Axioms for Community Medicine

I've been a community MD for a few months and I recently came across Dr. Rob Orman's ERCast.  This is a great podcast that's supremely relevant for community ED docs. One of his recent podcasts had a discussion on academics vs. community medicine (including Drs. Scott Weingart and Rob Rogers). Dr. Orman ends the podcast with these powerful axioms:

1.  When first starting out (6-12 months) think of it as doing an EM fellowship in community medicine.

2.  Give service to the group.  Devote a chunk of time to group practice by adding value, i.e. develop U/S, clinical pathways for PE, A.fib.

3.  Remember, proximity to a CT scanner (or MRI) is not a reason to order the test.

4.  You can only see ONE patient at a time.  The patient in front of you is the only patient you have.  If you focus on the waiting room, the last patient, you might end up spinning your wheels.

5.  Be nice to the nurses.  They can help and teach you or really HURT you.

6.  Take an advanced airway course early on.  This will reap huge dividends throughout your career.

7.  You are always a student FIRST.  Keep on learning and staying current, in addition to LLSA/CME.  Be the best emergency physician you can be.

8.  Be gracious with your consultants and be congenial.  These are people you will be working with for a LONG time. “Seek first to understand, then be understood.” ~ Stephen Covey

9.  Go to the monthly meeting.  Although you may think they are optional, they are not.

10.  The silent chief complaint is anxiety. In addition to the chief complaint, alleviate the anxiety of their symptoms.

11.  Always advocate for the patient.  When in a bind, ask yourself, “Self, what's best for my patient?”

Listen to ERcast by subscribing on iTunes!

Collected Tweets from ACEP Scientific Assembly 2011

In case you missed my tweets from ACEP in San Francisco, here is a collection of some of my updates.

Go with person with possible SAH & get immediate CT angio if positive. @emcrit

Pods sign: one spot that orthopods can listen to heart, lung, abdomen and document WNL...We Never Looked. Henry

More than 2 nerves affected in posterior fossa = bleed or tumor. Check articulation, word differentiation. Henry

Dizziness questions: Did the room spin? Did you feel like you were going to faint? Is this worse at night? Henry 

What is Purpose of lecturing?  Get people to learn. Do Audience centered speaking. Mattu

Audience will forget 40% of new content by 20 mins. After one week, 90% of new content forgotten. Mattu 

Limit content to 3-4 points U want them to remember. Be explicit about these points. Mattu 

Audio and videotape your lectures to improve speaking skills. Mattu

Buy "Secrets of Successful Speakers" by Nick Morgan, Lilly Walters, ET al. Mattu 

"At the end of this lecture, I want the audience to___". Plan for this when beginning your presentation. Mattu 

Come up with take home points and conclusion FIRST. What behavior change is the goal? Mattu 

Anything more than 4 points in your lecture and they will remember ZERO! Mattu 

Customize your lecture for the specific audience: degree, training level, specialty, native language, why are they there? Mattu 

Have a dynamic title in lecture. Use words like Pitfalls, Advances, Pearls. Death, disasters, killer NOT chapter titles. Mattu 

Start strong and finish strong! Grab their attention. Memorize the intro. Start with humor or a challenging case. Mattu 

Don't take questions at the end. Its a weak finish. Final 10 seconds are the most memorable. Mattu 

Don't need as many visuals. Simple slides. Big fonts: tahoma and arial are good. You are the message! Mattu 

Approach the sleepy or texting person and they will wake right up!" Mattu 

It's not what you say, it's how you say it. Tone, speed, body language. Mattu

Have 2 jokes prepared just in case of an AV glitch. Mattu