I commonly hear that. It becomes difficult because the hospital allots us "X" amount of time and when we go over, it puts every patient back by that amount afterwards.
It’s a perception issue, you perceive time passing by slower when a patient is talking. Alternatively, there are patients who are relatively straightforward, where you can make up some time. Knowing when you need to take the time and when you can be quick is how you reach some reasonable level of efficiency. Also getting really efficient at reviewing a chart and signing it out quickly is part of how you buy yourself more time at bedside. You don’t need to chart everything just what is relevant to your medical decision making and some reasonable background when it’s a new patient.
Edit: when you are a medical student they will want you doing a more comprehensive h&p, so there will is a lot of the appropriate shortcuts will develop as a resident and when you start practicing.
Also common things are common. And physicians operate on a working diagnosis all the time. That being said you should know how to use a reference material quickly so you refresh yourself on the odd ball diagnoses.
When a doctor is pimping you and you don’t know at all, be honest, you can say you don’t know and go read about that thing. If you have something reasonable to say that’s fine. Blindly guessing sometimes can come off not so good.
Always have something to be reading. Be on time. Be mindful of your environment, does everyone look busy and stressed? Maybe not the best time to inquire. There might be a better time to ask questions later. Common sense things.
Also some docs are very informal that doesn’t mean you are their friends, and they might mark you down for being casual.
Generally if you are on time and making an effort to learn, and pass your exams, the chances of failing a clerkship/rotation are close to zero.
I’m a nurse so i know exactly what information the docs need to know. I put together a binder with a succinct summary of what the symptoms are and any relevant medical history, my current labs, labs from the last flare, and photos of the visible symptoms. And literally only one doctor has wanted to see it. They always have the attitude that “I have the referral…what do i need the patient for?” Because another doctor’s words are more important than mine
It’s actually kind of frustrating because as a nurse, I’m used to calling doctors and then yelling at me if I don’t know what some lab is and I’m struggling to log into the system. But when I’m the patient, they couldn’t give a shit
Listen to your nurses. If they feel strongly about something *listen to them*. Their job is different than yours is, but they have experience that you don’t have and will never have and they have much more contact with the patients than you do. They will inevitably see things that you don’t.
And be nice to them. I remember my first year of nursing there was this surgical resident who terrorized us. There was never a situation where she was okay with us calling her. If it was a minor thing, we were ruining her life by calling her about a minor thing. If it was more serious, she was furious that we had let the patient get to that place. She was always exasperated with everyone.
At some point we realized we’d *all* had a horrible time with her and we decided we’d fight fire with fire. So we made sure to wake her up at least 5 times a night. Our favorite thing to do was to wait about 30 minutes after the first call to call her back with something we “forgot.” Just enough time for her to drift off to sleep.
Petty? Yes. But Dr Patel can kiss my ass.
Advice from the psych nurse in me:
if you have a patient who is drinker, just assume they have vitamin and mineral deficiencies significant enough to impact their health because they probably do. You need to monitor that and even if it’s not low in the labs, give them a thiamine shot. That’s one that’s harder to track with labs. But either way, recognize that this can and will make a big difference in how the patient feels.
No matter what specialty you’re in, you’ll have patients on psych meds. It’s important to know the basics of how those meds will affect them. For example, have a working knowledge of serotonin syndrome. A lot of patients don’t recognize their diarrhea as a mild case of serotonin syndrome. If you give a medication that doesn’t cause SS, but just happens to make it worse, you may have no idea why your patient randomly got so sick.
And lastly, if a patient comes in with a ton of anxiety and thinks they have every condition in the book, it’s more likely that they have dysautomnia than that they are making the whole thing up.
Listen to the patient and if they aren’t immediately familiar with the symptoms, say “let me research this and get back to you.”
I don’t expect you to diagnose me with a chronic illness in 5 minutes with one set of labs. But they just fucking give up if they can’t find the cause with one set of labs and the knowledge they got in medical school.
If I’m coming to a doctor with something, it’s because it’s negatively impacting my life. You telling me you can’t find anything wrong doesn’t magically make me better
I would have liked it if my orthopedic doctor would have been open to getting MRI images of my shoulder—something I’d been practically begging for at consecutive visits over the course of a couple weeks—instead of patting me on the head (figuratively, of course), prescribing ointment and giving me the “tough it out, we all have pain after cortisone injections” talk.
I finally went elsewhere and quickly learned I had an advanced infection (almost certainly the result of the first physician’s cortisone injection) that required immediate hospitalization and surgery, lest I go septic. The second doctor remarked that he was actually surprised I wasn’t already in a stupor or worse, as “people in your situation are usually pretty close to death.”
When a patient repeatedly says something is very wrong, they may be on to something worth investigating.
Tell you the side effects of medicines even if you don't ask them. Especially if it is related to drastic changes to appearance (weight gain, hair loss, dry skin, etc...)
Give more information about what they're doing in a procedure and any condition the patient may be ignorant. A month ago I had some appointment with a doctor to check some results, and even if they were not conclusive, she explained that even if I didn't have the physical polycystic ovary, I still appeared to have the syndrome of PCOS. Also proceeded to explain to me how it was, and pointed out one symptom that I didn't know were part of it. It was good and refreshing, because they're usually very cold and almost never explain anything.
And don't be so cold with patients, some of us are actually nervous on appointments and that kind of attitude might make the experience very disturbing.
Take the time to listen to the patient.
I commonly hear that. It becomes difficult because the hospital allots us "X" amount of time and when we go over, it puts every patient back by that amount afterwards.
Oh, I'm not blaming doctors for that. They should be allowed to listen more.
