Thread by @BrighamSK

Standing up a Hospitalist Group:

(a) Disposition is key; need dedicated case managers

(b) Need to alter APP/MD schedule to prevent burnout after just one week.

(c) Need better transition tools than historical sign outs.

(d) Relationship with consultants is pivotal.

You make friends by just taking over as primary and learn from colleagues.

(e) Admit when you’re wrong.

(f) Round with the nurses, maybe at the nurse station, and include them. Teach them.

(g) Don’t be afraid to hug a patient, especially when you are their only family…

…and they are about to die.

(h) The APPs look up to you as a resident would their attending; teach them and mentor them in the same way.

(i) Ensure team members know their limitations and how to step outside of that box.

(j) If a resident asks you to take a patient, say yes…

…even if it’s just one, it shows them you care. Check on the resident teams, it lets them know you’re all one team.

(k) Connect trainers and consultants. Be humble when an Intern gives recommendations from a consult service.

(l) Remember to ask, sincerely, how they are doing

(m) This goes to my just your residents, but other services and their trainees. We don’t eat our young.

(n) Coffee is the great equalizer, not just for medical staff, but all staff. Buy two coffees and give one to a Janitor. Tell them you’re so thankful for their hard work…

…because it’s true.

(o) Don’t Park in special parking lots, it insulated you from what your patients go through. Our job is to serve, not be served.

(p) Your patient that has no family and loves Menudo…? Bring it to him on rounds. Forget the dumb questions and treat him…

…like a friend. When we’re sick, we don’t always need a Doctor, we need someone to understand us.

(q) Dont ask questions as if you’re interrogating a suspect; ask to understand. “You look like you’ve had a bad day, tell me what’s going on,” is an invitation that you…

…sincerely want to know. In fact, asking in that fashion WILL make you want to know.

(r) Make a joke to liven up the mood. If they start peeing, get peeled up and say, “Oh boy!! you’re in luck today!!” They’ll chuckle, break down barriers, and open up.

(s) Don’t state at the computer screen; jotting down quick notes are okay, but TALK to them. Don’t question. TALK.

(t) Do what you said you’d do. Coming back later? DO IT!!

(U) Get case management involved with your Rounds. Speeds things up.

(v) Call rehab directly if…

You have to. Do a physician to physician.

(w) Read your X-Rays. No mention on the sclerotic foci in the numeral head on CT Chest that is likely benign. This shows the patient you care.

(x) Call Radiology

(y) When the patient is scared, it doesn’t matter how much you know, but how much you care.

(z) Above all, take care of yourself and your own family. Don’t ignore everything at the expense of patient care.

When I was at my lowest point during residency, my wife was having difficulty at home and I couldn’t hold it together. The best advice I got was from my patient. On his death bed, I asked him what he regrets most in his life and he said:

“I’m here all alone, no family, no friends. I thought I could do it by myself. My wife left me and my kids hate me. After everything, I love them all dearly and wish more than anything that they can be here.”

After several minutes of silence, he said:

“Go home to your family and be the person I couldn’t be. Whether you’re here or not, I will still die, but at least I’ll know that I’ve saved you from my fate and that means more to me than any extra minute left you might give me. Please.”

He gave me a tearful smile.

He died that night after I left to take care of my family. To this day, I’ll never forget him and, while I can get lost in my work, his words are with me to this day.

Thank you Jack.

@thecurbsiders