A busy hospital service needs a way to keep up with the “to dos” of the day.
The junior residents and students responsible for these tasks need a way to know what they’ve done and what still needs to be done.
The senior residents and attendings need to keep track of the information and what is happening to guide and supervise the junior residents and students.
And all of this means keeping an accurate and up to date patient list. This can happen digitally in Epic, which is often what attendings use, but for most residents and students it means printing out the Epic list to keep in their pocket as they move through their day (and/or night).
p.s. If by chance you are still making your residents use Excel i.e. they have to physically create the patient list, shame on you! (Unless you don’t have Epic or another digital way to keep the list, in which case, I’m really sorry.)
And how do residents and students use the patient list?
Almost everyone draws little boxes for every detail they need to check off … and then puts a check in the box when it’s done.
Different colors for different tasks? Doodles? Notes during rounds or lectures? All of these and more, I’m sure.
“Running the list” means starting at the top of the list and discussing each patient sequentially, one at a time. We make sure to go over the plan for each patient, discuss what has changed, learn what has been “checked off”, and decide what needs to be added to the list.
This happens routinely at the beginning and end of the work day, and during handoffs. But, on a busy day, it may happen even more often.
So back to the original question
Although it sometimes actually feels like the intellectual equivalent of running, I suspect that the origin of “running the list” has to do with the idea of a “running list” i.e. a list that you add to as new things come up. But that’s just an educated guess, since I couldn’t find any actual data. If you have other thoughts, let me know!
Running the list is an important part of caring for patients, but it can also be a practice.
What if, like a competitive runner, you took a moment before you “run” the list to center yourself, take a few deep breaths and get ready to run?
What if you tried to visualize each person on the list as you review the day’s tasks to remember that these aren’t just tasks… they are human beings in your care?
What if we consistently made it a goal to teach just a little bit (or a lot, if the time permits) every time we run the list? (Would this be “walking” the list? 🙂 )
And at the end of the day, when you put your patient list in the shredder (don’t forget this important step! #HIPPA), what if you did it intentionally – to mark the end of the work day and the transition to not being in the hospital?
“I was mad at the ER, so I said, ‘Hope you have a quiet night!” as I walked out.”
There aren’t many people more scientific in their thinking or more evidence-based in their practice than physicians. And yet, like many of our sports heroes, many physicians are very superstitious. We know that saying the word “quiet” doesn’t actually change what happens. It’s such a prevalent superstition though, that there is one randomized trial that was designed to prove it! (Make that two randomized trials…)
Why are human beings superstitious? Particularly in the face of uncertainty (…so just how many patients will come into the ER tonight?) superstitions reduce stress by creating a sense of control. It has also been shown that superstitions increase self-efficacy, which in turn results in improved performance in sports and other tasks. Maybe this is why baseball players and other athletes are so superstitious?
My conclusion? I’m going to keep joining the chorus of groans from my team when the new medical student says [the-word-we-do-not-say] when we are on call. It makes us laugh, creates a sense of being in this together, and who knows… maybe our performance will be improved, too!
Every year about this time, I create a list of presents I think busy healers (and healers in training) would appreciate. I don’t have to tell you that this has been a year that for all of us, but especially for everyone in medicine, has brought a new level of stress and sadness. The healers need healing… and in that spirit, here are some ideas of what you can send your friends in medicine for Hanukkah, Kwanza, Christmas, the Winter Solstice… or to celebrate the end of 2020 and beginning of a new year of hope.
#10.White coat, jacket and/or scrub “bling”. Everyone who works in a hospital has a badge that must be worn all the time. And we all need pens (except for the attendings… we just “borrow” pens that students and residents keep in their pockets for us … just kidding … mostly). Here are some suggestions: Find a lanyard or badge holder from their favorite sports team or that will otherwise have meaning for them. Buy a box of cheap pens (that can be given away to needy attendings) + a great pen that will remind them of you every time they write with it. For white coats, find a meaningful or humorous pin that could be worn on other clothes as well.
#9 Happy Feet. Think about putting together a “happy feet” box – include things like warm slippers, good socks, a certificate for a pair of shoes to wear in the hospital, compression socks, toenail clippers, and any other foot care products that sounds right.
