Midwinter, when respiratory illnesses are rampant, can be a time of mental and physical exhaustion, especially for those of us who take care of sick people. During the midwinter season, a serious pep talk from “the coach” can remind us why we are physicians. After a conversation about blog posts, upcoming articles, and the mental health of our readers, PIR’s Deputy Editor, Hugh Allen, sent me these thoughts. I thought Hugh’s comments are worth sharing. Here they are, unadulterated.- Joseph Zenel, MD, Editor in Chief, Pediatrics in Review
Suggestions for trainees (and the rest of us):
Listen—really listen to the patient and their family. A study by Phillips et al showed that the median time for a physician to interrupt a patient was 11 seconds(!).1 Don’t do this. Everyone has their own story, and careful listening often excels over multiple lab tests.
Think. Don’t simply order or do something without considering its worth to the patient. Is the test or procedure necessary? Can it cause harm? On the other hand, don’t become paralyzed by over analysis.
Keep your humanity. In this era of anti-immunization, harmful drug treatments, and drug abuse, it is easy to become frustrated and critical of the harm a patient’s choices are placing on themselves. They are still patients and deserve our best care.
Look at the patient and parents. Keep your face off the computer screen while typing the electronic record. Do it later.
Examine the patient. This sounds ludicrous, but I have seen a student “listening” to a patient with the tips of the stethoscope still on his neck, not in his ears. A careful physical examination should not be a thing of the past with overreliance on the echocardiogram, CT scan, or lab testing. It can be very revealing.
Wash your hands. You are a living fomite.
Never accept “this is the way we do it here.” The attending, fellow, or whoever might be right, but please be driven by data, not by “in my experience.” This can be a very dangerous route of repetitive wrongness. Deal with facts.
Never fudge! “I don’t know” is just fine.
Recognize and define problems. Keep asking questions. Find the answers. Publish them. Do not worry about naysayers.
Challenge dogma. Hold your ground if founded.
- Phillips KA, Ospina NS, Montori VM. Physicians interrupting patients. J Gen Intern Med. 2019 Oct;34(10):1965