Conventional wisdom tells patients to avoid the hospital in July. With hospitals teeming with a fresh crop of medical school graduates who have been doctors for less time than it’s been since your last haircut, the fear is that both the quality and efficiency of medical care tanks this time of year.

Of course, there is actually little data to support the notion of a July effect.¹ Personally, I am most concerned about September, when a false sense of security may set in.

However, summer is the time when new doctors are most eager to learn and seasoned physicians are at their most committed to teaching. With that in mind, the Twitter hashtag #TipsForNewDocs has become something of an annual tradition in June and July. Here are some of my favorites from this year (lightly edited for clarity).

From Wendy Johnson, MD, MPH (@Artivizm), a family medicine physician and medical director of La Familia Medical Center in Santa Fe, New Mexico: “One of the best axioms I’ve heard re: medicine: ‘Don’t just DO something, STAND there!’ When in doubt, stop for a minute, think about the whole picture, think about the patient’s story. You almost always have time, except in the most emergent situations.”

This is a great reminder that medical school often emphasizes what treatments and tests we might utilize in the most unusual circumstances, but in reality, such heroics are not only unnecessary, they may even prove harmful.

Elianna Saidenberg, MD (@ESaidenberg), a fellow in patient experience in the department of medicine at The Ottawa Hospital in Ontario, added: “Until a patient dies, there is treatment. May not be disease-modifying, but there is treatment of pain and other symptoms. Never, ever tell a patient or family that care or treatment is being withdrawn.”

In other words, it is not a matter of doing everything or doing nothing but rather determining what kind of care a patient needs in each moment.

This tweet by Louis Mullie, MD (@LouisMullie), an internal medicine resident at Centre Hospitalier de l’Université de Montréal, about how to stay out of trouble when performing procedures should probably be posted on the walls in most hospitals. “If you meet resistance, don’t push. If you (or someone else) breaks sterility, speak out—can you swear on your patient’s life that the procedure was clean? If you feel uncomfortable at any step, call for senior help.”

Marleny Franco, MD (@MFrancoMD), a pediatric emergency medicine specialist at Children’s Hospital of Philadelphia and St. Mary Medical Center, tweeted about an all-too-common error. “Don’t use a child as a language interpreter. It’s inappropriate, unfair to the child & family, and unethical. Get a proper in-person or phone interpreter.”

Consider the legal implications. I can’t imagine wanting to face a deposition, let alone a jury, in a case in which a child was permitted to serve as the medical interpreter. In fact, many adults can’t even decode half of the things we say, even in their own language (a reminder to avoid jargon and never to assume that patients have complete medical literacy).

Mark Reid, MD (@MedicalAxioms), a hospitalist in Denver, has published an entire book of modern medical quips, from serious to hysterical, that would have made even Dr. William Osler swoon with jealousy. Among Dr. Reid’s tweets sporting this hashtag is: “Some patients make themselves vomit in an attempt to relieve severe nausea. It’s not a trick or deception in an attempt to be taken seriously. It’s an age-old ‘home remedy.’”

It is indeed all too tempting to chalk up a patient’s self-induced vomiting (or their tympanic membrane piercing attempts to do so) as a form of malingering or an attempt to gain our attention. But this tweet is a reminder to keep an open mind about our patients’ motivations.

Gabrielle Inglis, MD (@GabrielleInglis), a family medicine physician in Boston, brilliantly flipped the script with a list of #TipsForAttendings, underscoring that, as supervisors and mentors, we have an enormous impact on both the academic and emotional well-being of our trainees. Here are her top five:

1. “Make your expectations clear for how and when to review cases with you and remember, every staff they work with wants it done differently.”
2. “Explicitly tell them to take a break to eat—and not just ice cream rounds but real food.”
3. “If you notice them becoming flustered while presenting, chances are it’s a reflection of your demeanor. Be curious, kind and patient.”
4. “Role model respect for everyone you work with in the hospital—including the unsung heroes, clerks and custodial staff.”
5. And finally, most important, “Don’t be a jerk.”

Want more? Visit these hashtags on Twitter. Do you have any great tips for new (and old) doctors? Send them my way or post them on Twitter with the hashtag included.

Reference

1. Jena AB, Sun EC, Romley JA. Mortality among high-risk patients with acute myocardial infarction admitted to U.S. teaching-intensive hospitals in July: a retrospective observational study. Circulation. 2013;128(25):2754-2763.