Dr. Christopher Unger welcomes interest in his private medical practice, which includes internal medicine, pediatrics, and dermatology. He enjoys teaching students and offers hands-on training. The document outlines administrative duties, clinical skills, and expectations for interns, including maintaining professionalism, attendance, and communication. It also provides appendices with guidelines for tasks like taking vital signs and sterilizing instruments.

1. 1
Introduction
Personal Message from Dr. Unger:
“I would like to welcome you and say that I am very appreciative of your interest
in this office.”
Medical Practice: This office is the private practice of Dr. Christopher Unger
who practices internal medicine, pediatrics, and has a special interest in
dermatology.
Background: Christopher Unger, M.D. was born on October 15, 1944 in
Lancaster, Pennsylvania. Dr. Unger obtained his Bachelor of Science from Ursinus
College with a major in chemistry. He received his M.D. from the University of
Pennsylvania School of Medicine, Philadelphia, Pennsylvania. He completed
several residencies in New England, including New England Deaconess Hospital
and Children’s Hospital Medical Center in Boston, MA. He was appointed Clinical
Fellow in Medicine at Harvard Medical School. He then became chief of outpatient
medicine at the U.S. Naval Hospital in Annapolis, Maryland, where he held the
rank of Lieutenant Commander. Dr. Unger was certified by the American Board of
Family Practice in 1974. He was also certified by the American Board of Internal
Medicine in 1984. His special interests are diagnostics, skin preservation, and

2. 2
teaching. He has completed the required criteria for certification in
echocardiography by the American College of Cardiology. Dr. Unger was given
the Laughlin Award by the Medical and Chirurgical Faculty of Maryland in 2001.
Program: Dr. Unger enjoys teaching students and training future medical
professionals. The program offers opportunities for hands-on experience and
prepares you to become a competitive candidate for graduate school.
Expectations for Interns
• Maintain internet access and email communication
• Acquire the Hepatitis B vaccine
• Present a good appearance and dress professionally
• Exude enthusiasm
• Portray intellectual curiosity
Students are required to keep a dependable and reliable schedule. The attendance
policy requires a two week notification of any schedule changes as well as finding
someone to cover your shift in the case of any emergencies. Always call the night
before your scheduled shift to review pertinent information regarding patients
scheduled during your shift. Dr. Unger’s vision for all students is to see them set
realistic career goals, acquire compassion, and stay focused.

3. 3
The Internship Experience
Arcieri and Green, authors of “Majoring in Success: Building your career while
still in college” in quoting Adele Scheele, states: “The most profound question next
to ‘who am I’ is ‘what do I want to do’. And interestingly enough, both of these
questions become clear only by experimentation. There is no way to know
beforehand” (p. 7).
• The internship experience helps students make better career decisions by
either confirming their choice or by causing the student to pursue another
path.
• It provides students an opportunity to see which areas of industry they enjoy
the most.
• It helps students develop important skills needed in the field, builds their
practical experience, enhances their resume and makes students more
employable.
• It also allows students to develop professional contacts with whom to
network.
• It teaches students how to perform in a professional environment and to
work well with others.

4. 4
Outline of Administrative Duties
• Managing the telephone – The expected way to answer the telephone is:
“Good morning/afternoon, Dr. Unger’s office, Name speaking, It’s a pleasure to
help you.”
Connect the caller to the correct person they need to speak to by telling that
individual what extension the call is parked at indicated by the last digit of
the number that is illuminated. When unsure of how to handle the call, place
caller on hold and ask for help. Always get the caller’s name and contact
number.
• Scheduling appointments – Patients call to schedule or cancel
appointments. The appointment book is on Alison, the medical receptionist’s
desk. When scheduling an appointment, always record it in pencil. Record the
patient’s name and best contact telephone number. If it is a new patient, connect
them with Alison. When cancelling an appointment, try to reschedule that
patient or make a note to follow-up with that patient.
• Retrieving and organizing records – Patient charts are alphabetized.
Know the layout of the chart in terms of order and the format of the ‘problem

5. 5
oriented medical record’. Patient charts are updated with every visit and when
calls are placed to that patient. Documentation such as prescription refill
requests and lab reports are filed once processed/ discussed with patient. It is
important not to leave messages or patient medical information with anyone
other than the patient. The only exception is if that patient is a minor.
Remember to document your conversation and date and sign your name. Older
records are housed in the archive which is the last room on the right going
toward the back of the office. The office sees many transient patients and
patients who need medical clearance for surgery or flight licensing. The
paperwork differs in these situations, so always check with Alison or Dr. Unger.
All charts are written and updated using a black ink pen
• Writing skills – All writing in any medical document needs to be clear
and accurate. Please do not scratch through mistakes; if errors are made, please
rewrite.
• Miscellaneous – Other intern responsibilities include sending out office
emails or responding to emails on behalf of Dr. Unger. Students also research
medical information with regards to patient’s condition or medication
information.

