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#TipsForNewDocs I take care of pts in the hospital for wks-months awaiting heart transplant, so I try to make the stay tolerable: 1) no VS checks/diuretics/etc. 11 PM to 5 AM 2) OK to bring in food from home 3) ask about (and fix) constipation and insomnia #kittlesonrules

Sometimes, it's important to hear more than what the patient is saying. Chapter 9, Mastering the Art of Patient Care. link.springer.com/book/10.1007/9… #kittlesonrules

#TipsForNewDocs When you present, choose words wisely. Bad: Complex 56 yo M with multiple medical problems... Good: 56 yo M s/p heart transplant 2016, rejection 2017, graft vasculopathy... If you're precise and concise, people will listen- and hear- more! #kittlesonrules

Medicine can feel like a foreign language- my tips for fluency in Chapter 2, Mastering the Art of Patient Care link.springer.com/book/10.1007/9… #kittlesonrules

Vutrisiran, a TTR silencer, is now FDA-approved for transthyretin cardiac amyloidosis- along w/two FDA-approved stabilizers, tafamidis and acoramidis. There is no trial evidence to guide single vs combo therapy. What will be your go-to regimen for ATTR-CM? Explain in comments!

#TipsForNewDocs There are some essential meds in cardiology. HFrEF: ARNI/BB/MRA/SGLT2i. 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

Phrases to avoid if you want your notes to make sense. #kittlesonrules Mastering the Art of Patient Care link.springer.com/book/10.1007/9…

#TipsForNewDocs Before ordering a test, have a plan for a normal, abnormal, or indeterminate result. If this thought experiment demonstrates the test won’t change management, or if you don’t know how to interpret/act upon all possible results, don’t order it. #kittlesonrules

#TipsForNewAttendings Trainees often ask questions like “Do you want increase Lasix today?” My favorite response: “What do YOU want to do?” Encourage them to make the decisions- prepare them for when you’re no longer their safety net! #kittlesonrules

How do you teach trainees to think independently? Chapter 8, Mastering the Art of Patient Care link.springer.com/book/10.1007/9… #kittlesonrules

#TipsForNewDocs Pt learns of mass on chest CT when the nurse tells her she's NPO for biopsy. Primary team assumed consult team told pt. Consult team assumed primary team told pt. Lesson: don’t assume. Include “tell the patient” as part of the plan. #kittlesonrules

Communication is an essential component of consultation-- more in Chapter 6, Mastering the Art of Patient Care. link.springer.com/book/10.1007/9… #kittlesonrules

#TipsForNewDocs Discussing treatment options with patients: Bad: Do you want to take a statin? Good: Let’s talk about why I believe a statin is the right option for you. Shared decision-making isn’t a laundry list- it’s a menu curated by medical judgment. #kittlesonrules

Shared decision-making is not abdication of medical decision-making- Chapter 9, The Tough Conversations, in Mastering the Art of Patient Care link.springer.com/book/10.1007/9… #kittlesonrules

#TipsForNewDocs I once saw a healthy pt- wanted echo w/dental appt, worried about endocarditis. My attending was the first who talked about anxiety, not the echo. A lesson for me: Take the time, figure out what the pt needs- may be diff from what they want. #kittlesonrules

Sometimes the right answer is no- Chapter 9, Mastering the Art of Patient Care link.springer.com/book/10.1007/9… #kittlesonrules

REBOOT! #458 Heart Failure with Reduced Ejection Fraction 💗 Kittleson Rules Outpatient Heart Failure Volume 1 Listen for the first time or refresh your memory and listen again!! #meded Michelle Kittleson MD PhD #medx

If you (like me) love a bargain, now’s a great time to get a copy :) link.springer.com/book/10.1007/9…

🆕 ACC Scientific Statement on managing #obesity in adults w/ #HF reviews Dx, evaluation, & risk assessment; outlines HF-specific Tx strategies including lifestyle changes, medications, & surgery; & highlights 🔑 evidence gaps & future directions jacc.org/doi/10.1016/j.… #JACC

The 4 Longest Days | JACC jacc.org/doi/10.1016/j.…