Mastering the art of patient care:
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| Format: | Buch |
| Sprache: | English |
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Springer
[2022]
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| Beschreibung: | xxv, 184 Seiten |
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| adam_text | Contents Part I 1 Building Your Medical Foundation Medical School............................................................................................. 1.1 The Early Years ............................................................................. 1.1.1 The Cheat-Sheet Method................................................. 1.1.2 Study Questions .............................................................. 1.1.3 Keep Hope Alive ............................................................ 1.2 The Clinical Years......................................................................... 1.2.1 Feign Enthusiasm............................................................ 1.2.2 Commit to the Rotation ................................................... 1.2.3 The Price of Service is Scut ............................................ 1.3 Final Thoughts............................................................................... References ............................................................................................... 2 Becoming Fluent in Medicine.................................................................... 2.1 2.2 Oral Presentations ......................................................................... 2.1.1 The Identifying Statement.............................................. 2.1.2 The History of Present Illness ...................................... 2.1.3 The Past Medical History .............................................. 2.1.4 Medications.................................................................... 2.1.5 Allergies
........................................................................ 2.1.6 Social History ................................................................ 2.1.7 Family History .............................................................. 2.1.8 Review of Systems......................................................... 2.1.9 Physical Examination and Laboratories ........................ 2.1.10 Assessment .................................................................... 2.1.11 Plan ............................................................................... 2.1.12 The Daily Presentation .................................................. 2.1.13 Keep to Your Script ....................................................... 2.1.14 Know Your Patient......................................................... 2.1.15 Practice Makes Perfect .................................................. The Art of the Note....................................................................... 3 3 5 5 5 7 8 9 10 10 10 11 12 12 12 13 14 15 16 17 18 18 19 20 22 22 23 23 24 xvii
Contents xviii 2.2.1 Make It Make Sense .......................................................... 2.2.2 Brevity is the Soul of a Good Note .................................. 2.2.3 If You Write It, You Own It .............................................. 2.2.4 Close the Loop .................................................................... 2.2.5 Useful Tips and Tricks........................................................ 2.2.6 Cringe-Worthy Phrases ...................................................... Final Thoughts................................................................................... 24 24 25 25 26 27 27 Your Career Path .......................................................................................... 29 29 30 30 31 31 32 32 33 33 34 34 34 34 35 36 36 36 37 37 37 38 38 39 39 39 2.3 3 Research ............................................................................................. 3.1.1 Pick the Mentor not the Project ........................................ 3.1.2 Start More Basic................................................................ 3.2 Giving Talks....................................................................................... 3.2.1 Relevance: Consider the Audience ................................... 3.2.2 The Importance of Anecdotes ........................................... 3.2.3 Punctuality is a Virtue ........................................................ 3.2.4 Make Your Slides Work for You ....................................... 3.2.5 Practice, Practice, Practice ................................................
3.3 Choosing a Specialty ........................................................................ 3.3.1 Process of Elimination........................................................ 3.3.2 What Do You Love? .......................................................... 3.3.3 Who Inspires You?.............................................................. 3.3.4 Does Lifestyle Matter? ...................................................... 3.3.5 What Comes Next .............................................................. 3.4 Picking a Training Program............................................................. 3.4.1 Volume.................................................................................. 3.4.2 Autonomy ........................................................................... 3.4.3 Mentorship ......................................................................... 3.5 More About Mentors ........................................................................ 3.5.1 Find a Role Model ............................................................. 3.5.2 Ask the Right Questions .................................................... 3.5.3 Assemble a Cabinet ........................................................... 3.6 Final Thoughts.................................................................................... References ................................................................................................... 3.1 Part II 4 Honing Your Clinical Judgment
Diagnosis........................................................................................................... 4.1 4.2 Read a Lot (of Notes) .................................................................. The Highest-Yield Questions........................................................... 4.2.1 What Are the Precipitating, Exacerbating, and Relieving Factors? ...................................... 45 4.2.2 Have the Symptoms Been Getting Better, Worse, or Staying the Same and Over What Period of Time? .............................................................. 46 43 44 45