6. 6
The most important message to remember is that when working with patient charts,
we are working with legal documents. When unsure, always ask someone who
knows. When making a mistake, ask for help in making corrections immediately.
Outline of Clinical Skills
• Obtaining accurate vital signs – A patient’s vital signs include four
measures: their pulse, temperature, blood pressure, and respirations.
- The pulse indicates the patient’s heart rate with the normal range being
60 – 80 beats per minute.
- The temperature reflects the patients internal body temperature with
normal being 98.7 degrees Fahrenheit. This office uses an under-the-
tongue digital thermometer.
- The blood pressure measures the pressure in the arteries when the heart
contracts (systole) and when the heart is at rest (diastole). Please see
appendix 1 for instructions on how to take an accurate manual BP
reading. The normal range for the systole is 100 – 140 mmHg and for the
diastole is 60 – 80 mmHg.

7. 7
- The respiration indicates the number of breathes per minute. Normal
range is 10 – 16.
Report all vital sign deviations to Dr. Unger and examine connections to the
patient’s medical history/condition.
• Obtaining complete medical history (yellow form in chart) – how, what,
why, who, where, and when. Obtain a complete medical history on all new
patients, patients having their annual physical exam, and patients who have not
been seen by Dr. Unger in a while. No amount of information is unnecessary or
insignificant. Ask patients open-ended questions that allow them to elaborate.
Chatting with patients allows them to relax while divulging pertinent
information. This information includes past and present medical conditions with
regards to patients, parents, siblings, and children if any. Part of the medical
report is also based on your observation of the patient. Record what you see in
addition to what the patient tells you. Observations include: general appearance,
color of skin such as pale and clammy to touch, any markings or growths, and
patients psychological disposition such as mood. The white form in chart is
used to update the patient’s medical information on all subsequent visits such as
follow-ups and any new conditions within the year. Remember to sign all

8. 8
forms where necessary. The skill of obtaining a good medical history is
perfected over time.
• Assisting with procedures – Please see Appendix 2 for supplies needed for
surgical preparation. If possible, discuss this with Dr. Unger during your night
before telephone contact time so you are prepared and know the specifics. Make
sure that the surgical room is set-up with necessary supplies. Keep a mental
note of all questions to ask during post-surgery discussion time. It’s an
awesome experience!! Ask if Dr. Unger needs you to write the operative notes.
If yes, follow the example listed as Appendix 4.
• Preparing labs – All lab supplies are kept in the lab (last room on
the left going towards the back of the office). All lab forms are kept in the
cupboard above the fax machine. Make sure that all specimen jars are clearly
marked with the patient’s name and the date. Alison will take care of the
paperwork. Place specimen and completed paperwork in a lab bag and place in
appropriate lab company’s drop box in hallway outside backdoor. Blood
samples are centrifuged in the lab. Make sure that you balance the patient’s
sample vials with the vials kept to the left of the centrifuge, lock centrifuge and
hit the start button. Please ask Alison if you need assistance.
• Sterilizing instruments – See Appendix 3 for step-by-step instructions.

9. 9
• EKG Testing – See Appendix 5 for guidelines on the placement of leads.
• Stocking supplies – All supplies are kept in the cupboard next to the
copy machine and the brown cabinet on the right across from the copier. Keep
examination rooms well stocked.
The most important message to remember when medically serving a patient is that
we cannot make mistakes. We have in our hands people’s lives, their health, their
privacy, and trust. We are not afforded opportunities to practice our skills at their
expense.
Intern’s Personal Growth and Development
Here are some ‘tips’ from Students helping Students in their “Scoring a great
Internship” article (p 3):
• Take initiative
• Be flexible
• Set realistic expectations
• Make the most of menial tasks