#8 Better sleep. Sleep can be hard if you have had a really hard stretch at work. It’s especially hard if you’ve worked all night and have to sleep during the day. You can put together a combination of gifts like new high-count sheets, eye covers and ear plugs for sleeping after a night shift, a certificate for a new mattress, a white noise machine or a weighted blanket.
#7 Work food. Busy students and residents frequently miss meals. Think about creating home made “snack packs” for the hospital by combining options like nuts, dried fruits, and high quality candy into small zip lock bags. Or buy healthy meal replacement bars in bulk. Make sure they are high quality, real food bars. My favorites are Kind bars but there are many other bars that are healthy and delicious.
#6 Gift cards. When you ask students and residents which gift cards would be most appreciated it’s pretty consistently these three: Amazon, Trader’s Joes, Whole Foods or other grocery stores, and Starbucks.
#5 Digital upgrades. A high-quality phone is a critically important tool in the hospital. Everyone in medicine spends a good part of the day texting each other, looking up patients on Haiku (the Epic phone app), checking UpToDate for the latest treatments, finding other medical information in many other places and – of course – staying in touch with our teams, friends and families. Up to date computers, iPads, and AirPods (or equivalent) are also great gift options for any student or resident.
#4 A cleaner house. Pre pandemic, I recommended someone to help clean as the number one gift for medical folks. But, even with the limitations imposed by COVID, there are still gifts that can help! Number one on this list would be a Roomba so they don’t have to vacuum.
#3 Healthy meals at home that don’t take time. The Instant Pot has been my top recommendation as a gift for students, residents and busy healers for several years. Another wonderful gift I’ve recommended before is How to Cook Everything Fast: A Better Way to Cook Great Food by Mark Bittman. This year, I would add a certificate to meal delivery plans. The one I use is Clean Creations (because I like to have vegetarian options), but many of my friends swear by Freshly. Every city has companies that are similar, so do some homework and you’ll find several to compare. If you are a good cook, you might consider creating your own “meal deliveryservice” for your loved one, especially if you live in the same city.
#2 Caffeine. This comes in different forms for different people, but unless they avoid caffeine for religious reasons, almost every healer and healer in training I know has a go to form of caffeine they love. For most people, it’s coffee. The number one gift on the list (my opinion) for coffee lovers is a Nespresso machine (and some pods to go with it). You can also get them a metal “pod” for their own coffee rather than the Nespresso pods which will save some money. There are other options for pod coffee machines, so you might want to read about them all before deciding. Having tried coffee from a variety of machines, I personal think Nespresso makes the best cup of coffee, but I am partial to espresso. Another great gift option for serious coffee drinkers is programmable coffeemaker so their coffee is ready when they get up at “dark thirty” to get to work. For tea drinkers, there are many options for teas, brewing systems, and pots. For all healers, regardless whether they are coffee or tea drinkers, a gift at the top of the list would have to be a Yeti or Contigo tumbler. These tumblers keep coffee or tea hot for hours… so your drink is still there and still hot when you get pulled away from that first sip.
#1 Money. Students and residents, with rare exceptions, don’t have money for special things. Some don’t have enough money after rent and loans for things most of us would consider essentials. Giving money may seem a bit impersonal, but you can make it personal with a letter, a card, or creative packaging.
“We had a graduation celebration, but it was smaller than usual… only 20 people… and the older people just stayed a little while.”
“We meant to stay socially distanced… but you know kids.”
“God will protect me… I don’t need a mask.”
Oh, how I wish this were over. We all do.
And it will end.
It will end, but what we have to grapple with now is how many of us will die unnecessarily before it ends… because the rest of us “had to get our hair cut” or thought this was some kind of political “hoax”… or just couldn’t be bothered.
Because I am a physician, I have a lot of friends and family who call to ask some version of “Do you think it would be safe if….” I usually respond by telling them what I’m doing and then answer questions as they try to figure out the changes they need to make to be safe.
So, with gratitude for the science that has helped us better understand #COVID19, here’s what I tell my friends and family we are doing when they ask….
