Seriously, if you don’t do this already give it a try. It takes like one extra minute and then when you round on them later you can ask them how they feel about oil vs acrylic paint or who their favorite wrestler is. And then your patient satisfaction scores go up and everybody wins.
Also makes presentating to the attending fun, but we are family med so we love this kind of thing.
You know what bugs me about discussions of physician burnout and resiliency?
They seem to be based on the idea that people who completed four years of medical school and however many years of residency and worked hard and sacrificed and were constantly pushed out of their comfort zone and didn’t see their family or friends as often as they wanted and made new friends and communities wherever they found themselves, and did this their entire young adulthood, aren’t actually resilient and that the issues they’re facing can be fixed by meditating for five minutes a day and taking a walk at lunchtime.
First of all, since when did physicians get lunchtime?
Second of all, since when did becoming a doctor in the first place not take a lot of resiliency, so why do people assume physicians, who have already demonstrated themselves to be resilient, are the ones who need fixing?
Couldn’t agree more. Say it louder. Physicians are being blamed for being human in an inhuman system. It’s up to EVERYONE to realize this is a serious issue driving physicians to suicide and abandonment of a passion they once loved. And it’s on all of us to say this is not how we want healthcare delivered.
I get really mad when I sit through those burnout discussions because I feel very blamed.
It is not the fault of someone who works 80-100 hours a week, never sees their family, and puts 100% of their emotional energy into a job that takes and takes from them that they feel burned out. So DON’T tell me to “practice mindfulness” or “do more yoga” or “make time for my family” – like I could somehow fix myself.
I am strong. As physicians and trainees we are incredible to fight through what we do every day. So let’s change the conversation – we’re not burned out. We’re taken advantage of. Our humanity and our love of our jobs is taken advantage of.
Don’t tell me to take a walk. Tell the system to allow me time for one.
I had a patient tell me about his “academy-award” winning poop that was the size of 1.5 foot long, 1.5 inches in diameter. And it was so hard he had to “get a stick from the back-yard to break it apart”. He said he took a laxative 3 days ago and I asked him why he stopped. He paused, laughed, and said, “I don’t know. Do you want me to tell you that I’m a masochist?” This conversation was delightful, no sarcasm I promise.
I heard an irregularly irregular heart beat on an old male patient. Got an EKG. Turned out to be a PAC. Dr congratulated me for picking it up and said it would be impossible to tell the difference between a-fib and PAC based on physical exam. In that moment I felt so proud of myself.
I’m going to spend the next few weeks, or whenever I have a chance, coming up with some quick helpful hints for intern year. First one, efficient H&P for a medicine admission!
Aquire patient name and MRN. Look up the patient. Any labs the ED ordered? Imaging? Micro, EKG? WHY ARE THEY PAGING MEDICINE WITH AN ADMISSION?!?!?! :-D
Review any previous discharge summaries. At the start of intern year, not a bad idea to print that last DC Summary.
Print/write down a med list.
Place holding orders. (Remember ORDERS SAVE LIVES. Notes do not.)
See the patient within 30mins to an hour of being told about them! If you are reading through the ED note and little red flags are popping up that this may be an ICU admission, go see them sooner! Make sure to bring that med list with you because the MED RECONCILIATION extremely important.
Come up with a way to get all the info you need from the patient. Do it the same way every time. Don’t forget to ask code status… also if a 30YO tells you they are DNR, ask WHY. Don’t forget to as MPOA and try to get a phone ##!
OKAY now return to computer! WRITE ORDERS. Thinking about you differential, start getting those orders in. If you need to call a consult ASAP, call it now. Do your med rec at this time.
Once you have most of your orders done, start writing your note.
Come up with a work flow that works for you. This is the flow I use most of the time. It was really hard to remember to place orders at the start of my intern year, but really the orders do save the lives.
Other interns/seniors have any other comments? Reblog/Comment!
“I always told my interns to lay eyes on the patient before doing anything else. A lot can be learned just from that doorway peek, and you may realize the patient is unstable or sicker than the ER let on and you can kick it into gear faster rather than spending time reviewing charts while the patient is tanking.”
Agree with @wayfaringmd about laying eyes. And @pagingmedicine’s point about the Med recon is key. I would only add that I ask immediately about their housing situation, next of kin, who to contact in an emergency, and the contact info /name of their primary care physician if they have one. And hell yes. Orders first. For so many reasons but basically: no orders, no movement, no care.
It’s been six years since I graduated from internal medicine residency. Enough time to give me some perspective.
1. People die; it’s not a personal failure on your part. Our interventions and therapies can make disease more manageable and prolong life, but death will always be the ultimate and natural conclusion of our efforts.
2. Your choice of specialty will not determine your ultimate life happiness. You are not doomed to misery should you chose not to sub-specialize nor are you guaranteed happiness if you do. Choose something you enjoy, something in which the mundane doesn’t zap your will to live. Choose a specialty that provides a lifestyle congruent with your values. But don’t confuse intellectual intrigue with life happiness; there is so much more to the latter that has nothing to do with medicine.
3. Remember what it means to be a normal person. To retain a sense of awe in what you now get to do on a regular basis. To be able to explain things in non-medical terms the way you learned them before being indoctrinated. To feel — sadness, joy, grief, loss, elation. To remember the viewpoint of suffering.
4. Keep friends outside of medicine. You’ll be more human. And more interesting.
5. Guidelines are helpful, but they are not strict rules. Don’t try to meet every guideline while losing site of the big picture. You wouldn’t want your 95-year-old grandma on a high dose statin to prevent a heart attack “some day,” metformin for the elevated fasting glucose only apparent within the past year and three blood pressure pills that make her feel dizzy all the time to achieve some magic number that no one agrees on anyway. Don’t subject someone else’s grandma to that either.
6. Retain your humility. When family members say, “Something’s not right with Grandpa,” listen. They are usually right. Ask questions when you don’t know the answer. It can be especially humbling to do so in front of your colleagues, but your pride is no longer your priority, it is the best care of your patient.
7. Be kind in your comments about the “outside community doctor.” There is a high likelihood you will be that person at some point in your career. They usually aren’t as dense as you might think; they are just struggling to provide the same perfect care you are in a very imperfect system.
8. Burnout is inevitable. Plan for it. Write down what drew you to medicine in the first place and review on a regular basis. And then review some more.
9. Other services are not your enemy. Be kind when someone calls you with a “dumb consult”; you have likely called one yourself.
10. Avoid perpetuating the cycle of abuse. Just because you were demeaned and humiliated as a student or resident does not mean you are entitled to do the same to your younger colleagues. They are no more “unmotivated,” “lazy,” or “arrogant” then you were.
11. Think about how your orders affect your patient. How they may actually contribute to their suffering and discomfort. Nurses have been asking for us to do this for years; it’s time we took note.
12. Be mindful of the habits you cultivate. How you speak to patients, families, nurses. How you treat your family when you are stressed. Your eating habits, your spending habits, your sleep habits. These will follow you past residency, for better or for worse. Make sure they have been chosen with intention.
13. Medical training has likely put you in debt. Just because you have a big salary out of residency, doesn’t mean that you are wealthy. Wealth = assets – debts. Do the math and avoid the temptation to increase your debt further immediately on graduation with a huge new house, car or other toys. A few years of frugal living will pay dividends later on.
14. It doesn’t automatically get better after residency. Hate to break it to you, but it’s the truth. But it can be great if you prioritize what’s really important. Just pick those priorities carefully.
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