Shadowfax already posted a really nice list but I have some ideas I’d like to share too, in particular some practice tips I have picked up in the now two years since I finished residency. Many of you may have discovered these things long ago, I don’t know what to tell you except that I’ve always been ahead of the curve when it comes to being kind of slow. On with the list…

Find out why your patient came to the ER.
I saw a young woman awhile back who had a bunch of vague subacute complaints that didn’t seem to add up. Finally I managed to figure out that she was worried about possibly being pregnant. All of a sudden that’s an easy dispo, a quick urine test or if you’re looking for a fight directions to the Dollar Store. Other common roundabout presentations include looking for a work excuse and/or narcotics. If you can just figure this stuff out right off the bat you’ll make life much easier for yourself.

Find out what your patient is worried about.
If a mom is worried that her baby’s fever is going to give her brain damage, then telling her it’s just a virus isn’t going to be very helpful. Try to pin down specific worries and fears — to medical types “laypeople” can worry about some pretty wacky stuff that we would never even think to consider. Addressing these can go along way towards everyone feeling good about the encounter.

Don’t forget the med list.
For some reason it took awhile for this lesson to stick. Medications cause lots of vague and unusual problems, both starting and stopping them. Always always get the med list, and in particular ask about new meds, changes in dosages, or recently stopped meds.

Be careful about admissions.
Never admit a patient without first asking them if they are willing to come in. If you are naive enough to call the admitting doc, get the orders, secure a room, etc before checking with the patient there is about a 90% chance they will flatly refuse admission once they find out no matter what you do or say. Additionally, wherever you go there will probably be a confusing mix of primary care docs who admit their own patients and primary care docs who utilize a hospitalist. If the patient has a doctor, make sure you find out who it is, unless you want to subject yourself to a justifiably irate overworked hospitalist who just did an entire H&P on someone else’s patient.

Time savers.
There are lots of little things you can do to improve efficiency. Here is the one that has been the most helpful for me: I can only go so fast because I feel obligated to return to the patient’s room a second time to review tests results and disposition. However I figured out away around this, for something simple, straightforward, and likely going home like chest pain in a 20 year old I tell them it’s almost certainly non-serious, we’ll run some tests, if everything comes back normal the nurse will be in to discharge you, if anything shows up abnormal on your tests I’ll come back to discuss it with you. Most people seem perfectly fine with this approach.

Don’t sweat stuff.
There will be lots of regulations and core measure stuff for you to abide by and this may not always jive with the latest and greatest research that is in your head as a newly minted attending physician. It may be stupid or impractical or misguided. My advice: don’t sweat it, just do it. Because it doesn’t matter if it’s stupid, all that matters is that it has been decreed by CMS or JCAHO or whoever and like it or not they make the rules. If it drives you crazy enough then get your MPH or run for Congress and fight the good fight. But you’re certainly not getting anything changed during your shift, so you might as well just let it go. There’s plenty of other worthwhile stuff to worry about.

Best of luck to all med students and residents moving on up the ladder July 1st, and for everyone else try your best not to get sick.