Stay Home. We stay home unless it’s for an essential need. For example – we would go to the dentist for a painful tooth (but not for a routine cleaning). We have supported our local restaurants with pick up or delivery, but we don’t go to restaurants yet. When we do, it will only be outside and only if we are sure CDC guidelines for restaurants are being followed. There is no way we would go inside for a movie, rally, worship or other public gathering. The data are more than clear… large gatherings inside are the highest risk activities right now.
I get our vegetables from Pierre at a Plant It Forward farmer’s market sponsored by Dandelion Cafe. (I’m mentioning them on purpose because having these just picked vegetables has been a true gift!) But I have the rest of my groceries delivered. I ask the delivery person to put them on the step (by text). I wear a mask, and don’t open the door until they are more than 6 feet away to thank them. (BTW, they are doing amazing work to keep our communities safe – please tip often and as much as you can).
One of the questions I get asked about staying home is “but I’m young… isn’t it ok for me to go out?”. The answer is yes and no. Younger people are less likely to die or develop chronic lung disease from COVID19, but it’s not impossible. Here’s the real issue – If you end up infected with COVID19 you’ll infect people around you that are at high risk… and they could die or have horrible outcomes from the disease. Do you really want to risk hurting your grandparents or that nice guy at the store who always says “Hi” to you? Think about creating a “quarantine pod” as an alternative to going out to restaurants, bars and concerts… it’s not going to be the same, but it’s a good compromise to keep socially connected while being as safe as possible.
Do it virtually if you can. If we are asked to run or be in a meeting, we do everything possible to make it virtual. If you are in charge of gatherings, this is an important responsibility. There is no reason to expose any of your colleagues or employees unnecessarily.
I’m an academic surgeon. I can’t do surgery virtually, but I can do a lot of clinic visits by video. I can do all my group teaching and committee meetings by Zoom. There is no moral justification to have meetings in person if they can be done online and I’m happy, as someone who can decide, to make sure my students and colleagues aren’t exposed to more risk than necessary.
Socialize outside. If I am meeting a friend (or friends) I’ll only do it outside and only if we have discussed in advance how to manage the event. I’m excited that this weekend I’m going to an outside workshop that FAMHouston is facilitating to teach refugees how to grow vegetables in container gardens. These are my friends, so I really want to see them! We have established in advanced that we will meet CDC guidelines with everyone in masks and more than 6 feet apart.
#WearYourMask. If I’m around anyone, I wear a mask, and I ask them to wear one – AND we stay at least 6 feet apart. The masks only come off if we are outside and more than 6 feet apart. It’s also really important to wear it properly! In particular, if your nose is hanging out, you might as well not have it on. Two other important things: 1) A face shield alone is better than nothing, but isn’t as protective as a mask and 2) the masks with the “breathing valve” aren’t worth wearing. Remember, my mask protects you. Your mask protects me. That’s why if we all wear masks we can stop the spread of COVID19!
Exercise with a mask available. When I’m outside exercising, I have a cooling mask (it is Houston, after all!) around my neck. As soon as I see someone coming towards me, I pull up my mask. I get a good 20-30 feet beyond them before it comes back down.
Bring your own glass. I had a friend over for a glass of wine on the back porch not too long ago. They didn’t come through my house (and I would do the same for them). I opened the gate to the backyard, and they walked through my back yard to the back porch where I met them. They brought their own wine glass. We sat on opposite sides of the porch, 10 feet away from each other and had a wonderful, soul healing visit.
Assume if someone else has touched it there is COVID19 on it. It’s a long shot, but what if… the UPS driver has COVID19 but is asymptomatic, coughs on their hands, picks up the package they are delivering … and now you pick it up. One inadvertent rub of the eyes at that point could easily mean an infection.
We put an old towel on a table and designated that table as “contaminated.” We put new packages on the table and immediately wash our hands. (If you work in an OR, you will understand this well… if you touch something contaminated you “rescrub” i.e. wash your hands before touching something else.) This sounds complicated but it’s not… if it’s just been handled by someone else, we assume it’s contaminated.
We have found that it’s easy to leave things on the table for 3 days before we open them (surprised us, too!). Obviously, groceries that need to be in the refrigerator are a little different (they get put in new plastic bags which go into the fridge). And, because three days may be long for some items…bottles of beverages get washed with soap and water before they go in the fridge.
