1/n Dr. Mark Siegel is a superb critical care physician, ethicist & legendary Internal Medicine Residency Program Director whose weekly notes I read eagerly. This week’s note is titled “what I’d say to new interns” #MarksWisdom #TipsForNewDocs #MedEd
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2/n Siegel starts saying #COVID19 took away joys of orientation: pizza, hot dogs, cold beer, gelato, unscripted conversations & new friendships. But don’t worry, show up, work hard, don't worry, you'll do great & then follows with 14 SPECIFIC TIPS: #MarksWisdom #TipsForNewDocs
3/n Tip #1: Take your own histories. Charts are rife with inaccurate, missing information. Key exposures, mounting symptoms, details patients held back- until you asked. To paraphrase Osler, patients will tell you the diagnosis, if you listen. #MarksWisdom #TipsForNewDocs #MedEd
4/n Tip #2: Think for yourself. We have brilliant consultants, but you know your patients best. Be respectful, consider what others say, but at the same time, look things up & think critically. In the end, your patient’s care is your responsibility. #MarksWisdom #TipsForNewDocs
5/n Tip #3 is appropriately short. Be concise. Long notes and presentations are hard to follow. Don’t bury the message. Filter, focus, and get to the point #MedEd #MarksWisdom #TipsForNewDocs
6/n Tip #4: Beware of copying and pasting. Too many notes overflow with outdared & irrelevant discussions & plans. Don’t risk your credibility. If you copy and paste, proofread carefully, and NEVER EVER copy someone else’s note. #MarksWisom #TipsForNewDocs
7/n Tip #5 is a favorite of mine: Circle back. Visit your patients at the end of the day. How are they doing? Do they have questions? Your patients want to see you again and you want to see them. #MarksWisdom #TipsForNewDocs
8/n Tip #6: Get to know your patient beyond their disease. Ask patients about kids, family, pets, interests & hobbies. Discuss the weather. Smile and laugh. Non-medical conversations build trust & enrich your day. #MarksWisdom #TipsForNewDocs
9/n Tip #7: Call the PCPs. Keep outpatient physicians in the loop. Many have known their patients for years & can help. Route your notes to them in EPIC or give them a call so they’re ready to see their patients after discharge. #MarksWisdom #TipsForNewDocs
10/n Tip #8: Avoid PRNs. When you write PRN orders, you’re signaling you don’t need to be called. Is that really the message you want to send? #MarksWisdom #TipsForNewDocs
11/n Tip #9: Document. Whenever you see a patient, write a note. Every time. Don’t make covering teams wonder why you ordered a head CT, sent blood cultures, or got an EKG. Describe your findings, your concerns, your plans. Event notes are precious #MarksWisom #TipsForNewDocs
12/n Tip #10: Ask questions. If you don’t understand something you’re probably not alone. Word to our attendings and senior residents: please role model humility. No question is silly or too simple. #MarksWisom #TipsForNewDocs
13/n Tip #11: Search for the root problem. Important to diagnose poorly controlled diabetes & order insulin but best physicians also discover the patient is living with homelessness & can’t afford meds. #MarksWisdom #TipsForNewDocs
14/n Tip #12 You’re right, it’s hard. Interns have a tendency to think they’re the only ones struggling, or that they’re not going to survive the year. I felt that way, so did your attendings and seniors. Avoid the temptation to blame yourself #MarksWisdom #TipsForNewDocs
15/n Tip# 13: Have fun & take care of yourself. Enjoy learning. Relish special moments with your patients. Nourish friendships. Take pride in your expanding skill sets. Remember the 4 tenets of wellness: eat, sleep, exercise, and socialize #MarksWisdom #TipsForNewDocs
16/n Tip #14 and beyond everything: NEVER forget you are part of THE HEALTHCARE TEAM, with nurses, therapists, social workers, pharmacists, transporters, and environmental assistants, working together for one purpose- to heal. #MarksWisdom #TipsForNewDocs
