Monday, December 7, 2009

Clinical vignettes - an incredible trip toward an infinite learning paradise

Fourth day of seven in the Pediatrics wards. I was awake last night finishing writing and reviewing abstracts to submit to the Society of Hospital Medicine. I went to bed finally at 2:30am; I submitted 4 clinical vignettes: a case of Mycoplasma Pneumoniae induced Stevens Johnson's Syndrome; a case of innapropriately diagnosed Diabetes insipidus in a patient with SSRI/SNRI-induced polydypsia; a case of catastrophic antiphospholipid syndrome; and finally, a case of edema blisters that appeared after an acute attack of hereditary angioedema.

We all see interesting cases every single day. All patients can be as fascinating and interesting as you want them to be. The residents at the Cleveland Clinic, present fantastic morning reports with all the imaging and labwork included, excellent bibliographic search, etc. This is in both Medicine and Pediatrics. As an academic hospitalist, I am invited to the morning reports to help catalize the case's presentation and emphasize high yield teaching points.

What surprises me, is the extemely poor academic outcome that yields from those morning reports in terms of productivity - the residents have already extensively summarized the case, and put it all together - the only thing is to put all the information in an abstract, as the slides can just be copied and pasted in a poster template. Or even the slides can be used to present in a National meeting as case conference. But, most of the residents leave those fantastic cases in the academic oblivion; they met their function - teach whomever was present in the morning report, but these cases deserve more than that; the educational value is superlative, and a lot of physicians can benefit from them; you share knowledge by means of presenting the cases in a national meeting. The work is already done; it is just means of finding submission deadlines for the different meetings and take the advantage of your own effort.

As a hospitalist, I work in teaching services with fantastic residents in both Internal Medicine and Pediatrics, and sometimes in non-teaching services, where I enjoy my loneliness to attempt to master the floors in the most cost-effective and evidence-based way as possible; I look for original references in the literature, and in many occasions, share the publications with my patients, to expand their knowledge and horizons. I don't hide things from my patients; the savvier they become, the more they develop their health literacy, the better outcomes they'll have. But, in addition, I learn an impressive amount of new things on a daily basis; and I find cases that are incredible for teaching purposes; more patients will benefit from the acquired knowledge and experience.

I have two choices; just "do my job", and try to be ready at 5 pm for sign out and prepare for the next day, and enhance the turnover. The other choice is "enjoy my job", learn as much as I can, make a list of all the interesting academic cases, read as much as possible, put them together, and when the time comes, present them in my own Department of Hospital Medicine Grand Rounds or in national meetings such as the Society of Hospital Medicine. Once you are in the meeting, it is pleasurable to see how you enhance other colleagues knowledge, but as well it is fascinating to learn a lot of different new things and overall, appreciate the different perspective and approach to Medicine in other institutions around the country.

Once in the meeting it is very interesting the peculiar questions you get asked which enrich and expands further the insight about the case. It makes you better; you learn from your colleagues experience and return home with novel ideas. These ideas work very well at the time of putting together the case for submission to a medical journal and then enhance the teaching in a global way.

Despite working late, I woke up with a lot of energy and enthusiasm, with the happiness of achievement; I hope that the abstracts will get accepted; it may happen otherwise, and then may think of improving them and perhaps submit to a different meeting or just have them for further teaching purposes, as our own experience and learning make us better every day to help is provide the best medical care and as always...primum non nocere.....

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