Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Lessons from 38 years of being an internal medicine ward attending

Robert Centor, MD
Physician
December 29, 2017
247 Shares
Share
Tweet
Share

Finishing my 38th year of internal medicine ward attending, I wish I knew then what I know now.  I estimate the equivalence of at least ten full years of ward attending; I think this meets the magic 10,000-hour number.  Hopefully, these notes to myself will help some newly minted ward attendings.  The job is quite difficult and multifaceted.

  • Understand the various responsibilities of the ward attending
    • Help your learners grow
    • Make certain the patients get top notch care
    • Be a good role model for the learners
  • Stay healthy, both mentally and physically
  • Never lose your humanity

What distinguishes ward attending is teaching.  While we have a great responsibility to our patients, we also have a great responsibility to our learners’ future patients.

This week I did exit interviews and mid-month interviews with two students and three residents.  When I do exit interviews, the learners also give me feedback.  Over the years many learners appreciate that discussions of patients diagnoses and management include an understanding of why.  Knowing why we do what we do is highly valued.  Perhaps some examples would help.

A heart failure patient comes in with significantly increased edema.  He tells us that the furosemide is not working as well as it previously worked.  The discussion that follows should include an understanding of loop diuretic absorption as well as an understanding of diuretic resistance.  Therefore, we must know how to diagnose whether the problem is furosemide absorption or loop diuretic resistance.  If we do not understand how loop diuretics work and why they might not work, then we may not provide the most efficient solution to the patient.  Understanding makes our task much easier.

A patient with COPD comes in dyspneic.  Unless we understand the differential diagnosis of worsening dyspnea in a COPD patient, we may treat the patient incorrectly.

A patient comes into the emergency department with confusion.  She has a serum sodium of 120.  We need to understand why normal saline is an incorrect response.  We need to understand hyponatremia causes and the dangers of overly fast correction.

Internal medicine is very complicated.  Our learners want to understand what to do and why.  Therefore, as educators, we have a responsibility to first learn and then share that learned understanding with our learners.

While doing that, we should show great respect for our learners.  Therefore, we must give them graduated responsibility.  Our first instinct to patient decision making should be to ask the team what they want to do and why.  There are several ways to deliver care to our patients.  When possible, let the team make the decisions so that they can grow.  The attending’s job is to protect the patient, so sometimes we must make the decision.  But when we make the decision, we must explain why.

We should respect our learners, especially their time.  Make rounds in a defined amount of time.  Let the learners have time to do their jobs.

Get to know them as human beings.  Help them maintain their humanity.  Ask them what they did for fun on their days off.  Share what you do for fun.

Treat patients with respect.  Show your learners how to treat patients with respect, how to listen to them and how to examine them.

And when you do this job properly, your patients benefit, and many future patients benefit.  It is a wonderful, complex, important job.  Work hard to make certain that your learners grow.

Robert Centor is an internal medicine physician who blogs at DB’s Medical Rants.

Image credit: Shutterstock.com

Prev

This retired physician is truly free

December 29, 2017 Kevin 7
…
Next

The physician's relationship with the beeper

December 29, 2017 Kevin 6
…

Tagged as: Hospital-Based Medicine

Post navigation

< Previous Post
This retired physician is truly free
Next Post >
The physician's relationship with the beeper

More by Robert Centor, MD

  • When the problem representation and the illness script do not match

    Robert Centor, MD
  • Think of diagnostic excellence as playing smooth jazz

    Robert Centor, MD
  • When constipation pain was worse than cancer pain

    Robert Centor, MD

Related Posts

  • The lessons learned from street medicine

    Nicholas Bascou
  • Lessons from the psychiatric ward

    Kristin Puhl, MD
  • How social media can advance humanism in medicine

    Pooja Lakshmin, MD
  • 3 lessons I’m learning about practicing medicine

    Klaus Kessel
  • The difference between learning medicine and doing medicine

    Steven Zhang, MD
  • KevinMD at the Richmond Academy of Medicine

    Kevin Pho, MD

More in Physician

  • Challenging the diagnosis: dehydration or bias?

    Sydney Lou Bonnick, MD
  • Practicing medicine with conviction

    Arthur Lazarus, MD, MBA
  • The power of memory in shaping human identity

    Emily F. Peters and Sandeep Jauhar, MD, PhD
  • Physicians have no autonomy. Here’s how to change that.

    Diane W. Shannon, MD, MPH
  • The erosion of patient care

    Laura de la Torre, MD
  • Navigating adulthood in the digital age

    Eleanor Menzin, MD
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • How to facilitate caregiver learning and support to improve clinical care outcomes

      Kerri Milyko, PhD | Tech
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 1 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Are Obesity Drugs for Adolescents Cost-Effective?
  • Lab Tests That Escape FDA Oversight May Come Under Agency Review
  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Low Tidal Volume Compliance Still Lacking in Mechanical Ventilation
  • IV Immunoglobulin May Cut Infection Risk of Anti-BCMA Agents for Myeloma

Meeting Coverage

  • Fezolinetant Benefits Women Not Suited for Hormone Therapy
  • Plant-Based Estrogen Improves Lipids in Postmenopausal Women
  • New Schizophrenia Treatments Are Coming: Don't Panic
  • Loneliness Needs to Be Treated Like Any Other Health Condition, Researcher Suggests
  • Stopping Medical Misinformation Requires Early Detection
  • Most Popular

  • Past Week

    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Reigniting after burnout: 3 physician stories

      Kim Downey, PT | Physician
    • Inside the grueling life of a surgery intern

      Randall S. Fong, MD | Physician
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • COVID-19 unleashed an ongoing crisis of delirium in hospitals

      Christina Reppas-Rindlisbacher, MD, Nathan Stall, MD, and Paula Rochon, MD | Conditions
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
  • Past 6 Months

    • Medical gaslighting: a growing challenge in today’s medical landscape

      Tami Burdick | Conditions
    • I want to be a doctor who can provide care for women: What states must I rule out for my medical education?

      Nandini Erodula | Education
    • Balancing opioid medication in chronic pain

      L. Joseph Parker, MD | Conditions
    • The erosion of patient care

      Laura de la Torre, MD | Physician
    • Mourning the silent epidemic: the physician suicide crisis and suggestions for change

      Amna Shabbir, MD | Physician
    • I’m a doctor, and I almost died during childbirth

      Bayo Curry-Winchell, MD | Physician
  • Recent Posts

    • How to facilitate caregiver learning and support to improve clinical care outcomes

      Kerri Milyko, PhD | Tech
    • Air quality alert: Reducing our carbon footprint in health care

      Shreya Aggarwal, MD | Conditions
    • Exploring HIV care and advocacy [PODCAST]

      The Podcast by KevinMD | Podcast
    • A teenager’s perspective: the pressing need for mental health days in schools

      Ruhi Saldanha | Conditions
    • Challenging the diagnosis: dehydration or bias?

      Sydney Lou Bonnick, MD | Physician
    • The art of pediatrics: Connecting through observation

      Alexander Rakowsky, MD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Lessons from 38 years of being an internal medicine ward attending
1 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...