Outpatient Consultations
Endocrine Clinic sessions are held every morning Monday through Friday, beginning for trainees at 9:00 A.M. Each session has a subspecialty orientation based on the attending's interests. Clinic sessions are held in the Outpatient Center: 7th Floor, Suite A or the Diabetes Center on the 2nd floor.
These procedures apply to all clinics:
Attendance is mandatory. You must be present on time and ready to contribute. Any conflicts (e.g., other longitudinal clinics, interviews, or other coverage assignments) must be cleared in advance with the fellow, who must in turn obtain permission from the clinic attending. Personal emergencies should also be reported to the fellow. Because patients have been scheduled based on the expectation of your participation, only compelling excuses will be considered acceptable.
Notes: You must dictate a concise note describing your clinical findings, previous study results, and the impression and plans that are formulated with the attending. Dictate your notes before you leave clinic and return the patient's chart to the attending directly or leave it in their box in the 1830 Bldg. Office. Dictate your notes by calling 5-9033. It is important to enter the correct physician identifier for the attending, the work type (30), and the patient's history number. At the beginning of your dictation, you should state that you are dictating a note from clinic #111.
Be sensitive to the fact that patients have been referred to or have an established relationship with the attending. You should be introduced to the patient by the attending. Occasionally, you may have to help patient's understand that you are acting as a member of the attending's team.
Dress: Everyone must be neatly groomed with a clean white coat and legible name tag.
Confidentiality: It is essential that your patient's consultation be carried out with respect for their privacy. All discussions of their case, both in the clinic and elsewhere, must be held in strict confidentiality.
The Nursing and Clinic Staff can help you understand and follow clinic procedures. They can help you perform test procedures, complete laboratory and radiology request forms, and make follow-up appointments. The Division's nurses are very knowledgeable about endocrine diseases and their management. Make good use of their expertise.
Inpatient Consultations
Consultation requests are called from the Division Office (1830 Building, Suite 333) to the on-service fellow. These requests are also recorded in the Consult Book in the Administrative Office.
The fellow assigns each consult to a rotating student, resident, or fellow, who is then responsible for interviewing and examining the patient, and reviewing all relevant records, laboratory and radiological data. Consultation requests received before attending rounds and all emergent consults must be completed on the day requested. You will present your patient on attending rounds, which are generally held daily in the late afternoon. Always discuss potentially emergent cases immediately with the fellow or attending.
Consultation notes must be logical, legible, and concise (no more than one page). A two-inch space should be reserved at the top of the Consultation Form for the attending's Impression and Plan, which should be completed after discussion with the attending. Please see the Endocrine Fellow to discuss filling out the Consultation Form. The attending must write and sign a brief note on each form to document that he/she has seen the patient and concurs with the diagnosis and recommendations. The white copy of the completed form should be placed in the medical record and the green and yellow copies given to the fellow who will return them to the Division Office. You may want to make a copy for your own records. It is also essential that the consultation team make direct contact with the patient's house officer and attending physician. This is generally the fellow and attending endocrinologist's responsibility, but trainees may occasionally be asked to assist. Follow-up is required for most endocrine consultations.
Once assigned to a case, you are responsible for visiting patient daily and reporting to the fellow and attending until it is determined that the case no longer needs our attention. You should also follow-up all requested laboratory and radiological studies, even these reports will not return until after discharge. When you leave the service, you should sign out all your cases to the fellow. Some patients will be admitted or their consultations will be directed to a faculty member not on-service that month. Ordinarily, these consultations will also be channeled through the on-service fellow and team. Although these cases may be discussed on attending rounds, the consulting trainee should establish direct contact with the designated attending.