Contents XIX What Made You Decide to Come in Today to Discuss Your Symptoms? ............................. 47 4.2.4 What Are You Most Worried About? ............................ 4.2.5 What Have You Tried to Make It Better? What Prior Testing Have You Had? ........................... Learning More Than What the Patient Says ................................ 4.3.1 Personality........................................................................ 4.3.2 Other Opinions ................................................................. 4.3.3 Location............................................................................ 4.3.4 Your (the Physician’s) State of Mind............................... Diagnostic Pitfalls.......................................................................... 4.4.1 Orthopnea ........................................................................ 4.4.2 Reproducible Chest Pain .................................................. 4.4.3 Assessment of Mental Status .......................................... The Power of Observation ............................................................ 4.5.1 Walking in the Exam Room ............................................ 4.5.2 Who’s with the Patient?................................................... 4.5.3 The Hospital Set-Up ....................................................... Final Thoughts.............................................................................. 4.2.3 4.3 4.4 4.5 4.6 5 and Interventions ......................................................................... There is No Perfect
Test................................................................ Bayes Theorem is Your Friend ..................................................... Pitfalls, Outliers, and Trends ......................................................... Duplication of Effort...................................................................... Communicate the Urgency............................................................ 5.5.1 Prepare the Patient .......................................................... 5.5.2 The Acute Recognition of a Chronic Problem is not the Same as an Acute Problem .................. 59 5.5.3 Use Your Influence When Warranted ............................ 5.6 The Cases that Keep You Up at Night .......................................... 5.6.1 Validation ........................................................................ 5.6.2 Tempered Reassurance ................................................... 5.6.3 A Plan with Managed Expectations................................ 5.7 The Worst-Case Scenario.............................................................. 5.8 The Golden Rule ........................................................................... 5.8.1 Contraindication Creep .................................................. 5.8.2 Indication Creep .............................................................. 5.9 “How Can It Hurt?” is Rarely the Right Justification................... 5.9.1 Be a Humble Student of Clinical Trials ......................... 5.9.2 When in Doubt, Return to the GoldenRule ..................... 5.9.3 Bandaids versus
Cures.................................................... 5.10 Final Thoughts.............................................................................. References ............................................................................................... Tests 5.1 5.2 5.3 5.4 5.5 47 48 49 49 50 50 50 51 51 51 52 52 52 52 53 54 55 55 56 57 58 58 59 60 61 61 61 62 62 64 64 65 66 66 67 67 68 68
Contents XX 6 The Art of the Consult.................................................................................. 6.1 6.2 6.3 6.4 Part III 7 How to Call a Consult ..................................................................... 6.1.1 Call Early ........................................................................... 6.1.2 Have a Specific Question .................................................. 6.1.3 Tell the Patient ................................................................... 6.1.4 Calibrate Your Concern...................................................... 6.1.5 Save the Plan for the Consultant ...................................... 6.1.6 Make Your Consultant Work for Your Patient ................ 6.1.7 Know When to Push .......................................................... How to Be a Consultant ................................................................... 6.2.1 Be Prepared......................................................................... 6.2.2 Be Specific ......................................................................... 6.2.3 Be Timely ........................................................................... 6.2.4 Be Part of the Team ........................................................... 6.2.5 Anticipate Questions .......................................................... 6.2.6 Know When to SignOff ..................................................... How to Work Together .................................................................... 6.3.1 Avoid Chart Wars
................................................................ 6.3.2 Pick Your Battles ................................................................ Final Thoughts.................................................................................. Establishing Your Medical Style Good Habits for a Lifetime......................................................................... Preparation ........................................................................................ The Worst-Case-Scenario Game ..................................................... Don’t Be Afraid of What You don’t Know .................................... Checklists: Not just for Interns Anymore ...................................... Time Management .......................................................................... Be Nice and Work Hard .................................................................. 7.6.1 Choose Kindness ............................................................... 7.6.2 Reliability and Respect ..................................................... 7.7 Final Thoughts.................................................................................. Reference .......................................................... 7.1 7.2 7.3 7.4 7.5 7.6 8 Leading Your Team ...................................................................................... 8.1 8.2 71 72 72 73 73 74 77 78 78 79 79 81 81 82 83 84 85 85 86 86 Tough Transitions: Being a Leader................................................. 8.1.1 Second-Year Resident
