Feedback for Friends

Hi everyone,

First, the answer to last week’s quiz, asking which ID colleague gave me feedback on my choice of antibiotics.* It was Dr. Matt Grant, who reminded me that current ATS/IDSA guidelines no longer recommend anaerobic coverage for aspiration pneumonia.

No one chose Matt. Drs. Dunne and Gupta got the most votes. Dr. Cherry thoroughly analyzed each candidate, which led him to choose Dr. Desruisseaux (though he did note correctly that Dr. Dunne was on vacation in Maine):

Dr. Martinello won the prize for truthiness: “I’m guessing all 5, and they provided 6 other options!”

I can always count on my ID colleagues. I think I choose the right antibiotic most of the time, but not always. And when I don’t, my ID friends are there to help.

(Note to Dr. Azar: thanks for your help yesterday. We stopped the tobramycin and anidulafungin).

Which brings me to today’s point: feedback works best among people who like one another. It’s easy to give feedback to people you care about, because you want them to be the best physicians they can be. In the same way, it’s easy to welcome input from friends, because you know their feedback is going to be thoughtful, sincere, and meant to help.

Good feedback starts with strong relationships. When you get to know and trust your colleagues, you create a climate conducive to feedback. Let’s call it “feedback for friends.”

Enjoy your Sunday, everyone. I’ve been pulled for jeopardy, so I’m heading into the MICU.

Mark

*In case you missed it, an idealized “event note” sent to the residency last week, highlighting my antibiotic choice.

Called to see patient for temp of 102.7. The patient is in the hospital for treatment of CHF. He was doing well until 10PM when he began experiencing rigors, cough with purulent sputum, and shortness of breath. Of note is that he failed a swallowing study earlier in the day. He denies chest pain, headache, stiff neck, diarrhea, dysuria, abdominal pain, back pain, or rashes.

PE: T 102.7^oF, P98, RR18, BP 124/66, SpO2 87% on RA

General: Fatigued-appearing, minimal respiratory distress

HEENT: conjunctivae clear, no oral lesions, neck supple

Heart: RR S1S2, no M/R/G

Lungs: Good air movement, crackles right base (clear earlier in the day per day team’s note)

Abdomen: NABS, soft, NT

Back: No spinal or CVAT

Extremities: No C/C/E

Skin: No rashes

Imp: Concern for new fever in this patient admitted for CHF. Given new cough, hypoxemia, and crackles on lung exam, I am concerned for pneumonia, possibly aspiration since he failed his swallowing evaluation. Since he’s only been in the hospital for 2 days, hospital acquired organisms are unlikely.

Plan:

1. BC x 2
2. CXR
3. Sputum culture
4. Begin Unasyn, pending cultures
5. NPO
6. IV maintenance fluids while NPO (D5 ½ NSS @75 cc/hr)
7. Start O2 to ensure SpO2 >90%