1/15 Some reflections on care for hospitalized patients after 5 years (🙀) of being a hospitalist attending #MedTwitter
2/ Always start with kindness. Many times, someone is not angry because of you - take the time to explore why that individual is having a rough day and offer an ear. If you feel unsafe, excuse yourself from that environment immediately.
3/ Do not assume that the patient knows that they are being admitted. This really goes for any information that you think might be jarring for a patient. Quickly verify their understanding of the situation before you add additional information.
4/ Handle the patient's concerns first. You may be worried about their leukocytosis but they may be worried about their pet at home. Grab that protein shake from the nutrition room or the blanket from the blanket warmer BEFORE you start talking to the patient.
5/ In the right setting, problem-list with your patient to show them what you are thinking about. Do your homework in advance but be upfront about your limitations (we are all human). It is important to demonstrate that you really are trying your best.
6/ Let the patient and staff know when there is a change in the plan. This is extremely important when it comes to medications that help alleviate symptoms - it should be a conversation.
7/ Once the patient's concerns are addressed, make your goals and expectations clear (including anticipated hospital course and post-discharge planning). Adjustment of a care plan needs to happen WITH the patient and this will help you identify barriers to care.
8/ Make your goals and expectations extremely clear with your learners. It is okay to demand excellence, our patients deserve that, but that needs to be backed up with the full support of the supervisor.
9/ If anyone on your team is not treated well, address it. Sometimes it is not possible to address it in front of the patient directly. In those cases, make sure to debrief and address it with the learners separately.
10/ Not all teaching and feedback needs to be delivered at once. Once the learner's emotional and physical bandwidth is spent, table it for a later time.
11/ Thank your learners for their tremendous effort. Reflect on how difficult it was for you in their shoes - what would acknowledgment from your supervisor have done for you?
12/ The resident is the team leader, but there are times when you are looked to (especially at the beginning of the academic year). If you are dismissive of others, it signals to your learners that it is okay to do this.
13/ Do not be afraid to express emotion, whether that is surrounding a patient's situation or a crisis in the world around us. Let your learners know when you are tired, they are likely feeling the same way.
14/ You are a team - model humility and curiosity! There is so much power in saying "I don't know" and then demonstrating how to figure it out. Most of training is refining the process of problem-solving (clinically AND logistically).
15/15 Be considerate of everyone's time. Everyone is juggling a lot of things, many of which are invisible. Be deliberate in everything that you do to enrich the experience of those around you. All other thoughts are welcome!
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