....................................................... 8.1.2 First-Year Fellow ............................................................... 8.1.3 Attending Physician........................................................... Teaching ............................................................................................ 8.2.1 Streamline Rounds.............................................................. 8.2.2 Encourage Debate ............................................................. 8.2.3 Create Captains-Claim the Role........................................ 8.2.4 Don’t Micromanage............................................................ 8.2.5 Rejoice in Trainees’Successes.......................................... 89 90 91 91 92 93 93 94 95 96 96 97 97 97 99 99 101 101 102 102 104 104
Contents 8.3 Learning ....................................................................................... 8.3.1 Look Things Up .............................................................. 8.3.2 Know the Right Questions .............................................. 8.3.3 Experience Trumps Education ........................................ Feedback........................................................................................ 8.4.1 Be Timely ........................................................................ 8.4.2 Be Specific ...................................................................... 8.4.3 Provide Context .............................................................. 8.4.4 Offer Strategies to Improve.............................................. 8.4.5 Check in to Assess Progress ............................................ 8.4.6 Positive Feedback is Important Too................................. Lead with Kindness ..................................................................... 8.5.1 Protect Your Team ........................................................... 8.5.2 Don’t Just Make the Offer, Make a Plan ......................... Final Thoughts............................................................................... 105 105 106 107 107 108 109 109 109 110 110 Ill Ill 112 113 The Tough Conversations ..................................................................... 9.1 The Emotion Behind the Question ............................................... 9.1.1 Can I Trust You?..............................................................
9.1.2 Am I Going to Be Okay? ............................................... 9.2 The Patient Who is Angry and Frustrated .................................... 9.2.1 Protect Yourself .............................................................. 9.2.2 Step 1: Listen .................................................................. 9.2.3 Step 2: Reflect.................................................................. 9.2.4 Step 3: Make a Concrete Action Plan ............................. 9.2.5 Step 4: Circle Back ......................................................... 9.3 Leaving Against Medical Advice ................................................. 9.4 The Patient Who Takes Too Long................................................. 9.5 The Patient Who Disagrees with You........................................... 9.5.1 Step 1: Identify the Problem........................................... 9.5.2 Step 2: Emphasize the Shared Mission and Medical Facts ............................................ 123 9.5.3 Step 3: Allow the Patient to Make Their Own Decision............................................................. 9.6 The Patient Who Wants a Second Opinion .................................. 9.6.1 Encourage Second Opinions........................................... 9.6.2 Learn from Being the Second Opinion .......................... 9.7 Practicing the Art of Saying No ................................................... 9.8 Breaking Bad News ...................................................................... 9.8.1 Step 1 : Have a Concrete Action
Plan............................... 9.8.2 Step 2: Determine the Delivery ...................................... 9.8.3 Step 3: Let the News Register ........................................ 9.8.4 Step 4: Explain the Plan .................................................. 9.8.5 Step 5: Make the Promise ................................................ 9.8.6 Step 6: Circle Back ......................................................... 115 116 116 117 117 118 119 119 120 120 120 121 122 123 8.4 8.5 8.6 9 XXI 124 124 124 125 126 128 128 129 129 130 130 130
Contents xxii When You don’t Know..................................................................... 9.9.1 Honesty on Rounds ............................................................ 9.9.2 Honesty with Patients ........................................................ 9.9.3 End-of- Life Care ............................................................... 9.9.4 Step 1 : Know All the Facts; Use Only the Ones the Families Need to Hear................................... 9.9.5 Step 2: Frame Best-Case and Worst-Case Scenarios .... 9.9.6 Step 3. Explore the patient’s Goals, Values, and Preferences.................................................... 135 9.9.7 Step 4. Make the Promise .................................................. 9.9.8 Step 5. Come to Consensus................................................ 9.10 More Thoughts About End-of-Life Care ....................................... 9.10.1 There Should be Grief....................................................... 9.10.2 You Do not Have a Crystal Ball ....................................... 9.10.3 Your Right Answer May Not Be Their Right Answer.................................................................. 137 9.11 Final Thoughts.................................................................................. Reference ..................................................................................................... 9.9 Part IV 10 131 132 132 133 134 134 135 136 136 136 137 138 138 Optimizing the Care of Patients and Yourself The Patient-Physician Bond
