4 Principles For A Focused Handover.

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:

Four Easy Ways To Connect With Your patient. 

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.

Sleepless On Call – 5 Things To Do Before You Wake Up Your Boss

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:

4 Thoughts On Why I Document My Patient’s Favorite Soccer Club

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)

Three Ways To Show The Patient That You Pay Attention – To Him

“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.  

Get Your Attending Fired Up – So You Can Finally Learn From Him, Big Time.

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:

4 Ways To Handle Grumpy Patients

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:

The importance of being honest – 4 ways to improve your patient’s satisfaction ratings

Whether our patients are content with our work greatly depends on their expectation prior to the treatment.
While we should always do our best to deliver high quality work, modulating -and many times lowering- their expectations can further maximize your patient’s satisfaction ratings. Here are 4 ways how you can do that.

Present your patients like this – and your attending will love you

Presenting cases is one of the most important skills in medicine. Mastering this skill will greatly improve your work as a doctor and enhance your career. When you give good presentations, your attending will

  • know you understood the patient
  • trust your judgement and
  • give you more responsibilities.

Doctors, who know how to present a patient will be perceived as professional by their colleagues and bosses. Here are 7 key points. 

Here Are 7 Steps To Telling Your Colleague About His Error – Without Becoming His Enemy

“Hey Daniel, greetings from Jack [our attending, name changed]: Don’t ever put in a pneumocath in a patient’s chest again, your patient suffered a pneumothorax”.

That’s how I was greeted to my late shift after I had put a chest tube in a patient the day before, which obviously hadn’t work out as we had hoped.

As it turned out, the patient had a pneumothorax before I even saw him. But either way, I wasn’t all that happy about this kind of feedback in front of all my colleagues. Obviously someone was happy I had caused a complication.