Tips for IM attendings – Chapter 3a – domains and skills visualized
This graph frames the domains and skills that characterize successful ward atttending rounds. As we consider the entirety of this task, this visualization may help you put the skills into a useful mental construct.
As we discuss the individual skills and domains, come back to this graph frequently. Continued study will reveal truths not originally apparent. (Source: DB's Medical Rants)
Source: DB's Medical Rants - July 5, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM attendings – Chapter 3a – domains and skills visualized
This graph frames the domains and skills that characterize successful ward atttending rounds. As we consider the entirety of this task, this visualization may help you put the skills into a useful mental construct.
As we discuss the individual skills and domains, come back to this graph frequently. Continued study will reveal truths not originally apparent. (Source: DB's Medical Rants)
Source: DB's Medical Rants - July 5, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 3 – Domains and skills
Over 10 years we began an interesting research line asking the question, what do learners value in successful ward attending rounds. The major paper in that research has this summary:
Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were “Teach by example (bedside manner)” (4.50), “Sharing of attending’s thought processes” (4.46), “Be approachable—not intimidating” (4.45), “Insist on respect for all team members” (4.43), “Conduct rounds in an organized, efficient & timely fashion” (4.39), and “State expectations for residents/students”...
Source: DB's Medical Rants - July 4, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 3 – Domains and skills
Over 10 years we began an interesting research line asking the question, what do learners value in successful ward attending rounds. The major paper in that research has this summary:
Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were “Teach by example (bedside manner)” (4.50), “Sharing of attending’s thought processes” (4.46), “Be approachable—not intimidating” (4.45), “Insist on respect for all team members” (4.43), “Conduct rounds in an organized, efficient & timely fashion” (4.39), and “State expectations for residents/students”...
Source: DB's Medical Rants - July 4, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips of IM Attendings – Chapter 3 – Domains and skills
Over 10 years we began an interesting research line asking the question, what do learners value in successful ward attending rounds. The major paper in that research has this summary:
Thirty-six faculty, 49 residents and 40 students participated. The highest rated attributes (mean rating) were “Teach by example (bedside manner)” (4.50), “Sharing of attending’s thought processes” (4.46), “Be approachable—not intimidating” (4.45), “Insist on respect for all team members” (4.43), “Conduct rounds in an organized, efficient & timely fashion” (4.39), and “State expectations for residents/students”...
Source: DB's Medical Rants - July 4, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM Attendings – Chapter 2 – Humility
“Humility is to make a right estimate of oneself.”
– Charles Haddon Spurgeon
“Don’t think too highly of yourself. But also don’t think too lowly of yourself. That’s false humility.”
– Tony Bennett (UVa Basketball Coach)
The best clinicians and the best educators exhibit humility. As a student and resident one attending physician repeatedly told us the importance of humility. Dr. Orhan Muren, a 5 foot tall Turkish pulmonologist, repeatedly told us that “in medicine never get cocky”. He was telling us to avoid hubris. He told us to consistently ask ourselves if we had the correct ...
Source: DB's Medical Rants - July 3, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM ward attendings – Chapter One – servant leadership
The best attending physicians, at least in my opinion, embody servant leadership. Unfortunately, we all have had attending physicians do not understand or live this philosophy.
A servant-leader focuses primarily on the growth and well-being of people and the communities to which they belong. While traditional leadership generally involves the accumulation and exercise of power by one at the “top of the pyramid,” servant leadership is different. The servant-leader shares power, puts the needs of others first and helps people develop and perform as highly as possible.
While the concept seems simple, the execution req...
Source: DB's Medical Rants - July 2, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Tips for IM ward attendings – Introduction
This article provides some concepts that have influence self reflection and conversations with colleagues: The Chromosomal Analysis of Teaching: The Search for Promoter Genes
Likewise I must recognize my colleague and friend Dr. Gustavo Heudebert, who I first met at Stanford in Dr. Skeff’s classroom. We have worked together for the past 21 years. During this time we have had many discussions about the ward attending process.
My colleagues and co-authors, especially Dr. Analia Castiglioni and Dr. Brita Roy, helped quantify some concepts in our ward attending rounds research. These studies helped me understand t...
