medical school

The ICU I worked in was a mix of people just passing through immediately after major surgery (heart, organ transplant) and the super-sick/actively dying. I would brush up on end-of-life stuff.

End-of-life stuff and geriatrics will likely be my professional focus, so sounds like ICU is the right place for me to be for training. Thanks, Kate! Would love to hear more about your experiences.

Gbx, my guess is that I will round at least a little for the experience, if not as regular practice for ICU social workers. Don't really know, though. Please tell me about this special circle of hell, which I assume means more than just having to wake up at an ungodly hour. Also, are medical staff assholes to SWers as general practice or not really?

Gonna have some lols the first time a 23 year old med student talks down to me :)

ICU rounds are only hellish because they take. for. ever. like, non-stop rounding from 7am into the early afternoon. and, you know, ICU pts are complex and attention to detail is crucial, my god they are interminable.

ime, medical staff are very appreciative of SW, simply because they magically make things happen that, like, really really need to happen in order for all that medical stuff to stick. this is particularly true (doubly, triply) in my world (the psych ward)

any attending that caught wind of a med student or resident talking down to a social worker would probably have their guts for garters, imo

ime ICU rounds have been very multidisciplinary - you should probably be prepared to round a bit. kate is right that a lot of your time will be spent dealing with end-of-life stuff, particularly if your hospital protocol calls for social work involvement in family meetings (and it should). these are situations that are tremendously interesting to read about and learn about, but can be very frustrating/difficult/emotionally draining IRL, so be prepared for some ugly. so few people have advance directives. you've probably gotten into hospital social work because you're interested in helping people through some of the most emotionally and financially stressful periods of their lives -- the thing about working in the ICU is much of the time that'll mean dealing more with families than the patients themselves, since often they're intubated or otherwise unable to communicate. but i think social work has an extremely important role in ICU care -- the clinicians understandably are under a lot of stress due to the fragile conditions of their patients, and too often there's a poor understanding of what the goals of care are/poor communication about what exactly is being done/etc. good, compassionate doctors take the time to sit down with families and have the difficult conversations, and thats the kind of doctor i want to be, but their time is not limitless. this is where you are needed. NB this is what my impression of social work is from a clinical perspective so maybe you will do totally different stuff idk

gbx what do you dislike about ICU rounding in particular?

that they take all day!

hahahaha so true. i sort of love rounds though

oh btw i did not see that xpost duh

Thanks much kk and gbx, that is helpful info!

Re: advance directives--this is a passion of mine. My folks are all set with theirs (I am their medical proxy), but I am on spouse's case to get his parents (who are in their 80s) to do planning. Of course, I have not documented my own wishes or gotten spouse to get his down on paper. . . guess that should be a New Year's resolution.

also "guts for garters" is my new favorite expression!

ICU rounds are usually multidisciplinary for clinical staff -- medical, nursing, pharmacy, RT -- but I'd be shocked if you'd be expected to sit there for hours while everyone reviews the blood gases, chest X-rays and electrolytes.

Most inpatient wards have discharge planning rounds roughly once a week, in which social work plays a big role in helping with family issues, making arrangements for placement in a care facility, etc. Discharge planning would be less important in ICU, as patients are usually transferred to the ward before plans are made for what to do at the end of the hospital stay.

I'd imagine your main role will be in helping families with end of life issues. The doctors should be the ones explaining the diagnosis, prognosis and treatment options, but the support and care from social work is very important in that situation (for one thing, as gbx says, you have more time to spend with them, and you'll probably be more caring/compassionate than most of the medical staff). You'll likely be asked to sit in in any meetings the medical staff have with families about possibly withdrawing care, etc.

Another thing that might be part of your work there is dealing with insurance insurance. Lots of patients have disability insurance to pay for time away from work, cover mortgage payments, etc. In the US, there'll also be the challenge of paying for the medical services in the first place. In Canada, social workers help families with all of those practical financial matters, and I'd expect that will come up for you even dealing with patients in ICU.

I wasn't sure if insurance issues would fall to the social work department or to other departments within the hospital (billing or what have you); I have, however, developed a knack/patience/persistence for dealing with bureaucracy (lol government contract work), so I can definitely handle that stuff.

How often are ICU pts in need of direct social work care? My limited experience with ICU pts has been with folks who are medically fragile but still able to communicate, participate in decision-making, etc. If ya'll had to put a % on it, what % of ICU pt directly engage with social work services?

Depends on the hospital. Some ICUs cover post-op, post-stroke, post-MI, sepsis and other situations where the patient won't be tubed and may be able to communicate and discuss things with you. In the hospital I work in, those patients are almost all managed in separate step down observation units, and ICU is reserved almost exclusively for intubated patients.

