Impressing your attending is completely subjective. Some are impressed by you if they are unaware of your presence. Others want you up to your elbows in patient care. Some fall in between these two extremes, however there are some basic things you can do to stay in the good graces of both your attending and your team.
We’ve all heard this one: “Mr. Smith is a 65 y/o male with a history of [insert 12 medical problems] admitted for chest pain.” The medical student, or even resident, has included every single problem the patient has had. Why? To be viewed as knowledgable. This isn’t helpful. By the time you get to the end of the “one liner,” I’ve forgotten how old the patient is. Do I care about most of the aforementioned problems? Not likely. Don’t be this person.
How about this: “Mr. Smith is a 65 y/o male admitted for chest pain.” Ironically, this is just as bad. It gives no relevant background to “set the stage”. Instead, try to describe the patient to your attending in a single sentence that includes the current problem with background information pertinent to it. “Mr. Smith is a 65 y/o male with a pertinent history of hypertension, hyperlipidemia, and tobacco abuse admitted with chest pain.” This captures the best of both. Background pertinent to chest pain (such as ACS risk factors) has been included, yet there is not so much information that I forget what I am even listening to.
Attendings may differ on how much background information they want in the first line, but including some relevant modifiers will help your team tune into your HPI and listen for things that will move certain diagnoses up or down their differential. Take home: describe your patient in a single, informative sentence – not two, and not one 45-second run-on.
I can’t tell you how frequently (especially on pediatrics) I hear residents and medical students tell me they didn’t completely examine the patient for fear of waking them up. When they do, they scramble to complete a sloppy physical exam while I’m also examining the patient or explaining the plan of care to the family. I get it – no one wants to make a child scream, anger a patient, or annoy a family because it’s early. But the hospital isn’t a hotel. Sometimes there are critical exam changes that are noted during pre-rounds that can completely change the plan of care. A full physical exam is a crucial part of the pre-rounding process.
You should know everything about your patient, more so than the person supervising you. Lab/vital sign trends, consultant recommendations, imaging results, micro results, etc. are all important! If you did not look it up or don’t know a specific piece of information about the patient, DO NOT WING IT. You might get on your attending’s bad side by not knowing a key result, but it’s far better to own your mistake than to compound it with a lie. Offer to find out the information on the spot, and get back to your team later in the day.
One of the key experiences the wards teach is learning how to think like a doctor. You want to evolve from that “reporter / interpreter” stage (I can find lab results and maybe tell you what they mean) to the “manager” stage (I can interpret the lab results and come up with an appropriate plan of care). Look up your patient’s condition. Figure out what the next step will be (using say, I don’t know, OnlineMedEd). Maybe the attending agrees with your plan, maybe they don’t, but the point is to put critical thinking into it. Ask the attending to critique it and ask how they mentally worked through their course of action. These “learning how to think” moments are infinitely more useful than textbook knowledge.
Take the initiative and read up on conditions you have questions on. Use the advanced search option on PubMed to filter through clinically relevant articles to answer your questions. This is a great way to get the most out of your conversations with your supervising resident or attending.
Finding the answers to your questions on your own demonstrates self-sufficiency and “real world” skills; it also enables you to have “next level” conversations. As an example, let’s say a patient of yours has pneumonia and a severe penicillin allergy (so amox-clav is out). Instead of asking the team, you find out that levofloxacin is one alternative therapy available. The discussion is then around why this choice may or may not apply to the patient, not “what alternatives are there”. By the way, that question will still get answered, but in a more organic and intuitive way.
If you commit to doing something, you had better execute it. Part of being a team member is being reliable. If you are not trustworthy in the eyes of your teammates, then the team can’t function at its highest efficiency. Find out a task’s deadline – is it urgent or important (they’re not the same), or is it something else? If it’s reporting on reading, is it easier to do during rounds or in the afternoon when things slow down? The onus is on you to plan appropriately. Establishing reliability will allow you to take on greater and greater responsibility, which helps you grow as a medical provider.
While this advice is not all-encompassing, this will certainly help you to avoid pitfalls on the wards, impress your attending, and become a better physician!
Nearly 50 years after NASA sent its first 'space doctor' into orbit, Jonny Kim, a decorated former Navy SEAL and Harvard-educated physician, is setting his sights on the Moon. If he makes it, history will follow.