14美國全科住院醫(yī)師一天

1、A DAY IN THE LIFE OF A FAMILY PRACTICE RESIDENT家庭醫(yī)學(xué)住院醫(yī)生的一天生活家庭醫(yī)學(xué)住院醫(yī)生的一天生活Terminology專業(yè)名詞Resident: a “post-graduate” undergoing a period of advanced training, gaining supervised practical experience in a medical specialty that normally follows graduation from medical school and licensing to practice

2、medicine 住院醫(yī)生：從醫(yī)學(xué)院畢業(yè)并取得行醫(yī)執(zhí)照后在一段時(shí)間內(nèi)在督導(dǎo)下接受某個(gè)醫(yī)學(xué)專業(yè)的進(jìn)一步培訓(xùn)以獲得臨床經(jīng)驗(yàn)。Intern: a first-year resident實(shí)習(xí)醫(yī)生：第一年住院醫(yī)生Education in the US:美國的教育High school, lasting 4 years to age 18 高中，4年時(shí)間，直到18歲University, lasting 4 years to age 22 大學(xué)，4年時(shí)間，直到22歲Medical school, lasting 4 years to age 26 醫(yī)學(xué)院，4年時(shí)間，直到26歲Family Medicine

3、 Residency, lasting 3 years to age 29 家庭醫(yī)學(xué)住院醫(yī)生，3年時(shí)間，直到29歲Three-year program3年計(jì)劃Year One Rotations 第一年輪轉(zhuǎn)Family Medicine Inservice (4 months)家庭醫(yī)學(xué)病房（4個(gè)月）Pediatrics (2 months)兒科（2個(gè)月）Obstetrics (2 months)產(chǎn)科（2個(gè)月）Emergency Room (1 month)急診室（1個(gè)月）Surgery (1 month)外科（1個(gè)月）Community Medicine (1 month)社區(qū)醫(yī)學(xué)（1個(gè)月）C

4、ommunity resources: 社區(qū)資源lCrisis Pregnancy 高危妊娠lHospice 臨終關(guān)懷lPT/OT康復(fù)醫(yī)學(xué)Three-year program3年計(jì)劃Year 2-3 Progressive Responsibility on the Family Medicine Inservice在家庭醫(yī)學(xué)病房第2-3年責(zé)任遞增1month rotations:一個(gè)月輪轉(zhuǎn)Second-year resident in ICU and OB supervising interns第二年住院醫(yī)生在ICU和產(chǎn)科監(jiān)督第一年住院醫(yī)生Third-year Senior supervis

5、ing second-year and first-year residents第三年住院醫(yī)生監(jiān)督第二年和第一年住院醫(yī)生Night Call 夜間呼叫l(wèi)Same as On-Call team responsibilities與待命人員職責(zé)一樣lOnly one resident in-house僅一個(gè)住院醫(yī)生在醫(yī)院值班l(xiāng)Height of progressive autonomy增加自主程度lIn-house attending physician 在醫(yī)院值班的主診醫(yī)師Three-year program3年計(jì)劃Year 2-3 Rotations: 第2-3年輪轉(zhuǎn)one-on-one wi

6、th attendings與主診醫(yī)師一對一both inpatient and outpatient住院病人和門診病人1 month 1個(gè)月Critical Care (ICU/Pulmonology)急危重癥醫(yī)學(xué)（ICU / 肺?。〨ynecology婦科Surgery外科Gastroenterology胃腸病科Cardiology心臟病科Behavioral Medicine行為醫(yī)學(xué)科Three-year program3年計(jì)劃Longer Rotations:更長的輪轉(zhuǎn)Obstetrics (2 months)產(chǎn)科（2個(gè)月）Orthopedics (1.5 months)骨科（1.5個(gè)月

7、）Three-year program3年計(jì)劃Shorter rotations (1/2 month)較短的輪轉(zhuǎn)（半個(gè)月）Neurology神經(jīng)科Ophthalmology眼科Dermatology皮膚科Ear/Nose/Throat耳鼻喉科Urology泌尿科Sports Medicine運(yùn)動(dòng)醫(yī)學(xué)科Practice Management 醫(yī)療管理Three-year program3年計(jì)劃Year 2-3 Electives (3 months total) 第2-3年選修（共3個(gè)月）Foreign medical work (with board certified teaching p