Now, I have to be honest. A lot of new data are coming out that says we may be on the far end of safe with this. Some surfaces clearly are more at risk (like door handles), but things that get delivered are probably not really a problem. This is one to figure out your comfort level, stay up to date on the new info, and come up with a reasonable plan.
I hope this helps.
Whenever I am tempted to say “just this once” … or fall into the trap of feeling like it can’t really be “that bad” to meet without masks, I think about how all my colleagues are putting their lives on the line to care for infected people… and how I would feel if I were the one responsible for their death, or the death of someone I know and love.
Like you, I’m surrounded and sometimes overwhelmed with the fears and anxieties of the COVID19 pandemic. The world seems so very fragile and vulnerable right now. This morning was tougher than usual for some reason. So…. I got out of my chair, put on my shoes and went for a walk trying to look, with eyes open, for things to sustain me, connect me and provide solace.
Here’s what I heard on my walk …
A virtuoso mockingbird singing to the world (and, I assume, a few cute nearby mockingbirds), six different languages from people walking near me (I love Houston!)… friendly “hellos” from almost everyone I passed (all more than 6 feet away)…
Here’s what I saw on my walk…
A magnificent tree that I had never really noticed before… a family rescuing a caterpillar from the street with a stick… small purple flowers in the grass… kids on bikes… a butterfly garden in a “pocket” prairie…
Here’s what I learned …
Fear is gone when gratitude is present. They can’t be present at the same time.
It’s therapeutic to spend a little time with your #EyesOpen, preferably outside.
If you are a healer, thank you for what you are doing and stay safe. I’ll hold you in the light.
Did you ever wonder why Christmas is on December 25th? … or why we decorate pine trees if Jesus was born in the Middle East? To make the long story short (while begging forgiveness from my theology professors for the oversimplification), it has to do with the Roman Empire adopting Christianity as the state religion in the 4th century. When the Romans moved to conquer what is now England and Germany, the people they were conquering were more than a little reluctant to give up their celebration of the solstice and their understanding of the wonder of trees…. so the two religions “merged”, allowing these symbols to become part of the Christian tradition.
As I thought about the holiday season, and the 12 days of Christmas, I came up with a different idea to celebrate this season… What if we all started a new tradition of donating a small amount to worthy groups for twelve days?
I’ve listed twelve of my favorite charities below, but feel free to come up with your own. Even if you donate a few dollars to each one, you are celebrating the season of Christmas, Hanukkah, Kwanza and the Solstice in a powerful way.
Doctors Without Borders (Médecins Sans Frontiers). This amazing group takes medical care into parts of the world where no one else will go. Their entire charter is worth reading, but they live by “observing neutrality and impartiality in the name of universal medical ethics and the right to humanitarian assistance.”
Your local food bank. Whatever preconceived notion you might have about hunger in America is almost surely wrong. So many families, Seniors and disabled folx rely on food banks. Make this year a time to learn more about hunger in America and donate to feed your neighbors.
Neighborhood initiatives. Regardless of your own religious background, or lack thereof, mosques, churches, temples, and synagogues seek to help those in need. Find the places of worship in your neighborhood, look online to see what good works they are doing, and donate to help them. Better yet, take your donation in person to meet your neighbor and thank them for their work.
Prevent Child Abuse America. As someone who works with abused children, I would also encourage you to donate to the chaplain program at your local children’s hospital. The chaplains see the specific needs of these children – but more often than not don’t have resources to provide meal vouchers, toys or clothes to help a family during these moments of tragedy and pain.
Make sure an isolated senior has a visitor and food by donating to Meals on Wheels.
Time. If you don’t have money to donate, make a commitment to volunteer with a local group to help others. “You make a living by what you get. You make a life by what you give.” ~Winston Churchill
I am personally involved with FAM Houston (consider this my COI declaration!), a group that inspires me through their mission of “working for justice by building empowered community among refugees, immigrants, and local Houstonians.” Through building friendships and creating community they show that any light, no matter how small, is a miracle of love. If you are in need of a worthy group for your twelfth day of Christmas donation, please consider them!
If you have a medical student, resident, physician or anyone who is super busy in your family, here are few last minute gift ideas for you….
