Posts Tagged ‘Communication’

Now that everyone has switched over… 2nd year med students have started their clinical rotations, 3rd year medical students have become 4th years and are beginning the countdown to graduation, and new interns have started their stress-year…

I thought it appropriate to cover something you will never be taught about your pager… at least not formally, anyway. So here it is:

It’s really quite simple. When wearing scrubs, you only have this semi-thin drawstring that doesn’t really hold a pager too well.

SCRUBS: If you wear your pager on your scrubs, it will flop around and sometimes unclip itself depending on your position.

WHITE COAT (side pocket): If you put it in your white coat side pocket, you will leave it on during conferences or you will not feel it vibrate. You also run the risk of it slamming into a door or wall as you walk.

WHITE COAT (top pocket): If you put your pager in your top pocket of your white coat or of your scrubs, well, that’s just inexcusable… it will fall out when you bend over & it will be impossible to reach if you wear a gown.

So here’s what you do (see the video at http://youtube.com/RookieDoc):

1. Tuck in your shirt – all the way – even in your underwear
2. Face your pager in towards you (not outward like you would if you were using a belt)
3. Clip the pager around your scrub bottoms drawstring AND your underwear

That’s it. I hope it helps

Here’s another one of those internship tips videos for medical students, interns, and residents. Check it out… This one’s about the doctor-patient relationship:

Now that people are in the thick of the internship interview season, the stress of getting prepared for internship is starting. Because of that, I thought it would be a good idea to reference a blog post that I saw a while back. The original post comes from Mother Jones, RN and is entitled Revisiting the Intern’s Survival Guide. It’s basically some sage advice (mixed in with some humor) from a nurse to new interns.

Here’s the link:

Revisiting the Intern’s Survival Guide

And here’s what I posted in the comments section back in June:

Great post.

For many, the appearance of arrogance actually comes from an intense fear of failure and fear of being exposed as someone who somehow slipped through the medical education cracks.

Unfortunately, some people try to cover or hide the fear, rather than saying, “You know what? I’m nervous. This is new to me. What has been your experience?”

“Smart interns forge alliances with the nursing staff” – great quote. If interns and nurses don’t see their missions as the same, they’re missing the boat. There’s a difference between a mission and a role. Both play different roles in the same mission.

And yes, there are too many new docs who start internship with an air of arrogance and, at times, downright rudeness. But, there is also a large pool of nurses that start off assuming there’s a turf battle. And both of these continue the cycle.

This probably sounds a little fluffy, but it would all be a lot smoother if we assumed the best in others.

For interns:
– Don’t assume you have to know everything.
– Don’t be afraid to ask for help
– Nurses know their job better than your attendings
– Social workers know their job better than your attendings
– The more you understand others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

For nurses:
– Interns are nervous, & everyone expresses it differently
– Be patient with the new folks
– Be especially patient with new interns from other cultures
– Don’t start off assuming a turf battle… sure defend that last piece of pizza
– The more you understand about others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

Also, be on the look out for an awesome freebie coming from RookieDoctor.com… very soon. The quantities will be limited because I can only ship out so many (before I go broke .

Medical school, internship, and residency are particularly busy times. If you’re a doctor in training or someone who cares about one, you can send a quick eCard to let them know you care.

They’re easy… they’re fast… and they’re free…

I just posted several ecards and this video tutorial showing you how to send them. Check it out.

There are several aspects of receiving feedback that are ultra-important during your training. The first is recognizing completely useless feedback. Unfortunately, most residency programs do nothing more than get your attending preceptors to fill out evaluation forms. And like a lot of things in healthcare, a number is assigned… something measurable, sort of. The problem with this approach is that these attendings are never given instruction or guidance on exactly HOW to evaluate or exactly HOW to give good feedback. So, it is important for you to recognize useless feedback.

Once recognized as useless, you should be able to turn it around and extract something useful… something you can build on. (I give you the exact scripts to use to accomplish this – in the members area).

Now those two are about getting feedback… the next thing you have to do is receive that feedback…

And finally, know what to do with it.

Well, I found an article that is nice a short and does a good job of providing an overview for accepting feedback. Here it is. It is used with permission from EzineArticles.com:

Workplace Communication – Accepting Feedback
By Ken Okel

Receiving feedback or criticism is a funny thing. When it’s good, we accept it and when it’s bad, we doubt its accuracy. Lost in all the emotions could be some good information that could help your career. Here are some suggestions for getting the most out of someone’s comments.

Just Listen: When you’re being told something that you didn’t do well, it’s very tempting to immediately interrupt and start defending yourself. Resist the urge. Listen to the comments and think about them for a moment before you say anything. When you do speak, say something neutral like, “Thanks for telling me that.” Remember, you’re on a quest for information that can help improve your skills. You may want to follow up with a question designed to let you know what you should do the next time you’re in a similar situation. “How would you handle the situation?” is a good one in that it gives you an example to follow.

Analyze Your Successes: When you receive positive feedback, it’s easy to start congratulating yourself but not think about what you did right. Here the ego takes over. But sometimes, it’s possible to stumble into success with no idea of what you did well. To get the full story, ask some questions like, “What could I do better?” which can keep the discussion going.

