One effect of the chief trying to make me behave like a junior resident already is that I’ve realized I don’t know how to listen. I’ve gotten pretty good at giving reports on a patient’s history and pertinent data (at the beginning of the year I was actually pretty bad at this, I think partly due to being too nervous to talk straight, and partly due to being badly disorganized; I think I do a decent job now) – but listening to a detailed report is something else.
Two of us interns were reporting to him about consults we’d seen. After I told my story, my brain kind of switched off. I heard the other intern talking, but it went past my head – until I realized that I was supposed to be reporting this to the attending in a couple of minutes. Whoops – I heard medical comorbidities, but which ones exactly? I heard elevated liver enzymes – but are we talking alkaline phosphatase and bilirubin, or transaminases? I heard an abnormal abdominal exam – but which quadrant, exactly?
After all, when we do signout, it’s usually about patients we already know. If there is a new consult, the night intern isn’t going to tell it to me in much detail, and I plan on going over the chart and talking to the patient for myself. The medical students tell us about their patients, but again, I plan on having already seen the patient and collected the vitals and labs myself. I just listen to the students to see if they got it right, not because I don’t already know.
So if I’m going to be taking reports from interns, and then talking to the attendings on that basis, I’ll need to learn how to actually hear what’s being said, and remember it as well as if I’d found it out for myself.
One of the older surgeons was rounding this morning. He’s “old school” in the sense that he’s an expert on every area of surgery, from trauma to vascular to all kinds of details about general practice, to thoracic, and even some cardiac and transplant – and he wishes we were experts, too. What impressed me the most was how he gave attention to every aspect of the patient’s condition. Many of the younger attendings (by which I mean, not close to retirement age – they still finished training a good while ago) barely want to hear about the medical issues on the surgery patients (let the chiefs handle the electrolytes, blood pressure, glucose, calcium problems), let alone the consults. This attending walked into the room of a patient who had been admitted with severe cardiac and respiratory issues, and then in addition ended up having an operation by us. She’s mostly gotten over that now; if that were her only problem, she’d be ready for discharge. But her heart and lungs are still very problematic. He walked into the room, and immediately began analyzing her shortness of breath, and inquiring into what therapy she was getting. I, irresponsibly, had written it off as chronic, baseline, and not my problem. His attitude used to be my ideal; I need to remember it again.