Five Things To Do Before Starting Clinic

“An ounce of prevention is worth a pound of cure.”

Everyone has heard the old saying above, but I’ll bet you didn’t know the same basic advice applies to being an intern in clinic, too. There are a lot of things you can do to prepare yourself for your student and outpatient clinic experiences, but five things, specifically, will truly benefit more than you can possibly imagine if you do them at least a few weeks in advance of beginning your clinic experience:

1. Familiarize yourself with all of the clinic’s paperwork
2. Memorize and practice new patient examinations
3. Refresh your adjusting techniques
4. Learn the clinic policies and procedures
5. Familiarize yourself with the various equipment in the clinic

I know, these sound basic and, well, probably even boring, but take it from someone who deals with interns everyday and who still remembers what it was like to be an intern himself! Doing these five, common sense things before you begin your clinic experience will make things run smoother, faster and, therefore, much less stressfully, all of which are good things. Wouldn’t it be nice to focus on your patients when you’re in clinic instead of the stuff you probably should have known before you started clinic, anyway? You bet!

Familiarize Yourself With Clinic Paperwork

There are three types of paperwork in the clinic: the stuff the patient fills out, the stuff you use for exams, daily visits and other care, and the “behind-the-scenes” stuff you use during Case Management Reviews (CMR’s), for checkout, to record observed visits, etc. Why bother seeing what the patient fills out? It’s very helpful to know what information is asked of a patient. Lots of patients get tired or confused with the new patient paperwork, so knowing the information that should be there will really help you when it’s time for you to make sure it actually is there. The day-to-day paperwork that your files are built from is self-explanatory. You need to know all the paperwork you are expected to use because you learn about it in your clinic courses, and the clinicians expect you to know what you’re doing when you get to clinic. I can’t tell you how much time students waste not knowing what forms to fill out, or how. Likewise with the behind-the-scenes paperwork. A few weeks before you start clinic, go to the front desk and ask for one of everything and read through it, understand it, write on it, whatever it takes for you to be as familiar with it as if you designed it all yourself.

Memorize and Practice New Patient Exams

I know, I know… “Get real” you’re saying to yourself. Of all the advice I give students, this is the best, by a longshot, and the one very few students do. This can make things so much easier on you and your patients while you’re in clinic, I can’t even begin to list the advantages. My advice to you is about a month before you start clinic, go to the front desk and ask for the new patient exam packet, take it home, and use the heck out of it. Make your first exam look like it’s your hundredth to your patient. You will be more confident, you will save tons of time, and you will radiate a professional image that is often lacking when students wait until the hit the clinic before they conduct their first exam. Every time you have to stop to look at the exam form to figure out what to do next, you waste time that is multiplied throughout the visit. This is why a 60-minute exam takes most interns 2+ hours. Our exam paperwork is organized by regions, but you shouldn’t conduct your exam that way. You should perform exams from least aggressive procedures to most aggressive (i.e. you perform active range of motion before provocative orthopedic exams) and keep things grouped by patient posture, not region (i.e. do all your standing procedures, then seated, then supine, then side-lying, then prone). If you memorize the exam forms and get the flow down, you will only need to look at the forms when it is time to actually write in any positives or pertinent information. You will fly through your exams and you will save yourself, literally, days of time, freeing you up to provide care for your patients, be on-call, out in the community doing other activities you enjoy, etc. Think about it. It is a lot of work, but it pays off so much I really can’t stress it. Doing this very thing is what got me out of Palmer’s clinic a full trimester early when I was a student, so it works, and it works well. Trust me.

Refresh Your Adjusting Techniques

Breeze up on your adjusting. Practice with your dry spine and speeder board, go back through your notes, and really focus on assessment. Most students are pretty decent at adjusting. Most students are pretty poor at assessment. The better you get at evaluating your patients, the better your adjusting will be.

Learn the Clinic Policies and Procedures

Break out a notebook and the Clinic Manual and get to work. There are a lot of policies and procedures. Being familiar with them will save you tons of time and will win you a lot of favor with the clinicians. We notice who knows what they are doing and who is completely clueless. What will you do in your own practice? I sure hope you will know your procedures like the back of your hand, so treat the student and outpatient clinics at school like they are yours. Own them. It will show, you’ll make a great impression on your patients and your teachers, and you’ll be efficient and professional. What’s not to like?!

Familiarize Yourself With the Clinic Equipment

Again, this is a huge time-saver. Why wait around for a clinician to show you how to use the Foot Levelers application, or how to use the PT equipment (which you have already learned how to use in class, remember!), or how to bring a table up or down, etc? This is your profession, and so you should be intimately familiar with the tools of your trade. The clinic has a whopping three different styles of table (we had more than a dozen when I was in school). Learn how they raise and lower, learn about the safeties on the HyLo and how to adjust it to your patient’s build, learn the drops, swing-outs, flexion-distraction mechanisms, etc. It takes about 15 minutes to learn the tables and another 15 to learn the PT equipment, so take a half hour out of your day a week before you see your first patient and learn how to use this stuff. Nothing looks dumber than an intern who can’t raise a table up or who spends 5 minutes changing face paper because they have never practiced. Nothing looks smoother than a professional intern who does things like they are second nature. 

The guy who flounders in clinic has obviously not gone the extra mile, or isn’t very busy. The intern who is polished, professional and knows what he is doing, is fast and efficient and gets the job done is the one who has spent the extra time to gain proficiency and is proud of his work. Ask yourself this question… WHO WOULD YOU RATHER GO TO AS A PATIENT?! Answer that, honestly, and you know what you need to do for a few weeks before starting clinic.