LogintotheNOncdynamic role on mobile heart beat and instruct teams/ED they can contact you that way instead of the pager.
Just an extra note that you should at least chart scroll each patient daily and update the email handoff so that the next person that comes on is uptodate, thanks!
WelcometoNeuro-onc!
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As the resident, you are responsible for being aware of the patients on the neuro-oncology list. Patients that are knowntothe neuro-oncology service on the Ward service will be followed by their primary neuro-oncologist directly. It is still goodtobe aware of these patients and know when they are leaving, if follow-up has been arranged, etc.
**Email is KEY on this rotation — if you do not have your Columbia email on your phone right now, you must change that. It is the primary way in which the attendings will communicate with you; in some cases they use email the way you might text. It is not uncommon for themtoemail about follow up appointments or new patients they want youtosee that day (or that they wanttomeet youtoround in 15 minutes).
**Be suretouse the neuro-onctemplates (can steal from me) for both initial and follow up visits.In clinic, please make suretoget vitals (including height and weight!!) on all patients and enter this into CROWN.
A few other things that have come up:
1. When you are in clinic, you should not be pulledtoround. Just remind the attendings that you're in clinic -- they don't always realize.
2. If rounds are goingtohappen late at night and you think the issue could wait till the next day, it's oktoask if they can round the next morning instead of at 7pmonce clinic finishes.
Conferences:
Tumor Board - Thursdays at 9:15 in the radiology conference room in PH1 (If you walk past the PH elevators on the first floor, cross the hallway that would take youtoCHONY/harkness, you’ll see a conference room on the right - it’s in there.
A typical day
Arrive at 7am - leave by 6-7pm.
There are typically 2-3 new consults and 1-2 follow ups with notes each day. Follow ups and new consults knowntoneuro-oncology are staffed with the primary neuro-oncologist. Patients newtoneuro-oncology are staffed with the on-call attending.
The first thingtodo in the morning is chart review patients on the list - including labs for everyone, overnight events and overall course (better/worse). Identify patients nearing discharge. Identify which patients have active neuro-oncissues and needtobe seen (excluding ward patients). Notify the attending associated with the patient about your plans. They may also email you about patients they want seen in follow ups.
Dr. Iwamoto rounds on Monday and Thursday at 1pm on follow-ups.
UseNeurologyOncology Notefor all notes. Write notes any time you aremaking substantive recommendations on grad, neurosurg, or hospitalist/medicine services. If you are staffing a follow up with an attending, they should have a note.
Initial Consults: These are done for grad patients, neurosurgery patients, and patients on non-neurology teams for the most part.
We accept consults on people with a clear neuro-oncproblem (ie neuropathic pain in a patient on chemo for a solid tumor is not a neuro-oncproblem, but high likelihood of lepto causing neuropathic pain is a neuro-oncproblem).
For new brain tumors, we tend nottoconsult until there is pathology, although sometimes we see post-ops who have clear GBM’s/gliomas as initial consults before they leave the hospital, even without final path. You can always email the attending that is on new consults any given week if you are unsure whether or nottoaccept a consult. I see 2-3 new consults/day, although sometimes fewer. Always put the “AddtoNeuro-Onc” order in.
Consults come from a few directions:
1.)attending hears about a patient
2.)Neurosurgery calls you
3.)The consult team feels a consult they receive is most appropriate for neuroonc.
You write a neurology free text note with the neurooncinitial consult template.
**For known neuro-oncpatients who cometothe ED it can be a little bit tricky. If there is a triage question (i.e.: the patient is obtunded and senttothe ED - ?herniation / bleed and needing NICU vs. stable scan needing step-down), they should be seen by the consult team. If you are in clinic, they should be seen by the consult team. If you are not in clinic AND its not busy AND they were sent in by neuro-oncology for either direct admissiontoward/grad or a neuro-oncprocess, it may make sense for youtosee them andtoleave the consult team out of it.
Clinic:
You are in neuro-oncclinic on Tuesdayand Wednesday afternoons (unlesstold otherwise).
LPs on grad service:
Now that neuro-oncis a little more low key, you will find yourself having enough time some days. If you recommend LP’stograd service patients, and you have the time, you can do the LP for them. If you aretoo busy they can have the NSGY PA’s do them.
Followup appointments:
Dr. Kreisl in particular wants ustomake sure her patients have followups before they leave. You can generally look in Crown, and then email her if they do not. Dr. Iwamoto seemstodo this on his own, although it never hurtstoremind him. Dr. Lassman also tendstotake care of this, but again, always goodtocheck in and make sure patients who are not empowered enoughtocall them have appointments scheduled.
A few things re: notes
Attending may provide brief follow-up notes for established neuro-oncpatients on the WARD and STROKE servicesin lieu ofa note from the rotating resident. More intense encounters such as family meetings may require resident note.
The rotator would provide full initial consult note for incremental and established patient regardless of admitting service location (neurology services included).
The rotator would provide follow-up note for patients on GRAD, NICU, OTHER SERVICES if seen with an attending.
Please let me know if you have any questions or if anything comes up!
Billy Roth, MD
Chief Resident
Department of Neurology
Columbia University Medical Center