8、hysician)海外醫(yī)療工作（與通過資格認(rèn)證的醫(yī)師一起工作）Rheumatology風(fēng)濕病科Nephrology/Renal腎臟科Infectious Disease感染病Cardiovascular Surgery心血管外科Anesthesia麻醉科Procedural Training 操作訓(xùn)練FIRST-YEAR RESIDENT (THE INTERN) 住院醫(yī)生第一年（實(shí)習(xí)醫(yī)生）住院醫(yī)生第一年（實(shí)習(xí)醫(yī)生）4:30 AM: YOU AWAKEN 4:30 AM: 醒來5:30 AM: YOU ARRIVE AT THE HOSPITAL 5:30 AM: 到達(dá)醫(yī)院6 PATIENTS

9、 ON THE WARD, 1 IN THE INTENSIVE CARE UNIT TO SEE 病房中有6個(gè)病人，1個(gè)病人在重癥監(jiān)護(hù)室需要去看YOU MUST WRITE PROGRESS NOTES AND ORDERS FOR EACH PATIENT 你必須寫下每個(gè)病人的病情進(jìn)展和醫(yī)囑SOAP note SOAP記錄法S: Subjective S:主觀的O: Objective O:客觀的Vital signs, ventilator settings 生命體征，呼吸機(jī)設(shè)置Physical Exam體格檢查Labs實(shí)驗(yàn)室檢查Studies研究資料A: Assessment (dia

10、gnoses, progress) A: 評估（診斷，進(jìn)展）P: Plan for each assessment P: 對每個(gè)評估的計(jì)劃Checking labs, studies, monitors核查實(shí)驗(yàn)室結(jié)果、文獻(xiàn)、監(jiān)護(hù)Checking with ICU nurses for overnight updates向ICU護(hù)士了解前夜的病情變化Checking on your patients (pediatric/adult, medicine/surgery, ICU)檢查病人（兒童、成人、內(nèi)科、外科、ICU）Reviewing specialist recommendations回顧

11、專科醫(yī)生的建議CODE BLUE!緊急呼叫6:45 AM: ONE OF YOUR PATIENTS BECOMES A CODE BLUE 6:45 AM你的一個(gè)病人病情危重YOU RUN THE CODE AS FIRST RESPONDER; RESPIRATORY THERAPY, ANESTHESIA, AND CODE TEAM ASSIST 你作為第一急救者啟動(dòng)急救；呼吸治療，麻醉，急救團(tuán)隊(duì)幫助PATIENT REVIVES 病人復(fù)蘇TRANSFERRED TO THE INTENSIVE CARE UNIT 轉(zhuǎn)移到重癥監(jiān)護(hù)室CODE BLUE!緊急呼叫Advanced Card

12、iac Life Support (ACLS)高級心臟生命支持Pediatric Life Support (PALS)小兒生命支持Advanced Life Support for Obstetrics (ALSO)高級產(chǎn)科生命支持Algorithms 流程圖Team Approach團(tuán)隊(duì)方法7:45 AM: YOU ARRIVE AT THE REPORT ROOM FOR ROUNDS 7:45 AM: 你到達(dá)醫(yī)生辦公室開始查房YOU UPDATE YOUR SUPERVISING SENIOR RESIDENT ON YOUR PATIENTS 你向指導(dǎo)你的高級住院醫(yī)生匯報(bào)病人的新情況

13、Team團(tuán)隊(duì) -Senior 3rd-year resident 高年級（3年級）住院醫(yī)生Oversees whole service 負(fù)責(zé)監(jiān)督整個(gè)病房的醫(yī)療服務(wù)-Senior 2nd-year resident 高年級（2年級）住院醫(yī)生Oversees Intensive Care and Obstetrics 監(jiān)督重癥監(jiān)護(hù)室和產(chǎn)房 -Interns/1st-year residents (4) 實(shí)習(xí)醫(yī)生/1年級住院醫(yī)生Report on the patients they saw in the morning (SOAP) 早晨匯報(bào)所見的病人情況（SOAP）*Senior resident

14、s help to refine interns assessment and plan 高級住院醫(yī)生幫助改進(jìn)實(shí)習(xí)醫(yī)生的評估和診療計(jì)劃8:00 AM: YOU AND YOUR RESIDENT TEAM SET ASIDE TIME TO 8:00 AM: 你和你的住院醫(yī)生團(tuán)隊(duì)留出時(shí)間：THANK GOD FOR HEALING感謝神的醫(yī)治TO PRAY FOR WISDOM祈求智慧TO REFLECT THAT HE IS IN CONTROL 思想祂在掌握TO ACKNOWLEDGE THAT ALL GOOD THINGS COME FROM HIM, INCLUDING MEDICI

