Posts tagged journal

Agree with above medical student’s assessment.

The satisfying addendum by attendings to a well written assessment and plan.

The Burning Flush of Confrontation

I stood there and did my best to explain what we felt was going on, our impression of the possible causes, and our investigations around them, some of which simply could not be done tonight.

The family was not satisfied. “We want answers. Now.” From there came the questions. “Why must it happen later? Why is this test being done? Why will you not take our complaints seriously?”

I reassured everyone that we were checking every avenue, that there was a method and reason behind the tests and explained as plainly and thoroughly as I could. More importantly, I tried to address their concerns up front and with honesty.

Nothing could appease my audience. I could feel the growing dissatisfaction in their tone, the tension that my presence brought to an obviously well meaning and concerned family.

However, standing there, the focus of every pair of eyes in the room, I began to feel the churning of my stomach, the pounding nudge in my chest, and the burning flush of my face. I had become an enemy in the room, an obstacle between the vocal family who wished to be heard and heard by none other but the doctor himself. It was time I excused myself.

I returned quickly to my attending and explained the situation: I had attempted my best to alleviate their anxiety and answer their questions but I had failed. I needed help.

When he arrived, even then the discussion presented challenges. It took a lot of work to come to an agreement and understanding.

The communication channel is open both ways. The solution to defusing a situation like this is always to make people feel that they have been acknowledged, that their concerns have been understood, that they are not an afterthought in this already complicated system of care. Even with that in mind, the discussion can be challenging. It really takes a lot of patience, perseverance, and thick skin to build up the rapport needed in difficult situations.

Perhaps with time and experience, I can find a way to finally manage this myself. For now: please do not shoot the messenger.

Were you ever involved in a confrontation? How did you deal with it?

Invest in building your network. It will pay dividends in the future.
A specialist’s advice on building relationships with other doctors, community resources and services in a future practice.

Thunder Clatter by Wild Cub.

It is starting to look and feel more and more like summer. A sunny Monday afternoon like this requires the appropriate accompaniment. Here is the song for my drive home. 

SoundCloud / Wild Cub

The Satchel. Through thick and thin, my satchel has accompanied me through medical school. Initially, it strictly carried books and papers; now it is a repurposed bag for a clinical life. I talked briefly about what I usually carry with me in my first clinical pearl post. In response to Wayfaring MD’s post, I thought I would share what I actually bring with me. These are my standard issue items, with room for switching or adding more items as needed: Satchel Pocket evaluation forms: For clinical skills and procedures. Pocket Medicine: A compact book for diagnostics, investigations and laboratory values. Two clipboards: The first contains regular paper for note taking including pre-printed progress notes and other chart-related forms; the second contains preceptor documentations including more formal evaluation sheets, outcomes checklists as well as my weekly schedule. The notepad: Where I write and gather my patient information and keep the to-do list for the patients I am responsible for. Moleskin notebook: Where I keep rotation specific clinical pearls and other tips and tricks. Two pens: Always keep a back up pen. Always. Pen light: For the quick neurological screen. ID cards Three packs of lubricating jelly: Need to do a digital rectal exam or a bimanual exam? Gloves are everywhere but these are not. Access codes and contact list Juice box Two granola bars Pager: How I wish this could not be standard issue. Stethoscope: If I am not walking around with it around my neck, it goes back into the bag until its next calling. Other items that I will sometimes include are rotation specific pocketbooks, headphones, and my phone charger to name a few. To the medical readers, what do you carry with you? Tag your response with #what’s in your pocket.

The Satchel.

Through thick and thin, my satchel has accompanied me through medical school. Initially, it strictly carried books and papers; now it is a repurposed bag for a clinical life.

I talked briefly about what I usually carry with me in my first clinical pearl post. In response to Wayfaring MD’s post, I thought I would share what I actually bring with me. These are my standard issue items, with room for switching or adding more items as needed:

  • Satchel
  • Pocket evaluation forms: For clinical skills and procedures.
  • Pocket Medicine: A compact book for diagnostics, investigations and laboratory values.
  • Two clipboards: The first contains regular paper for note taking including pre-printed progress notes and other chart-related forms; the second contains preceptor documentations including more formal evaluation sheets, outcomes checklists as well as my weekly schedule.
  • The notepad: Where I write and gather my patient information and keep the to-do list for the patients I am responsible for.
  • Moleskin notebook: Where I keep rotation specific clinical pearls and other tips and tricks.
  • Two pens: Always keep a back up pen. Always.
  • Pen light: For the quick neurological screen.
  • ID cards
  • Three packs of lubricating jelly: Need to do a digital rectal exam or a bimanual exam? Gloves are everywhere but these are not.
  • Access codes and contact list
  • Juice box
  • Two granola bars
  • Pager: How I wish this could not be standard issue.
  • Stethoscope: If I am not walking around with it around my neck, it goes back into the bag until its next calling.

Other items that I will sometimes include are rotation specific pocketbooks, headphones, and my phone charger to name a few.

To the medical readers, what do you carry with you? Tag your response with #what’s in your pocket.

Advanced Cardiovascular Life Support.

Fourth year is only three months away and part of the additional skills I need, besides renewing my CPR and First-Aid is to undergo ACLS training. 

This will begin in a few weeks’ time.

Sick Leave

I showed up to the ward, hoping to be productive or at least to lend a helping hand for the day. I managed to round on all of my patients.

But I despite my best efforts, I could not quite hack. Having barely a voice is not conducive to this line of work.

After just two hours of work, I am taking the rest of the day off to sleep and rest. I shall see you guys on the other side.

Sincerely,
Tom of the Medical State of Mind

371 plays

Until We Get There by Lucius.

Another day, another song to lift my spirit. This is my study music for the night. 

Monday. My hopes this morning were dashed as soon as I took a breath. A stuffy nose. Achoo! I had not yet fully recovered. I went to work sounding a little worse for wear and it only went downhill from there. My voice got hoarser, my throat felt raspier, my urge to cough grew greater.  I felt miserable. Yet here I was, seeing patients in the emergency department. I developed a metric for the patients I saw: if you felt and looked better than me, you were probably not sick enough to stay in hospital. Worked like a charm. And I still feel terrible.

Monday.

My hopes this morning were dashed as soon as I took a breath. A stuffy nose. Achoo! I had not yet fully recovered.

I went to work sounding a little worse for wear and it only went downhill from there. My voice got hoarser, my throat felt raspier, my urge to cough grew greater. 

I felt miserable. Yet here I was, seeing patients in the emergency department. I developed a metric for the patients I saw: if you felt and looked better than me, you were probably not sick enough to stay in hospital.

Worked like a charm.

And I still feel terrible.

Down with the Sickness. Getting sick is an occupational hazzard. Working in an environment that deals with this as a job description, I am constantly being coughed on, sneezed on, and in contact with surfaces contaminated with bodily fluids. Sure, the immune system buffs up over time and I become less prone to infections, but it is not perfect. Though my exam is fast approaching, I will need to take this weekend light.

Down with the Sickness.

Getting sick is an occupational hazzard. Working in an environment that deals with this as a job description, I am constantly being coughed on, sneezed on, and in contact with surfaces contaminated with bodily fluids.

Sure, the immune system buffs up over time and I become less prone to infections, but it is not perfect.

Though my exam is fast approaching, I will need to take this weekend light.