If we can believe the movies and the TV shows the great doctors are always right.
Have you finished your goal-setting for the new year? If not, this time of the year is the perfect to set new goals, that’ll bring you ahead. Just as in any other part of your life, you should set goals for your medical career. Here is how I set goals for the new year.
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:
The most important principle in medicine is pretty simple: “Primum non nocere.” : First of all: Do no harm. People, who go to the hospital and are worse afterwards many times were treated by doctors who don’t follow this piece of advice. Afterwards the patients generally seek legal advice.
So remembering this principle is really helpful. But how do we apply it?
Does that mean that I should refrain from all procedures that imply a risk?
We have an intern on our ICU, who will be a physician in a few months. She asked me what can I do to lose my fear? “Fear of what?” I asked.
“Fear of having my first day at work. Here during my internship I follow you around, I watch, sometimes I put in needles. But having the responsibility for all these patients? The whole unit? That is totally different from what I do here during my internship. So what can I do to prepare better for “day one”?” She replied. Here is my 5 step strategy:
Sleep deprivation is one of the main sources of errors. But many times after a night shift, you’ll have to show up the same day in the hospital for another night shift. That is why after a night shift we should start replenishing our energy levels right away. Ultimately there is only one way to recover from a night shift: high quality sleep. But how can we achieve that?
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:
Few fields demand such a high degree of energy, concentration and emotional stability in order to do a great job, as medicine.
Listening attentively, suturing a vessel, implanting a catheter- those are all tasks that require energy, focus and concentration.
Whether you do a good job in your internship will greatly depend on what you do off the job. Coming to work physically fit and mentally strong will definitely boost your career.
In this job you need to keep your batteries charged. Here are three steps to high energy levels.
There are many ways to Rome, but in my experience there are three major keys to a successful medical career. Here they are:
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.
