There is no doubt you will be well educated and well trained in the science of medicine. Statins post stroke, pneumovax to reduce lung abscesses, CAR-T for cancer, but I want you to start focusing on the human condition. This is not an exhaustive list by any means but is a start at how we should think of our fellow humans. I’m a hospitalist so I will try to only speak to what I know. Other specialties feel free to add.
Alcohol is not a problem. It is a solution to a problem. Don’t get frustrated that the alcoholic won’t stop if we don’t help with the problem.
On hospital day three of there pneumonia admission, your ten point review of systems is a lie. I propose a ten point review of who they are. Knowing who they are can sometimes give you better insight to their illness and sometimes just make the relationship stronger. Example, my dying cancer patient loved Texas hold em, playing a couple hands on day 20 before he died was more important than any ROS, exam, or meds I could give him.
Everybody around you is unique with their own anxieties and problems. That person who just got off the elevator, they might have just lost their newborn. That person who slammed the bathroom door might have just found out their spouse has cancer, that angry nurse might have a kid with special needs at home, that person holding up the cafeteria line might have just been told that their partner has Alzheimer’s. Be kind to everybody, the hospital is a very special place.
Don’t turn your back to the patient and type. Don’t stand up hovering over the bedside. Don’t not give silence a chance. These things are way more important than an S3.
Don’t overvalue the risk of death. Specifically speaking about PEGs. Sometimes it’s ok to accept aspiration if death is not valued over eating. Better yet, don’t villainize vices at the end of life.
Opiates treat pain but cause suffering. Unless you are dying. BZDs cause way more anxiety when you try to remove them than the anxiety you were trying to treat in the first place.
Don’t lie to your patients. If they don’t take their asa, they won’t die. Learn how to couch it better or analogize it better. The odds are in their favor if they don’t take asa, but if they didn’t take it and got an MI would they regret it? Then it’s a discussion about regret mitigation. Whatever their choice, you’ll both be less frustrated and they will feel more respected and you will get more respect. Don’t lie.
Short of physically assaulting you, any abuse you get from patients or families is usually not personal and is the expression of the vulnerability and fear. Do stand up for yourself but give them the benefit of the worst of ourselves when dealing with the betrayal of our bodies.
Your career is an ongoing prospective trial with an n of one. Your value is standing up for the 95% of your practice that you can back up with your own well reasoned decisions. Don’t be dogmatic. 5% of your values come from the margins of cognitive dissonance. If you don’t look, you will never see.
You are the right person for the job.
Last but most important. On death. We all die. We don’t all die the same way. Sometimes we die slowly on a vent and suffer to give our family the time to come to peace. Sometimes we take chemo for regret mitigation other times because we want our kids to know we didn’t quit even though we know we are dying. Sometimes are lives are robbed in the night and our families never get to say goodbye. The discussion around and about death is the most nuanced discussion you will ever have. Put your values aside. Ask questions and listen. Their motivations for delaying death are sometimes very meaningful and understandable even if you don’t agree with it. Don’t place the burden of removal of life support on the family, it’s not fair. Love and fear cannot hear reason.
The day you have no anxiety walking through those hospital doors is the day you hang it up.
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