Don’t Carry Around Comments Like Luggage: It’s easy to hold on to feedback long after it can be useful. Listen to the information, consider how you can improve or continue a good practice, and then, move on.

Consider the Source: Most advice comes from a well meaning place but that doesn’t mean it’s always right. Upon listening to it, you may know immediately that it’s worthless (make sure you’re certain of this) but it’s still important to listen and then thank the person for the feedback. Just the act of listening shows respect to the other person. Sure, their advice may be bogus but if you overreact, then they’ll likely never again give you feedback, which could hurt you later on if their observations improve.

In his presentation, “Stop Crying in Your Cubicle” Ken Okel helps companies communicate better, become more efficient, and smile a whole lot more.

For his free newsletter and special report, 7 Communication Mistakes that are Costing You Money, go to his website at http://www.kenokel.com

You’ll also be able to see a video of Ken’s famous police dog attack story.

See Ken’s tips invade YouTube at: http://www.youtube.com/user/KenOkel

Article Source: http://EzineArticles.com/?expert=Ken_Okel

I just posted another video to YouTube… This one is the second video in the RookieDoctor.com series on Residency Horror Stories. You might be wondering where the first one is… Well, it’s a little long and has some embarrassing information in it, so it’s only available to members. (Yes, even more embarrassing than this video.)

In this video you get to see how I screwed up telling someone that they were dying. Horror for me… but, good for you, because I extract several important lessons from this story for you. In fact, that’s the very reason I’m sharing these horror stories with you… You can take the good and leave the bad and it’s told to you in a way that you won’t forget… a story.

So please take this stuff with you through your clinical training years and apply it. You will be a better doctor for it and, of course, your patients will benefit too.

I would really appreciate your comments… You don’t have to tell me how much of an idiot I was, though I learned my lesson… Hopefully you learned my lesson too.

Anyway, let me know what you thought about the video and if you have any horror stories of your own. There’s many more where this one came from… but thankfully not all from me.

If you submit any stories about your training or someone else’s please do not include patient identifiers or institutional identifiers. Of course, if you do, I’ll remove them from the story and I will alter some of the details for the sake of anonymity and privacy. But if you share your stories, others might benefit from the lessons.

OK. I had a sad, humbling experience on a trip to Wal-Mart last night. My wife asked me to return something and my daughter was/is sick, so I had to get a prescription filled. Not a big deal, right?

Well, three things… One. I am not a Wal-Mart guy. No offense to Wal-Mart Inc, but in my area the “customer service” there is quite pathetic. It is the type of place where those hilarious guys at Despair.com get inspiration. I have to consciously prepare myself to keep my mouth shut… suck it up… and move on.

Two. I am not a go-to-the-store-and-return something guy either. It’s just not me. I don’t like doing it. If I can get out of it, I will. (But if I’m wronged, I’m going full tilt – Better Business Bureau, letters to the home office, etc… just don’t make me return anything.)

Three. It’s the week after Christmas and the place is packed.

Anyway, I went.

There were no less than 40 people in line at the “customer service” desk (so naturally, I didn’t return anything . I briskly bobbed and weaved to get to the pharmacy pick-up line. I was number 16 in line. Ahead of me stood 15 uncomfortable-looking, elderly patients. Since 11 of the 15 folks did not have a smooth pick-up, I had plenty of time to stand there… to just watch and listen.

Here is some of what I saw and heard:

• The patients in line were elderly and uncomfortable standing so long.
• Most of the patients had even sicker-looking (in a chronic sense) family members sitting aisles away on empty shelves or in wheelchairs.
• While in line, these patients were cordial and patient, but as time went on, frustration and fatigue began to show.
• While they were waiting and becoming increasingly tired, several employees were walking out from the back talking about their break and why they need to take it now, “even though it’s busy”.
• Several patients were discussing “coming back out of retirement” just to be able to afford things for daily living.
• Several quoted the $4 prescriptions as the reason they were willing to withstand the “customer service” and the lines.
• Despite their interest in the $4 bargain, most (8) of them were unable to actually get the $4 drug… mostly because the way it was written.
• 11 out of 15 had issues with their scripts being filled at all – and not one of the 11 was given a solution that they could control… The staff blamed each issue on the doctor or the government – 8 on the doctor, 2 on the government (specifically Medicare Part D), and one on both.
• The second person in line (appearing to be in her late 70s) ended up being shouted at by the pharmacist, “Didn’t you read Medicare Part D?! Your doctor has to put the indication on your prescription! It’s not my fault! Go ask your doctor. We called, but your doctor is not getting back to us.”
• There was one employee who was visibly working her tail off to get the patients their meds before they even reached the counter. She walked out and asked each person in line their names and began trying to get their stuff 3, 4, and 5 people deep in line. No one thanked her. No one said, “Job well done”, at least in the 45 minutes I stood in line.

