Something Smells Like Band-aids

Sometimes life slips you a little good when all you've been concentrating on is the bad. I like those times.

I felt like a proud parent this morning when one of the residents presented his first journal club as part of the Evidence Based Medicine curriculum that I'm now responsible for running. He did beautifully. In fact, it went off exactly how I envisioned it in my head. And I actually think he (and the audience) learned something. Bonus! My husband teases me and calls me the "Queen of all things Journal Club". I won't lie. I love journal articles and the conversation they ignite and the delicious calculations we can perform with the data. Crazy-town.

I'm about to sit on a panel for 4th year medical students to talk about one of my other favorite topics of all time. Why I chose Pediatrics! There's nothing that can ignite my passion for my career choice quite like explaining the why and wherefores to a bunch of blessedly altruistic medical students. Did I mention there's pizza?

On Thursday, I'm leaving for Kansas City to attend the Pediatric Hospital Medicine conference. I'm looking forward to lots of lectures, debates and nerdy networking. My husband is coming with me and we've decided to drive. We're still recovering from our most recent airline experience involving a "paperwork issue" that led to an hour delay and missed connection, a night spent in a hotel 30 miles from the airport with nothing but the clothes we were wearing and a free toothbrush, a $60 cab ride to said hotel, a broken toilet and general magnificent levels of incompetence. Oh, and it was my birthday. Needless to say, we're looking forward to a romantic road trip.

So, thanks life. Thanks for the reminder.

New Year's In July

My favorite time of year has always been the Fall. Fall meant that school was starting again and I had another year to prove myself and do things right. I usually started the school year with a handful of resolutions. You know, like ummmm, try to be in the cool crowd. For once. The first few weeks I would carefully model myself after the pictures in my Seventeen magazine and slip into my 'bubbly' persona as soon as I walked into the building for my first class. Year after year I tried this and inevitably would settle into my less-than-cool self which was much less time and energy consuming. But, so much more rewarding. In hindsight.

Nowadays, I have those same feelings in the beginning of July. No not the "please let me be cool this year" feeling. The anticipation of something fresh, something better. A chance to renew my commitment to my profession and make good on those resolutions. Only now they are more along the lines of 1. Read Pediatrics EVERY month 2. Answer my PREP self-assessment questions online weekly 3. Peruse the current literature on clinical scenarios I encounter at work 4. volunteer to teach PBL for the medical students 5. Push myself to teach the residents I work with at each and every opportunity even though I only see them at night and all they really want to do is get through until morning.

I couldn't wait to get to work tonight and meet the new residents. The memory of walking into the hospital at 5am on my first day as an intern is seared into my brain. I love that memory and I love realizing how far I've come. So here's to a new year's worth of resolutions. I just hope I'm more successful with these than with that 'learning how to knit' resolution....

A Worthy Endeavor

The word o' the day is diligence. Diligence is defined as "persevering and careful in work, hardworking". Alternately, as defined in Atul Gawande's Better, "the necessity of giving sufficient attention to detail to avoid error and prevail against obstacles". According to Gawande, diligence is both central to a physician's performance and very difficult to accomplish on a day to day basis. I would have to agree with him. How many obstacles do we as physicians encounter on our quest for diligence? Let's see...fatigue is a biggie. This one is near and dear to my heart because, i'll admit it, at 3am (which will hereby be referred to as the witching hour) I am struggling to put out fires and keep everyone alive until the reinforcements show up. The only obstacle against which I'm trying to prevail is the mud in which my thoughts have become hopelessly tangled and mired. Not that I don't try. There have been plenty of times when I lay down to catch that 1 precious hour of sleep before morning labs come back and I think "Is that baby peeing enough? Well, the nurse would tell me if she isn't. Wouldn't she?". I put my shoes back on and leave my dark call room to check on that baby's urine output. But does that happen every single time?  Another obstacle is time. I know from my clinic based colleagues that having enough time to give the patients what they need AND get what you need from them AND write orders AND document AND communicate with staff AND breathe is next to impossible. But I know they do their best until that last appointment of the day. For residents, the duty hour regulations presents a double edged sword. They have the same amount of work to do in a shorter period of time. They have to be even more efficient in their work and pay even more attention to detail because there are so many patient hand offs these days.  A study published by Landrigan et al in Pediatrics in 2008 showed that after duty hour implementation, there were no changes in the rate of medication errors and a borderline increase in resident ordering errors. Are we as their mentors teaching them how to be diligent while maintaining efficiency?

Consider your own obstacles to diligence in your career. Do you strive to be diligent in what you do every single day? Why not? As physicians, what are our rewards for diligence?