Has your bread become stale?

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].

Diagnosing and treating illnesses are the bread and butter of hospitalist medicine. Has your bread become stale?

I used to be envious of older physicians who ‘grandfathered in’ and became exempt from the requirement to recertify every 10 years for the American Board of Internal Medicine. Preparing for the boards is extremely time consuming and, at times, incredibly stressful, but it’s what we have to do to prove that our medical knowledge is up to date, right?

Who hasn’t heard of at least one nightmare outcome after a physician treated a patient with out-of-date standards, probably the same ones he learned in medical school a long, long time ago? We may snicker at this scenario, but could we be guilty too? Could we be so set in our ways, so self-confident that we refuse to grow?

I was watching a hospital medicine CME DVD a few months ago and was shocked, as well as embarrassed, to learn that the way I was performing part of my neurological exam was antiquated. There was a new “gold standard” that I had never learned before. After all, I had been doing the exact same thing for years; too many years, it seems. I mistakenly assumed that all the physical examination skills I had learned in medical school were set in stone. But as in all aspects of medicine, even best practices for performing a basic examination have evolved over the years.

Then there is the old habit of ordering multiple blood tests on hospitalized patients every day. That’s just how many of us were trained during residency, but in real life it’s not always necessary. Sure, if there’s a reason to be concerned about specific parameters they should be followed closely, but most inpatients don’t really need chemistries and a CBC each and every day; if they weren’t already anemic, we could make them anemic with excessive blood draws. And how much of that knee-jerk reflex to order daily “routine labs” is really just defensive medicine anyway?

I recently started teaching residents and was a little apprehensive in the very beginning. After all, 2 decades later, I still remember the good (and bad) attendings, and to this very day I incorporate parts of what the good ones taught me into patient encounters. Now I would be the one who could leave a lasting, hopefully positive impression in brilliant young minds. I have found teaching residents to be motivating and eye-opening. I get to see what’s new on their burgeoning, technologically advanced horizons; and I am learning from them, too. It’s invigorating to grow in the field I love so much, to expand my mind and, sometimes, humbly acknowledge I need to switch gears and proceed in a different direction; I suspect many others would benefit from this revelation as well.

Dr. Hester is a hospitalist at Baltimore-Washington Medical Center in Glen Burnie, Md. She is the creator of the Patient Whiz, a patient-engagement app for iOS. Reach her at [email protected].