.................................................................... 10.1 Addressing Patients......................................................................... 10.1.1 Introductions...................................................................... 10.1.2 Patients with Dementia or Learning Disabilities ........... 10.1.3 Unresponsive Patients ...................................................... 10.2 Managing Expectations .................................................................. 10.2.1 Hospital Standard Time.................................................... 10.2.2 Discharge Planning .......................................................... 10.2.3 Side Effects........................................................................ 10.2.4 The Results of Tests/Interventions................................... 10.3 Care Versus Service ........................................................................ 10.3.1 Delays Are the Luxury of the Healthy ........................... 10.3.2 Trust the Experts .............................................................. 10.3.3 Know When to Expedite ................................................... 10.4 The Person Behind the Patient........................................................ 10.4.1 Embrace the Little Details ............................................... 10.4.2 Ask the Follow-Up Question ........................................... 10.4.3 Address the Little Indignities ........................................... 10.4.4 Humor
................................................................................ 10.5 Maintaining Homeostasis................................................................ 10.5.1 Eat ...................................................................................... 10.5.2 Poop .................................................................................... 10.5.3 Sleep .................................................................................. 10.6 Final Thoughts.................................................................................. 141 142 142 143 144 144 144 145 145 146 146 147 147 148 148 149 149 150 151 152 153 154 154 155
Contents 11 Being a Woman in Medicine (Men: Don’t Skip This Chapter!)........ 11.1 Navigating the Training Environment ............................................ 11.1.1 Never Assume the Worst.................................................... 11.1.2 Claim Your Role.................................................................. 11.1.3 Humor and Sarcasm Can Help .......................................... 11.2 Motherhood (Parenthood) ................................................................ 11.2.1 What You Need to Successfully Parent as a Physician ....................................................... 161 11.2.2 The Right Time to Have Kids............................................ 11.2.3 Unfounded Fear 1: You Won’t Remember How to Be a Good Physician ....................................... 162 11.2.4 Unfounded Fear 2: Your Baby Will Forget You.............. 11.2.5 Unfounded Fear 3: You Will Never “Get It Together”............................................................... 163 11.3 Navigating the Career....................................................................... 11.3.1 Your Priorities Are Right Because They’re Yours .......... 11.3.2 Comparison is the Thief of Joy ........................................ 11.3.3 There is More to Academic Medicine Than Research ............................................................... 165 11.4 Final Thoughts................................................................................... Reference ....................................................................................................... 12
Self-Care ........................................................................................................... 12.1 Boundaries ........................................................................................ 12.1.1 Vacation Time..................................................................... 12.1.2100% Care Does Not Require 100% Access ....................... 12.2 Patient Reviews ................................................................................ 12.3 Grief and Mistakes .......................................................................... 12.3.1 Separate Fault from Fluke.................................................. 12.3.2 Distinguish the Unforeseen from the Expected .............. 12.3.3 Accept that Control is an Illusion .................................... 12.3.4 Learn from Your Successes Too........................................ 12.4 Savor Your Victories......................................................................... 12.5 Find the Joy ...................................................................................... 12.6 Final Thoughts.................................................................................. Reference ....................................................................................................... xxiii 157 157 157 159 160 160 161 163 164 164 165 166 166 167 167 167 168 169 171 171 172 173 174 174 175 176 176 13.1 The Myth of Zero Risk..................................................................... 13.2 The Road to Bad
Outcomes.............................................................. 13.3 Disagreement and Covid ................................................................. 13.4 Final Thoughts................................................................................... References ..................................................................................................... 177 177 178 180 181 181 Afterword: The Joy of Medicine ......................................................................... 183 13 What Covid-19 Has Taught Us (or Not) ..................................................
Michelle Kittleson Mastering the Art of Patient Care Like a mentor you may turn to in times of crisis, this book provides the wisdom earned from countless mentors and patients. You may be standing on the precipice of medical training or well into your career, trying to recapture the joy of medicine. A love of people and a love of science barely capture the essence of a life in medicine; there is so much more to being a physician than the ability to diagnose and treat diseases. While nothing can fully prepare you for the fear and anxiety that comes with inexperience, Mastering the Art of Patient Care eases some of that uncertainty with a system for surviving and thriving in medical school and beyond. Whatever your stage, the goal of this book is to share successes and failures to help you be a physician who takes outstanding care of patients, colleagues, and trainees and derives great joy from saving lives.