Source: DB's Medical Rants - July 1, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Dealing with obstacles
Over the past several months, I have been slowly reading The Obstacle Is the Way: The Timeless Art of Turning Trials into Triumph
Here are some quotes:
“We forget: In life, it doesn’t matter what happens to you or where you came from. It matters what you do with what happens and what you’ve been given.”
“The only guarantee, ever, is that things will go wrong. The only thing we can use to mitigate this is anticipation. Because the only variable we control completely is ourselves.”
“It’s okay to be discouraged. It’s not okay to quit. To know you want to quit but to plant your feet and keep inching closer u...
Source: DB's Medical Rants - June 24, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
On taking an excellent history
The art of eliciting the medical history requires medical knowledge, cultural knowledge, and many “people skills”. History taking is not science, but rather art, because it requires interpretation and clarification. Patients with the same symptoms express them differently. A major feature of the art of medicine involves learning how to interpret different descriptions of the same phenomenon.
A few examples might clarify these concepts.
The patient tells you that they have chest pain. At this point you really know very little. What are they really describing? How might they characterize the pain?
A p...
Source: DB's Medical Rants - June 22, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Listening to our patients
Around 30 years ago, LRZ taught me a most important lesson. LRZ, one of my most fondly remembered patients, was a classic blue collar guy. He had a wonderful gregarious personality. He had significant systolic dysfunction, yet still worked hard for the city. Amongst other things he did, he shoveled the salt into trucks on snow and ice days. He functioned well most days.
One day he came to see me. In those days, prior to ACE inhibitors or the use of beta blockers, we focused on digoxin and diuretics. As I picked up his chart I noted that he had gained 3 pounds. From past experience, I knew that he would soon...
Source: DB's Medical Rants - June 21, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
For new 3rd yr med students #med3advice
You cannot make up the stories patients tell you
You should not share these stories with your non-medical friends
Read about your patients
Keep a notebook (paper or digital) of clinical questions that you see each day
Spend 30-60 minutes reading about those notebook entries each day (reading reinforces the discussion from rounds)
Remember that your patients benefit from your caring
Sit down, talk to your patients, touch them in an appropriate manner (I favor wrist pulse) – they benefit and you learn more
Ask questions when you do not understand something
Take care of your personal health – exercise, eat relativ...
Source: DB's Medical Rants - June 12, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Imposing regulations without evidence
“Experts” consistently champion evidence based medicine. Policy wonks opine that we could greatly improve patient care if we more consistently followed the evidence. Evidence has become a major buzzword in health care.
Yet too often regulations impact physicians that have no evidence base. I have argued against the clinical skills exam for many years. Please read this Washington Post article about the exam – $1,300 to take one test? Med students are fed up.
How about the method of note writing that CMS inspired? Does anyone believe that our notes have improved with the billing requirements?
Do ...
Source: DB's Medical Rants - June 10, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Weight control planning – Day 3/7 #weightcontrol
Today is another day, just like yesterday. I worked out early this morning, and started the day with an excellent low calorie bagel and lox. My planning for the day duplicates yesterday’s. I have no dinner plans, and when that happens I try to eat light in the evening. Still not sure about lunch, only that it will be modest (filling but not stuffing).
Today resembles many other days. A good day includes a workout, modest eating (I do not count calories, but I do try to not overeat.
“Eat Breakfast Like a King, Lunch Like a Prince, and Dinner Like a Pauper”
I do not do that every day, because I often go t...
Source: DB's Medical Rants - June 7, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Weight control planning – Day 2/7 #weightcontrol
Monday started with an energetic OTF workout. As I said yesterday, I have the first half of this week planned already. Breakfast was modest, as will be lunch. I plan a light dinner tonight.
Today I have done some reading about weight loss and maintenance. The Difference Between Losing Weight And Keeping It Off and I’m an obesity doctor. I’ve seen long-term weight loss work. Here’s how.
… the one common theme is that while maintaining their losses requires ongoing effort, that effort isn’t perceived by these weight loss masters as a hardship but rather as just living with new lifestyles,...
Source: DB's Medical Rants - June 6, 2016 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
