Ultra-Brief Survival Guide for the July Medical Intern and BEYOND
Ultra-Brief Survival Guide for the July Intern and BEYOND
When you first see a patient (and continually) acknowledge them as people first - look at them, hear them, touch them.
Nurses are the key to hospital function and your happiness. They know your patient so empower them, learn from them, teach them.
Be friendly and show respect to EVERYONE you encounter throughout the day. It is both part of being a good person (and practical) - you may need their help one day.
Try to make sense of all clinical issues - from basic to complex. Be flexible - one way to be aware of what you know and don't know about a concept is to try and teach it.
Define your patients problems. The differential you generate to explain them will guide your questions, exam, testing. Be mindful of this as you assimilate information. Making sense is far superior to "memory".
Triage all day. Understanding what is the most important will help guide how you parcel your time - at the bedside, in discussions with the rest of the health care team, in your pursuit and follow up of diagnostic testing.
Triage your differential diagnoses. Ensure the most dangerous issues are ruled out before accepting more innocuous explanations. Make a "do not miss" list of lethal diagnoses that can be easily overlooked.
Read and ask questions. Find a group of "go-to" people in all specialties who you trust. Remember - one guaranteed way of missing a diagnosis is to not think of it!
When confronted with a clinical problem (if there is time), think about the underlying pathophysiology. Let this guide your therapy.
Make eye contact with the "leader" on rounds. Reasoning, even faulty, is far superior to silence and avoidance. Organize your thoughts before speaking and express them in full sentences.
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