Comanagement is a service in the internal medicine department where a group of doctors help take care of different surgical patients alongside the surgeon. When you have a busy service, it's helpful to work in teams to help best take care of each patient. For example, after surgeries the patient spends a night or more in the hospital and we helped manage chronic medical conditions like diabetes, heart disease, thyroid problems, COPD, obstructive sleep apnea, seizure medications etc. We assisted with Neurosurgery patients staying overnight and orthopedic surgery patients.
I arrived anywhere between 7:30 or 8:00 a.m. and looked at all of the labs, imaging, and notes from nursing staff that occurred overnight. I read through other doctors', pharmacist's, wound nurse's, physical therapist's, or occupational therapist's notes and made sure there weren't problems overnight. Then I visited the patients in their rooms at around 8:30 and I met with my attending and some medical students at 9:00.
We then went room to room as a group, called "rounding", and visited all the patients again and discussed if any changes to my plans from the morning needed to be made and discussed other possiblities of treatments.
I wrote notes and finished up orders until noon.
In the afternoons I worked in the preoperative clinic. The anesthesiologists also work in this clinic and the main goal is to make sure a patient is safe to proceed with surgery. We looked at labs or other exams that may need done prior to surgery. All of this varies on the patient's health and medical conditions the patient has as well as what type of procedure they are scheduled for and what medications they are on. We went over with each patient what medications to hold before surgery. We also looked at potential barriers we may have in the hospital after their surgery and what sort of medications or resources they may need while they stay with us. That way I could be more organized when they came in next week and have the medications or devices they may need or consults to other providers ready for them.
When surgeries ended throughout the day I would see new patients and make sure they had what they needed ready for the evening. Diet orders, wound care orders, their home medications or medications that may need adjusted, etc. Clinic and my other duties usually ended by 4:00 or 5:00 p.m.
Fun month, with improved work hours from prior months!
Check out my other day in the life posts from other rotations HERE .