You won't find the following questions on your shelf exam or your boards exams -- yet, they represent some of the most valuable skills you can hold as a physician. This piece is about what I wish we could teach and grade in medical education. At the end of the day, building strong relationships is what matters -- whether it is with your patients, their families, or other members of the healthcare team. So, good luck, and remember, there's always more to learn about patient care far beyond what any formal medical school curriculum will teach.
Question #1: Where is the blanket warmer in the unit located?
- Next to the nourishment room
- Under the charge RN's desk
- Trick question, the closest warmer is on the unit next door
Blanket warmers are possibly the most underrated piece of medical equipment. Most hospitalized patients are there because they feel terrible -- and there are few things more soothing than a warm blanket. When your patients complain they are too cold or too hot, remember that the hospital is essentially the world's least comfortable waiting room. Your patients often can't get out of bed without setting off alarms, and they are stuck in a situation where they have almost no control. If they are too cold, bring them a warm blanket, and make sure you tuck it underneath the existing blankets (you may remove the top blanket if needed). For extra credit, take two blankets and wrap one around their shoulders like a shawl and place the other around their legs and feet, tucking them in. Honors for the student who also restocks the warmer with clean blankets.
Question #2: How does your patient take their coffee?
- Black
- Cream and sugar
- They don't drink coffee, but they love Coca Cola (and you're in a Pepsi hospital)
Much like question #1, this has much to do with the lack of control a patient has over their environment. They do not have the luxury of leaving to run an errand and purchase food for themselves, and we already know enough about hospital food to know there are approximately four good options on rotation. Lucky patients will have family bring in food for them, but many do not have the support or financial means for this. Anytime you are in a patient's room, it takes little effort to confirm they have everything they need. If they are thirsty, bring them something to drink. Obviously, make sure you tell someone if they have any particular restrictions or if you are unsure, but for most patients, having a fresh glass of ice-cold water goes a long way. Extra credit to the student who knows which patients prefer ice chips and those who like their water lukewarm. Honors if they can find Coca Cola for their patient who refuses Pepsi.
Question #3: Can you choose your patient's nurse out of this photo lineup?
We are absolutely nothing without the other members of our healthcare team. Our nurses, nursing assistants, technicians, secretaries, and janitors are all there for a reason and deserve so much more credit than they are given. I could not do my job without trusting the nursing and support staff on the floors. Our nurses are our eyes and ears during the day, and they will be the first to notice a change in patient status. When you are asked to come to bedside, go to bedside. Make the effort to know your patient's nurses and find them during rounds in the morning. Face-to-face interactions are so much more meaningful -- you will know far more about your patient by talking to their nurse than you will from chart reviewing. Similarly, if you have the chance, go see your patient work with therapies (physical, occupational, speech-language pathology, etc.) -- there is so much you can learn from every member of the healthcare team!
Question #4: Looking beyond your patient's medical condition, what is important to them? Do they have a family to provide support? Do they have a pet they need to find care for?
Know your patient's support system and keep them updated daily -- not just when things go wrong. Building rapport with patients and families is vital to what we do. It's one thing to know the test answer, but another altogether to figure out a treatment plan your patient will be compliant with. At the end of every history and physical exam (H&P), I always ask what people enjoy doing outside of the hospital -- that gives me more information than even the most detailed physical examination. In the afternoons, go back and spend time with your patients. Learn about them as people, not just disease states. This is more valuable than any flashcard set will ever be.
Question #5: Why should you care about notes?
- Billing reasons
- To look busy during the day
- To communicate your plan
Notes (and note bloat) are everywhere -- with "copy forward" many notes suffer from lazy and incorrect information, or they become nothing more than a list of medications. Use your notes to explain your thought process: why bumetanide instead of furosemide (Lasix); why you chose the antibiotics you are using. If you are unsure, look it up and commit to what you think is the best plan. If you are right, you look like a rock star. If you are wrong, you learn why. Not a single resident or attending will remember how many diagnoses you get right or wrong. The worst plan is to half-treat, so don't be afraid to stick to a differential diagnosis, but be flexible enough to change your mind when new information comes in.
I can't promise that knowing the answers to these questions will make you top in the class, but I can promise it will make you a better physician. At the end of the day, your patients will remember you as the one who took extra time to know them as more than just a diagnosis and disposition -- not what grade you got on your exams.
is an Internal Medicine/Geriatrics PGY-2 at Medical College of Wisconsin.