“Running the List”

Where did this term come from?

For those not in medicine:

  • 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.
  • Fine tipped pens are key (Every resident has a favorite type of pen which they hide from their attendings).

And then we run the list

“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!

Final thoughts

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?

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#MedGradWishList

Every year about this time, I try to put together a list for people trying to find the right gift for someone they know who is graduating from medical school.

This year’s list is a special one.

If you haven’t heard of #medgradwishlist, it’s an amazing grassroots effort to create Amazon wish lists for URM students matching this week. This is a brilliant “pay it forward” initiative. I’ve been a Program Director and a Dean of Student Affairs and I know how many new grads finish medical school with enormous debt and empty bank accounts. The ~17,000 students graduating from medical school this year are about to start on the exciting – but stressful – path of becoming a physician. Not being able to afford the things that make that journey possible just isn’t acceptable.

If you want to support these soon to be MDs, here is the spreadsheet with the names of the residents who have registered.  (You can also search #medgradwishlist on Twitter). You can buy things on their list anonymously (or not). When you find the right thing for the right person, don’t forget to include some memories of your internship, advice, and words of encouragement!

If you are a student (or even a struggling resident) in need, please join this effort to get what you need. We are sure you will pay it forward to extend this support to next year’s class!

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I spent quite a bit of time looking at all the #medgradwishlists on Amazon, and I’m happy to share what I learned. In addition to their great ideas, I have some suggestions to add…

@drmlb‘s Top Ten #medgradwishlist suggestions

Instant Pot. This was on a lot of the Amazon lists, and I agree!!! II had to suggest one item to make life as a resident easier, it would be this. Several people asked for air fryers on their Amazon lists. Just as an FYI, you already (sort of) own an air fryer since your oven set on convection does close to the same thing!

Someone to help clean and do laundry. I know you can’t put this on an Amazon wish list, but if you have a family member who either can do this for you, or pay someone to do this for you, it’s one of the best gifts you will ever receive.

Digital gifts to make communicating and studying easier. The single most important tool for an intern is their phone. If they don’t have a new phone that can reliably work with WIFi and cellular, this should be at the top of your gift list. A computer that works, has the ability to do streaming well, and is reliable is also key since it’s how they will study, write, and watch educational videos. They’ll want the flexibility of studying in a coffee shop (once we get COVID19 under control) or on their couch so make sure it’s a laptop and not a desktop computer.

There were some great ideas on the Amazon lists for items that aren’t quite as expensive as computers that you might consider as well: ring light for Zoom meetings, LED study light, lap top desk for your lap, iPad Pro, Apple pencil.I should add that buying a large quantity of pens to be “borrowed” by attendings would be a big win, too.

The kitchen (other than the Instant Pot). It’s so important to eat well when you work as hard as interns work (and to stay well caffeinated). There were some great ideas from my new colleagues on their Amazon lists including single serve coffee makers, pot and pan sets, nonstick bakeware set (if they are a baker!), wine opener :-),  and food storage bags and containers. A box or two of Kind Bars (my favorite) or other meal replacement bars is a great gift, too. And for the times cooking is just one task too many – Door Dash, Uber Eats, and/or Grub Hub gift cards are a great gift. One other must have… a Yeti mug to keep coffee hot during rounds!

Clocks and watches. We all have phones that can serve as alarm clocks, but an alarm clock that gently lights up the room is a much better way to wake up than sudden noise. I wouldn’t say an Apple watch is essential (and if you do a lot of procedures it might be easy to lose) but it is worn by a good percentage of folx in the hospital. A new watch might be in order, even if it’s not an expensive digital watch.

USMLE3 study book. If you are a family member who is thinking about getting this as a present, you might also want to include a check for $895 as a “bookmark” to cover the cost of registering for this exam.

Make your home a stress-free zone. If you are setting up a new home, this list can be really extensive. You’ll need to go home to a clean, happy space, so whatever you can do to make that happen is important. There were a lot of good ideas in the Amazon wish lists including self-cleaning cat boxes, pet hair removal brushes, furniture, shower curtains, towels, and a video doorbell. I’d add a Roomba vacuum cleaner to this list, too! BTW, a good TV is important, too. We all need to binge watch the Great British Baking Show as therapy sometimes.

Sleep. In this category I would include good quality pillows, a new mattress, light blocking curtains, white noise machines, and electric or weighted blankets.

