Blog | Thursday, May 17, 2018

Tips for IM attendings, take a mental break

Currently I am reading a fascinating book, “When” by Daniel Pink. Yesterday while flying to a medical society meeting, I read a chapter about fatigue and its impact on our focus.

During the reading I reflected on an accidental routine I developed when night float started. At our post call rounds, which start at 7 a.m. and are supposed to end by 10 a.m. (I really do finish with the learners by then), we first hear the overnight admissions from the night float. We work hard to keep those presentations to no longer than 1 hour. We then take a 15-minute break. The break allows the team to make some consultant calls, write a few orders, or just chat. When we resume, the team is ready to go.

Presenting 8 new patients is challenging for any team. If we presented everyone without taking a break, the team would fall behind on many basic tasks. They would sit there worried about getting consultations, ordering imaging, etc.

They also need time to move around. We present sitting, and it usually takes 2 full hours to hear 8 patients (and that means going quite fast at times). Those 15 minutes are gold. Almost all residents and interns are very grateful. But I am also grateful. I take that time to walk downstairs to get a drink. I chat with the students or house staff, depending on the day. When we start back we are refreshed and (I believe) more productive.

Breaks are healthy. Talking about non-medical issues is healthy.

So think about how you can take a mental break (and perhaps even a physical break) during rounds. You and your learners will benefit, and therefore your patients will benefit.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.