15、NE 承認(rèn)所有的好事情都來自于祂，包括醫(yī)學(xué)。8:30 AM: Residents read an up-to-date article regarding one medical problem per night and discuss with each other, led by seniors 8:30 AM: 住院醫(yī)生每晚讀一篇與醫(yī)學(xué)問題相關(guān)的文章，然后在高年級住院醫(yī)生領(lǐng)導(dǎo)下，與大家討論。Basics基礎(chǔ)Signs/Symptoms體征/癥狀Etiology病因Diagnosis (Differential, Work-up)診斷（鑒別診斷，實(shí)驗(yàn)室檢查）Treatment治療Medi

16、cations用藥9:00 AM: YOUR ATTENDING PHYSICIAN ARRIVES 你的主診醫(yī)師到達(dá)THE TEAM QUICKLY UPDATES HIM ON THE STATUS OF THE PATIENTS團(tuán)隊(duì)快速向他匯報(bào)病人的病情進(jìn)展THE ATTENDING PHYSICIAN, SENIOR RESIDENT, AND INTERNS ROUND ON PATIENTS 主診醫(yī)師、高年級住院醫(yī)生和實(shí)習(xí)醫(yī)生巡查病人Attending Rounds主診醫(yī)師查房9:30 AM: Go to patients bedside and see patients with

17、 attendings, especially: 9:30 AM: 與主診醫(yī)師去病人床旁看病人，尤其是：new patients 新病人patients with classic findings有典型表現(xiàn)的病人Patients with atypical findings不典型表現(xiàn)的病人Discuss together一起討論Inpatient Pharmacist住院部藥師Checks drug interactions檢查藥物相互作用Recommends treatment推薦治療Rounds查房Intern reporting to Attending實(shí)習(xí)醫(yī)生向主診醫(yī)師匯報(bào)Intern

18、 presenting x-ray on electronic imaging hospital program實(shí)習(xí)醫(yī)生在醫(yī)院電子成像系統(tǒng)上描述X光片所見11:00AM: YOU AND THE OTHER 3 INTERNS RESUME CARING FOR YOUR INDIVIDUAL PATIENTS 11:00AM:你和其他的3名實(shí)習(xí)醫(yī)生繼續(xù)看顧自己的病人DISCHARGING 2 PATIENTS, AND CHECKING ONCE AGAIN ON YOUR MORE CRITICAL ONES 為兩個(gè)患者辦理出院，然后再次查看病重的患者12:00PM: YOU RETURN

19、 TO THE REPORT ROOM FOR TEACHING ROUNDS 12:00PM:你回到醫(yī)生辦公室接受教學(xué)查房Noon Teaching午間教學(xué)Case presentation by interns to team實(shí)習(xí)醫(yī)生向團(tuán)隊(duì)做病例匯報(bào)Special patients特殊病人Guest Speakers客座講員Review Questions回顧問題Grand Rounds大查房Special topics特別主題Newest treatments/developments最新治療/進(jìn)展New policies新政策Case presentations病例匯報(bào)1:00 PM:

20、 YOU CHECK-OUT YOUR PATIENTS TO YOUR SENIOR RESIDENTS BEFORE LEAVING FOR CLINIC 1:00 PM: 向高年級住院醫(yī)生交班，然后離開去診所1:30 PM: YOU ARRIVE AT CLINIC 1:30 PM: 到達(dá)診所ALREADY, THREE PATIENTS ARE WAITING FOR YOU 已經(jīng)有3個(gè)患者在等你了A PATIENT WITH GASTROESOPHAGEAL REFLUX DISEASE 一個(gè)患者有胃食道返流病AN EXERCISE TREADMILL TEST 一個(gè)要做腳踏車運(yùn)動(dòng)試

21、驗(yàn)A CIRCUMCISION 一個(gè)包皮環(huán)切術(shù)Clinic, where residents and attendings practice medicine together.診所，是住院醫(yī)生和主診醫(yī)師共同行醫(yī)的地方。You discuss each case with your preceptor. 你同督導(dǎo)老師討論每個(gè)病例Clinic Training 門診訓(xùn)練Continuity clinics 持續(xù)性照顧的門診First Year: 1-2 half-day clinics/week第一年：每周1-2個(gè)半天的診所工作36 patients per half day每個(gè)半天看3-6個(gè)病

