At this time of year, your goal with residents is to get the to relax. 1/
Let them put easy things together.
Pneumonia with hepatitis and hyponatremia might be legionella. (It was). 2/
Pneumonia with hepatitis and hyponatremia might be legionella. (It was). 2/
After 9 months, the interns are scared shitless of missing some tiny detail.
They miss the forest for the trees. Due to anxiety and hyper-vigilance. 3/
They miss the forest for the trees. Due to anxiety and hyper-vigilance. 3/
If you can get the team to relax and see what’s happening in front of them, they will do better. 4/
Let them have fun and laugh so they remember why they signed up. 5/
The only thing that matters in a bedside presentation is
1. What do you think is wrong and
2. What are you going to do about it 6/
1. What do you think is wrong and
2. What are you going to do about it 6/
I don’t even care if you list the 99 things the patient “denies” and tell me how many “oxys” he uses. 7/
We don’t do nitpicking in spring.
We do big picture.
We strengthen your intuition and rebuild your common sense. 8/
We do big picture.
We strengthen your intuition and rebuild your common sense. 8/
The old man in a coma doesn’t have asymptomatic bacteriuria.
He’s unconscious, not asymptomatic. 9/
He’s unconscious, not asymptomatic. 9/
He has a Foley in last week for 3 days perioperatively.
Don’t make it hard. Make it easy.
Common things are common. 10/
Don’t make it hard. Make it easy.
Common things are common. 10/
We had a case last week where the team was trying to hammer the square peg or a story into the round hole of a diagnosis. 11/
I said, “We are doctors. Very capable. Let’s just start over. From the beginning. Let’s call his son and figure out what happened and go from there.” 12/
Heart failure could make a person confused.
I felt better when we found the PCO2 = 75mmHg. 13/
I felt better when we found the PCO2 = 75mmHg. 13/
Residents think best when the atmosphere is loose and playful.
When any new ideas are worth considering.
No energy is wasted in worry. Successes are celebrated. 14/
When any new ideas are worth considering.
No energy is wasted in worry. Successes are celebrated. 14/
Most important: Residents do best when they return to the stories patients tell. When we remind ourselves of the joy of letting someone spin us a yarn.
Just let the story run it’s course. Funny, tragic, unbelievable. 15/
Just let the story run it’s course. Funny, tragic, unbelievable. 15/
These young doctors are not practicing to become an AI healthcare kiosk.
They are practicing to hear stories and learn how diseases intermingle with fascinating human lives. 16/
They are practicing to hear stories and learn how diseases intermingle with fascinating human lives. 16/
You can look up the dose of LEVOFLOXACIN for Legionella in 2 seconds. (750mg daily for NL GFR)
Spend the time trying to figure out where he got it.
Where is the germ hiding in the water? 17/
Spend the time trying to figure out where he got it.
Where is the germ hiding in the water? 17/
Who is this person who has caught this rare (in Colorado) infection and what’s going to keep them from getting their antibiotics and getting better? 18/
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