Thread by @TheRealDoctorT

Students rotating with me often ask for pointers or tips to help them become better clinicians.

MedTwitter is full of plenty of great advice.

The following are some more general bits and pieces that I’ve compiled over the years.

They aren’t perfect.

Neither am I. 1/

Yesterday I tweeted and asked for advice on life and medicine that people could share.

The response was overwhelming (below).

Don’t be afraid to ask others for help, or to learn from the lessons that they teach.

Be humble in your search for knowledge. It is all around you. 2/

https://twitter.com/therealdoctort/status/1212433827399917573

Depending on what field you go into, the patient’s history and exam are usually crucial.

Especially the history-taking.

This is your opportunity to make a first impression. To establish the beginnings of a connection.

Your time will be limited. Your patience shouldn’t be. 3/

Invariably my mind wanders.

After I think I’ve discovered what I was looking for in their story, I disengage and start thinking about something else.

It takes all my mental energy to pull my mind back into focus.

You must stay engaged.

The answer isn’t always obvious. 4/

When I examine, I make sure to keep an open mind.

Never alter your perceptions to fit your diagnosis.

Observe.

Understand that the diagnosis is a work-in-progress. Don’t use it as a lens through which you see all.

I have been very, very wrong.

Many, many times. 5/

Be systematic.

Your system will save you when you get careless. And you will get careless.

I have been careless. We all will be, eventually.

Forcing myself to adhere to a systematic way of approaching problems has warded off disaster more than once. 6/

They tell you that when you hear hoofbeats, you should think “horses” not “zebras.”

What they don’t tell you is that lions don’t make a sound when they’re stalking.

You will be blindsided by something you missed, sooner or later.

It is inevitable.

It is human.

It is okay. 7/

Make sure patients understand what you’re saying.

You have been trained to speak in jargon.

Epistaxis? Nosebleed.
Edema? Swelling.
Erythema? Redness.
PO? By mouth.
PRN? As needed.

Jargon is of no use to you here. It is specific language, but it is confusing.

Be clear. 8/

They deserve your very best.

Each and every patient encounter is a first chance, and a last chance.

Be there. In the moment. With all your skills and everything in your toolbox.

Cultivate empathy.

Connect.

You won’t always be able to.

But try. 9/

Be kind. Be honest. Be kind.

No matter what you end up doing, you will eventually have to interact with fellow human beings, whether they’re patients, or colleagues, or friends, or loved ones.

Your honesty and kindness to them isn’t just about them.

It’s about you. 10/

Taking kindness one step further, in terms of professionalism, there is no place in it for cruelty.

Treat your fellow humans with respect. If they don’t deserve your respect, still be true to your character.

I’m not saying you have to like everyone.

Just don’t be a jerk. 11/

Understand that ultimately you are here for others.

Every patient is unique, and uniquely suffering.

Believe them.

You’re not here to pass judgment.

Only then can you begin to help.

You have to be able to meet people where they’re willing to meet you, and go from there. 12/

If you feel like an abject failure sometimes, welcome to Medicine.

If you feel scared, or overwhelmed, welcome to Medicine.

If you feel elated, and overjoyed, welcome to Medicine.

If you feel awestruck, welcome to Medicine.

Whatever you feel, it’s ok.

You’re ok.

Welcome.