22、人140 patient visits 共看140個(gè)病人Second Year: 2-3 half-days 第二年：2-3個(gè)半天710 patients per half day每個(gè)半天看7-10個(gè)病人500 patient visits 共看500個(gè)病人Third Year: 3-4 half-days 第三年：3-4個(gè)半天1115 patients per half day 每個(gè)半天看11-15個(gè)病人1000 patient visits 共看1000個(gè)病人YOU SYNCHRONIZE YOUR POCKET PC 將你的掌上電腦同步化Personal Digital Assistan

23、t個(gè)人數(shù)字助理 (PDA)Data base meta-analysis: Up-to-date 數(shù)據(jù)庫數(shù)據(jù)庫meta分析：更新分析：更新Internet網(wǎng)絡(luò)Books: dictionaries, texts書籍：字典，課本Tools: OB wheel, algorithms 工具：產(chǎn)科輪表；流程圖Most updated drug interface: epocrates 最新更新的藥物界面： epocrateslDiagnosis診斷l(xiāng)Therapy治療lSymtoms癥狀lLabs實(shí)驗(yàn)室檢查lMed Calculations醫(yī)學(xué)計(jì)算lTables表格Use of Electronic

24、 Medical Records (EMR), initiated in the U.S. by Family Medicine Physicians使用由家庭醫(yī)生引入美國的醫(yī)學(xué)電子檔案Air panels to use within patient rooms for all documentation在病房里可以無線連接所有文件5:00 PM: FINISHED WITH CLINIC, YOU RETURN TO THE HOSPITAL FOR CALL 5:00 PM: 完成診所工作，回到醫(yī)院值班5:30 PM: YOU RETURN TO THE HOSPITAL AND CHEC

25、K OUT WITH YOUR COLLEAGUES 5:30 PM: 你回到醫(yī)院跟同事接班6:00PM: YOU ARE PAGED TO SEE TWO PATIENTS IN THE EMERGENCY ROOM 6:00PM: 你被叫去看兩個(gè)急診室里的病人Admissions收入院Throughout the day貫穿整天Emergency Room physician stabilizes patient and transfers patient to the family medicine team急診醫(yī)生穩(wěn)定病情后就將病人轉(zhuǎn)給全科醫(yī)生團(tuán)隊(duì)Residents review ER

26、 events and patients work-up 住院醫(yī)生回顧急診情況和病人的檢查結(jié)果Call for old records調(diào)出以往的記錄Full work-up: History and Physical整體情況：病史和查體Intern sees patient first, unless critical (senior resident would go with intern then)若非緊急情況，實(shí)習(xí)醫(yī)生先看病人（若緊急則高年級住院醫(yī)生一起去）History & Physical病史和查體Chief Complaint主訴History of Present Il

27、lness現(xiàn)病史Past Medical / Surgical History既往醫(yī)療/手術(shù)史Allergies / Medications過敏史/用藥史Review of Systems系統(tǒng)回顧Social History: 社會(huì)史Tobacco/alcohol/drugs煙/酒/藥物Family situation家庭史Sexual history性生活史Spiritual history精神病史History & Physical病史和查體Vital Signs生命體征Physical Exam體格檢查Labs實(shí)驗(yàn)室檢查Studies研究Assessment病情評估Plan診療計(jì)

28、劃Discuss with senior, fine tune plan與高年級住院醫(yī)生討論，調(diào)整診療計(jì)劃Intern and senior discuss with attending physician 實(shí)習(xí)醫(yī)生和高年級住院醫(yī)生與主診醫(yī)師討論7:30 PM: YOU FINISH WRITING ORDERS FOR TRANSFER TO THE INTENSIVE CARE UNIT ON YOUR NEW PATIENT WITH DIABETIC KETOACIDOSIS 7:30 PM:你寫完了將新接收的糖尿病酮癥酸中毒的患者轉(zhuǎn)到重癥監(jiān)護(hù)室的醫(yī)囑8:00 PM: YOU AND

29、YOUR SENIOR ARE FINISHING IN THE EMERGENCY ROOM WHEN YOU ARE PAGED TO A DELIVERY 8:00 PM: 你和你的高年資住院醫(yī)生完成了急診室里的工作，這時(shí)你被叫去接生HEART TONES DECLINE, REQUIRING VACUUM ASSISTANCE 心音減弱，需要吸引器助產(chǎn)YOU REPAIR A SECOND DEGREE PERINEAL LACERATION 你修補(bǔ)會(huì)陰二度撕裂傷口9:30 PM: YOURE PAGED TO THE NURSERY TO SEE THE NEWBORN YOU JU

