Your attitude, your expression, your words, and your actions all impact communication. And communication is vital to success in your home life, your social life, and your career.
Be very careful… Jokes and things done to make people feel better are not always about the intentions behind them. Even intending good, you may offend someone or make them feel violated. In this case, a surgeon was sued for giving a temporary tattoo. Kind of cute to some… deeply violated to others.
And the point is not to be careful just because you will get sued. No. Be careful, because you may leave someone feeling violated and you might get sued. Both.
Personally, I’d have trouble sleeping in either case.
OK. Normally, I probably wouldn’t highlight a hospital ranking article for new interns and residents, but this one is very well done. It is a great article to learn from. US News and World Report’s America’s Best Hospitals covers ventilator associated pneumonia (VAP) protocols, bedside manner, handoffs and signout, turf battles between specialties, getting feedback from patients, and more. Although it is written as if you know very little about medicine and surgery, there are some great lessons and perspective changers for med students, interns, and residents.
A huge part of your training is getting feedback – constructive feedback. Too often you will come across upper level residents, attendings, and supervisors who give useless feedback. And you should not settle for feedback that is useless.
Here’s what I mean…
Let’s say you go and ask your attending, “Dr. BossMan, I was just wondering how I’m doing. Am I doing okay?”
You will see, the problem lies in how you asked the question. Invariably, the answer will be “Fine. You’re doing fine.” Or, “You’re doing great. You have nothing to worry about.”
Useless. Completely and utterly useless.
This kind of “feedback” will not help you improve. It will not help you to form good habits, nor will it alert you to bad ones.
Here’s a better question for your attending… “Dr. Advisor, can you take a moment to look over this H&P and tell me how I can make it better?“
You can do this with any particular area you want to improve in. Note writing, history taking, presenting patients, introducing yourself, signing out patients, running codes, etc. Whatever it is.
I just added more to the feedback portion to the RookieDoc Orientation Mastery Program to help you optimize your feedback – templates and scripts – exact phrases to try for yourself. You really need to form good habits now.
Walking by the nurse’s station, I heard the ward secretary complaining about “these residents nowadays”. She named a few, but for the most part, grouped all residents together – as if all house staff are cut from the same white coat.
She had some valid points, but the way she blurted them out – the tone, the implications, the facial expressions, and the volume – all somewhat discredited her concerns. It was just someone complaining at work… that’s all it was to most.
Nearing the end of the tirade, she turned to me and said, “Dr. Tori, somebody’s gotta do somethin’ ’bout these new residents. Somebody’s gotta get to ’em before they get this way.”
I asked, “What’s the problem?” (even though I heard the whole thing from beginning to end)
She replied, “I don’t know. They just don’t have no sense.”
“About what?” I asked.
She said, “You know, the way they talk… manners… etiquette. It’s all about them.”
I said, “OK, here’s what I want you to do: Write it down. Tell me what residents need to do. Give me specifics.”
Here’s her list
- The way you ask a question – Start with “Good morning” or “Good afternoon” or any greeting. Then start your question like “May I have…” or “Do you have…”
- If there are three or four unused phones at the nurse’s station, don’t grab the one right in front of the secretary.
- Greet me first, before you ask me which nurse has your patient.
- When you page someone, please let us know.
Not unreasonable, huh?
I would probably add:
- Write legibly
- Put your pager or phone number after your signature
- Identify yourself and team/coverage when returning a page
- Greet the one who answers the phone
- Go over complicated orders with the nurse and/or secretary before leaving
- Tell someone when you put stat orders on a chart
Add any more that you can think of in the comments…
At first, I was skeptical. Something inside of me said that sending only very small ‘tweets’ of information would be useless and distracting. But after hearing about a bunch of people I respect using Twitter, I looked into it a little more – a lot more actually.
I found that by reading my friends’ ‘tweets’ about what they were doing, I learned some things about them that I didn’t know before – even though we were friends. Actually, I’ve hit some of them up for advice in those areas after learning their interest in them. Twitter is like text messaging on steroids.
So, I decided to do it for RookieDoctor.com. Rather than wait until there is a collection of good links or a bunch of useful articles before sending a RookieDoc FAQ or making a new RookieDoc PDF report, I can just tweet them, as I find them.
Likewise, if you find something you think other med students, interns, or residents might find useful, you can ‘tweet’ me directly. Go check out Twitter now and look it over. If you happen to sign up, then start “following” me (RookieDoc) and send me a personal message to let me know you’re on board.