Generally speaking, hospital social work is mostly dealing with families, not the patients themselves. Even stable ward patients are often too sick (delirious etc) and/or neurologically impaired (stroke, dementia, etc) to get as much out of your services as their family members will.

am about 2/3 through gawande's "better" and imo this is the strongest of his 3 books. the section on physician involvement in state executions is both characteristically thoughtful and uncharacteristically forthright. would highly recommend

haaaaaaate PS

?

wait so are you a first year right now?

no, physical sciences on the MCAT lol

Hey so it is pretty much official (so long as university and hospital can see eye to eye on the paperwork) that I'll be starting a social work internship in gee doubleyou's ICU in May!

What can I do to prepare?

Strictly hypothetical q: say someone has bronchitis and has to choose between a Z-pack or cipro to treat--which should it be?

The hypothetical traveler got rxs from her doc in case of UTI or TD, but failed to discuss URIs, which was dumb of both her and doc because she ends up getting bronchitis every couple of years.

You don't want Cipro for a chest infection, poor lung penetration. Moxi is the respiratory fluoroquinolone of choice around here. Cipro's good for GI and UTI.

Zithromax all the way.

if it's really bronchitis, the person likely does not need an antibiotic. dare you to suggest that!

cipro in fact gets into the lungs just fine, it just has poor activity against strep pneumoniae, which is why it's a poor empiric choice for most lower respiratory tract infections (and not considered a "respiratory quinolone" like levo or moxi). if a sputum culture comes back sensitive to cipro, it's a fine drug to which to de-escalate, assuming it's the narrowest-spectrum choice. it's even a part of some hospitals' empiric double-pseudomonas coverage (usually along with a beta-lactam) for ICU-bound PNA patients

when i was on ID rotations, in central connecticut, the resistance of strep pneumo to azithromycin was around 20%, so doxycycline (along with ceftriaxone, if the person was going to be hospitalized) was preferred empirically for most presumed LRTIs, assuming there were no drug-resistant risk factors. for most outpatient pneumonias/bronchitis, azithromycin works as well against the virus that probably caused the complaints as any other antibiotic, though ;)

oh sorry, i didn't really catch the context of the question -- ie for travel. when i traveled to thailand/burma to work last summer, i brought zithromax. either is fine for her purposes really.

ha, just read the other thread! i agree with kate!

Azithro also has anti inflammatory qualities iirc which is why it gets prescribed for COPD exacerbations that aren't clearly bacterial

Thankfully the crap cleared up on its own, but I thank you for the advice and discussion!

Somewhat related question: what do/did ya'll do when you were stoodents and had a messy URI (active coughing/sniffling/sneezing) but were expected to be seeing patients in the hospital (including ICU)? Just drug up, wear a mask, and try not to cough at the bedside on rounds? Or are you encouraged to actually stay away in such situations (ha)?

as a student? stay home. or show up with a mask, have someone notice you're sick, and get sent home.

as an intern, i'm a little too integral to the actual operations of the medical team (ie - if i'm not there someone else has to do a lot more work), so the threshold is a lot higher. i've only taken one sick day all year, iirc, though i probably could've reasonably take one or two more.

tho i haven't done (and won't ever do) an ICU rotation as a resident, i'd imagine the thresholds are even lower for students and maybe just a tad higher for interns (due, again, to the volume of work).

ah, thanks, good to know. I was thinking it was probably NAGL to be a coughing/sneezing/sniffling bug bomb in front of patients and families, especially when the patients are in critical care. Like, even if you wear a mask and are otherwise really careful about infection control.

My roommate is kinda freaking out right now because she got bit by a cat in Myanmar but didn't get her first rabies vaccine shot until 6 days later

She also has been wrestling with a case of food poisoning that is displaying flu-like symptoms

What do I tell her to console her

go to a fucking doctor

Yeah she went yesterday

best consolation is soup ime

laphet ime

If she gets a rabies vaccine before she's symptomatic (and that's assuming the cat even has rabies), she's good.

And if not, send her to Milwaukee: http://en.wikipedia.org/wiki/Milwaukee_protocol

ianad but before i clicked that i was going to recommend putting her into a coma because i heard about that girl on some stupid npr show. before i heard that i didn't realize quite how bad rabies is!

