Blog | Monday, December 15, 2014

Lessons learned from 35 years of ward attending


My first time was January 1980. I remember where and remember 1 patient. Like many new attendings I overestimated my skills. Over the years I have learned much about ward attending success. Now I plan a series of posts that share some thoughts.

The overriding principle of ward attending seems obvious, but apparently evades many who become ward attendings. We have several responsibilities. First, we must try to have the team deliver the best possible care for our patients. Second, we must help all of our learners grow into excellent physicians.

These responsibilities have changed from the 70s and early 80s. Then the attending did a bit of teaching, but the resident had the patient care responsibility and ran rounds. My resident rounding experience helped frame my current ward attending style.

When academic practices started billing for attending services, the attending role changed focus. Unfortunately, some attending physicians undervalue the teaching role.

So compared to 1980 when I started, the role has more complexity. We have to balance work hour requirements, billing requirements, learners' needs and patients' needs.

Yet the job is doable, and in many ways more enjoyable now than when I started.

We should prioritize several factors in developing our attending style. First, the interns and residents have work to do each day. We must respect their time constraints. No matter how brilliant we are as attending physicians, rounds that last too long are disrespectful and therefore substandard. Second, the learners should have the opportunity to present their plans and we should evaluate those plans. If we strongly disagree, we must explain why we should go in a different direction. Our disagreement should stimulate a learning situation. We should have good justification for changing the plan, but we do have a responsibility to the patient to develop the best plan. If one can justify more than one way to address a current issue, let the learners proceed with their plan. Finally, we are role models. We must demonstrate excellent bedside manner, respect for patients, and physical exam findings. Our learners need us to show them physician excellence. We must discuss patient interactions and patient education.

db is the nickname for Robert M. Centor, MD, FACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and is the Regional Associate Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds over 100 days each year. This post originally appeared at his blog, db's Medical Rants.