpretation of data.

But as we graduate past the third year of medical school, our notes become more sparse and focused. My notes as a sub-intern were worse than those by the fresh third year medical student on the team. This contraction comes out of necessity; as an intern next year, I may be writing 10 daily notes on my patients, and I simply cannot keep producing volumes of work. My attention has shifted from being a clerk and documenting unnecessarily to taking care of the patient and making sure orders get executed. As a fourth year, I may know what matters in a note and where to focus. But lastly, being on a consult service for much of the year has taught me the value of short notes. For most purposes, the concise, well-written, clear synopsis is superior to a rambling, overly thorough note. That is what I've been trying to work on in this rotation. That being said, when I get a new consult, I still take a look at the third year medical student note since, until I am an intern in a few months, I have the time and I really appreciate the hard work put into the four page life-stories of each patient.