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Contents Part I 1 Building Your Medical Foundation Medical School. 1.1 The Early Years . 1.1.1 The Cheat-Sheet Method. 1.1.2 Study Questions . 1.1.3 Keep Hope Alive . 1.2 The Clinical Years. 1.2.1 Feign Enthusiasm. 1.2.2 Commit to the Rotation . 1.2.3 The Price of Service is Scut . 1.3 Final Thoughts. References . 2 Becoming Fluent in Medicine. 2.1 2.2 Oral Presentations . 2.1.1 The Identifying Statement. 2.1.2 The History of Present Illness . 2.1.3 The Past Medical History . 2.1.4 Medications. 2.1.5 Allergies
. 2.1.6 Social History . 2.1.7 Family History . 2.1.8 Review of Systems. 2.1.9 Physical Examination and Laboratories . 2.1.10 Assessment . 2.1.11 Plan . 2.1.12 The Daily Presentation . 2.1.13 Keep to Your Script . 2.1.14 Know Your Patient. 2.1.15 Practice Makes Perfect . The Art of the Note. 3 3 5 5 5 7 8 9 10 10 10 11 12 12 12 13 14 15 16 17 18 18 19 20 22 22 23 23 24 xvii
Contents xviii 2.2.1 Make It Make Sense . 2.2.2 Brevity is the Soul of a Good Note . 2.2.3 If You Write It, You Own It . 2.2.4 Close the Loop . 2.2.5 Useful Tips and Tricks. 2.2.6 Cringe-Worthy Phrases . Final Thoughts. 24 24 25 25 26 27 27 Your Career Path . 29 29 30 30 31 31 32 32 33 33 34 34 34 34 35 36 36 36 37 37 37 38 38 39 39 39 2.3 3 Research . 3.1.1 Pick the Mentor not the Project . 3.1.2 Start More Basic. 3.2 Giving Talks. 3.2.1 Relevance: Consider the Audience . 3.2.2 The Importance of Anecdotes . 3.2.3 Punctuality is a Virtue . 3.2.4 Make Your Slides Work for You . 3.2.5 Practice, Practice, Practice .
3.3 Choosing a Specialty . 3.3.1 Process of Elimination. 3.3.2 What Do You Love? . 3.3.3 Who Inspires You?. 3.3.4 Does Lifestyle Matter? . 3.3.5 What Comes Next . 3.4 Picking a Training Program. 3.4.1 Volume. 3.4.2 Autonomy . 3.4.3 Mentorship . 3.5 More About Mentors . 3.5.1 Find a Role Model . 3.5.2 Ask the Right Questions . 3.5.3 Assemble a Cabinet . 3.6 Final Thoughts. References . 3.1 Part II 4 Honing Your Clinical Judgment
Diagnosis. 4.1 4.2 Read a Lot (of Notes) . The Highest-Yield Questions. 4.2.1 What Are the Precipitating, Exacerbating, and Relieving Factors? . 45 4.2.2 Have the Symptoms Been Getting Better, Worse, or Staying the Same and Over What Period of Time? . 46 43 44 45
Contents XIX What Made You Decide to Come in Today to Discuss Your Symptoms? . 47 4.2.4 What Are You Most Worried About? . 4.2.5 What Have You Tried to Make It Better? What Prior Testing Have You Had? . Learning More Than What the Patient Says . 4.3.1 Personality. 4.3.2 Other Opinions . 4.3.3 Location. 4.3.4 Your (the Physician’s) State of Mind. Diagnostic Pitfalls. 4.4.1 Orthopnea . 4.4.2 Reproducible Chest Pain . 4.4.3 Assessment of Mental Status . The Power of Observation . 4.5.1 Walking in the Exam Room . 4.5.2 Who’s with the Patient?. 4.5.3 The Hospital Set-Up . Final Thoughts. 4.2.3 4.3 4.4 4.5 4.6 5 and Interventions . There is No Perfect