I’m starting with this one because even though it’s obvious, we forget the power of stories in our lives to heal and support each other. Consider writing a long letter with stories about how they inspire you, when they decided on their career, funny events, etc. Stress joy, humor… and gratitude.
Many of us study with music, and most of us work (at least sometimes) with music in the background. These two platforms are currently the most used in the hospital. Being able to listen to the music of your choice without commercials is a great gift!
Of all the cooking appliances and gifts, this one is the best for people who want to eat well but don’t have a lot of time. Even if you have to wrap the “IOU” (i.e. a picture of the InstantPot), it will be a very appreciated gift!
No one likes to clean their home, but all of us need this! Even if it’s a deep clean every 3 months for a year, this is a great gift for anyone. Although there are professional services you can find, consider contacting local places of worship or non-profit organizations who may know responsible individuals who need the work.
This one might seem a little strange, but you’ll have to trust me. For anyone who is “too busy” this is an easy way to really stop – even for 10 minutes a day – and “refuel”. BTW, get yourself a subscription (or at least try the first 10 lessons which are free). You’re welcome 🙂
I don't know where prayers go,
or what they do.
Do cats pray, while they sleep
half-asleep in the sun?
Does the opossum pray as it
crosses the street?
The sunflowers? The old black oak
growing older every year?
I know I can walk through the world,
along the shore or under the trees,
with my mind filled with things
of little importance, in full
self-attendance. A condition I can't really
call being alive
Is a prayer a gift, or a petition,
or does it matter?
The sunflowers blaze, maybe that's their way.
Maybe the cats are sound asleep. Maybe not.
While I was thinking this I happened to be standing
just outside my door, with my notebook open,
which is the way I begin every morning.
Then a wren in the privet began to sing.
He was positively drenched in enthusiasm,
I don't know why. And yet, why not.
I wouldn't persuade you from whatever you believe
or whatever you don't. That's your business.
But I thought, of the wren's singing, what could this be
if it isn't a prayer?
So I just listened, my pen in the air.
Tomorrow is Thanksgiving, so today I’m with my family, looking at the timeline for tomorrow and discussing when the pies need to go in, who is making the cornbread and calculating how long the turkey needs to cook.
As of today, there will be 12,996 families in the United States who lost a family member to gun violence in 2018…. almost 13,000 Thanksgiving tables with an empty seat from a preventable death – from this year alone.
Late at night on November 7th, the NRA posted this on Twitter:
I, and many other physicians responded as soon as we saw it…
My second tweet was followed by a long thread of PubMed abstracts with research results showing how we might start decreasing deaths from gun violence. The NRA, interestingly, removed all of those Tweets from their timeline.
#ThisIsOurLane has become a movement. A callous Tweet from the NRA started it, but that’s not what is sustaining it now. As I discussed in this podcast, I think what the NRA did was make physicians realize that this “debate” is not about politics, it’s about lives… human lives… sisters, brothers, mothers, fathers, friends. It’s about our patients and, unfortunately, our colleagues. As a result of what has happened since November 7th, physicians have realized we need two things to move this forward: stories and data. Human beings are not swayed by debates, they are moved by stories. Good decisions can’t be made on emotions alone – we need data and that means research, and funds to do that research.
Commit to questioning what you hear – from both sides. Question whether the fear created by the NRA is to serve another, more political aim… one that you might not completely understand or agree with. Ask questions. Ask for data. Recognize and ignore political rhetoric (from both sides). Keep an open mind.
Support the funding of research into gun violence. Contact your representatives to let them know this a priority for you. This is no different than what we did as a society when we looked at death from car crashes… and developed seat belts, stronger cars frames and air bags. Wouldn’t it be great if we could see the same decrease in gun deaths through research?
If you are in healthcare, tell the stories in a way that respects your patients and their rights… but tell them. If you are on social media, use that platform. Until people realize that these are our siblings, parents, colleagues, and not just statistics, we won’t make progress. We have to move hearts before we can move minds.
I am so thankful for my family, for the opportunity to gather at the Thanksgiving table together, and for the many friends and opportunities that have been given to me. My heart goes out to all families who have lost a loved one to gun violence, including the horrible loss of life by suicide. May you find some small solace in knowing that we are holding you in the light – and that we will continue to work hard to end the tragic epidemic of gun violence in our country.