10. 10
• Ask for help and advice
• Don’t burn your bridges, build networks
• Acquire tacit knowledge through observing how the experts do it
• Build your portfolio and update your resume
Dr Unger’s Recommendation Requirements
• Minimum of 125 hours required for a written recommendation
• Ability to grow professionally
• Ability to work under stress
• Strong organizational skills
• Ability to understand highly stressed patients
We are located at 8218 Wisconsin Avenue Suite 208
Bethesda, MD 20814

11. 11
How to take an accurate manual blood pressure reading
Figure 1 – electronic blood pressure monitor and cuff.1 figure 2 – stethoscope.2
Introduction
Electronic blood pressure equipment is used at most medical facilities. It is,
however, very important that all health-care professionals are able to acquire the
1
30
November
2010.
http://www.health-­‐mobility.com/cgi-­‐
bin/category/Blood_Pressure_Monitor?gclid=CNW48IiryaUCFRZy5QodRF7VYw
2
30
November
2010.
http://www.google.com/images?rlz=1T4RNTN_enUS366US366&q=picture+of+stethoscope&um=1&ie=UTF-­‐
8&source=univ&ei=Xln1TLzfEcWblgfLocDVBQ&sa=X&oi=image_result_group&ct=title&resnum=1&ved=0CDkQsAQ
wAA&biw=1259&bih=531

12. 12
skill of being able to take and record an accurate blood pressure reading. The
instruments needed are a stethoscope and blood pressure monitor and cuff.
Step-by-step Instructions
1. Check the stethoscope to see if the sound is amplified by placing the
earpiece in your ear and tapping the flat end of the stethoscope lightly. If the
sound is dull, turn the stethoscope around (switch ears).
2. Have patients extend either their right or left arm forward, with palm of hand
facing upwards, and attach the cuff comfortably around the middle of their
upper arm (just above the elbow area).
3. Explain to the patient that he/she will experience slight pressure when the
cuff is inflated.
4. Place the flat round part of the stethoscope under the cuff just above the
elbow crease of forearm and place the earpiece in your ears prior to
inflating.
5. Tighten the bulb on the blood pressure cuff and begin to pump the bulb
while watching the monitor. The monitor will indicate the pressure
increasing in the cuff. Inflate until the pressure reaches 180.
6. Slowly release the bulb to deflate the cuff while watching the monitor and
listening to the sound in your ear.
7. Record the first reading as the number reflected on the monitor at the first
sound which will sound like a thump/beat. The reading on the monitor will
also very briefly pause at this number so you have to be watching very
closely as not to miss it. This first number is the systolic reading and is the
top number of the blood pressure reading; it indicates the contracting of the
heart.
8. Record the second number when the beating sound stops. This too will be
indicated on the monitor by a brief pause. This number is the diastolic
number and is the lower number of the blood pressure reading; it indicates
the heart at rest.

13. 13
9. Once you have the second number, completely deflate the cuffs and remove
it and the stethoscope from patient’s arm and your ears respectively.
10. Record the blood pressure as the systolic (first number) over the diastolic
(second number).
Blood pressure readings are measured in units of millimeters mercury (mmHg).
The normal range for the systolic is 100 – 140. The normal range for the diastolic
is 60 – 80. The blood pressure is therefore recorded as: eg. 100/60.
Report any reading outside normal range to the attending physician. It is good
practice to know the patient’s medical history that might be reflected in their blood
pressure reading (eg. they have hypertension and might be taking blood pressure
medication). Mention this to the physician when reporting the reading.
Notice
1. An
accurate
blood
pressure
reading
is
of
vital
importance.
When
you
are
unsure
of
the
reading,
tell
the
physician
so
he
/she
can
re-­‐take
it
or
you
should
re-­‐take
it
using
the
opposite
arm.
2. Faulty
equipment
can
also
cause
inaccuracies,
so
check
cuff
for
air
leaks
and
be
sure
that
your
stethoscope
is
in
good
working
condition.

14. 14
Surgical Preparation
Alcohol
Betadine
Cotton balls
Surgical drapes
Gauze pads
Razor
Specimen jars
Topical anesthetic
Xylocaine 2% with epinephrine

15. 15
Figure 1 - Iris Scissors – Iris scissors are used in ophthalmic surgery to remove
necrotic tissue and follow the contours of the tissue in small areas. 3
Figure 2 – Ethilon Suture Material – This material is non-absorbable, sterile, and is
used as surgical sutures.4
3
30
November
2010.
http://www.surgicalsindia.com/iris-­‐scissors.html
4
30
November
2010.
http://www.surgicalsindia.com/iris-­‐scissors.html