Here are some tips and pearls for interns and residents to take away from this experience:

• Small things on your part can make a humongous difference for your patients.
• Write the indication on your elderly patients’ scripts.
• Advise your patients to bring their discharge instructions with them to the pharmacy when they leave the hospital for the first time.
• If you are writing a narcotic, put your DEA number and spell out the number of pills to dispense.
• Try to avoid writing “Use as directed”… that doesn’t fly with some co-pays, Medicare D, and some discount programs.
• Choose the medications wisely… with cost being a huge piece to factor in.
• Ask your patients if they’ve ever had problems filling scripts before and what the nature of the problem was… too many to dispense, not covered by insurance, etc.
• Consider titrating doses before adding new classes, if possible.
• Keep an updated list of the discount meds available. And familiarize yourself with other discount programs (Target, Wal-Mart, Giant, etc).
• Get in the habit of writing the generic name anyway.
• If you get paged from a pharmacy outside of your hospital, it is probably regarding a patient you just discharged… Answer it promptly. That person who was just hospitalized is probably standing in Wal-Mart, or sitting off to the side waiting for a family member to fill their scripts.
• Write legibly.
• If there’s a discrepancy when looking at their meds and the meds you thought they were taking at home, ask the patient. Reconcile your scripts with their current meds.
• Be careful what you talk about in front of others. Sure, there’s nothing wrong with discussing where everyone wants to order from for lunch. But if you do that while a patient or their family is in earshot, you might really rub them the wrong way.
• Social workers and case managers know about these patients’ frustrations and potential problems… learn from them. Ask them for feedback. And appreciate what they do. (The insurance industry is like Wal-Mart on steroids.)
• When someone does something well, or goes a little further than they have to, tell them about it… thank them… let them know that it was appreciated.

Now, it is important to realize that when you actually do these things, you will not be praised. No one will thank you. No one will really notice. And that’s okay. It’s not about you. It’s about them, the patients.

And if you don’t think it’s about your patients, then quit health care right now… and go work at Wal-Mart. You’ll fit right in… probably best-suited for “customer service”.

And here are some tips for Wal-Mart and pharmacies, in general:

• Put some seats or benches for your elderly patrons. Be generous and be strategic. Put them in such a way that people can remain in line and remain seated if need be.
• Consider having a health professional (MD, DO, NP, PA, Pharm D, etc) that can write scripts for the edits and tweaks that someone else simply forgot… things like indication, quantity, etc.
• Consider having a looping video that explains procedures, policies, what’s needed, etc. so that people don’t have to wait in line to find out that they’re missing something.
• Keep track of all of the issues that prevent people from getting their scripts on the first trip up to the counter… use that list to get to the root causes… or at least publish it. If it is truly the doctors, then send the list to me, I’ll get it out there.
• Try to hire people that “own” problems, not the Me-Myself-and-I types that consistently shunt blame.
• Remind your workers that it might be viewed as a little inconsiderate to discuss their breaks while frustrated customers look on. Remind them to consider how they would feel.
• Tell your pharmacists that it is a very, very rare patient that ever “reads Medicare Part D”… In fact, I’ve never met one.

There’s my rant, but there are lessons in there, though. I learned a lot standing in line at Wal-Mart.

So, you did pretty well, or maybe even great on the MCATs… You submitted your applications through ERAS… You were even granted a few interviews for internship and residency in top programs…

Now don’t screw it up.

If you’re thinking that you’ve been successful all your life, and that you’ve WOWed almost everyone you’ve met up to this point in your life… then you better hold on.

Being successful is fine… Being confident is also fine… But if you’re cocky or arrogant, you just might screw it up now. And here’s why:

Being a physician is just as much about being a “people person” as it is about knowing the medical science. In some cases, even more so. And one of those cases is in clinical practice. And another of those cases is actually getting in to your training program of choice.

You see, if you’re cocky, you are going to miss one of the most important people in the residency interview process. If you’re arrogant, you are going to go into that interview thinking that the only important people there are the interviewers. And if that’s the case, you are at high risk for not getting your program of choice… and rightfully so.

Any guess on who the most overlooked VIP of the residency program is?

(more…)

You’re on-call and it’s three in the morning. You get called from the ER and you call them back from your call room, because you had just laid down. You’ll find that it’s almost like they have a direct connection to your pillow. As soon as your head hits that pillow, they’ll call you.

You call back and they see the in-house caller ID “resident call room” and the ER doc says, “Whoa! Dr. Tori, trying to get some sleep? Trying to rest your head? Why don’t you come on down? I have a few admissions for you.”

Great. That kind of stuff starts to tick you off after awhile. The first few times you’re like sure and you head on down. The next few times you start to get the idea that people think you’re a slacker because you’re in your call room.

Well, here’s the thing… (more…)

OK. Normally, I probably wouldn’t highlight a hospital ranking article for new interns and residents, but this one is very well done. It is a great article to learn from. US News and World Report’s America’s Best Hospitals covers ventilator associated pneumonia (VAP) protocols, bedside manner, handoffs and signout, turf battles between specialties, getting feedback from patients, and more. Although it is written as if you know very little about medicine and surgery, there are some great lessons and perspective changers for med students, interns, and residents.