🎇 🔥 Exciting breaking news! 🔥 🎇
NEJM Voices features essays grounded in real-world practice -- including pieces by me (!!) that will appear every 2 weeks.
Check out my inaugural essay, about how a country-music star made me a better doctor. I hope you like it 😊
#TipsForNewDocs
Rules of vasoactive agents in shock
1) The right combination is what works (to achieve goals of MAP, CI, filling pressures)
2) When what you're doing isn't working, pivot quickly to a new strategy
Pragmatic, nimble, flexible = success
#kittlesonrules
Monday's tweet was about using powers of observation to aid in diagnosis. More details in Chapter 4. Mastering the Art of Patient Care.
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
When I’m in the hallway between pts, I try to pay attention to how the next pt looks as they walk into the exam room. Stooped, short of breath, teetering, alone, w/family? You’ll get a sense of their well-being even before the visit begins.
#kittlesonrules
#TipsForNewDocs
When you're not sure what to do, break it down by first principles:
Will the test change management?
Will the intervention made my pt feel better and/or live longer?
Let the Golden Rules of medicine guide you.
#kittlesonrules
Do you fear giving talks? I learned from experience on how to give an effective one-- check out my tips in Mastering the Art of Patient Care.
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
If a HF patient is undergoing diuresis and K < 3.5, stop diuresis with loop/thiazide diuretic until K improves. ICD shocks attributed to diuretic-induced hypokalemia is a form of iatrogenesis imperfecta best avoided.
#kittlesonrules
Monday's tweet focused on one aspect of consult etiquette. Check out Ch 6 Mastering the Art of Patient Care for more details.
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
Consult etiquette when referring a patient to a specialist.
Bad: I’m sure they’ll see you this week.
Good: Medically, anytime in the next month is fine.
If a consult isn't urgent, say so. If it is, call the consultant and let them know!
#kittlesonrules
There are many, many reasons to write a good note. Here are my tips!
Mastering the Art of Patient Care
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
In the cath lab yrs ago, I couldn't engage an RCA. The experienced tech offered help. The next time, I taught a new tech and fellow. Experience trumps education. Always take the help! It'll benefit you, your patient, and those you teach.
#kittlesonrules
How do you navigate the boundaries of the patient-physician bond?
Read more in Mastering the Art of Patient Care.
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
The art of performing a consult:
1) be prepared: know as much as you can before you walk in the room
2) be an expert: no unhelpful generalizations like "avoid nephrotoxins"
3) be useful: provide timely communication with the referring
#kittlesonrules
The 5 highest-yield questions to make a diagnosis.
Mastering the Art of Patient Care.
link.springer.com/book/10.1007...
#kittlesonrules
#TipsForNewDocs
When I care for seriously ill pts, I say: "If there was something more you could be doing, I would tell you. This is not your fault."
Do your best to relieve the burden of self-recrimination felt by very sick pts and their families.
#kittlesonrules
#TipsForNewDocs
On night call, I used to answer: “What's the emergency?"
Then, I needed on-call peds for my kid- his first words: “How can I help?"
That’s how I respond now.
Not being nice won't limit calls, it just makes them unpleasant for all involved.
#kittlesonrules