This is the first in our Residency Survival Guide series. To get weekly tips on how to ace your residency, sign up here.
New levels of patient responsibility. Working with nurses. So many sleepless nights. Residency is full of challenges and learning curves. Every week, we’ll give you five actionable tips from physicians who’ve been there.
This week: inpatient management and how to talk to patients.
1. Don’t: Assume relationships
Simple #TipsforNewDocs:— Fumiko Ladd Chino, MD (@fumikochino) June 18, 2019
1) Introduce yourself & your role to everyone in room
2) never assume relationships, (verify spouse, kid, friend)
3) SIT DOWN (no chair? GET A CHAIR)
4) Speak in plain language (oncologist = cancer doctor)
5) “what ?s do you have” is better than “any ?s”
When you’re meeting a patient for the first time, be sure to clearly establish relationships. You can introduce yourself to everyone by saying something like: “Hi everybody, I’m Dr. X. My first name is Sheila, and I’m part of the team looking after Mrs. Buchowski.”
If your patient and the other people in the room aren’t responding, prompt them with questions like: “How are you two connected?”; “What’s your relationship to Mrs. Buchowski?”; “Would you mind just telling me a bit about everybody in the room, so I can get acquainted?” Questions that may seem awkward for social interactions are interpreted quite differently when posed in a professional setting. Don’t be social, be professional.
One more tip: When you’re talking to patients and families, keep your hands away from the doorknob.
2. Do: Find out the reason for their visit
Ask your patient,— Andrew Stolbach, MD, MPH (@toxicologist12) May 24, 2019
“What were you hoping we could do for you today?”
For those cases when you take a history and still aren’t sure why they came to the hospital, the answer may be illuminating. (Basically, a really nice way of asking, “Why are you here?”)
Asking patients what they’re hoping you can do for them may ultimately have the same meaning as “why are you here?” but it gives the patient more flexibility. They may be inclined to divulge a richer history, making your job easier. Other ways of asking this include, “I’ve read your chart, but I want to hear from you”; or “What problem would you like solved?”
3. Don’t: Leave patients with unanswered questions
A registered nurse on Figure 1 noted that on two separate occasions, patients learned their diagnosis from her as she was doing the bedside report. This means their physician forgot to tell them their diagnosis. Patients are expected to trust their physicians, though it behooves the doctor to appreciate that trust. Explaining procedures, diagnoses, and treatments to patients will foster more trust between physician and patient and reduce stress and anxiety. Treat the patient like the boss. They don’t need to know everything, but they want to feel like they do.
4. Do: Be honest about your limitations
#TipsForNewDocs— Michelle Kittleson MD (@MKIttlesonMD) June 30, 2019
What do you say to a pt when you don’t know?
Someone knows: “That’s not my area, but we’ll find the right doc.”
No one knows: “Docs are better at telling you what something isn’t instead of what it is- but we’ve ruled out the serious causes.”#kittlesonrules
In an age where patients are accustomed to getting instant answers online, it can feel daunting to tell a patient, “I don’t know.” The truth is doctors have always had a hard time saying “I don’t know.”
Demonstrate both humility and capability to your patients. First, show them you don’t always know the answers. Second, show them how you’ll find answers. This combination of humility and capability wins over patients and attendings alike. Writing down their questions can help them feel heard and assure them you’ll to find the answer later. It’s okay to let patients know you’ll get back to them, but don’t let them down.
5. Don’t: Forget that pain has many names
Me (Intern): “You having chest pain?”— Dorian L. Beasley MD, FACC (@cardiojaydoc02) July 2, 2019
Attending MD: “You having chest discomfort?”
Patient: “Yes! It’s like a pressure or tightness.”
Patients separate pain from pressure or tightness.
Ask if they’re having chest discomfort. #TipsForNewDocs
Discomfort, tension, tightness, pressure, sensation, pain, burning, heaviness, uneasiness: All these words can be interpreted differently from patient to patient. Whether it’s a language barrier or a reluctance to say “pain” because they’ve felt worse pain before, it’s best to either reframe what you’re asking or start with open-ended questions. Try, “what do you feel?” instead of limiting them with a yes-no question.
Survival guide affirmation:
If you’re ever lost in the woods with a group, the first priority isn’t navigation, shelter, or food. It’s fire. Making a fire helps repurpose the group’s focus, provides a sense of security, and lifts everyone’s mood. The first meeting of a patient and their family should have the same effect.