We teach wrong when we teach residents to write elaborate notes. 1/many
Doctoring is not performed in front of a computer in a work room. 2/I’m going off
Every extra minute spent writing pretty notes is a minute not spent
- solving the sick person’s problem
- learning about the disease, it’s diagnosis and treatment
- discussing complex medical decisions with colleagues
And most importantly
- talking to your patient 3/
How many times do I hear “he is noncompliant” and “she has no understanding of what’s wrong with her”!
Well, non of those things is going to change while you stare into the monitor in the “work room.” 4/ stay with me
Notes need not be perfect. 5/this is the thesis
Write that down. 5/srsly
Notes are a quick and dirty representation of the ACTUAL WORK YOU HAVE DONE THAT DAY.
Of which zero is done on the note, itself. 6/
The note is not your patient. 7/man
Just jam down some words that represent the actual doctoring you have performed. Explain in haiku efficiency what the hell you are thinking. One sentence about what you think is going on and what you intend to do about it. 8/
Then log off, step into the hallway of the hospital, and walk around to see what’s going on in each of your patient’s rooms. 9/don’t be scared!
Believe me, they don’t know what you are doing when you aren’t in their room and they don’t care. 10/#facts
Your patients view you as a Mechanic of Health, not a Court Reporter of Disease.
Work they don’t see you doing is not getting done. 11/
Some among you may start your rebuttal “CMS documentation requirements state...”
You are the exact medical educators turning medical doctors into hopeless depressed spiritually void bureaucrats. Go get an MBA and leave doctors to practice medicine. 12/12
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If a patient is having trouble getting along with staff in the hospital I sometimes take the time to teach them how to get the best care possible in the hospital. 1/
First you get to know the names of all the people taking care of you. 2/
Understand while they are here doing their job and treat you with courtesy and respect they are also human beings who appreciate being treated with courtesy and respect. 3/
Somewhere in the last few months I unfollowed or blocked the lynchpin of social media crazy and now they’ve all gone away.
The antivaxxers, flat earth, fluoride is poison, 5G, COVID’s a hoax. All of them. Gone. All I see day after day is normal, logical, scientific opinions.
I wish I knew how I closed the wormhole to Tinfoil Hatland. It’s become so pleasant here where reliable people depend on other reliable people to render reliable opinions.
Alternatively, maybe I silence the people who are full on 🍌🍌🍌 so fast and so effortlessly that I just keep screening them right out of my sphere of attention. 🤔🤔🤔
I recently had a house staff teaching team and as an experiment we added a “problem” onto the end of each patient’s problem list called:
Bias.
[A thread]
With humility, I admit I Didn’t think this project would bear as much fruit as it did.
After all the problems of ACUTE HYPOXEMIC RESPIRATORY INSUFFICIENCY and SIRS, I would ask the team to consider how the patient’s race, gender, orientation, nationality, ethnicity, language, socioeconomic status, addiction, etc. was affecting their care past or present.