30、ST DELIVERED 9:30 PM: 你被叫到嬰兒室去探視你剛剛接生的新生兒10:15 PM: ANOTHER PATIENT WITH ALCOHOL WITHDRAWAL SEIZURES AWAITS YOU IN THE EMERGENCY ROOM 10:15 PM: 另一個(gè)有著酒精戒斷性癲癇發(fā)作的患者在急診室等著你11:00 pm: FINALLY YOURE DONE TIME TO CATCH 5 HOURS OF SLEEP BEFORE STARTING YOUR DAY ALL OVER AGAIN! 11:00 pm: 終于結(jié)束了在重新開始明天的工作前抓緊時(shí)間睡5

31、個(gè)小時(shí)SECOND YEAR RESIDENT第二年住院醫(yī)生第二年住院醫(yī)生6:30 AM: YOU AWAKEN; TODAY YOULL BE WORKING AT THE MATERNAL HEALTH CLINIC 6:30 AM: 醒來；今天要在孕產(chǎn)婦門診工作8:00 AM: THIRTY PATIENTS ARE WAITING TO BE SEEN 8:00 AM: 有30個(gè)患者要來看6 ULTRASOUNDS TO DO 6有6個(gè)超聲要作ONE PATIENT IS BLEEDING 一個(gè)患者在出血12:00 PM: FINISHED WITH PATIENTS, YOU WOR

32、K A LITTLE ON YOUR RESEARCH PROJECT 12:00 PM: 看完患者，你做一些科研課題方面的工作12:30 PM: YOU SPEND THE AFTERNOON WITH DR. YODER, A PRIVATE GASTROENTEROLOGIST 12:30 PM:你和私人開業(yè)的胃腸病學(xué)專家Dr.YODER一起度過下午 6 COLONOSCOPIES, 3 UPPER ENDOSCOPIES, 1 CONSULT 6個(gè)結(jié)腸鏡檢查，3個(gè)上消化道內(nèi)窺鏡，一個(gè)會(huì)診5:00 PM: YOU RETURN TO THE CLINIC TO PICK UP THE C

33、ELL PHONE AND PAGER FOR PHONES-CALL 5:00 PM: 你回到診所去取接急診電話的手機(jī)和呼機(jī)5:30 PM: DINNER WITH YOUR FAMILY IS CONSTANTLY INTERRUPTED BY PHONE CALLS FROM PATIENTS WITH CONCERNS 5:30 PM: 同家人進(jìn)餐，但不時(shí)被來自詢問病情的病人的電話打斷EAR INFECTION 耳部感染CHRONIC BACK PAIN 慢性背痛ANXIETY ATTACK 焦慮發(fā)作9:00 PM: YOU ARE PAGED TO INFORM YOU THAT O

34、NE OF YOUR PRIVATE OBSTETRICAL PATIENTS IS IN LABOR 9:00 PM: 呼機(jī)響，你被告知你的一個(gè)產(chǎn)科病人正在臨產(chǎn)11:30 PM: BABY DELIVERED, PHONES-CALL OVER, YOU RETURN HOME TO A SLEEPING FAMILY 11:30 PM: 嬰兒娩出，接急診電話的任務(wù)完成，你回到熟睡的家人身邊THIRD YEAR RESIDENT第三年住院醫(yī)生第三年住院醫(yī)生6:30 AM: YOU AWAKEN; GETTING READY TO LEARN ALL MORNING FROM ORTHOPAE

35、DIC SURGERY AND CLINIC WITH DR HOLT, A TEACHING PHYSICIAN 6:30 AM: 醒來，準(zhǔn)備用整個(gè)上午在骨科 教學(xué)醫(yī)生 DR HOLT的門診中學(xué)習(xí)1:00 PM: FINISHED WITH ORTHOPAEDICS, YOU DRIVE ACROSS TOWN TO START YOUR OWN FAMILY MEDICINE AFTERNOON CLINIC 1:00 PM: 骨科手術(shù)完成，你開車穿過城鎮(zhèn)開始自己下午的全科門診OBSTETRICAL PATIENT 產(chǎn)科病人VASECTOMY 輸精管切除術(shù)OTHER VARIED PROBLEMS: HYPERTENSION, DIABETES, SKIN CONDITIONS, UPPER RESPIRATORY INFECTIONS 其他各種問題：高血壓，糖尿病，皮膚病，上呼吸道感染4:00 PM: QUARTERLY MEETING WITH YOUR ADVISOR 4:00 PM: 同你的指導(dǎo)教授的季度會(huì)議REVIEWS YOUR PROGRESS AND EVALUATIONS