An open letter to clinical clerks

I've recently been thinking a lot about medical education again. There are some clerks who really seem to get it - why they are in the hospital rather than sitting at home learning from books. This post isn't for them.

I don't expect much from a clerk, but I make my expectations clear on the first day. Please read it. You know what, if your resident sends you any email, read it.

Don't argue with your resident about these expectations, especially to suggest that the staff physician should have already done the tasks that belong to you. Yes, some of these tasks are time consuming, but by fulfilling your obligations to the service you are practicing your clinical skills, solidifying knowledge and finding things you don't already know. What's Celestone? You can leave the obstetrical service without ever knowing if you don't recognize the medication in the patient's history.

Pretend to have fun. Even if you hate the rotation you are on, it's a big deal to the patients, nurses, staff and your residents that you at least appear interested. You'll be surprised at how much more you will learn when you feign interest. Residents will be more likely to drag you to the cool case they saw last night. Nurses will include you in their patients' care. You will see more and learn more as you dig in and pay attention to the facets of various illnesses and how they present. Pregnant women get cholecystitis. Pediatric patients fracture limbs. Geriatric patients are like petri dishes for all aspects of medicine. Pay attention. Something you find interesting will show up every day when you pay attention.

If you think your resident is over reacting, you may not be paying enough attention. Ask his or her thoughts.

Respect the hierarchy. If you respect your junior residents, they will protect you and keep you in the loop when fun things are happening. Basically, you are at the bottom of the totem pole. The guy cleaning floors is above you. Show respect to everyone you work with. They all have something to teach you - even the guy cleaning the floor.

Respect your fellow clerks. Backstabbing is not cool.

Be available. Don't turn off your pager or cell phone. Don't hide.

Get to know your patients. Very often, only the clerk knows the full story about a patient.

Unless you have the evidence to back your statement don't contradict your resident. Really.

You don't know enough to start looking for short cuts through your clinical and interviewing skills. Follow the guidelines you have.


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