Ward attending notes to my younger self

Finishing my 38th year of internal medicine ward attending, I wish I knew then what I know now.  I estimate the equivalence of at least 10 full years of ward attending, I think this meets the magic 10,000 hour number.  Hopefully, these notes to myself will help some newly minted ward attendings.  The job is quite difficult and multifaceted. Understand the various responsibilities of the ward attending Help your learners grow Make certain the patients get top notch care Be a good role model for the learners Stay healthy, both mentally and physically Never lose your humanity What distinguishes ward attending is teaching.  While we have a great responsibility to our patients, we also have a great responsibility to our learners’ future patients. This week I did exit interviews and mid-month interviews with 2 students and 3 residents.  When I do exit interviews, the learners also give me feedback.  Over the years many learners appreciate that discussions of patients diagnoses and management include an understanding of why.  Knowing why we do what we do is highly valued.  Perhaps some examples would help. A heart failure patient comes in with significantly increased edema.  He tells us that the furosemide is not working as well as it previously worked.  The discussion that follows should include an understanding of loop diuretic absorption as well as an understanding of diuretic resistance.  Therefore, we must know how to diagnose whether the problem is furose...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs