MY MEDICINE MANTRAS
Inspired/requested by @TT's "My 'Art of Medicine.'" Mostly comprised of things I chant to myself or repeat ad nauseum to my interns.
- •This is the scariest day of this family's life.Whenever a family or patient is rude, mean, uncooperative, or yells at me (which happens more than you'd think), I remind myself of this obvious fact. I know it seems duh to you, as a probable family member, but this is my job. The hospital isn't scary for me, I've seen this child's illness many times (usually, at least), and often, this kid isn't the sickest on my docket. But for each of my patients, this is probably the worst, scariest thing possible and fear makes people act a fool.
- •It's not my fault, but it's also not theirs.Seriously, people in the health care system can be real jerks when they don't get what they want (pain killers, antibiotics, a super quick appointment, a fire). They forget their doctors are people too. It can be easy to package them up as unkind or inconsiderate, but I (try, at least, to) think about how powerless they feel, and that they don't know how much I also feel that way.
- •Trust your gut.Every single instance where I've walked into a room and immediately felt my stomach drop has turned into a critical situation. I can rarely explain why, but it has honestly saved lives (and that is not something I seriously say often) (though I like to joke about it when I'm getting my patients juice and crackers). It's hard to trust something that can't be defined, learned, or taught, but it is crucial, and a mantra not limited to medicine.
- •What will I be furious at myself for missing?Trusting my gut is all well and good, but that's just a feeling, not a diagnosis. I look at the situation like I'm an outsider and think of how I would insult myself for not considering something obvious or horrible. It sounds like self-bullying, and it probably is, but it's effective. It's also a good tack to take when a parent is histrionic/nasty, because it forces me to consider what I'd feel SO BAD about missing if I just sent home a sick kid because of their obnoxious parent.
- •I may not be sure what is going on, but I know it's not dangerous.That's sometimes the best I can do, especially with pain of unknown cause. It doesn't mean we stop looking for why something is there, or that we don't treat it. It is just a very reassuring statement that lets me sleep at night and calms anxious parents.
- •Get off your butt and look at the patient.A lot of modern medicine is sitting around and typing medications and documentation into a computer. There are a lot of hospital physicians who spend their whole day in a workroom, not with patients. While that can be completely acceptable, whenever I'm told about some new symptom, worsening pain, maybe a fever, I go lay eyes on the patient myself. I have literally never regretted doing this, and it has led to some of my biggest saves.
- •It's important to do everything we can, but there is also a natural course we can not control.We have to reflect on what can be done better and lessons learned, of course. But as important as doctors think they are, sometimes the outcome is exactly the same no matter what we do, both good and bad. It's not worth torturing myself over minutiae, because in all likelihood, it didn't make any difference. This mantra is often hard to swallow, particularly after a code.
- •Patients declare themselves.Sometimes, the best way to figure out what's going on is to just wait and watch. This goes against our nature, because there's such a strong impulse to fix, but simple monitoring can be the best intervention. If the patient is going to get sick, they'll get sick, and we can treat them with the advantage of time and knowledge. If they're going to get better, we haven't exposed them to possibly dangerous therapies, and their body has healed itself. Let them show you.
- •Always ask if you want to know.My intern year, I started asking families why they thought their child's illness was an emergency when they came to the ER. I learned SO MUCH. Sometimes it was that their child had never thrown up before, one time it was because a mom had lost a previous child to SIDS, many times another family member insisted they take them. Sure, sometimes the reasons were not great, but instead of being annoyed and guessing, I probably should have just been asking all along.
- •Treat the pain.Regardless of origin (chronic, injury, mental), pain hurts. I'm not stingy about pain killers. After I get thing under control, then I can check up on the history, the root cause, but skepticism and tough love have no place when a patient first shows up.
- •Do no harm but take no shit.Just kidding, I take tons of shit. But I take that do no harm part very seriously.