 Hey friends, today I'm going to take you on a full day of my life as an internal medicine hospitalist. Now today's going to be an extra interesting day as I'm triaging for the entire hospital but more on that later. Now my mornings usually start around 5-5.30 am where I get up, shower, and get ready to go to work. On days where I do wake up a bit earlier I may do some work for the YouTube channel or side business for about 20-30 minutes, otherwise I'm sleeping until the last second to make sure that I'm well rested, and of course that morning coffee always helps. But now it's time to head to the hospital, my drive is about 20 minutes in the morning which I spend listening to medical podcasts or an audiobook. And thankfully I happen to get to the hospital right before 7 am today. Now as an internal medicine hospitalist my job is to take care of admitted patients in the hospital. This includes patients who come overnight. So the first thing I do when I get to the hospital is I look at my list for the day and identify new patients that I don't recognize. These are the admissions from the overnight team. I'll then move these patients to my personal list on the electronic medical record and print my daily patient list. Now between 7.15 to 7.45 am usually reading everyone's charts, looking at their vitals, their labs, and overnight events before I go see them. And the time this takes will vary. For example my old patients will likely take me 1-2 minutes to scan through since I know them pretty well so I know what to look for. The new patients however will take me anywhere from 5-10 minutes to read through and understand why they're there in the first place and what's been done for them since they were admitted overnight. But once I'm done scanning through everyone's chart now it's time to get ready to go see everyone. And usually between the hours of 8 am to 9.45 to 10 am I'm seeing all the patients both old and new. Thankfully throughout my rounds today everyone is doing well so the rounds are moving quickly from patient to patient. But look at that I got an admission. Now remember as a hospitalist my job is to take care of admitted patients right? This means that admissions during the day will also come to me. Now every hospital and hospitals group does this differently. At my current group we use a round robin admission format. This means one person takes the calls for all the admissions and transfers and assigns them to the next doctor in the list who's up for an admission. So right now it's my turn. And so I take a look at the message and admission, pull up their chart and thankfully this admission is a simple one. This current gentleman is a surgery admission after a knee replacement. Now it's important to note that at many hospitals the procedure teams like a surgery team may not have a primary service. Which means that after a procedure they won't be the primary team taking care of that patient. Which makes sense for a surgeon to spend more time doing surgeries for the hospital. So if a surgeon thinks that their patient needs to be washed after a procedure for pain control, complex medical reasons or physical therapy then they'll be admitted to the medicine team and doctors like myself. And while sometimes hospitals will complain about these admissions honestly they're the easiest ones. It takes me about 10 to 15 minutes to read their history and medicine list and then I go see them in the post op area as soon as they're waking up from anesthesia. And this particular patient was a simple knee replacement done on an elderly male so he was going to be washed overnight to be evaluated by the physical therapy team since he lived home by himself. But there we go one admission done for the day. Now back to my daily responsibilities. Now at 10 a.m. every day regardless of where I am on my patient list I have to meet with the social work and other ancillary staff. This is where we discuss each patient, discuss who's ready to leave and who may have additional things to do such as rehab placement, equipment for home or referrals before they're ready to leave. And after these multidisciplinary or social worker rounds I finish seeing all of my remaining patients and then begin my discharges for the day. But as soon as I'm about to sit down sure enough another admission. Now unlike the first one this patient is sick. This is an elderly male with a history of a current brain who bleeds, who comes with his family due to confusion. Now a patient like this requires me to see him ASAP. Given his bleeding history we had to order a head CT given his confusion and sure enough there was slight worsening bleeding from his past imaging. This led me to immediately call the neurosurgery and neurology team to see him and get him to the ICU ASAP. Now a patient like this makes the day a little bit more difficult because it requires me to drop by and check in multiple times a day to make sure they're not worsening. So I already know that this patient is going to keep me busy for many reasons throughout the morning. But after seeing this patient in the emergency room and discussing with the consultants and understanding that he's