How to discuss a patient with the boss – in 2 minutes!

Your time with the boss -the attending physician- will always be very limited. Often you will only have two minutes to present a patient, discuss the results and make a treatment plan.
This is difficult, but it is possible.

The other day I had an important matter to discuss with the attending. He had to be at another meeting, so I walked him to the meeting, which took two minutes and we managed to solve the problem during that time.

But to get this done preparation and a plan is necessary.

 

Here is my 6-step action plan to pull this off in 2 minutes:

  1.  Be well-prepared and have the necessary information ready. When decisions have to be made by the attending it will depend on you to deliver the problem clear and precise.So before you call him, get the facts.Once you get to know the attending, you will be able to predict what information he’s gonna ask.
  2. Catch his attention. You need his full concentration. Tell him that there is an important decision to be made. Don’t say: “Sir, WE have a problem.” (cause he doesn’t, you do!) 10 seconds.
  3. Bring the patient to his memory. Give him the chance to recall the patient:  First, don’t expect him to have the case in his memory from the last time you talked about the case.
    You should mention name, age, sex and relevant diseases. The reasons why the patient is in the clinic now, what has been done so far.
    This shouldn’t take more than 20 seconds.
  4. Now give him the new facts that are necessary to make a new treatment or workup plan. He needs the raw data. “The patient has got 40°C fever  and shortness of breath.“ Not: “I think he could have pneumonia…” At this point, your opinion doesn’t count.
    Be sure to also include bonus information: If the patient just had a CT scan, tell him. If he already is on iv antibiotics, he also should know that before he comes up with a treatment plan.
    30 seconds
  5. Give him at least two solutions that are thought through and again mention relevant facts for further workup. E.g.: “We have two options: Escalate the iv antibiotics to meropenem, or cultivate blood cultures, do a bronchoscopy to screen for pneumocystis and wait until we have a result.Important: Do not give him your opinion, yet. You want HIS opinion. Maybe after you have talked the case through he’ll ask you what you think, and for this you should be prepared. But first, just focus on the facts and listen.
    50 seconds (depending on the specialty. Most surgeons will only need 10 seconds; with internists, could take a while)
  6. Stick to the plan! When you have agreed on a treatment plan: Stick to it, and reassure him you’re gonna put it to practice right away! (10 seconds)This one sounds like a nobrainer, right? Well, I know people who have gotten in big time trouble because they asked attendings No 2,3,4, hoping they would suggest different actions. Attending No. 1 surprisingly didn’t like that and their relationship was seriously damaged.

In the end it just comes down to having the important information ready and presenting them in an order.

Question: What is your number one trick to discuss an urgent matter with your boss quickly? Please leave a comment!

Please note: I reserve the right to delete comments that are offensive or off-topic.

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