Wednesday, March 11, 2015

Mrs. Fanning.

Ben working hard on Mrs. Fanning.

Today I rounded with my team and it was great. Things rocked and rolled along smoothly and everyone seemed to be in high spirits. We connected with our patients and embraced some teachable moments. And all of it was good. It was very, very good.

We were efficient. Like always, I looked at the clock and then together we decided upon an ETFR. That is, estimated time finishing rounding. Because everyone knows that, at Grady especially, there is always, always more to do and a reason to stay. Especially at Grady.


Rounds finished up by 10:45 or so. The interns had work to do and loose ends to tie up. My resident was in clinic and the fourth year medical student had to scurry off to the senior resident conference. So that left me alone with Ben, the brand new junior medical student on my team.

Had we not just finished rounding this would have been a no brainer. I'd have grabbed Ben and hoofed it upstairs to the 12th floor and make "gravity rounds." That's when you start at the highest floor and see your patients based upon geographic location in the hospital. This only works if no one is critically ill on the service. In those cases, of course, the most ill get your attention first.

Anyways. What I did next is one of my favorite exercises that I do with medical students during such moments, so I thought I'd share.

Ben and I went to a quiet area near the nurses station. I handed him a piece of paper and said, "You're going to take a history from me, okay? My name is Mrs. . .uhh. . .Fanning. And I'm a 44 year old woman coming to the hospital for a fever and productive cough. You're going to take a complete history from me. Then I'm going to give you all of the elements of the physical and labs per your request. After that, I'll leave you for ten minutes. Then, when I come back, you're going to present her to me--including your assessment and plan. Okay?"

Ben's face lit up. "Okay!"

And so. Ben was introduced to Mrs. Fanning and her rusty sputum and shaking chills. He asked her questions about her present illness, personal life, and even how much she drinks. Honest Mrs. Fanning opened right up about her occasional marijuana, remote smoking history and her recent travels. She told him exactly where she was when she started feeling sick. ("At the corner of Moreland and Freedom Parkway.") Next, I reported the physical examination and provided him with her laboratory data. Ben copied it all down as I told him and asked a couple more questions.

And then? I stood up. "I'll be back in ten minutes, okay?" Ben nodded and immediately got to work.

I strolled around the nurses station and chatted up a few of my favorite nurses. I ran into Mario, one of my favorite people in environmental services. Before I knew it, ten minutes had come and gone. When I approached Ben, I found him feverishly writing down his final thoughts.

"Time's up." I offered him an exaggerated smile. "Let's make it happen." I waved my hand in my direction, summoning him to stand. "We are going to treat this like post call rounds. Sound good?"

"Sounds good!"

We stood in the hall way next to a random room.  And Ben subsequently brought our hypothetical lady to life. He sure did.

"I think this mostly likely represents pneumonia."

"From what?"

"Community acquired pneumonia."

"From what? Strep? Legionella? Atypical organisms? What?"

I made him defend every management decision. Then I made suggestions on the areas where he felt less sure. The cool thing about this teaching exercise is that I get to not only pinpoint which areas of communication in the initial history to focus upon, I also get the chance to point out the things that normally no one says. How much you fidget with your hands. Your rhythmic "um" or your tendency to  always say "actually" when you're word finding.


So Ben was awesome and dear Mrs. Fanning seemed to be in good hands. But you know what was even cooler? Doing that little twenty minute exercise gives me confidence that the real Mrs. Fannings will benefit from my criticisms. And even better is that I got to have a foray into middle school drama again.

Yeah, man.

So this was what I did today at Grady. And you know what? It was awesome. I saw him growing right before my eyes. I just thought of something: I hated my Internal Medicine rotation because my attending ignored me and my resident scutted me all about. I was asked to introduce my self three separate times although I'd been there all month long. Like Ben, it was my very first clinical rotation. And you know what? I vowed to never do Medicine. Like ever.

But you know what? The buck stopped there with that. Ben didn't get ignored by his attending. Nope. I tried my best to give him my full attention. And his "patient" got his.

I guess today I felt like I made a difference. And when that happens, it is so affirming. Like I'm doing exactly what I'm supposed to be doing. . . .fanning the flames of enthusiasm so that a wildfire ignites in both my learner and myself. One that hopefully gets unleashed on all of their future learners . . . and especially on real Mrs. Fannings.

I love this job.

Happy Humpday.


  1. An excellent teaching technique. Hope he appreciates you!

  2. I think you make a difference every day and in so many lives, from the environmental services people, to the nurses, to the residents, to the patients,... and that doesn't even get started on your impact at home. x0 N2

  3. Love a resident I always try to remember that one of the best things you can give a student is your time....individual one on one teaching/advising/encouraging time if schedules allow.....thanks for being such an inspiration-love your blog!


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