Advice for a new attending

[1632Apex]

Recently started as a new hospitalist at a large hospital. Overall things are going well but the learning curve has been much steeper than I anticipated. I'm at the same hospital where I did my residency so luckily I haven't had to learn a new system, new set of politics, new building, etc, but it's still been a challenging transition. I've also made a couple of relatively minor mistakes. Nothing that resulted in any bad outcomes, but it's definitely shaken my confidence, which has left me with this ever-constant nagging feeling that I should be looking everything up, or calling consults on every patient even though I know that's not really necessary. Any advice?

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[jdh71]

Other than reassurance that you are just where you are supposed to be and it WILL get better? Not much else to say.

You are going to make minor mistakes. Training makes sure that we don't make MAJOR mistakes. Just learn from your minor mistakes. Never do it again.

And consultants live to do consults. Yeah avoid asking for help at 4:30 in the afternoon but don't feel bad if you ask for a lot of advice in cases where you aren't totally sure or simply want reassurance you are thinking about things correctly. After a few years you will begin to gel on what you ask about and what you can comfortably manage.

 

[NotAProgDirector]

Truth: Residency only teaches you about 50% of what you really need to know. You learn the next 40% in the first 6 months. The last 10% takes the rest of your career. Just as you get really good, it's time to retire.

 

[Jane2020]

It's stressful the first 6-9 months after finishing residency. You are now the final decision maker for your patients. If you want to do the best job you have to realize that believing "I am a bad Doctor when I make a mistake that affects patient care" is wrong and will throw you, like you are feeling. Instead the truth is "I am an imperfect Doctor. I want to do my best every time. I can't. I will make a mistake today, this week or this month that might hurt my patients. How do I deal with this?" Every year there is an enormous amount of new information, research findings, new meds or treatments to learn about. Some days you will be so busy or so tired that you forget something important. In residency you worked as a team. That way patients got better care and you helped each other if one of you made a mistake or forgot something. Your team now are the floor nurses, ancillary staff like lab, radiology, nutrition, social work, and specialists who want to help. Journals and websites like UptoDate are vital. What also makes you a better clinician is letting staff know you value their input. If you blow them off, ignore them, refuse to take advice because it came from a non-provider, they will feel intimidated and quit reminding you about labs you forget to order, meds they see prescribed by other docs that work better than what you ordered, telling you about ancillary services that are available that you didn't know about, the best type of radiology study for the information you need, etc. Some of the staff will have a lot more experience dealing with certain diseases than you will early in your career. You will make mistakes. So you develop a plan to learn the new info and let staff help you become a better Doctor.

 

[scpod]

If you weren't a loaner during med school and residency you should have made a few good friends that you can count on now and then. I still have a group of guys that run things past each other now and then. I'm pretty confident about my knowledge and my abilities, but I run into situations I've never seen before quite often. Also, you should look at making a few friends with some of the specialists in your hospital. They are often more than happy to "curbside" consult about a patient and discuss whether or not they need to be consulted officially. Not ALL of them are, but you should be able to find a few you feel comfortable with.

 

[PCPDoc983]

Hi, on that same token, any advice for new outpatient attending? Besides getting a thorough H&P, and addressing all preventative/vaccinations

Do you guys generally order comprehensive labs as a baseline (CBC, CMP, TSH, FLP, PSA) on most patients? I feel like as residents we were minimalists because of the patient population but now as an attending the consensus is to order more to be a perfectionist. I just hate ordering and then spending 30 min counseling on why a borderline useless test is positive. Sigh

 

[gutonc]

Hi, on that same token, any advice for new outpatient attending? Besides getting a thorough H&P, and addressing all preventative/vaccinations

Do you guys generally order comprehensive labs as a baseline (CBC, CMP, TSH, FLP, PSA) on most patients? I feel like as residents we were minimalists because of the patient population but now as an attending the consensus is to order more to be a perfectionist. I just hate ordering and then spending 30 min counseling on why a borderline useless test is positive. Sigh

Never ask a question you don't want the answer to.

 

[PlutoBoy]

Hi, on that same token, any advice for new outpatient attending? Besides getting a thorough H&P, and addressing all preventative/vaccinations

Do you guys generally order comprehensive labs as a baseline (CBC, CMP, TSH, FLP, PSA) on most patients? I feel like as residents we were minimalists because of the patient population but now as an attending the consensus is to order more to be a perfectionist. I just hate ordering and then spending 30 min counseling on why a borderline useless test is positive. Sigh

I order a CBC, CMP. FLP if risk factors or not done in a while. TSH if there are symptoms. PSA if patient wants it.

Order as little as possible. The more you order, the more you need to work, the higher the chance to miss something, and you have a higher liability.

*True story: I know of an attending that used to order BUN/Creatinine only. He would get pissed if you ordered a BMP. He said well if you order a BMP and the sodium is low or whatever now you are stuck and have to deal with it. Kind of a dick move but I understand his point.

 

[DrSnips]

I know of an attending that used to order BUN/Creatinine only.

I'm imagining obtaining baseline labs on an inpatient from a PCP's office and finding they have an isolated BUN/Crt and nothing else. "The $&*% is this?"

 

[IMreshopeful]

I order a CBC, CMP. FLP if risk factors or not done in a while. TSH if there are symptoms. PSA if patient wants it.

Order as little as possible. The more you order, the more you need to work, the higher the chance to miss something, and you have a higher liability.

*True story: I know of an attending that used to order BUN/Creatinine only. He would get pissed if you ordered a BMP. He said well if you order a BMP and the sodium is low or whatever now you are stuck and have to deal with it. Kind of a dick move but I understand his point.

Yeah it's like getting the echo prior to random surgeries that some surgeons like to do...then there's an incidental finding...then said finding gets worked up and delays surgery...etc

Don't do crap that isn't going to change your management

 

[DrSnips]

Yeah it's like getting the echo prior to random surgeries that some surgeons like to do

Yeah, I call that a checho (pronounced check-o).

 

[NotAProgDirector]

I know of an attending that used to order BUN/Creatinine only. He would get pissed if you ordered a BMP. He said well if you order a BMP and the sodium is low or whatever now you are stuck and have to deal with it. Kind of a dick move but I understand his point.

Silly doc. Why bother getting a BUN?