A Day in the Life of a DCLS

I realized a few minutes ago when I took a break from all of the required writing I currently have to do, that it had been several days since I posted.  So I’ve decided to give you a description of what I typically do any given day:

Arrive at the medical center between 6:30am-7:00am.  It takes about 5 minutes to walk to my desk across the hall from the core lab from the street (big place).  I have approximately 45 minutes to review the patient charts, lab results, and lab orders, for the patients in whatever unit I am currently assigned to round in – right now I am rounding in the MICU or Medical Intensive Care Unit which has 3 hallways of patients.

Rounding, for most areas, starts between 7:45am-8:00am although some areas start rounding at 4am and others do not start until 1pm, just depends on the area and the specialty.  Rounding also takes anywhere from 2 – 5 hours to complete depending on the complexity of the patients, admits during rounding, or if there is a patient emergency during rounding (i.e. respiratory distress, code, etc).  The patient care team comprises of the Attending physician, one or two fellows depending on the specialty, between two and five residents, an intern, a clinical pharmacist, and myself.  Sometimes we will have a couple of medical students or pharmacy students as team members.  Occasionally, and it is really dependent on the area and the acuity of the patient, the patient’s nurse, a respiratory therapist, a dietician, or case manager/discharge planner will also round with the patient care team but they are on a patient by patient basis.

I have had questions in regarding everything from:

• What is the transfusion ratio on a patient that received a hodge-podge of 82 different blood products during a massive transfusion protocol (they lived!)?
• What tests should be ordered to evaluate a rapidly climbing potassium result?
• Can old age cause positive double-stranded DNA (the patient was only 57 years old)?
• Why were no bands reported on the differential today but there were bands reported yesterday?
• How often should we measure a APTT for a patient that was switched to argatroban for heparin-induced thrombocytopenia?
• Plus many, many more …

After rounding I scarf down some food while responding to emails.  Most emails relate to our Diagnostic Management Team.  We receive a request for consultation and the various team members chime in until a consensus is made and then the recommendation is presented to the physician.  About two thirds of the time I am the one who contacts the physician by both phone and then followed with an official email.  As of today, since I started residency 8 weeks ago, the DMT has saved $50,761.80 in unnecessary testing.

At some point in the afternoon, between emails and phone calls, I also perform a utilization review for the previous 24 hours where I am looking for the commonly mis-ordered tests, which include but are not limited to: coagulation testing beyond PT, PTT, and Fibrinogen, hepatitis testing, “funky” immunology testing, etc.  If they have already resulted then I contact the physician by phone and email notifying them that either it was the incorrect test, the timing of the test affected results, and solutions to the issue which include either the appropriate test to order or a when an appropriate time to order the test is for their patient.  If the test has not already resulted, I cancel the test and contact the physician by phone and email explaining the reasoning for the cancellation as well as solutions as previously stated.  This portion has only been in effect for the last three weeks (since the new residents arrived essentially) and this has saved an additional $5,350.30 in inappropriate testing.

The rest of the time, unfortunately, is spent doing lots … and I mean lots … of writing.  The thesis project proposal itself is 30 pages of solid writing, which does not include the IRB submission forms, presentations every week and sometimes multiple presentations, journal of daily activities, documentation of all activities and patients seen in rounds.

Somewhere in this schedule I also attend Clinical Pathology / Anatomic Pathology Grand Rounds with the pathology residents as well as Infectious Disease Grand Rounds.  I am scheduled to present in both in the near future.  Grand Rounds are where all of the physicians (attendings, fellows, residents, and even sometimes med students) discuss interesting cases from the previous week and potentially change protocols relating to either diagnostic or treatment strategy.  I may attend others in the future, but these are the two the I currently attend every week.  I also assist the pathology residents in their clinical pathology quality improvement projects because none of them have any idea what to do in the non-anatomic pathology realm.  No … seriously … they have no idea!  So I help in developing and assigning the projects to the pathologist residents and then monitor their progress and help evaluate the finished project.  There is a resident with a project every month so this never ends.

So this is pretty much a day in the life.  The emails and phone calls do not stop when I leave as I still receive them at night.  Healthcare does not have banker’s hours – it is a 24 hour / 7 days a week / 365 days a year job.

And, quite frankly, direct savings of over $56,112.10 in an 8 week period of time ain’t too shabby. 🙂

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