Test. Bayes Theorem is Your Friend . Pitfalls, Outliers, and Trends . Duplication of Effort. Communicate the Urgency. 5.5.1 Prepare the Patient . 5.5.2 The Acute Recognition of a Chronic Problem is not the Same as an Acute Problem . 59 5.5.3 Use Your Influence When Warranted . 5.6 The Cases that Keep You Up at Night . 5.6.1 Validation . 5.6.2 Tempered Reassurance . 5.6.3 A Plan with Managed Expectations. 5.7 The Worst-Case Scenario. 5.8 The Golden Rule . 5.8.1 Contraindication Creep . 5.8.2 Indication Creep . 5.9 “How Can It Hurt?” is Rarely the Right Justification. 5.9.1 Be a Humble Student of Clinical Trials . 5.9.2 When in Doubt, Return to the GoldenRule . 5.9.3 Bandaids versus
Cures. 5.10 Final Thoughts. References . Tests 5.1 5.2 5.3 5.4 5.5 47 48 49 49 50 50 50 51 51 51 52 52 52 52 53 54 55 55 56 57 58 58 59 60 61 61 61 62 62 64 64 65 66 66 67 67 68 68
Contents XX 6 The Art of the Consult. 6.1 6.2 6.3 6.4 Part III 7 How to Call a Consult . 6.1.1 Call Early . 6.1.2 Have a Specific Question . 6.1.3 Tell the Patient . 6.1.4 Calibrate Your Concern. 6.1.5 Save the Plan for the Consultant . 6.1.6 Make Your Consultant Work for Your Patient . 6.1.7 Know When to Push . How to Be a Consultant . 6.2.1 Be Prepared. 6.2.2 Be Specific . 6.2.3 Be Timely . 6.2.4 Be Part of the Team . 6.2.5 Anticipate Questions . 6.2.6 Know When to SignOff . How to Work Together . 6.3.1 Avoid Chart Wars
. 6.3.2 Pick Your Battles . Final Thoughts. Establishing Your Medical Style Good Habits for a Lifetime. Preparation . The Worst-Case-Scenario Game . Don’t Be Afraid of What You don’t Know . Checklists: Not just for Interns Anymore . Time Management . Be Nice and Work Hard . 7.6.1 Choose Kindness . 7.6.2 Reliability and Respect . 7.7 Final Thoughts. Reference . 7.1 7.2 7.3 7.4 7.5 7.6 8 Leading Your Team . 8.1 8.2 71 72 72 73 73 74 77 78 78 79 79 81 81 82 83 84 85 85 86 86 Tough Transitions: Being a Leader. 8.1.1 Second-Year Resident
. 8.1.2 First-Year Fellow . 8.1.3 Attending Physician. Teaching . 8.2.1 Streamline Rounds. 8.2.2 Encourage Debate . 8.2.3 Create Captains-Claim the Role. 8.2.4 Don’t Micromanage. 8.2.5 Rejoice in Trainees’Successes. 89 90 91 91 92 93 93 94 95 96 96 97 97 97 99 99 101 101 102 102 104 104
Contents 8.3 Learning . 8.3.1 Look Things Up . 8.3.2 Know the Right Questions . 8.3.3 Experience Trumps Education . Feedback. 8.4.1 Be Timely . 8.4.2 Be Specific . 8.4.3 Provide Context . 8.4.4 Offer Strategies to Improve. 8.4.5 Check in to Assess Progress . 8.4.6 Positive Feedback is Important Too. Lead with Kindness . 8.5.1 Protect Your Team . 8.5.2 Don’t Just Make the Offer, Make a Plan . Final Thoughts. 105 105 106 107 107 108 109 109 109 110 110 Ill Ill 112 113 The Tough Conversations . 9.1 The Emotion Behind the Question . 9.1.1 Can I Trust You?.
