Day 2: Equally, if not more inspiring!

The story of Michael Skolnik stimulated some fascinating but somewhat difficult discussions. As a resident, especially a first year resident (scrambling to see patients, figure out a plan and write notes), it’s hard to remember to take the time to give a thorough informed consent, even for simple procedures such as circumcisions. Our consent form for this procedure at my hospital is a page long at like a font size of 10. But is there really that much to talk about? And to be honest, I have NEVER read that form all the way through. I know it talks a little bit about my hospital being a teaching hospital and a little about the hierarchy of residents, attendings, etc. It’s pretty technically written though, not anything I would want to read if I were a patient even with the same amount of education I have. Other thoughts that our discussion got me thinking about:

1) Asking the patient “What do you want from treatment?” before offering any options is a powerful way to center the conversation and ensure the patient and physician are on the same page from the start. 2) Second opinions: Practicing medicine independently and confidently seems to be ingrained in us in medical school. I don’t understand that. As an intern, I have already come to see how much I depend on pharmacy, nutrition and nursing when I am presenting my assessment and plan on rounds. Why does that change when we become attendings? How brave a physician is to offer second opinions. I hope at some point this will not be considered courageous but simply standard of care.

I have taken over a QI project at my institution with the goal of improving communication between residents and nurses. We have asked nursing to utilize a text-paging system and specified what information is helpful for us to know prior to contacting nursing by phone or face to face. One of the main goals of this project is to try to eliminate the multiple interruptions we get from pages while admitting kids or taking care of other sicker kids. Nursing knows that unless they specify “FYI,” we will call them back within at least 20 minutes, or sooner if they or we, after reading the page from them, see the need to. This has been a pretty well accepted change on the part of the both nursing and residents. It was awesome hearing about all the QI projects our residents are already doing. I am excited to start one of my own and experience all the steps that come with performing a QI project! It’s hard to pick one thing to focus on. There are so many changes that need to be made.

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