Top Tweets for #ScriptsForNewDocs

over 1 year ago

#Scriptsfornewdocs If you don’t know what to do next in a life circumstance, good to error on the side of kindness. If you don’t know what to do next in a clinical context, good to error on the side of conscientiousness.

0

3

2

0

480

almost 2 years ago

#Scriptsfornewdocs No script. When the dust settles… Summarize their experience in a concise, single sentence. Name the emotion (usually fear of losing someone you love) Normalize that emotion & response given the circumstances. Validate (‘I share your concern’)👇

almost 2 years ago

#TipsForNewDocs Never underestimate the power of circling back. You have a fraught discussion with a pt- they're upset, angry, scared, disappointed. Circle back in person or by phone. Once the emotions have settled, often more fruitful discussion can ensue. #kittlesonrules

5

95

9

3

11K

1

3

1

0

572

almost 2 years ago

#Scriptsfornewdocs ‘Tell me your understanding of the plan based on what _____ (🫁, 🫀, 🦴, 🦠) team told you…’ Never assume. Sometimes trust. Always verify. #Teachback is #Teamwork when it comes to patient communication.

almost 2 years ago

#TipsForNewDocs Pt learns of mass on chest CT when the nurse tells her she's NPO for biopsy. Primary team assumed consult team told pt. Consult team assumed primary team told pt. Lesson: don’t assume. Include “tell the patient�� as part of the plan. #kittlesonrules

10

117

7

8

13K

0

3

0

477

Shunichi Nakagawa @snakagawa_md

almost 2 years ago

‘Warning shots’ for prognosis are helpful #scriptsfornewdocs ‘Can I share w/ you my fear of what’s going on?…’ ‘Here are the possibilities… this is what we’d expect to see the next ___ day(s) if its X instead of Y’ Trust takes time. Transparency about a guarded px helps

almost 2 years ago

Telling the prognosis is challenging. It is better not to be definitive at first. But it is also not helpful to be vague when you should be definitive. Think carefully about how you phrase it.

2

32

7

5

11K

0

5

1

0

1K

Robert Oubre, MD | The Doctor of Documentation

about 2 years ago

#Scriptsfornewdocs ‘You did the right thing coming to the hospital. You’re in the right place & (insert RNs name) will take good care of you. I’ve ordered ____ to help relieve ____. We’ll be watching for ____ & know more when ____.’ #Validate #Alleviate #Educate #Anticipate

@Dr_Oubre

about 2 years ago

Hospitalists must quickly establish trust with patients they've never met. Tips: 🔹 Mention PCP's name 🔹 Mention nocturnist's and/or ER doc's name 🔹 Know some of their meds / history 🔹 Sit. Smile. Listen.

4

47

2

9

14K

1

13

5

6

4K

about 2 years ago

#Scriptsfornewdocs ‘Can I share with you my fear?’ ‘Is now a good time to talk about our medical team’s impression of what’s going on, including best and worst case scenarios?’ #warningshot

about 2 years ago

#TipsForNewDocs Do you have things you always say when delivering bad news? Mine: "We might not have all the answers, but here's our plan to get the answers." "I promise to always be honest when things aren't going well." #kittlesonrules

6

122

6

32

16K

1

6

1

1K

Carl Elliott @FearLoathingBTX

over 2 years ago

#Scriptsfornewdocs When someone’s A1C comes back at 6.5, we don’t say, ‘your pancreas ‘failed’ the test.’ We do say, ‘the test showed _____. This is what it means for your care…’ Inserting ‘failure’ elicits shame and erodes any potential for a 💪therapeutic alliance.

over 2 years ago

Maybe an odd question. Why do physicians say patients "failed" a swallow test, or "failed" a spontaneous breathing test? Failure implies agency. It also feels vaguely shameful, even though the patient can't really be blamed.

15

38

6

2

5K

1

2

0

700

over 2 years ago

#Scriptsfornewdocs Feeling the therapeutic alliance is disrupted / at risk bc a strong emotion? Then STOP and rebuild by expressing empathy with NURSE statements. Feelings of fear, mistrust, betrayal, anger, or neglect must be addressed before moving forward.

CoryRohlfsen's tweet photo. #Scriptsfornewdocs

Feeling the therapeutic alliance is disrupted / at risk bc a strong emotion?

Then STOP and rebuild by expressing empathy with NURSE statements.

Feelings of fear, mistrust, betrayal, anger, or neglect must be addressed before moving forward. https://t.co/iztse262kS

over 2 years ago

#TipsForNewDocs Don't be afraid to address the elephant in the room. When reviewing abnormal results, ask the pt what worries them most and explain your plan to rule it in or out. Pt voices greatest fears + plan to address them = comfort in uncertainty. #kittlesonrules

2

117

13

11

11K

0

9

2

3

1K

Robert Oubre, MD | The Doctor of Documentation

over 2 years ago

#Scriptsfornewdocs ‘I want to make sure we get to what’s important to you. What brings you in today?’ ‘… Anything else to address?’ After the pleasantries of course ;) Note: patient centered agenda setting is not an elementary skillset

@Dr_Oubre

over 2 years ago

Med schools should not only teach history taking, but also patient redirection. It's tough, and nuanced... but "never interrupt a patient" is not the right approach (I'm sure many will be triggered by that statement). But being a good doctor does not mean...

41

997

60

126

183K

1

8

2

0

2K

over 2 years ago

#ScriptsForNewDocs ‘I don’t want to move forward until we get this right. I trust ____ b/c they’re fair, smart, and often think differently than I do. Their input may help us approach this differently with a fresh perspective… okay if I call them to stop by?’ #teamwork

over 2 years ago

#TipsForNewDocs When you and a pt are at an impasse, encourage a second opinion. If the 2nd opinion agrees with you, you look great. If the 2nd opinion is different, you learn something new. Regardless, you and the pt benefit: win-win! #kittlesonrules

7

123

16

4

18K

0

2

1

0

616

over 2 years ago

#ScriptsForNewDocs A new dx (eg DM2, COPD, HF) can land a pt anywhere from tears to ‘meh.’ Explanations are needed, but best to start w/ seeing where they’re at. Here’s how: ‘Do you know anyone who’s had this diagnosis before?’ Explore, then explain