currently stabilized, I go back to seeing all the other patients for the day. And once I'm done seeing everybody given the busy morning it's finally time for some food. Now as a doctor I like to have a lighter lunch to avoid getting sleepy from a carb heavy meal. So today's a nice salad, yogurt and some topochico. Which by the way thankfully are all complimentary for all physicians at our hospital. And while eating my lunch I'm also writing the history and physical notes for my first two admissions from the morning. And to make sure I'm even more efficient enough for getting into orders, here's exactly how I write my notes while making sure that all the orders are placed for each patient. So just as I'm talking to you guys in the middle of today, so as I'm finishing up this H&P, this history and physical, sometimes the things that doctors forget how to do is to put in orders or they'll put in orders and they never get to their note. Often what I'll do is I use two screens like I'm doing now on one side I have the orders, on the other side I'm writing my notes. So as I'm writing my note I'm pretty much adding in the orders as they go and then I go to the next problem, add in the orders and then move forward. The orders and notes are all done and my note is consistent with the management I'm actually doing. So about maybe 10 minutes away from finishing this note and then I'm pretty much done for the morning. Now as soon as I'm done finishing those H&P notes I go ahead and knock out the rest of my progress notes for the day for the remaining patients. And if we look at the time it's 11 a.m. which means it's time to triage for the entire hospital. Now like we mentioned before there is one doctor for the entire hospital who takes all the requests for admissions and transfers. So today from 11 a.m. to 3 p.m. that's me. It means that anytime I can get a call from a surrounding hospital, surrounding clinic, other emergency rooms as well as our own emergency room to admit a patient. And because this role can get very busy very quickly it also thankfully means that I have no personal admissions coming for the rest of the day. So while I'm waiting for those guaranteed calls from the emergency room and other hospitals between the time of 11 to 3 I'm finishing any of those remaining notes for the morning although most are thankfully done already. And I'm also already starting to field calls from the transfer center for new patients in surrounding areas saying either yes or no that they can come to our hospital. Most tend to be appropriate requests and some of them require additional workup or discussions with consultants like a surgeon. During this time since my notes are done I'm also using this extra bit of free time to call family members to update them on their loved ones. And after calling that last family member and a busy morning I am beat and need a break. And so often during the quieter parts in the afternoon I will go for a 10 to 20 minute walk in the hospital and of course my phone on. This gives me that added boost and energy that I need for the remainder of the day. But today after my walk I returned to my call room and finished any remaining work which usually includes updating my notes for the day for all my patients for any changes that may have happened since I signed their notes in the morning. I also go back to check on our patient who had that brain bleed to just see how he's doing. Thankfully he's doing better and on the right management and supervision in the ICU. But now it's about 3 p.m. and I'm free to go home. Now this is the interesting part about being a hospice. Although my shift starts at 7 a.m. and ends at 7 p.m. at this point I have no more admission responsibilities for the day. So as long as I believe that all my patients are stable and I've done all my work I can technically take texts and pages from home. So now it's time to drive home and turn my home office into my workplace for the afternoon. And during this time I'll often get a few messages from nurses each hour about medications, labs and orders as well as giving me updates on the patients. And to make sure that I'm constantly moving while at home I'll do some many workouts in between. And of course get some cuddle time with Kobe who's my golden doodle. But this is one of my favorite parts about being a hospice where I get to do that last bit of work from home. Definitely makes the day go faster and look at that it's almost 7 p.m. And during this last half hour I usually look at everyone's labs and vitals and keep an eye out for notes from consultants once more before calling it a day. And for any patient that I'm worried about for example our brain bleed patient or anyone who needs follow up on their labs or vitals I'll go ahead and text the 19 to say hey these patients may need a closer eye overnight. And by this time it's 7 p.m. which means I'm done for the day. I hope you all enjoyed following me today and my full day as a hospice. Be sure to check out this full breakdown of exactly what a hospice is in this episode right here and as always my friends thanks for being a part of my journey and I'll see you guys in the next one.