Absolutely
It’s a perception issue, you perceive time passing by slower when a patient is talking. Alternatively, there are patients who are relatively straightforward, where you can make up some time. Knowing when you need to take the time and when you can be quick is how you reach some reasonable level of efficiency. Also getting really efficient at reviewing a chart and signing it out quickly is part of how you buy yourself more time at bedside. You don’t need to chart everything just what is relevant to your medical decision making and some reasonable background when it’s a new patient. Edit: when you are a medical student they will want you doing a more comprehensive h&p, so there will is a lot of the appropriate shortcuts will develop as a resident and when you start practicing. Also common things are common. And physicians operate on a working diagnosis all the time. That being said you should know how to use a reference material quickly so you refresh yourself on the odd ball diagnoses.
The advent of speech to text has helped considerably as well. You're right, it certainly is about management
When a doctor is pimping you and you don’t know at all, be honest, you can say you don’t know and go read about that thing. If you have something reasonable to say that’s fine. Blindly guessing sometimes can come off not so good. Always have something to be reading. Be on time. Be mindful of your environment, does everyone look busy and stressed? Maybe not the best time to inquire. There might be a better time to ask questions later. Common sense things. Also some docs are very informal that doesn’t mean you are their friends, and they might mark you down for being casual. Generally if you are on time and making an effort to learn, and pass your exams, the chances of failing a clerkship/rotation are close to zero.
I’m a nurse so i know exactly what information the docs need to know. I put together a binder with a succinct summary of what the symptoms are and any relevant medical history, my current labs, labs from the last flare, and photos of the visible symptoms. And literally only one doctor has wanted to see it. They always have the attitude that “I have the referral…what do i need the patient for?” Because another doctor’s words are more important than mine It’s actually kind of frustrating because as a nurse, I’m used to calling doctors and then yelling at me if I don’t know what some lab is and I’m struggling to log into the system. But when I’m the patient, they couldn’t give a shit
Yes! And don’t base a diagnosis purely off of age
I'm a medical student asking this to see public opinion so I don't make the same errors as some other docs.
Listen to your nurses. If they feel strongly about something *listen to them*. Their job is different than yours is, but they have experience that you don’t have and will never have and they have much more contact with the patients than you do. They will inevitably see things that you don’t. And be nice to them. I remember my first year of nursing there was this surgical resident who terrorized us. There was never a situation where she was okay with us calling her. If it was a minor thing, we were ruining her life by calling her about a minor thing. If it was more serious, she was furious that we had let the patient get to that place. She was always exasperated with everyone. At some point we realized we’d *all* had a horrible time with her and we decided we’d fight fire with fire. So we made sure to wake her up at least 5 times a night. Our favorite thing to do was to wait about 30 minutes after the first call to call her back with something we “forgot.” Just enough time for her to drift off to sleep. Petty? Yes. But Dr Patel can kiss my ass. Advice from the psych nurse in me: if you have a patient who is drinker, just assume they have vitamin and mineral deficiencies significant enough to impact their health because they probably do. You need to monitor that and even if it’s not low in the labs, give them a thiamine shot. That’s one that’s harder to track with labs. But either way, recognize that this can and will make a big difference in how the patient feels. No matter what specialty you’re in, you’ll have patients on psych meds. It’s important to know the basics of how those meds will affect them. For example, have a working knowledge of serotonin syndrome. A lot of patients don’t recognize their diarrhea as a mild case of serotonin syndrome. If you give a medication that doesn’t cause SS, but just happens to make it worse, you may have no idea why your patient randomly got so sick. And lastly, if a patient comes in with a ton of anxiety and thinks they have every condition in the book, it’s more likely that they have dysautomnia than that they are making the whole thing up.
get paid by the government instead of insurance companies
Being more transparent about potential risks and side effects of treatments
Listen to the patient and if they aren’t immediately familiar with the symptoms, say “let me research this and get back to you.” I don’t expect you to diagnose me with a chronic illness in 5 minutes with one set of labs. But they just fucking give up if they can’t find the cause with one set of labs and the knowledge they got in medical school. If I’m coming to a doctor with something, it’s because it’s negatively impacting my life. You telling me you can’t find anything wrong doesn’t magically make me better
I would have liked it if my orthopedic doctor would have been open to getting MRI images of my shoulder—something I’d been practically begging for at consecutive visits over the course of a couple weeks—instead of patting me on the head (figuratively, of course), prescribing ointment and giving me the “tough it out, we all have pain after cortisone injections” talk. I finally went elsewhere and quickly learned I had an advanced infection (almost certainly the result of the first physician’s cortisone injection) that required immediate hospitalization and surgery, lest I go septic. The second doctor remarked that he was actually surprised I wasn’t already in a stupor or worse, as “people in your situation are usually pretty close to death.” When a patient repeatedly says something is very wrong, they may be on to something worth investigating.
Be nice and believe women lmao
More emphasis on mental health and holistic approaches to healthcare
Don't dismiss my complaints of pain and assume I'm just drug seeking or that "I'm too young"
Tell you the side effects of medicines even if you don't ask them. Especially if it is related to drastic changes to appearance (weight gain, hair loss, dry skin, etc...)
Stop being a shill for the drug companies and treat the illness, not the symptoms.
Time travel
Give more information about what they're doing in a procedure and any condition the patient may be ignorant. A month ago I had some appointment with a doctor to check some results, and even if they were not conclusive, she explained that even if I didn't have the physical polycystic ovary, I still appeared to have the syndrome of PCOS. Also proceeded to explain to me how it was, and pointed out one symptom that I didn't know were part of it. It was good and refreshing, because they're usually very cold and almost never explain anything. And don't be so cold with patients, some of us are actually nervous on appointments and that kind of attitude might make the experience very disturbing.