Communication is one of the most under-appreciated aspects of medicine. We need to communicate with lots of people with different knowledge and backgrounds. It’s easier said than done.
The easiest way to facilitate your calls is to be good to the other team members. I strongly recommend you try your best to remember names (but I’m notoriously bad at it). Before your first call, try to figure out who the following are:
It’s not magic. Being nice to people around you, even if you’re tired and freaking out inside, will reward you time and time again. The saying “what goes around comes around” is extremely true in a hospital setting.
When asking for a consult, ALWAYS make sure you know the basics about the patient’s situation. On call, especially if you’re cross covering, you won’t have time to go through a patient’s entire chart, but at least know a minimum amount of information:
Ultimately, know why you’re calling — funny, but as you get more senior, you’ll get calls that go like this:
–ID? yeah, can you come and see this patient? He has an abscess.
–Ok… How old is the patient?
And then you hear pages flipping…
–ok; what was he admitted for?
-Well, I don’t really know the patient… I was asked by my senior to call you for his abscess…
You do not want to be that person.
Communication with an attending physician should be the same as with any other resident. The enthusiasm in answering questions, especially after hours, can be quite different, so residents needs to be ready and prepared for the eventuality of dealing with a grumpy person. I recommend making extra sure that the call is warranted and that you cannot get an answer to your question any other way.
Let’s face it. Contacting an attending physician, a fellow or even a senior resident can be intimidating. However, when you actually need help, it’s important to be able to put that anxiety to one side and put the well-being of your patient first. Just take a deep breath and dial the number!
The most important aspect of communicating with fellow residents and medical students is the handoff (or handover - depending on where you are in the world). A good handoff is an art form. Not too long, not too short. You need to be able to summarize the patient’s issues in a few words. A proper handoff shows respect for your colleagues and, of course, for your patients. Unfortunately, this is often not taught well in medical school and, since it has been associated with surgical errors and malpractice claims, I believe it is an important skill worth developing.
It’s common courtesy for the team leader of the group to contact the resident on call with a well organized handover, ideally they would meet in person to “run the list”.
Despite much research on the topic, there remains much controversy on what is a “good” and “safe” handoff. Using the mnemonic (and we all love mnemonics, don’t we?) SBAR has been recommended.
However, I found it relatively vague. I personally prefer this version:
I recommend trying your best to transfer the information Twitter style (i.e. 140 characters or less). This forces you be more efficient and choose your words carefully. At the end of the list, you and the other resident will be glad you did.
Ideally, the same process should take place the next morning. From experience, I have been less consistent, but I tried to do it. Even if I wrote nice notes during the night, I believe every little bit of information helps to make the flow of information as smooth as possible.
Have thoughts to share — email me Marc-Emile@messil.com
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