Be cautious about what you put out there though. As a physician, the world holds you to a different standard – sometimes rightfully so, sometimes not. Certainly, you should never, ever put patient information or even institution information online in any way… not a web page, not a blog, and not Twitter.
If it’s not something you would shout across a crowded room, then don’t even think of putting it out there. It will come back and bite you.
Go ahead… tweet me 🙂 Rookie Doc on Twitter
I posted a survey where you can ask me anything about internship and residency. I’ll answer some questions on the RookieDoc FAQs – these are occasional phone conferences for RookieDoc fans and members where I discuss a hot topic or answer questions.
I may not get to every question directly, but may be able to post important answers here, in special RookieDoc reports (PDF), on the RookieDoc Squidoo lens, or in the Audio Tips series.
Okay, I just spent almost the entire day putting some finishing touches on something that will really help you out… but indirectly.
It’s really cool, but in a way, it’s sad that I had to do it.
The fact is that because of your career path, and because of the current stage in that path, your relationships are in for a change – a shake-up. You are going to face stress from angles you never really thought of. Although it is all manageable, it is not easy. And unfortunately, our family and friends are usually the ones that bear the brunt of it.
So, I created tips and strategies for them – for your friends and family. No charge, no gimmick, no catch.
Very simple… They sign up with their name and email. Then every so often, I send them a little message – audio and written – only a few minutes long – but full of great info and ideas for maintaining your relationships (and sanity).
They can sign up here:
Or, better yet, send them to the main RookieDoctor.com site, to the Family & Friends section. Here’s the direct link: Audio Tips for Loved Ones and Friends of Interns and Residents.
Having an excellent bedside manner is ultra important. If you master having a good bedside manner, you stand to make your patient feel better, potentially heal quicker, and certainly complain less. Your patient will trust you more, and you’ll be able to extract a better history.
If you have a good bedside manner, your patient will tell other people. Your patient’s nurse will tell other people. And guess what? It will absolutely impact how your attending evaluates you.
You will be sued less, get paged less, and be respected more.
And it is so simple to start. Here are three quick tips from the Rookie Doc Squidoo lens:
1 – While sitting a patient up to listen to their lungs, just say, “Hey. While I have you up, let me flip your pillow to the cool side.”
2 – When you plan to order some medications, don’t just tell them you’re ordering them. Explain that it will take a little while for them to come up from the pharmacy.
3 – When you’re all done in the room, put things back the way you found them. Put the call bell in reach, move the phone closer, and, if their allowed to eat/drink, move their tray closer to them.
There are many, many more little things you can do listed at the Rookie Doc Membership Site.
OK. It’s official. I’m tired of this phrase. (Just heard this from a ward secretary in a normally vibrant, happy-go-lucky hospital.)
- Not in my job description
- They don’t pay me enough to do that
- If they want me to do that, they’ll have to pay me more
- Blah, blah, I, blah, me, blah, Me, me, me, I, I
“Not in my job description”, in all of its forms, is destructive. Don’t use it. It doesn’t help anyone, and, in fact, it hurts you.
Simple analogy… A ship is in a horrible storm, tossing and turning in mountainous waves. Rain pouring in. The ship can’t be controlled. What’s the next step? Get rid of the least important cargo. Start throwing stuff overboard. Are you that piece of cargo? If the ship starts sinking, are you the one they’ll get rid of?
If you are the cargo that’s thrown overboard, it’s not some conspiracy against you. It’s not your gender, your ethnicity, your haircut, your political stance, or your job title. It’s much more simple than a plot. It’s just a matter of – to get this ship sailing in the right direction, we have to get rid of the least valuable cargo. And that least valuable cargo is the stuff that only fits into a single purpose, a single task, or a single job description. If we can use the cargo for multiple things, even outside of it’s normal uses, then let’s keep it. It may come in handy.
Sure, there are times when something is outside of your power, your influence, your knowledge, etc. And sure, there are times where you are working on something more important than what you are being asked to do. But there are better ways to say it.
- “Actually, I don’t know the answer to that, but So-and-So might be able to help. Try extension 2345. They should be able to help.”
- “You know what? I’m sorry. As a secretary, I can’t take verbal orders. But let me get his nurse for you.”
- “Normally, I’d help you and send off that fax, but I have heavy patients right now. Sorry.”
- “Aw. I wish I could help. But I don’t even know where to begin finding an answer to that.”
You can say “No” without saying “It’s not in my job description.”