On Acute General Medicine service (#internalmedicine) at the moment, and realise I repeat myself a lot when telling the junior doctors (interns, residents, fellows/registrars) how we should do things. Also applies to #IDTwitter I think. Here are a few of them (in a thread) 🧵
1. Don't look at the radiology reports before you've looked at the X-rays/scans yourself, and decided what you think they show. Otherwise you'll never get good at interpreting them. (exception: ultrasounds!)
2. Check every medication on every patient every day. Often they are no longer needed, or were not needed in the first place. With electronic prescribing software, this actually takes longer than in the paper days, but it's important and worth the time!
3. Use a pro-forma on the post take round to ensure things are not overlooked. The one I use includes home situation, important results, physical exam from today, DVT prophylaxis, cannulae/catheters, alcohol&smoking history, allergies, working diagnosis, problem list
4. Look at specialist letters and recent discharge summaries. This can often avoid re-inventing the wheel
5. Do less blood tests! Most patients do not need blood tests more than twice per week. And don't do any investigation unless you are going to act on the result
6. Always consider the patient's and families wishes and concerns, and any advanced care directives or resus plans in any important management decision
7. When I say we can discharge a patient, don't let me walk away without asking me for the discharge diagnoses and discharge plan. The doctor writing the discharge summary should not have to read my mind.
8. Don't consult other specialties without talking to me first. I prob don't need advice on the management of the patient's diabetes, pain, heart failure etc.. If I do, I'll call the appropriate consultant.
9. Oh and one more: If you're feeling hungry or the ward round is going on for hours - speak up! I'll buy us all coffee
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