Hematology and Oncology In-patient
All inpatient chemotherapy, and most other Hem-Onc related problems requiring hospitalization, are dealt with on a single inpatient ward. The inpatient Hem-Onc service on 7E at East Newton Street Campus is staffed by a senior medical resident, two interns, variable numbers of medical students, and one Hem-Onc Fellow. A Hem-Onc Attending (in rotations lasting 3 weeks) is assigned to supervise the care of patients on the inpatient Hem-Onc service and to conduct teaching rounds. The Fellow will be most involved in patients who are actively undergoing treatment with chemotherapy or transplant or who are in the process of initial diagnostic work ups. The roles of the Fellow on the inpatient Hem-Onc service are to, 1. act as liaison between the Consult service and outpatient clinics and the ward service, 2. assist the housestaff in dealing with difficult management problems, 3. enhance teaching of housestaff through researching and providing literature related to patients on the ward, and 4. supervise all chemotherapy (including entering all chemotherapy orders with subsequent attending co-signature). The goal of all these activities is to maximize learning of both housestaff and Fellows. The rationale for having the Fellows enter all chemotherapy orders is to afford Fellows as much experience as possible in selecting, evaluating and administering chemotherapy. Fellows should feel free to utilize the expertise of the Attending staff extensively in order to develop and understand reasons for planned chemotherapy. In addition Fellows can gain much information from the dedicated Oncologic Pharmacists who are stationed in the clinic and often go on AM rounds with the team.
Fellows are expected to attend morning rounds with the housestaff team (starting after morning report on weekdays) and to answer questions the housestaff have related to Hem-Onc issues. Fellows are expected to play an important role in running the service and making decisions and for this reason Fellows are not assigned to the inpatient ward rotation until they have completed 6 months of Hem-Onc training. If Fellows have morning clinic sessions attendance at clinic takes precedence over morning ward rounds. Fellows should focus their efforts on inpatients with specific Hem-Onc issues including diagnostic and staging problems (these often come up on newly diagnosed patients) and planning and ordering of chemotherapy. Fellows are not expected to write regular notes in charts of all patients on the ward. Fellows are expected to write History and Physical notes along with rationale for work-up and treatment for new patients transferred from the consult service or admitted from the clinic. The Fellows admission notes should especially emphasize the parts of the history and physical that are specifically relevant to Heme-Onc management (e.g. detailed chemotherapy history, tumor measurements), and should provide also a clear plan for the patients admission.
Clinic Attendings are expected to call the inpatient service fellow about new admissions, and Fellows are encouraged to go to clinic to see the patient and review chart and go over the plan for chemotherapy with the clinic Attending. Fellows should provide articles and other information for housestaff regarding specific Hem-Onc issues that arise on service. Fellows are encouraged to do as much formal teaching of housestaff as possible including conducting extended case discussions as time allows, review of blood smears and bone marrow slides, review of pathology and relevant radiological studies. Teaching rounds are conducted by the Inpatient Service Attending (or occasionally other Attendings) at 1:15-2:30PM Mon, Mon and Fri in the conference room adjacent to 7E. In addition, on Wednesday a lunch conference called “FIRM Conference” is held from 11:30AM-1:00Pm. Fellows are welcome to attend (or even lead if so inclined) these rounds which involve general teaching on Hem-Onc issues directly tied to patients on the ward. It is encouraged that the ward team go to the patient bedside during these rounds (as appropriate) to take history and examine patients with important findings.
In addition to the team of doctors assigned to cover the inpatient Hem-Onc service, it is usual that both Fellows and Attendings who follow patients in the outpatient clinic will participate in the care of those patients when they are admitted. This is especially true for patients with Acute Leukemias or on the transplant service.