Clinical Interest for Patients
My clinical interests include treating patients with COPD or the acute respiratory distress syndrome and other aspects of critical care medicine
My care philosophy is expressed in a series of aphorisms I teach medical students, interns, residents and fellows:
1. The patient comes first. Helping the patient and their family takes precedence over your own emotional, social, economic, philosophical, religious or intellectual concerns. Treat every patient with the greatest respect, regardless of their circumstance in life.
2. Know what you know, and know what you don't know. Admitting ignorance is the first step towards learning (first attributed to Socrates).
3. Create an atmosphere that encourages everyone to participate in patient care. Be grateful for any information you acquire, regardless of its source. Nurses spend far more time with patients than do physicians. Their input should be solicited and their observations and suggestions should be incorporated into your plans. Family members often have access to information that physicians don't. Actively seek out information from every source of you can. No one has a monopoly on good ideas.
4. Check the medications. When something unusual or unexpected occurs, you will be dealing with a side effect of a medication more often than not. Know the three most common side effects of every medication a patient is taking, and of every medication you prescribe. If a patient is taking three or more medications with an x, y or z in their names, the patient's problem will be a side-effect of one of these medications 90% of the time (because medications given for psychiatric problems usually contain these letters and they very commonly cause side-effects).
5. Advise, as well as inform your patients. Most patients and their families want more than just information. Don't leave them with the burden of decision-making. Do your best to educate the concerned parties about all the available options, give them the opportunity to ask questions, but then tell them what you think should be done, in a fashion that allows them to choose your option, or any other, with comfort. “A physician who merely spreads an array of vendibles in front of the patient and then says, ‘Go ahead and choose, it’s your life’ is guilty of shirking his/her duty, if not of malpractice” (Inglefinger, NEJM 1980)
6. Respect the Zen of Medicine. Be receptive to your intuition. You spend years being trained to distinguish normal from abnormal. If something seems curious or unusual, it probably is. Follow up on your suspicions.
7. Get to know your patient as a person, and deal with their emotional concerns. Most patients (and their families) coming to see a physician are scared. This fear is frequently overlooked in the urgency of trying to make a diagnosis, devise a therapy or perform a procedure. Getting to know your patient personally is one of the joys of the profession, and doing so enables you to understand their problems within the context of their lives. “Connecting” is more than just being nice, it is critical to doing your job well. No matter how good you are at making a correct diagnosis or knowing correct treatments, patient satisfaction requires that their personal concerns be addressed. Don’t forget to do so.
8. Remember the importance of daily rounds. Most patients await your arrival with great anticipation. Don't disappoint them by providing brief, uninformative or superficial encounters. What percent of rounds is spent reviewing lab studies or other results versus talking to or examining your patients? Remember that most patients consider your daily visit(s) as the most important time of their day! It is difficult to find sufficient time for meaningful interactions during morning rounds as all the patients on your service need to be seen and the work of the day must be scheduled. Explain this to your patients, tell them you’ll come back when you have more time, and then be sure to do so. Sitting on the bed sends the message that now you have the time, and that you’re inviting them to express their concerns and ask their questions (see # 7).
9. Read, think, ask and learn. It is a privilege to be a physician, but with this privilege comes the enormous responsibility for patient’s lives and well-being. This responsibility can only be met by practicing the best medicine possible, and “best” is always changing. While a lifetime commitment to education is needed, the intellectual stimulation that results from meeting this commitment is another of the extraordinary joys of the profession.
10. Re-read, re-think, re-ask and re-learn. (see #9).
In my spare time I enjoy skiing, golf and reading (both fiction and non-fiction).