Make time to learn about your patients outside their diagnosis. It will create a sense of a rapport!
Here are some questions that can stimulate interesting conversations:
1) What kind of work do you do (or did you do)?
2) Have you lived in this city for a while?
3) Do you have a good family / friend support system in the area? Do you have anyone I can call while I am here?
4) Do you enjoy playing any sports? What kind of hobbies do you enjoy? (Can be good in Cardiology to determine METS and baseline functional status)
5) I like to ask questions based on their TV channel they may be watching in the hospital (particularly if a sports fan).
6) If patients are wearing a shirt from their recent travel/vacation, can ask how their trip was.
7) How are your kids/ parents doing?
In the outpatient setting, it can be helpful to create a separate section for 'patient notes' w/ personal details (work, kids and names, sports hobbies).
These can remind you of previous conversations and personal information. Patients appreciate the attention to detail!
This idea was influenced by my wife @salonijairdn. In medicine, sometimes we see patients as a diagnosis (patient w/ HF, COPD, etc)
The better we know and connect with our patients outside of their medical diagnosis, I believe the better care we can provide! Comment 👇
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- Part of acute coronary syndrome (ACS)
- Acute plaque rupture that causes partial occlusion to the vessel that results in injury & infarct to the sub-endocardial myocardium.
- Can have non-specific ST-T changes, commonly TWI and elevated troponins
Presentation:
- Chest pain (heaviness/pressure) usually > 20 minutes with minimal exertion, new-onset / increase in severity, better with sublingual NTG
- Patients tend to be older, higher comorbid (DM, HTN, HLD) and high likelihood of prior MI, PCI, or CABG
Presentation:
- Dyspnea: earliest and most common
- Orthopnea: more with advanced disease (90% sensitive and specific), can develop PND and Cheyne-Stokes
- Fatigue/exercise intolerance
- Anorexia, abdominal pain, bloating with advanced right-sided heart failure
Physical Examination:
- Well-compensated: no symptoms
- Volume overloaded: weight gain, elevated JVP, +Hepatojugular reflex (>4 cm)
- Pedal edema (can be non-specific if venous insufficiency, nephrotic syndrome, hepatic dysfunction, use of Ca2+ blocker, or TZD)
The limiting resources during residency, fellowship, & even attending life are time and energy. As a fellow, I am working on trying to improve these 4 aspects.
Lets dive in:
1) Healthy Eating:
- This is critical because in the healthcare setting, we are expected to do physical work (walk around and see patients) & mental work (medical analysis, clinical decision-making)
- As we know, the brain consumes around 20% glucose and requires energy