Information

When presenting complex patients, especially as a medical student, you really need to either tape the presentation and listen (which you may not have time for) or run through what you are going to say in your head or out loud to make certain what youre saying makes sense.

For the past few months I’ve heard very good presentation and some very poor ones. The good ones show a bit of thinking on the part of the presenter in the following way: problem-system-status-countermeasure- follow-up

Example of bad: Presenting a elderly patient s/p surgery whose urine output has dropped then presents all the rest of the things that happened in the past 24 hours, then presents all of the organ systems in their entirety, then presents all of the lab data as a monologue and all of the x-ray data and then stops talking and looks up at you.

The problem with this presentation is that you are not synthesizing any of the information, and you’re presenting so much information without emphasis that it is very difficult for anyone who is listening to put together what’s going on patient. In addition, the attending’s mind begins to wander, at least mine does, and the dangerous aspect of that is that they won’t be able to pick up on the cues that may be important in caring for the patient.

 

Example of good: Mr. Johnson had a total urine output of 240 mL over 24 hours yesterday his weight is down 2 kg, his inputs were 3.5 L and his outputs were 500 mL. His BUN went from 22 to 30 and his creatinine went from 1.6 to 1.8.

As another example: Mrs. Smith got started on five dobutamine her blood pressure at the time was 90/60 her pulse was 95 and she is on beta blockers.  Her lactate was 2.6 and urine output droppped to .3 mL per kilo per hour. Her bicarb was down from 24 to 19 and her BUN had risen from 35-42 and her creatinine from 1.5 to 1.8

You can see from the examples that presenting the event with the context of the data from the system that the event relates to:  1. it proves that you’re thinking, 2. it allows the other people on the team to have a better chance of putting the information together to come up with a viable treatment option and it will also help you learn what data relates to what organ system.

 

While there may be an attending that will discourage you from presenting this way first of all I think it that’s crazy but second of all even if you have to present in a different fashion you need to use this advice for you to present to yourself or to present others to show that you’re simplified synthesizing the information and putting things together to get a real picture of the patient thanks

My take on why quality and patient safety improvements in medicine have been so hard to demonstrate, and why. I also present my belief in how we can move more effectively in quality and patient safety if we give up on competition. Also Brian Hughley and I playing “James” by Pat Metheny from a few years ago. Thanks.

Just got back from a great trip to the Big Apple with my friends from Albemarle County fire. The purpose was to buff FDNY firehouses and units and we saw a ton. The link goes to a video of the pictures I took.  FDNY trip pic video

Couple of thoughts about what goes on in NYC. FDNY is an amazing organization, incredible people, incredible equipment, and incredible training. The “Rock” their training school and simulation center is amazing and their devotion to training is astounding, especially since they think a great deal of themselves, and usually organizations like that rest on their laurels, the FDNY doesn’t do that.

But the disdain for EMS in NYC is really shocking. As many of you know FDNY EMS and FDNY are essentially separate organizations living under the same roof. The FDNY firefighters are trained in CFR (first responder) which is less training than EMT, and yet first respond to all major EMS incidents. What they do their other than comfort and help lift is hard to figure out. And that’s fine, I don’t like many EMS calls myself, but it does actually save lives occasionally, and in order to save the lives you should, you need to have a solid EMS system, which does not seem to exist in NYC. Also, as a former New Yorker, I know how hard it is for us to think anything done outside of NY is worth a sh*t, but I think if you took an unbiased person and had them watch the NYC EMS system in work during a complex call, and then watched the Virginia system in most jurisdictions, I think the differences would be striking.

I don’t know the solution for EMS in NYC but the first step in addressing any problem is realizing you have one.

Discussion with Chief Eggleston on “Dealing with Reality”. As a leader, how do handle it when your goals and vision run up against obstacles so great that they endanger your success. We also talk about strategies to win over detractors or drive over them. Thanks for listening.

Starting a series on how to lead clinical teams, whether its a trauma center or a fire department. This part gives the background on what kind of positions are worth taking, and what to do when you show up. Thanks for listening. JY