Michelle Kittleson MD PhD
@MKIttlesonMD
#kittlesonrules | Cardiologist | Prof of Medicine @CedarsSinai | Author Mastering the Art of Patient Care available at https://t.co/zdJT2MVNhb
ID:1064746012416258048
https://bio.cedars-sinai.org/kittlesonm/index.html 20-11-2018 05:03:26
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#TipsForNewDocs
There are some essential meds in cardiology.
HFrEF: ARNI/BB/MRA/SLGT2i.
CAD: aspirin/statin.
If a pt isn’t on the first-line meds, document why.
Clear notes: you look good + others don’t have to reinvent the wheel= win-win!
#kittlesonrules
#TipsForNewDocs :
Art of the consult:
1) call early in the morning (consultants have lives too)
2) try to have a specific question: not “pt is anemic” but rather “anemia, low retic, no fecal occult blood, norm Fe/B12/folate —> do we need bone marrow bx?”
#kittlesonrules
#TipsForNewDocs
Sinus tachycardia is the delirium of cardiology.
Delirium --> it's (basically) never the brain's fault.
Sinus tach --> it's (basically) never the heart's fault.
Don't be distracted by the wrong organ in search of the right answer!
#kittlesonrules
Sometimes I’m asked how I “do it all“ w/3 kids and a career. I don’t.
Career extras like research get put on hold when family requires more attention.
Life happens in stages- don’t be hard on yourself. You’re not supposed to accomplish it all at once.
#kittlesonrules
#TipsForNewAttendings
Sometimes you can tell a trainee doesn't agree w/your plan but isn't sure what to say. Encourage questions and debate. You'll model respectful disagreement and explaining your rationale --> better understanding for you and the trainee.
#kittlesonrules
#TipsForNewDocs
Inpatient has renal mass on u/s. Plan is outpatient eval.
No: 'Defer to outpatient.'
Yes: 'Per discussion w/rads, renal cell ca possible. Pt ready for discharge today; PMD aware, renal CT scheduled.”
Don’t leave loose ends hanging.
#kittlesonrules
#TipsForNewDocs
It's great to titrate up meds on inpatients, but before you do, check the medication administration record (MAR) to ensure pt rec'd prior ordered dose first.
Just b/c you order a med doesn't mean the pt received it-- trust the MAR!
#kittlesonrules
#TipsForNewDocs
Complicated pt came to see me (cardiology).
GI: get abd CT w/contrast.
Nephro: don’t get abd CT w/contrast.
Pt: ???
So I messaged GI/nephro for her.
Talk to your colleagues! Avoid relaying medical recommendations through the pt.
#kittlesonrules
#TipsForNewDocs
The practice of medicine gets better (more rewarding, less scary) with experience.
Approach medicine like a foreign language- put in the effort to memorize the grammar and vocabulary and you will soon be able to appreciate the poetry.
#kittlesonrules
#TipsForNewDocs
If the only justification you can muster for ordering a test is 'the results would be of academic interest” or “I just want to know,” then don't order the test.
#kittlesonrules
#TipsForNewDocs
Bad: See the cardiologist for an angiogram.
Good: See the cardiologist to decide the next best step for your symptoms.
Don't paint the consultant into a corner- allow them to use their expertise to chart the right course for the patient!
#kittlesonrules
#TipsForNewDocs
You’re never too important to look it up. I’m a cardiologist and I still look up the treatment of pericarditis. I don't treat it a lot and want to ensure I have the duration/taper of NSAIDs right. UpToDate = your friend for life.
#kittlesonrules
#TipsForNewDocs
Cringe-worthy chart phrases:
“Avoid nephrotoxins” (w/o adding relevant ones)
“Lungs clear. No crackles.” (redundant)
“Pt has leg swelling x3d”… exam: “no edema.” (inconsistent)
“Consider XYZ” (w/o saying why or why not)
#kittlesonrules
#TipsForNewDocs
There’s a right time for negative/constructive feedback, but there’s never a wrong time for positive feedback.
Give credit where credit is due: appreciate trainees, referring physicians, nurses, and ancillary staff early and often.
#kittlesonrules
#TipsForNewDocs
Taking a social history: Bad: no smoking or alcohol
Good: born/raised, job, lives with, kids/grandkids, smoking, alcohol, drugs
Learn the details that make your patient a person - getting to know them = providing better care.
#kittlesonrules
#TipsForNewDocs
Past medical history--
Wrong:
- AF
- DM
Right:
- Persistent AF managed w/rate control/anticoag, CHA2DS2-VASc 3
- Type 2 DM, Hgb A1c 7.5% 7/20, no end-organ dz
The PMH should provide descriptions of dz severity. Don't list- stratify!
#kittlesonrules