16. 16
Figure 3 – Mosquito Hemostats – Hemostats are used to grasp and clamp blood
vessels.5
Figure 4 – Scalpel Blades and Holders – Blades used in surgical procedures.6
Figure 5 – Disposable Syringes - Syringes are used to administer injections, insert
intravenous drugs into the bloodstream. 7
Any
potentially
sharp
item
should
always
be
disposed
of
in
the
SHARPS
CONTAINERS
5
30
November
2010.
http://www.pjtool.com/hemostats.aspx?gclid=CLTzi7KnyaUCFZlN5QodsEdjFQ
6
30
November
2010.
http://www.swann-­‐morton.com/
7
30
November
2010.
http://www.amazon.com/Monoject-­‐3cc-­‐Syringes-­‐Syringe-­‐SWD513330Z/dp/B000VSXH5Q

17. 17

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How to sterilize surgical instruments
1. Clean instruments thoroughly by soaking them in hot antibacterial soapy
water immediately after each use.
2. Make sure that instruments are free from all residues such as blood and
tissue.
3. Allow instruments to dry.
4. Place instruments in sterilization pouches.
5. Label, date, and initial pouches prior to sealing properly.
6. Place in autoclave for 1 hour.
7. Make sure instruments stay apart from one another and do not stack pouches
on top of each other.
8. Check water level and replace with distilled water.
9. Canisters should be placed upside down in autoclave so as not to accumulate
the water.
10. Allow a distance of approximately 1” between trays to allow the steam to
circulate.
11. Lock and start autoclave.

19. 19

20. 20
Operative Notes
An Example
Date:
Time:
Patient: DOB:
Pre operative: Mosaic warts (on right foot): Patient has had two complex, deep,
painful warts of the anterior plantar foot. There is one, one cm bulky lesion
approximately five mm depth, there is a second lesion 1.5cm, approximately 5mm
depth.
Procedure: The surgical field was carefully cleansed with isopropyl alcohol times
three.
1. Anesthesia – none required
2. Excision of mosaic warts of right foot. Re-excision was performed three
times. Liquid nitrogen was applied and reapplied times four.
3. Thermal ablation was applied at 6 watts.
4. Estimated blood loss of 14cc.
5. Wound care: Betadine applied three times. Sponge count 7 in / 7 out.
Following the cleansing of the operative site the wound was dressed with a
dry-sterile non-adhesive dressing.
The patient tolerated all procedures well. She was advised to use ibuprofen 400mg
as needed for pain.
Pathology sent to respective lab for histopathology.
Christopher Unger, M.D.

21. 21
The Placement of EKG Leads
An EKG test measures the electrical activity of the heart which causes
the heart to pump blood through the heart chambers to the lungs and the
rest of the body. The electrical activity is shown on the EKG machine as
waves. The EKG machine connects to the patient through ten leads
(some EKG machines have 12 leads) which are strategically placed on
the patient’s body in the following positions indicated on the diagram of
the anatomical body:
Figure 1 - Anatomical male8
8
5
December
2010.
http://www.google.com/search?sourceid=navclient&aq=1h&oq=ana&ie=UTF-­‐
8&rlz=1T4RNTN_enUS366US366&q=anatomical+position+diagram

22. 22
Limb Leads
1 – Right arm – RA
2 – Left arm – LA
3 – Right leg – RL
4 – Left leg - LL
Precordial Leads
5 – V1
6 - V2
7 – V3
8 – V4
9 – V5
10 – V6

23. EKG Graph
Figure 29 - graph
9
5
December
2010.
http://www.google.com/imgres?imgurl=http://images.picotech.com/ecg_graph_1.gif&imgrefurl=http://www.pico
tech.com/applications/ecg.html&h=531&w=635&sz=11&tbnid=tNQRjp2ZmeCgIM:&tbnh=115&tbnw=137&prev=/i
mages%3Fq%3Dekg%2Bgraphs&zoom=1&q=ekg+graphs&usg=__hQd73i5KgXY1j8fcxjL9WWjnL5k=&sa=X&ei=di38T
N-­‐-­‐J8SBlAemy4WaBQ&ved=0CCwQ9QEwBA

24. 24
Abbreviations
NKDA – no known drug allergies
ROS – review of systems
ENT – ear, nose, throat
C/RESP – cardio-respiratory
GI – gastro-intestinal
GU – gastro-urinary
N/M – neuro-muscular
PFSH – past family social history