The Airing of Grievances

February 12, 2017

Hi everyone:

Heide and I finally mailed our holiday cards last week, but today we’ll officially end the season with a belated celebration of Festivus and the annual “airing of grievances.” Here are mine:

1. Copying and pasting: Especially inaccurate, obsolete information and, worst of all, copying others’ work. When we copy and paste, people stop believing our notes.

2. Sloppy presentations: Going out of order, including unrelated past medical history in the chief concern, calling humans "male" and "female," and putting the "review of systems" in the HPI.

3. Crimes against logic: Making internally contradictory statements: “Her neck veins were flat…so we gave Lasix,” and falling repeatedly for cognitive traps.

4. Useless tests: Particularly sleep disrupting, money wasting, wild goose chasing tests. I hate batteries of tests, tests without hypotheses, and whole body scans. I really hate slightly abnormal results that come in my inbox after patients are discharged. Porphyria? Really?

5. Complaining: Okay, right, it makes no sense to complain about complaining. So be constructive; send solutions.

6. Tribalism: Everyone knows Yale residents are terrific and the rest are losers. Sad! (Enough said).

7. Superficial physical exams: Not checking for JVP; not describing the quality, location, and radiation of murmurs; not checking for orthostasis or pulsus paradoxicus; avoiding GU and rectal exams; and performing cursory mental status exams; etc.

8. Superficial histories: Relying on others’ histories instead of our own, not reading old charts, missing emotional cues, avoiding difficult questions, and forgetting that patients tell us the diagnosis, if we listen.

9. Evidence-free medicine: Following habit and local custom instead of reading the literature.

10. Cowardice: Especially when the times compel us to protect our patients, support our colleagues, and stand for human rights, science, honesty, tolerance, hope, and kindness.

I’m being such a curmudgeon today, but there they are, they’re off my chest. Feel free to experience the catharsis that is Festivus and share your grievances too. We're listening.

Can you believe it’s snowing again?

Mark

Submitted by Mark David Siegel on February 12, 2017