Music. Most people fill their space at home with sound as well as light, so think about good WiFi speakers like Sonos and/or gift certificates for ad-free music services  like Apple Music, Spotify, Pandora.

Health. Last but not least! The most important thing on this list in my opinion is a great water bottle since, particularly with masks on all day, none of us drink enough water. A new Sonicare toothbrush or WaterPik for dental health will be appreciated. Foot care is another important part of being a healthy resident, so consider gifting compression socks, good shoes, work insoles and/or a foot massager. Anything that promotes or makes fitness easier is also a good gift – a new bicycle for commuting, new shoes for the hospital, workout gloves, free weights, resistance bands. You might also consider a meditation app like Headspace, or subscription to yoga classes on line. And… lest I fail to jump on this wonderful bandwagon, if you can afford the Peloton, it’s a favorite among physicians!

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p.s. What NOT to buy or ask for

  • Scrubs. I noticed a lot of folx asking for scrubs. Nope – don’t do it! You will be required to wear the scrubs from the hospital since there are rules about them being washed in the hospital laundry.
  • Textbooks. You are pretty much guaranteed to have access to a library where these books will be in digital format and free. These books are heavy! You aren’t going to take them to work and when you get home, you may have other things to read that take priority.
  • Printers. This is expensive and you just won’t use them. You are going to have to stay digital to really learn what you need to learn as a resident. Besides, if you do need to print out the return slip for Amazon, there will always be a printer at the hospital you can use!
  • Black bag. If you are a family member thinking of getting one of these… don’t.

And finally…

For my new colleagues matching this week and starting your internship in June …

May your journey through this liminal time be as stress free and as joyful as possible. May every day as an intern bring you hearts to heal and hands to hold, new learning, and a sense of wonder and awe.

We are so happy you are joining us in this noble and sacred work!

Beepers and Pagers and Phones… Oh, my!

I was looking at my beeper then other day and realized it looks exactly like beepers looked 25 years ago.   Think about it.

Here is what mobile phones looked like 25 years ago…

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 Who invented beepers?

There are some conflicting stories about who invented the first “beeper” (because they only made a noise)

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“More than 20 million people in the United States today are connected by an invisible, ubiquitous wireless link, originally developed in 1949 by a hospitalized radio engineer. Charles F. Neergard was annoyed by the constant, loud voice paging of doctors on his hospital floor, and reasoned that there must be a way to quietly inform only the intended recipient that a message was waiting. The first commercial pagers were deployed in St. Thomas Hospital in London England and were the approximate size and weight of today’s two D-cell Mag-light.”  from llinoissignal.com

“In 1921, the first pager-like system was in use by the Detroit Police Department. However, it was not until 1949 that the very first telephone pager was patented. The inventor’s name was Al Gross and his pagers were first used in New York City’s Jewish Hospital. Al Gross’ pager was not a consumer device available to everyone. The FCC did not approve the pager for public use until 1958.”  from inventors.about.com

Timeline of history of the pager

In the era of nothing but landlines, pagers were necessary to contact people who were moving around. Which leads to the next obvious question:

Why do we still have pagers in medicine?

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Most physicians preferentially use texting as a method to communicate with each other (when we can).  But, we all still have pagers, too.  There are several reasons:

1) You can turn off a pager (when you aren’t working).  It’s harder to turn off your cell phone.

2) Pagers don’t interfere with medical equipment.  (Unlike some cell phones).  (Although there are some who feel that the benefit of improved communication outweighs the potential risk of interference. )

3) Pagers work in the basement and in steel reinforced buildings (like hospitals), places that limit cell phone reception

4) You can dial one number to reach a group of people (important for codes, etc)

5) The battery life is much better than a cell phone

6)  In a disaster situation (like a hurricane) pagers still work when cell phones don’t

Where are the new solutions?

There are systems now that allow you to use special mobile phones within the walls of the hospital.  Some systems, like Spectralink, use proprietary phones that work only within the hospital.  Others, like Vocera, use software to allow the use of iPhones for the same purpose.  Apple has acquired a patent for a similar system which suggests they may be working on new technology.

Making a new product for the almost 1,000,000 physicians in the United States would seem to be a market big enough to warrant some creative ideas!  How about the most obvious one – Why can’t the full function of a pager be added to a cell phone? 

Any engineers and/or entrepreneurs looking for a new product to develop?

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