Mobile phones for doctors have changed the clinical routine tremendously. The pager is gone and everybody can be reached whenever he is at work. Is this a progress? I am not sure.
Turns out that the threshold to contact doctors in semi-important issues is close to an all-time-low while the number of calls and hence interruptions is close to a peak.
I don’t know about you, but I have a big problem listening to patients. I mean real listening.
Our daily workload increases all the time, our days become more and more procedure- and action-focused.
Over the years I’ve gotten more and more effective in getting things done. I am totally focused on my stuffed to-do-list and listening closely to a patient rarely is on it.
Rarely do I ask an open-ended question and just wait for the patient to talk for a little while. Usually I just ask for complaints, 1-2 minutes of closed-ended questions and I am off to the next task.
If you’re hoping this blogpost ends with the resume that doctors absolutely must have the apple watch or they can’t fulfill their obligations: I have to disappoint you.
I didn’t purchase the apple watch, my wife gave it to me as a gift when I finished my residency training. I was really thrilled even though I didn’t have clear expectations regarding the service this gadget would provide for me during the day-to-day work…
But there are a couple of features that are quite nice:
Since lack of time is a major concern in every hospital, I’m quite amazed how time is wasted during handovers. Anecdotes and stories not only distract us from the important facts but cause major delays.
I am not against a joke or story from time to time, I like a friendly atmosphere at work. But I prefer a focused, concentrated handover and a little bit of smalltalk afterwards, if time allows it.
Over the years I have come to learn that there are 4 main principles for a focused handover. Here they are:
Having a good connection to your patient has a positive impact on your work in several different ways:
Connecting to a patient on a personal level helps you..
- to keep in mind that you are dealing with people, not with body parts or diagnoses.
- to remember other important information about him. (Your brain makes a connection)
- to have a lot more fun at work.
A couple of weeks ago I was on call in the ICU and I was called by a 2nd year resident. “Mr. Miller isn’t well and has desaturated repeatedly.”
How was I supposed to reply?
“Thank you for the information, good night.”
“I’ll take care of the problem, why don’t YOU go to bed.”
Obviously, the way this piece information was presented neither helped me, the patient or the poor guy on the other side of the phone.
When you wake up your boss during the middle of the night, you should be a little more prepared than someone, who calls 911.
So what can you do to make your boss happy at 3 AM in the morning. Let’s try these six steps:
The nurses made fun of me the other day because I wrote down my patient’s favorite soccer club in the chart. “Patient is a fan of Fenerbahce Istanbul, while his best friend cheers for Galatasaray“ I filled in social history part of the digital chart.
I didn’t have a deeper intention when I did, but I noted I had conversations with four different nurses on the patient’s background, his interests and his life.
1. He cared, so I cared.
The first question the patient asked me, (after admission to the ICU!) was whether I could look up the latest soccer results of the turkish soccer league. It seemed to matter to him and played a more important role than the job he had for many years.
2. A deeper connection.
It aroused the attention of the nurses in the patient (and mine to). If that’s what it takes to get myself and the nurses interested in a patient and thus make a personal and maybe even an emotional connection with the patient possible: I’m in.
3. A goal to work towards.
Let’s say the nurses and doctors know more about the patient. Let’s say the patient has a cat, he walks once a day, or he has a rose garden he needs to take care of: Now the doctors and nurses have a more concrete goal to work towards. The goal changed from „Let’s make him healthy again“. Instead it is: “Let’s do everything, so he can take care of his rose garden.”
4. The patient will like you more.
Sympathy is the foundation of trust. Patients, who like their doctors will trust them more and adhere to treatment plans more.
And by the way, he will find you way more interesting, too.
From now on I’m going to ask for the patient’s hobbies, their favorite TV show and the name of their hamster and document it. Let the show begin and stay tuned for some fun stuff.
Nurses and doctors, who connect on some other level with their patients for the least have more fun at work. Probably they make a better performance, too. (No statistic available, sorry)
“Most people do not listen with the intent to understand; they listen with the intent to reply.”
― Stephen R. Covey, The 7 Habits of Highly Effective People.
During the first years of my career I tried to save every second. One main strategy was to prepare a quick answer while the patient was still talking. As soon as I thought I knew what the patient was trying to tell me, I’d interrupt him and either tell him what to do with his problem, or prescribe something and leave.
But listening to a patient is more than solving his problem. It gives him respect and the feeling that he matters.
Here is what I do most of the day:
1. Aquire data. (history, examination, discuss patient with nurses, ultrasound, laboratory values and so on).
2. Discuss the data with the boss.
3. Do what the boss and I agreed on in step 2. (Do more examination, initiate treatment, stop treatment, get other consults and so on.)
So far so good. I have written many posts about my part of this. How I screwed up and what I learned from it.
Now this post is about the attending. Here is how you know whether you have good attending working with you here. Possibly surprisingly to many, whether you have a good or bad attending becomes evident in step 2, not in step 3 when he gives you his magical treatment regimen.
A good attending will do the following during step 2:
A couple of days ago an 86-year-old patient was admitted to us during my night shift: Glasgow coma scale 5, pH of 7.1 CO2 of 110 mmHg. Even though this seemed like a clear indication for intubation, because of his medical history we were hesitant to intubate him right away and decided to give non invasive ventilation a try.
The nurse and I spent practically the whole night watching after him. With great success. His blood gases and mental status improved rapidly. In the morning of my following night shift I asked him, now with an O2 Saturation of 100% and normal blood gases how he felt.
I’m gonna be honest with you, I was fishing for compliments and kind of expected something like: