The Two Week Rule

Eventually you will fill all of the pockets of your white coat with various pocket reference books, tools, and pens the wieght of which will suprise you. These things will accumulate on you like barnacles on a whale and you will be reluctant to scrape them off against the possibility that you might need one of the items and not have it.

A good rule of thumb is that if you have not used something in two weeks you probably don’t need it and it is safe to leave it home.

The advent of the PDA has gone a long way towards reducing the load carried by interns and medical students. The contents of Harrison’s Textbook of Medicine, which in print weighs ten pounds, fits easily onto a small corner of my PDA’s memory so you can see that with a decent PDA you can carry around a complete library of reference books.

Which you’ll never use, of course. The best applications for the PDA are the electronic equivalents of the pocket reference books. The best, in my opinion, is Eprocrates.

Epocrates is the “killer app” for medical handheld computing and does for PDA what the spreadsheet did for the personal computer and what porn did for the internet. The current version includes a drug reference handbook, a concise medical texbook, a catalogue of lab tests and their interpretation, a medical calculator, and a few more goodies. All of them are cross-referenced and formatted to be read easily on the typical PDA screen.

Epocrates got it’s start as a drug reference and in this it is superior to any other product on the market. You can search its database by drug class or name. It gives you dosages for adults and children, contraindications, mechanism of action, and even price.

Epocrates also has a rapid clinical reference database which I mentioned earlier. Let’s suppose you are treating a Sickle Cell patient. With a couple of taps you can pull up everything you really need to know about the condition including its pathophysiology, treatment, prognosis, and even what labs and studies to order on your patient. Now, to be honest the detail isn’t quite as good as a medicine textbook but it is surely good enough for rounds and will keep you safe in case you are pimped.

On a similar note the “Five Minute Clinical Consult” series is pretty good. They are written for practically every specialty and now that you can load them into your PDA you don’t have to carry around a huge book.

A “Sanford Guide to Anti-Microbial Therapy” is another one of those essential little books (which you can also get for the PDA). It is a good place to look when starting an antibiotic regimine on a patient, especially if you are considering “empiric” therapy, that is, before cultures and sensitivities come back from the lab.

Most medical centers also publish their own small infectious disease manual which lists characteristics of the microbes specific to the medical center.

The trend now is to tie wireless devices into the hospital database. At Duke this works pretty well and you can easily access lab results and other improtant rounding data on your PDA. Some schools are years away from this. Wireless connectivity is a nice plus but not essential and sometimes more trouble than it’s worth unless your school has implemented the technology to make it seamless for the user.

I despise mucking around with computers. All I want is to turn them on and use them,

Good PDAs can be pretty expensive. Many schools make their purchase manatory (along with a laptop computer) and this just adds to your student loan debt. If I could, I’d hold off getting one until third year because you will not need it for first and second year and any PDA you buy as a first year will be pushing obselecnce by the time you start third year. Either that or the prices will come down.

It should go without saying that you will need comfortable shoes. Whether you are in the OR or rounding on a medicine service, you will spend much of the day on your feet. Your dogs will be barking for not the least of which reason as that during first and second year you spent most of your day sitting down. Clogs are very fashionable for men and women and you will see the surgeons wearing them. I think they look kind of silly but then I prefer a more conservative look.

Whatever your preference in fashion, a pair of shoes that are comfortable, cool, and easy to slip on and off will make your long hours on the wards more enjoyable. If you can slip them on and off this will let you really rest your feet if you have a moment to sit down as well as making it easier for you to get moving when you are on call and are startled awake by your beeper.

Would it kill you to buy more than one white coat? Presumably you should change the oil on your coat every three or four thousand miles. Still, you will see medical students and residents rounding with white coats which are almost gray from use. I know it is just me being superficial and that many of the folks I see skulking around in greasy, off-brown white coats are ten times the physician I will ever be but that’s no excuse to look like an ass-bag.

Buy three. Wear one for a few days then wash the the stupid thing. Hit it with an iron too, if you are to cheap to buy the polyester blend.

Oh, and get your wife, girlfriend, or same-sex spousal equivalent (as we say at Duke) to sew a few extra pockets on the inside to carry your gear. A pocket with a velcro or button closure is nice for your PDA. Most scrubs don’t have very good pockets and the minute you break into a trot when the code pager goes off your PDA will slide right out onto the floor.

Trust me.