Continuity Clinic

September 20, 2000

Dr. Karl

Continuity Clinic, the weekly half-day when interns and residents drop whatever they're doing and head over to the clinic, can often be a welcome oasis of slower-paced outpatient care during an otherwise hectic and stressful workday.

However, it can also become a despised interruption of life's normal flow of activity, adding the aggravation of difficult patients to barrage of pages from the hospital, which continue unabated.

This issue, Q Fever!’s I&R correspondent, Dr. Karl Newman, shows you the ins and outs of: Continuity Clinic.

Did I hear someone say "Clinic"?

I love continuity clinic. It's a very special time of week, and do you know why? Let me tell you the way my senior resident used to tell it:

A haf' a day o' continuity
Dat's my life it gotta be
So I'll be heah from one to fo'
Nothin' less, and nothin' mo'

I have to admit, though - it can be stressful dealing with patients while you're being called by the hospital about stuff that comes up over there. So here's some advice to make life in clinic run a whole lot more smoothly for ya:

1. Yes or No.

WHAAH??!! Take it from me. Nothing wastes more time, for both you and for the patient, than asking "open-ended" questions that can take forever to answer. Try asking "Yes" or "No" questions instead. You'll be suprised at what happens!

YOU: Hi, Mr.______, is everything allright today?
PATIENT: Yeah, doc, the only thing is...
YOU: Yes or no, please.
PATIENT: What?
YOU: Yes or no, please. Are YOU having any difficulty breathing?
PATIENT: Well, no, but...
YOU: Chest pain, fever, diarrhea, nausea, or vomiting?
PATIENT: No, see, that's what I'm trying to...
YOU: Headache, cough, back pain, rectal bleeding, rash?
PATIENT: Look, Doc, I just wanted to...
YOU: Yes or no, please.
PATIENT: Are YOU serious?
YOU: Yes.
PATIENT: YOU gotta be kidding.
YOU: No.
PATIENT: Yes or no.
YOU: Yes.

It's amazing how well this technique works! Quick note: "Maybe" isn't one of the choices!

2. Present to your attending.

HUHH?! You heard me! Get your attending a present. Every time you present a case!

Who do you think your attending will be more impresed with: a dude who knows a whole lot about medicine and stuff, but who always comes empty-handed, or someone like yourself, who knows almost nothing about anything, but who shows up with a box of chocolates, or flowers?

THINK ABOUT IT!

So I recommend bringing gifts a-plenty for your attendings. Especially if they'll be doing your final evaluation! Hint: Attendings love Blockbuster gift certificates!

3. Send 'em to the ER.

WHATZAT??!! Yeah. The worst thing a resident can do is miss a diagnosis. And the thing is, the clinic just doesn't have the facilities and equipment to properly diagnose many potentially fatal illnesses! You don't want to miss a pulmonary embolus, or massive internal bleeding. Doing so could be deadly!!

So I'll make it a point to send all my clinic patients to the ER for a full exam and workup. In fact, I recommend they go straight to the ER next time! It's in their best interests and mine too.

Make sure you call and arrange all the tests they need beforehand - usually the cath lab needs at least 1/2 - 1 hour advance notice, so in the meantime I'll get them a full-body CT, a V/Q scan, and a colonoscopy while they're waiting. You'll be glad you did!

Whooaaah! Looks like we're outta time, kids! Next time, we'll continue our Internship & Residency series with some anectodes my friend's babysitter told me last week 'fore they hauled her off to the Big House again... Till then, keep your settings on single chirp, and keep reachin' for the snooze!

“Just tell ‘em Dr. Karl sent ya!”

Remember: Quality Without The Q Is Just Uality!