plasmon, you taught kaplan in the past, right? i hesitate to turn this into SDN, but here it goes: what kind of consistency should i be looking for on these practice tests before i have a good idea of what my score will be? i'm doing very well on the practice exams, but the range is so wide i really have no idea what to do with my scores, or how fluky they are. i understand the concept of the bell curve and how once you're a consistent 10/11 test taker, a couple of good guesses makes it much easier to jump up a point or two relative to 7/8/9 students, but the full-length (kaplan #3) just kind of scared the shit out of me. i got a 13/14/15, which i just feel like is not where i am yet (or probably ever, given that my exam is in 3 weeks) -- my last 2 were 11/11/10 (though this was a month ago) and 12/13/10 (earlier this week). i guess it was just a harder test with a more generous curve, but that score is so ridiculously high as to be meaningless to me, bio in particular. i think i'm a solid 11/12/11 right now. i plan on taking the other two required FLs next week, but after that, are there any tests that you think are better than others? i'm not gonna have time to take all 15 other ones or however many there are

do you remember FL3 being particularly outlier-y? i've heard stories about #11, but not 3

ime, particularly as a recovering english major, a teensy bit of extra effort and consideration on the language portion paid huge dividends. like, i was getting 11-12 and finishing with loads of time to spare, and once i forced myself to go more slowly and pay attention i was getting 13-14 consistently

otherwise i have no recollection of what happened with the MCAT

i'm sort of perversely enjoying getting into a groove with taking these tests, though, they all unfold the same way. physical sciences i hate, not because it's difficult but just because of all the math/thinking involved. i always use every second of the time there. verbal is actually pretty fun; i find myself enjoying most of the passages and sometimes forget I'm taking a test, so i have to watch my time sometimes there too. bio is just a crapshoot, it seems to be the section most dependent on recall knowledge, so i just go into it crossing my fingers that they test areas where i'm strong.

^^^p much how i felt about it, too

I taught for Princeton Review, and that was >10 years ago now.

I don't know anything about Kaplan's tests, sorry. But if you scored a 42 right after a 32 and a 35 it seems the curve was in your favor on that last one.

Even so, you're consistently scoring in the double digits in all sections. That should be more than enough.

I always found it hard to score more than 12-13 in verbal reasoning, 'cause I'd end up skimming, racing through it, and debating/arguing with the questions. I don't think my scores ever changed much with practice. Many of my students didn't improve much on that section either, once they got the basics of testmanship down.

I didn't bother to re-learn the organic chem in the biology section (which I'd done years earlier), so I never beat 11 there. The rest of bio was easy enough even though I'd never done a biology course, just memorization.

I loved physical sciences, that's what I ended up teaching for TPR along with VR and the essays. That's the section where extra time spent working through problems was most helpful, and I just loved the mental gymnastics.

Do they even have essays anymore? It was a stupidly simple format but I don't think I ever had more fun writing something for marks.

Main advice I'd give is to work toward the big day as a performance. Don't spend too much time drilling the details, and especially don't do too many practice tests, you'll wear yourself down. Make sure you prepare physically for the day, like an athlete getting ready for a competition -- get some sleep, exercise, fresh air, music or whatever you get your mind cleared and focussed. If you have routines for tests, follow them.

Don't stress about your score on the full length practice tests, focus on your performance in that situation as a test taker. Do them under as exactly similar conditions as possible, so you'll be right at home on game day. For you, the goal of a full length practice test shouldn't be to predict ahead of time how well you'll do (for diagnostic purposes) -- you're clearly good enough -- it's to maximize your performance on the real thing.

i luv discrete questions

If memory serves, the test is designed to have a standard deviation of 1 point to either side, on each of the 1-15 sections (fun fact: this is why the essay is scaled entirely differently, because it can't be standardized as well), so in theory it's designed that you could have a 6 point swing in either direction, though it'd be much more likely to float within a narrower range (like 2 points).

Dear Medical School/Medical Ppl Thread,

Can you think of any good reasons to be a hospital social worker that I might be overlooking? Because at this point I am just biding my time to gtfo.

My experience, to date:

Hospitals (at least my acute-care, for-profit, urban teaching hospital) equate social workers with discharge planners

Discharge planning is the ne plus ultra of "social work"

Discharge planning involves very little actual social work

Why hospitals employ licensed social discharge workers is curious on the surface. Below the surface, having LICSWs on the payroll has everything to do with accreditation and billing and zero to do with the actual skills required to do the "hospital social work" job

The situation may be different in inpatient psych? I dunno those social workers are note even in my (Case Management) department.

U.S. healthcare is so fucked up I mean can I even

Fuck this I am in no way inclined to pursue a job as a hospital social worker but hey I just wanna put it out there to see if anyone might have a counterpoint

Also I had not anticipated this AT ALL but I find the hospital environment rather dull tbh.

i can only speak from my own limited experience, but social workers as bona fide discharge planners doesn't seem like an outrageously unfair assessment of their work in hospitals, at least on medical floors. if you've got your heart set on working in hospitals, as you said it might be worth your while to look into providing your services on specialty floors; gbx might be able to tell you more about inpatient psych work, but i can tell you there is probably a lot of interesting and possibly fulfilling end-of-life and family meeting type stuff on oncology floors as well

also personal update i have my first interview in november, woo-hoo!

we have LICSWs that do ED assessments of psych patients as part of the admissions process