9.1.2 Am I Going to Be Okay? . 9.2 The Patient Who is Angry and Frustrated . 9.2.1 Protect Yourself . 9.2.2 Step 1: Listen . 9.2.3 Step 2: Reflect. 9.2.4 Step 3: Make a Concrete Action Plan . 9.2.5 Step 4: Circle Back . 9.3 Leaving Against Medical Advice . 9.4 The Patient Who Takes Too Long. 9.5 The Patient Who Disagrees with You. 9.5.1 Step 1: Identify the Problem. 9.5.2 Step 2: Emphasize the Shared Mission and Medical Facts . 123 9.5.3 Step 3: Allow the Patient to Make Their Own Decision. 9.6 The Patient Who Wants a Second Opinion . 9.6.1 Encourage Second Opinions. 9.6.2 Learn from Being the Second Opinion . 9.7 Practicing the Art of Saying No . 9.8 Breaking Bad News . 9.8.1 Step 1 : Have a Concrete Action
Plan. 9.8.2 Step 2: Determine the Delivery . 9.8.3 Step 3: Let the News Register . 9.8.4 Step 4: Explain the Plan . 9.8.5 Step 5: Make the Promise . 9.8.6 Step 6: Circle Back . 115 116 116 117 117 118 119 119 120 120 120 121 122 123 8.4 8.5 8.6 9 XXI 124 124 124 125 126 128 128 129 129 130 130 130
Contents xxii When You don’t Know. 9.9.1 Honesty on Rounds . 9.9.2 Honesty with Patients . 9.9.3 End-of- Life Care . 9.9.4 Step 1 : Know All the Facts; Use Only the Ones the Families Need to Hear. 9.9.5 Step 2: Frame Best-Case and Worst-Case Scenarios . 9.9.6 Step 3. Explore the patient’s Goals, Values, and Preferences. 135 9.9.7 Step 4. Make the Promise . 9.9.8 Step 5. Come to Consensus. 9.10 More Thoughts About End-of-Life Care . 9.10.1 There Should be Grief. 9.10.2 You Do not Have a Crystal Ball . 9.10.3 Your Right Answer May Not Be Their Right Answer. 137 9.11 Final Thoughts. Reference . 9.9 Part IV 10 131 132 132 133 134 134 135 136 136 136 137 138 138 Optimizing the Care of Patients and Yourself The Patient-Physician Bond
. 10.1 Addressing Patients. 10.1.1 Introductions. 10.1.2 Patients with Dementia or Learning Disabilities . 10.1.3 Unresponsive Patients . 10.2 Managing Expectations . 10.2.1 Hospital Standard Time. 10.2.2 Discharge Planning . 10.2.3 Side Effects. 10.2.4 The Results of Tests/Interventions. 10.3 Care Versus Service . 10.3.1 Delays Are the Luxury of the Healthy . 10.3.2 Trust the Experts . 10.3.3 Know When to Expedite . 10.4 The Person Behind the Patient. 10.4.1 Embrace the Little Details . 10.4.2 Ask the Follow-Up Question . 10.4.3 Address the Little Indignities . 10.4.4 Humor
. 10.5 Maintaining Homeostasis. 10.5.1 Eat . 10.5.2 Poop . 10.5.3 Sleep . 10.6 Final Thoughts. 141 142 142 143 144 144 144 145 145 146 146 147 147 148 148 149 149 150 151 152 153 154 154 155
Contents 11 Being a Woman in Medicine (Men: Don’t Skip This Chapter!). 11.1 Navigating the Training Environment . 11.1.1 Never Assume the Worst. 11.1.2 Claim Your Role. 11.1.3 Humor and Sarcasm Can Help . 11.2 Motherhood (Parenthood) . 11.2.1 What You Need to Successfully Parent as a Physician . 161 11.2.2 The Right Time to Have Kids. 11.2.3 Unfounded Fear 1: You Won’t Remember How to Be a Good Physician . 162 11.2.4 Unfounded Fear 2: Your Baby Will Forget You. 11.2.5 Unfounded Fear 3: You Will Never “Get It Together”. 163 11.3 Navigating the Career. 11.3.1 Your Priorities Are Right Because They’re Yours . 11.3.2 Comparison is the Thief of Joy . 11.3.3 There is More to Academic Medicine Than Research . 165 11.4 Final Thoughts. Reference . 12
Self-Care . 12.1 Boundaries . 12.1.1 Vacation Time. 12.1.2100% Care Does Not Require 100% Access . 12.2 Patient Reviews . 12.3 Grief and Mistakes . 12.3.1 Separate Fault from Fluke. 12.3.2 Distinguish the Unforeseen from the Expected . 12.3.3 Accept that Control is an Illusion . 12.3.4 Learn from Your Successes Too. 12.4 Savor Your Victories. 12.5 Find the Joy . 12.6 Final Thoughts. Reference . xxiii 157 157 157 159 160 160 161 163 164 164 165 166 166 167 167 167 168 169 171 171 172 173 174 174 175 176 176 13.1 The Myth of Zero Risk. 13.2 The Road to Bad
Outcomes. 13.3 Disagreement and Covid . 13.4 Final Thoughts. References . 177 177 178 180 181 181 Afterword: The Joy of Medicine . 183 13 What Covid-19 Has Taught Us (or Not) .
