Thread by @medicalaxioms

Practice guessing everything:
- what will the troponin be
- how many days in the hospital
- what’s the next CBC
- peptic ulcer or gastric cancer
- lives or dies
#TipsForNewDocs

This makes you an active participant in the result.

Instead of 7 or 10 it becomes I’m right or I’m wrong.

In time you’ll create a virtual version of each patient in your mind. Some will be destroyed by the truth and facts as they develop.

But in time you’ll get pretty good at it. Patients will be admitted, career for, and leave just as expected.

This is no parlor trick. Knowing what is likely to happen before it happens is a powerful advantage when caring for the sick.

Anticipating the patient with a sore arm will end up in the OR with necrotizing fasciitis may help you keep them out of a drawer in the basement.

If the patient in front of you keep deviating further and further from the virtual patient in your mind, something very fundamental may be wrong. Like the diagnosis.

In time without learning any more medicine you can become a better doctor just by improving your guessing.

With practice, you can become better at guessing even if you have no idea how your are doing it. Even if you can’t explain it to someone else. You just get better with practice.

It allows you to save time, “I don’t need a dimmer it will be positive. I need a CT PE.”

It allows you to save money, “I do t need a INR tomorrow. I just started warfarin today and it won’t have changed with one dose.”

It allows you to save hospital days, “I see where this lengthy hospital stay is going. It’s going to end up with hospice at home. Let’s save this lady the days and start that discussion now.”

As you keep practicing your guessing and start to get good at it, something profound happens.

You start to notice what really matters.

Urine sodiums rarely help me predict anything.
A patient cold and clammy and looking scared trumps everything.
Vital signs are vital.
Serum WBC bounce around meaninglessly.

If you keep guessing, you start to unravel the truth of the natural world.

Hemoglobin matters in bleeding.
The rate the hemoglobin is changing REALLY matters.

Thus

Bleeding is calculus, not arithmetic.

Guessing results is not disrespectful to patients any more than your waiter is disrespectful to you when they anticipate you may be ready for dessert.

Predicting what a person will need next is a sign of love, not disdain.