User login
As I reflect on my 1 year of writing for this newspaper and my first year as an attending, some things stand out as being, for me, consistently challenging and others, consistently rewarding. Time has seemed to go by much faster than during residency. So, without further ado, here is a list of those things that I have, continue to, and may always either struggle with or find joy in.
The checkout e-mail
What I feared the most about becoming an attending – managing a team day to day and teaching students and residents – has come easier than I thought. What has brought me the most angst, however, is passing my team off to my partners. As I write my "checkout e-mail," I am often plagued by doubt and worry that I have overlooked something. I worry I have ordered too many/not enough studies, consulted too often/not enough, or discharged too early/not early enough.
For the first half, and most emotionally pathologic part, of the year, I would log in each day after coming off-service, to see how my partners had changed things, to see what I had missed, and to see how the patients were progressing. I would even text my partners and residents to "see how Mr. X is doing" or to ask "How is the team doing?" This would often result in me second-guessing myself and ruining my day off. I don’t do this anymore.
Now I give myself several healthy days of "no team contact" before I log in to finish notes and inevitably check in on patients. I know that there must be a balance of educational follow-up, feedback, and a healthy forgiving mind, but I still struggle to find it.
Placement
Though there are some scoring systems that help the clinician know which patients need to be hospitalized, who needs the ICU, and who can go home, a lot of this falls in evidence-based medicine’s gray zone. One of the learning curves for me was to know which patients I should insist go to the unit, insist be evaluated by the unit, or who, though sick, can be managed on the floor. In the end, I have found that my gut feeling and the first 15 seconds of my encounter with the patient help me more with placement than any scoring system or guideline.
The consult
It has been a bit painful learning to juggle the nuances of consultant services preferences (who always wants to be involved vs. who rarely does), attending preferences (some want to know when any of their patients are in-house), and what is my own comfort level. I think, for the most part, I have erred on the overconsult side this year, and though I have felt embarrassed a couple of times, it has been the safer route as I become comfortable as a hospitalist.
Discharge
As with The Placement, there is virtually no evidence to help The Discharge. As a resident, an earlier discharge usually was better, but as an attending, The Discharge is where the complex intertwinement of disease, social situation, physical therapy, and unfortunately, day of the week manifests (see previous column: "Closed on weekends?" Hospitalist News, May 2014). Also, like The Placement, this often ends up being a gut feeling supported by close follow-up, a good conversation with the patient and family, and some hopeful finger-crossing.
Being a people pleaser
This personality trait has helped me to be a good student, a responsive employee, and sometimes a good doctor. But it has also caused me a good amount of suffering. Thus, when despite my best efforts a patient or family continues to be upset with how quickly or slowly things are being done, which services are or are not involved, etc., I feel bad. Maybe this will change in the coming years. Maybe not.
Teaching
I have always liked teaching, but as a resident this often played second fiddle to grunt work and "res-interning." As an attending, however, I have finally been able to make this a significant part of every day. I enjoy it, and I think my residents and medical students enjoy that I enjoy it. This has been one of the true pleasures of my first year as an attending.
Connection
As an attending I now benefit from much more time to enjoy my patient connections. Less tired and harried, I have longer conversations and enjoy actively practicing communication. I have the ability to have more in-depth conversations about goals of care, and have found that often these conversations end with a decrease in anxiety and a sense of peace.
I now also have a business card with an e-mail address that receives occasional thank-you notes. Yesterday, I received an e-mail that said simply, "Thank you for your great service." How incredibly fulfilling. Talk about unexpected joy.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
As I reflect on my 1 year of writing for this newspaper and my first year as an attending, some things stand out as being, for me, consistently challenging and others, consistently rewarding. Time has seemed to go by much faster than during residency. So, without further ado, here is a list of those things that I have, continue to, and may always either struggle with or find joy in.
The checkout e-mail
What I feared the most about becoming an attending – managing a team day to day and teaching students and residents – has come easier than I thought. What has brought me the most angst, however, is passing my team off to my partners. As I write my "checkout e-mail," I am often plagued by doubt and worry that I have overlooked something. I worry I have ordered too many/not enough studies, consulted too often/not enough, or discharged too early/not early enough.
For the first half, and most emotionally pathologic part, of the year, I would log in each day after coming off-service, to see how my partners had changed things, to see what I had missed, and to see how the patients were progressing. I would even text my partners and residents to "see how Mr. X is doing" or to ask "How is the team doing?" This would often result in me second-guessing myself and ruining my day off. I don’t do this anymore.
Now I give myself several healthy days of "no team contact" before I log in to finish notes and inevitably check in on patients. I know that there must be a balance of educational follow-up, feedback, and a healthy forgiving mind, but I still struggle to find it.
Placement
Though there are some scoring systems that help the clinician know which patients need to be hospitalized, who needs the ICU, and who can go home, a lot of this falls in evidence-based medicine’s gray zone. One of the learning curves for me was to know which patients I should insist go to the unit, insist be evaluated by the unit, or who, though sick, can be managed on the floor. In the end, I have found that my gut feeling and the first 15 seconds of my encounter with the patient help me more with placement than any scoring system or guideline.
The consult
It has been a bit painful learning to juggle the nuances of consultant services preferences (who always wants to be involved vs. who rarely does), attending preferences (some want to know when any of their patients are in-house), and what is my own comfort level. I think, for the most part, I have erred on the overconsult side this year, and though I have felt embarrassed a couple of times, it has been the safer route as I become comfortable as a hospitalist.
