#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

76F has lipid panel: cholesterol 254, HDL 89, LDL 145, triglycerides 92. ASCVD 10-year risk 21.5%.

Also needs MV repair for MVP with severe MR so CTCA ordered: no evidence of coronary artery disease and coronary artery calcium score zero.

What do you recommend?

#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

A patient transplanted as a child establishes care in your adult program- no complications or concerns.

A few weeks later, his mom requests a phone call with you, without her son, because she was not at his visit. He gives permission to talk with her.

What do you do?

#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

A patient with whom you had a very close relationship but haven't seen in 5 years calls your office. He doesn't want to schedule an appointment, telehealth or in clinic, but requests that you call him to discuss recent health concerns.

What do you do?

#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

A patient sees your colleague for cardiac evaluation, then requests to switch their care to you because you have more experience. You review your colleague's management which is appropriate and know that your experience/expertise are not warranted.

What do you do?

#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

#TipsForNewDocs

Secret to a stellar oral presentation: HPI -> PMH -> Meds/allergies -> SH -> FH -> ROS -> PE -> labs -> A/P - same order, every time.

Rounds are not the place for extemporaneous soliloquies (is there ever a place for those?).

#kittlesonrules

#TipsForNewDocs

The active problem list is not a diary.

Ask yourself: is the fact that the patient was admitted for community-acquired pneumonia in 2002 still relevant in 2020?

If an item doesn't spark joy (i.e., better patient care), delete it!

#kittlesonrules