Signout is actually a special moment that goes unnoticed by many of my fellow residents. It is the singular time that junior residents are on the receiving end of patient presentations from other doctors. Signout is a time we may have the opportunity to feel, momentarily, like an attending. I don’t mean this with respect to the power or responsibility, but rather the markedly different feeling of analyzing someone else’s work. Studies show that attendings actually think differently than residents. A lot of this is experience, learning to hone in on what matters. But some of it is a difference in role, requiring different cognitive skills. Analyzing someone else’s work is an entirely separate cognitive process from presenting your own.

How can we get better at receiving signout? First, we should change our disposition when receiving a patient from the previous team (pardon the pun). Currently, the atmosphere of signout is friendly, professional, collegial, and I think, just a little too polite. After all, we don’t want to keep our colleagues from leaving on time and we don’t want to be seen as pushy or overly second guessing. But this is prioritizing manners over patient care. What I’m advocating is a less friendly, even skeptical tenor during signout, if only for a moment: one of questioning. The null hypothesis ought to be: “The previous team missed something huge.” I’m not saying to wheel every abdominal pain patient who is about to pass an oral intake trial of Jell-O and water to the CT scanner. Rather, I’m saying to ask “what about” and “what if” questions. Ask “Did you think of … ?” and “How do you know it’s not … ?” questions. After signout, go meet and actually examine the patient. (Admit it: You’ve met patients for the very first time only when handing them their discharge papers!)

It’s not that your colleagues are so often wrong. It’s that we don’t always follow up on intentions to do important tasks, including serial abdominal exams. So the first to-do item on any signout plan should be to personally examine the patient. To avoid forgetting, I ask Siri to remind me 30 minutes later: “Did you examine the patient in bed 3A?” My incomplete macro for signout includes a stock line: “I will personally examine the patient.” If I don’t do this, the responsibility is mine. On the other hand, if signouts are well presented and well received, they can feel less like a dangerous transfers of care and more like consults.