#TipsForNewDocs Antidotes to imposter syndrome: 1) Recognize it's universal & appropriate- you should feel uncertain early in your career 2) Debrief & vent w/trusted colleagues, mentors- put your inexperience in perspective and learn from their experience #kittlesonrules

@MKIttlesonMD Love #kittlesonrules - there are plenty of things to do if the considered treatment does Not match patients goals, priorities and preferences. Holding hands and saying you’ll be there is not a small feat

#TipsForNewDocs: Art of the consult: 1) call early in the morning (consultants have lives too) 2) try to have a specific question: not “pt is anemic” but rather “anemia, low retic, no fecal occult blood, norm Fe/B12/folate —> do we need bone marrow bx?” #kittlesonrules

#TipsForNewDocs There are some essential meds in cardiology. HFrEF: ARNI/BB/MRA/SLGT2i. CAD: aspirin/statin. If a pt isn’t on the first-line meds, document why. Clear notes: you look good + others don’t have to reinvent the wheel= win-win! #kittlesonrules

#TipsForNewDocs Don't shy away from giving patients bad news- false hope is worse. Offer honest assessment of prognosis + options -> together make a plan. End with a promise: you will still be their doc even if you can't fix their disease. #kittlesonrules

#TipsForNewDocs Sinus tachycardia is the delirium of cardiology. Delirium --> it's (basically) never the brain's fault. Sinus tach --> it's (basically) never the heart's fault. Don't be distracted by the wrong organ in search of the right answer! #kittlesonrules

#TipsForNewAttendings Sometimes you can tell a trainee doesn't agree w/your plan but isn't sure what to say. Encourage questions and debate. You'll model respectful disagreement and explaining your rationale --> better understanding for you and the trainee. #kittlesonrules

Sometimes I’m asked how I “do it all“ w/3 kids and a career. I don’t. Career extras like research get put on hold when family requires more attention. Life happens in stages- don’t be hard on yourself. You’re not supposed to accomplish it all at once. #kittlesonrules

#TipsForNewDocs Inpatient has renal mass on u/s. Plan is outpatient eval. No: "Defer to outpatient." Yes: "Per discussion w/rads, renal cell ca possible. Pt ready for discharge today; PMD aware, renal CT scheduled.” Don’t leave loose ends hanging. #kittlesonrules

#TipsForNewDocs The practice of medicine gets better (more rewarding, less scary) with experience. Approach medicine like a foreign language- put in the effort to memorize the grammar and vocabulary and you will soon be able to appreciate the poetry. #kittlesonrules

#TipsForNewDocs Complicated pt came to see me (cardiology). GI: get abd CT w/contrast. Nephro: don’t get abd CT w/contrast. Pt: ??? So I messaged GI/nephro for her. Talk to your colleagues! Avoid relaying medical recommendations through the pt. #kittlesonrules

#TipsForNewDocs It's great to titrate up meds on inpatients, but before you do, check the medication administration record (MAR) to ensure pt rec'd prior ordered dose first. Just b/c you order a med doesn't mean the pt received it-- trust the MAR! #kittlesonrules

#TipsForNewDocs If the only justification you can muster for ordering a test is "the results would be of academic interest” or “I just want to know,” then don't order the test. #kittlesonrules

#TipsForNewDocs Bad: See the cardiologist for an angiogram. Good: See the cardiologist to decide the next best step for your symptoms. Don't paint the consultant into a corner- allow them to use their expertise to chart the right course for the patient! #kittlesonrules

#TipsForNewDocs You’re never too important to look it up. I’m a cardiologist and I still look up the treatment of pericarditis. I don't treat it a lot and want to ensure I have the duration/taper of NSAIDs right. UpToDate = your friend for life. #kittlesonrules

#TipsForNewDocs Cringe-worthy chart phrases: “Avoid nephrotoxins” (w/o adding relevant ones) “Lungs clear. No crackles.” (redundant) “Pt has leg swelling x3d”… exam: “no edema.” (inconsistent) “Consider XYZ” (w/o saying why or why not) #kittlesonrules

#TipsForNewDocs There’s a right time for negative/constructive feedback, but there’s never a wrong time for positive feedback. Give credit where credit is due: appreciate trainees, referring physicians, nurses, and ancillary staff early and often. #kittlesonrules

#TipsForNewDocs Taking a social history: Bad: no smoking or alcohol Good: born/raised, job, lives with, kids/grandkids, smoking, alcohol, drugs Learn the details that make your patient a person - getting to know them = providing better care. #kittlesonrules

#TipsForNewDocs Past medical history-- Wrong: - AF - DM Right: - Persistent AF managed w/rate control/anticoag, CHA2DS2-VASc 3 - Type 2 DM, Hgb A1c 7.5% 7/20, no end-organ dz The PMH should provide descriptions of dz severity. Don't list- stratify! #kittlesonrules

#TipsForNewDocs Secret to a stellar oral presentation: HPI -> PMH -> Meds/allergies -> SH -> FH -> ROS -> PE -> labs -> A/P - same order, every time. Rounds are not the place for extemporaneous soliloquies (is there ever a place for those?). #kittlesonrules