#TipsForNewAttendings The importance of knowing all the details of your patient's care doesn't end when you're no longer a trainee. Trust, but verify, the details presented to you- then, you can be certain patients are receiving the best care. #kittlesonrules

#TipsForNewAttendings When I enter the room with my trainee entourage, I’m generally the smallest woman in the room. So how do I explain that I’m the attending? “Hi, I’m Dr. K and I’m the boss of this team!” Claim your role! Works every time. #kittlesonrules

You are scheduled to lead a hourlong virtual case-based discussion at 1 PM with four third-year medical students rotating at your hospital. By 1:10 PM, no students have logged on. Do you wait it out or log off and ask the admin in charge of the rotation to reschedule?

#TipsForNewDocs I have a “mentor web.” Some relationships are clear: people who trained me. Others are not: chance introductions -> amazing support. The lesson: embrace opportunities to shine. Keep showing up. Working hard can pay off in unexpected ways. #kittlesonrules

#TipsForNewDocs Clear presentations on rounds: Present in the same order every time (like filling in blanks in a template). Don't editorialize objective data- state facts. Don’t wander into A/P until you get to the A/P- you and listeners will get lost. #kittlesonrules

#TipsForNewDocs Be a Captain, not a Waiter. Waiter: "How much Lasix would you like, Dr. K?" Captain: "Pt is wet- double Lasix to 80 IV BID w/goal 2L neg." Think through the A&P- even if you're wrong, you learn more if you have an opinion. #kittlesonrules

#TipsForNewDocs When assessing training programs, ask current trainees about 3 critical tenets of med ed: Volume: exposure to a broad range of diseases? Autonomy: do attendings let you take charge of your pts? Mentorship: are role models approachable? #kittlesonrules

#TipsForNewDocs You’re never too important to pre-round. Almost 20 years from training, I still review labs & notes from RNs & consultants before team rounds. If you have an idea of the plan, rounding is more efficient and you can spend more time teaching. #kittlesonrules

#TipsForNewAttendings It is scary feeling like the buck stops with you, but remember you can always seek advice from trusted mentors and colleagues. They will always be happy to hear from you – so use them! #kittlesonrules

#TipsForNewAttendings If you learn of bad behavior directed at your team, address it. You may use humor or something stronger, but don’t let it go. Your job is to train but also to defend and support. With your good example, they will pay it forward. #kittlesonrules

#TipsForNewDocs Don't copy anything in your note you don't understand. Ex: don't write "PTLD s/p R-CHOP" w/o knowing pt has post-transplant lymphoproliferative disorder s/p ritux, Cytoxan, Adriamycin, vincristine, pred. Your notes should make sense to you. #kittlesonrules

#TipsForNewDocs If your note indicates that your final recommendations depend on pending tests, add an addendum or new note with those recs once the results are available. Closing the loop in communication is an essential component of effective patient care. #kittlesonrules

#TipsForNewDocs Patient doesn’t accept your recommendation. How to proceed and document? No: "Patient refuses X.” Yes: "Patient declines X due to __. I explained indications, risks, benefits of X: ___ and the potential consequences of declining X: ___. " #kittlesonrules

#TipsForNewDocs To establish rapport w/pts when you don't have a lot time: prep in advance w/PMH, meds, etc. and focus discussion on HPI & social hx. You'll have all relevant med facts + time w/pts is spent on what matters: how they feel and who they are. #kittlesonrules

#TipsForNewDocs Unless it's super-obvious, ask a pt how to pronounce their name when you first meet. I may or may not have mispronounced a pt’s name for years, only realizing my error when he corrected me on rounds with the residents. . . don't be like me! #kittlesonrules

#TipsForNewDocs Inspired by many amazing mentors: After lung auscultation, turn the pillow over. The small gesture, providing a freshly cool pillow, is a subtle way to offer comfort in a stressful time. Now adopted as #kittlesonrules

#TipsForNewDocs HF advice: Pt hasn't met I/O goal at 8 PM: do you have to spot-dose Lasix then or can it wait until morning? Pt needs BID diuretic: can you schedule the second dose at 2 PM instead of 6 PM? Treat HF, but not at the expense of sleep! #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

FINEARTS: finerenone --> reduction in worsening HF + CV death in pts w/HF + EF > 40% TOPCAT: spironolactone --> no diff in HFH/CV death in pts w/HF + EF >=45% but benefit in Americas vs Russia/Georgia For your pts w/HF + HFmrEF/HFpEF, which MRA will you use?

#TipsForNewDocs An EMR smartphrase I include in my note template: "The symptoms are consistent with *** and I recommended ***. Instead of copied-forward one-size-fits-all phraseology, forces me to craft a differential + evaluation/management plan! #kittlesonrules