Michelle Kittleson Mastering the Art of Patient Care Like a mentor you may turn to in times of crisis, this book provides the wisdom earned from countless mentors and patients. You may be standing on the precipice of medical training or well into your career, trying to recapture the joy of medicine. A love of people and a love of science barely capture the essence of a life in medicine; there is so much more to being a physician than the ability to diagnose and treat diseases. While nothing can fully prepare you for the fear and anxiety that comes with inexperience, Mastering the Art of Patient Care eases some of that uncertainty with a system for surviving and thriving in medical school and beyond. Whatever your stage, the goal of this book is to share successes and failures to help you be a physician who takes outstanding care of patients, colleagues, and trainees and derives great joy from saving lives. |
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| author | Kittleson, Michelle ca. 20./21. Jh |
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| author_role | aut |
| author_sort | Kittleson, Michelle ca. 20./21. Jh |
| author_variant | m k mk |
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| ctrlnum | (OCoLC)1422446650 (DE-599)BVBBV049506385 |
| dewey-full | 610 |
| dewey-hundreds | 600 - Technology (Applied sciences) |
| dewey-ones | 610 - Medicine and health |
| dewey-raw | 610 |
| dewey-search | 610 |
| dewey-sort | 3610 |
| dewey-tens | 610 - Medicine and health |
| discipline | Medizin |
| discipline_str_mv | Medizin |
| format | Book |
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| index_date | 2024-07-03T23:22:25Z |
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| institution | BVB |
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| spelling | Kittleson, Michelle ca. 20./21. Jh. Verfasser (DE-588)1317997085 aut Mastering the art of patient care Michelle Kittleson Cham Springer [2022] xxv, 184 Seiten txt rdacontent n rdamedia nc rdacarrier Clinical Medicine Medical Education Medicine Medical education Medizinische Versorgung (DE-588)4038270-9 gnd rswk-swf Patient (DE-588)4044903-8 gnd rswk-swf Arzt (DE-588)4003157-3 gnd rswk-swf Medizinische Ausbildung (DE-588)4169212-3 gnd rswk-swf Berufsausübung (DE-588)4144740-2 gnd rswk-swf Arzt (DE-588)4003157-3 s Patient (DE-588)4044903-8 s Medizinische Ausbildung (DE-588)4169212-3 s DE-604 Medizinische Versorgung (DE-588)4038270-9 s Berufsausübung (DE-588)4144740-2 s Erscheint auch als Online-Ausgabe 978-3-031-20920-8 Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034851433&sequence=000001&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis Digitalisierung UB Augsburg - ADAM Catalogue Enrichment application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=034851433&sequence=000003&line_number=0002&func_code=DB_RECORDS&service_type=MEDIA Klappentext |
| spellingShingle | Kittleson, Michelle ca. 20./21. Jh Mastering the art of patient care Clinical Medicine Medical Education Medicine Medical education Medizinische Versorgung (DE-588)4038270-9 gnd Patient (DE-588)4044903-8 gnd Arzt (DE-588)4003157-3 gnd Medizinische Ausbildung (DE-588)4169212-3 gnd Berufsausübung (DE-588)4144740-2 gnd |
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| title | Mastering the art of patient care |
| title_auth | Mastering the art of patient care |
| title_exact_search | Mastering the art of patient care |
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| title_full | Mastering the art of patient care Michelle Kittleson |
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| title_short | Mastering the art of patient care |
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| topic_facet | Clinical Medicine Medical Education Medicine Medical education Medizinische Versorgung Patient Arzt Medizinische Ausbildung Berufsausübung |
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