Discharge
As with The Placement, there is virtually no evidence to help The Discharge. As a resident, an earlier discharge usually was better, but as an attending, The Discharge is where the complex intertwinement of disease, social situation, physical therapy, and unfortunately, day of the week manifests (see previous column: "Closed on weekends?" Hospitalist News, May 2014). Also, like The Placement, this often ends up being a gut feeling supported by close follow-up, a good conversation with the patient and family, and some hopeful finger-crossing.
Being a people pleaser
This personality trait has helped me to be a good student, a responsive employee, and sometimes a good doctor. But it has also caused me a good amount of suffering. Thus, when despite my best efforts a patient or family continues to be upset with how quickly or slowly things are being done, which services are or are not involved, etc., I feel bad. Maybe this will change in the coming years. Maybe not.
Teaching
I have always liked teaching, but as a resident this often played second fiddle to grunt work and "res-interning." As an attending, however, I have finally been able to make this a significant part of every day. I enjoy it, and I think my residents and medical students enjoy that I enjoy it. This has been one of the true pleasures of my first year as an attending.
Connection
As an attending I now benefit from much more time to enjoy my patient connections. Less tired and harried, I have longer conversations and enjoy actively practicing communication. I have the ability to have more in-depth conversations about goals of care, and have found that often these conversations end with a decrease in anxiety and a sense of peace.
I now also have a business card with an e-mail address that receives occasional thank-you notes. Yesterday, I received an e-mail that said simply, "Thank you for your great service." How incredibly fulfilling. Talk about unexpected joy.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
As I reflect on my 1 year of writing for this newspaper and my first year as an attending, some things stand out as being, for me, consistently challenging and others, consistently rewarding. Time has seemed to go by much faster than during residency. So, without further ado, here is a list of those things that I have, continue to, and may always either struggle with or find joy in.
The checkout e-mail
What I feared the most about becoming an attending – managing a team day to day and teaching students and residents – has come easier than I thought. What has brought me the most angst, however, is passing my team off to my partners. As I write my "checkout e-mail," I am often plagued by doubt and worry that I have overlooked something. I worry I have ordered too many/not enough studies, consulted too often/not enough, or discharged too early/not early enough.
For the first half, and most emotionally pathologic part, of the year, I would log in each day after coming off-service, to see how my partners had changed things, to see what I had missed, and to see how the patients were progressing. I would even text my partners and residents to "see how Mr. X is doing" or to ask "How is the team doing?" This would often result in me second-guessing myself and ruining my day off. I don’t do this anymore.
Now I give myself several healthy days of "no team contact" before I log in to finish notes and inevitably check in on patients. I know that there must be a balance of educational follow-up, feedback, and a healthy forgiving mind, but I still struggle to find it.
Placement
Though there are some scoring systems that help the clinician know which patients need to be hospitalized, who needs the ICU, and who can go home, a lot of this falls in evidence-based medicine’s gray zone. One of the learning curves for me was to know which patients I should insist go to the unit, insist be evaluated by the unit, or who, though sick, can be managed on the floor. In the end, I have found that my gut feeling and the first 15 seconds of my encounter with the patient help me more with placement than any scoring system or guideline.
The consult
It has been a bit painful learning to juggle the nuances of consultant services preferences (who always wants to be involved vs. who rarely does), attending preferences (some want to know when any of their patients are in-house), and what is my own comfort level. I think, for the most part, I have erred on the overconsult side this year, and though I have felt embarrassed a couple of times, it has been the safer route as I become comfortable as a hospitalist.
Discharge
As with The Placement, there is virtually no evidence to help The Discharge. As a resident, an earlier discharge usually was better, but as an attending, The Discharge is where the complex intertwinement of disease, social situation, physical therapy, and unfortunately, day of the week manifests (see previous column: "Closed on weekends?" Hospitalist News, May 2014). Also, like The Placement, this often ends up being a gut feeling supported by close follow-up, a good conversation with the patient and family, and some hopeful finger-crossing.
Being a people pleaser
This personality trait has helped me to be a good student, a responsive employee, and sometimes a good doctor. But it has also caused me a good amount of suffering. Thus, when despite my best efforts a patient or family continues to be upset with how quickly or slowly things are being done, which services are or are not involved, etc., I feel bad. Maybe this will change in the coming years. Maybe not.
Teaching
I have always liked teaching, but as a resident this often played second fiddle to grunt work and "res-interning." As an attending, however, I have finally been able to make this a significant part of every day. I enjoy it, and I think my residents and medical students enjoy that I enjoy it. This has been one of the true pleasures of my first year as an attending.
Connection
As an attending I now benefit from much more time to enjoy my patient connections. Less tired and harried, I have longer conversations and enjoy actively practicing communication. I have the ability to have more in-depth conversations about goals of care, and have found that often these conversations end with a decrease in anxiety and a sense of peace.
I now also have a business card with an e-mail address that receives occasional thank-you notes. Yesterday, I received an e-mail that said simply, "Thank you for your great service." How incredibly fulfilling. Talk about unexpected joy.
Dr. Horton completed his residency in internal medicine and pediatrics at the University of Utah and Primary Children’s Medical Center, both in Salt Lake City, in July 2013, and joined the faculty there. He is sharing his new-career experiences with Hospitalist News.
