Saturday, October 20, 2012


The hospital where I did my internship didn't have EMR, so one of my super-important jobs when I was doing cross cover was....

Rewriting orders.

Any time a patient even sneezed, you had to rewrite all their orders. I'm exaggerating, but it happened a lot. Like if GI took them for a colonoscopy, they needed all new orders after. IVC filter placed... new orders. Room change... new orders. And sometimes just because.

The primary team was supposed to leave the new orders with the nurse, but a lot of the times they would forget. Or else, maybe the new orders got lost. Or else, they wouldn't realize that the patient needed new orders after, like, a particularly large bowel movement.

I remember one time on call, a nurse paged me and said that I had to write a patient's admission orders completely over. Like copy two pages verbatim. Why? Because the patient had been sitting in the admitting unit for five days and that's when the orders had been written, so they had expired. That seemed REALLY WEIRD that the patient hadn't gotten a bed for that long, but I grudgingly went to rewrite all these orders like a good soldier.

That's when I noticed that there had been nothing written in the chart that was dated earlier than yesterday. In fact, it turned out the patient had only come to the hospital yesterday. The intern had simply written the wrong date on the admission orders.

When I pointed this out, the nurse grudgingly agreed that I didn't have to completely rewrite every single order. "You're not even going to rewrite the insulin orders?"
She seemed really disappointed.


  1. At my hospital, if we see a consult and write the H&P on the consult sheet and then subsequently admit the patient, the nurses ask us to write a new H&P on an H&P sheet. I did this a few times as a med student before deciding that I was not willing to participate in such an utter waste of my time, particularly if I was awake in the middle of the night. Most of the nurses are okay with my refusals, but I get the occasional one who grumbles about the H&P being on the wrong sheet.

    (Note: This obviously only works if you've written a good H&P on the consult sheet.)

  2. That's yet another reason everybody should be on electronic charting. "Rewriting" a set of orders after a procedure takes about thirty seconds, for the doc to scroll down the list of prior orders and check all the boxes.

    I know there are still lots of docs who have to write out all their orders in longhand, on sheets of dead tree, but I can't fathom how you can afford to take that much time.