Inpatient internal medicine got off to a sort of rough start. Admittedly, the first few days that I work in a new place tend to be more difficult and less productive than I’d prefer. This has held true for just about every rotation I’ve had so far. It’s a bit unreasonable to expect that you can be new best friends with everyone immediately, and understand perfectly how they would like you to perform.
In the first week of inpatient internal medicine I struggled. It had been quite a while since I had last done a full history and physical, and it had been even longer since I had had to present formally to an attending. My senior resident was a stickler for formality and the attending was formidable as well. I was never very comfortable presenting, but the pressure of the senior resident and attending staring me down made it worse. Needless to say, I stumbled a lot and eventually the intern took over the presentation. Then, later in the week, the senior resident delivered some feedback about my presentation skills that wrecked any shred of confidence I had and made the remaining time with her worse, since I didn’t feel comfortable around her at all. I hardly wanted to speak let alone present. This was a disheartening beginning to a long month of inpatient work.
However, as the weeks went on, my experience improved. We had new senior residents. One was very relaxed, which began to right the wrongs of the previous week. The next senior resident was the best, though. He was so positive, always cheerful, even on call nights as the phone rang off the hook. When I presented patients to him, instead of insisting on a regimented format, he simply said, “Tell me about the patient.” This approach made me much more comfortable telling the resident everything I knew. Instead of trying to fit the facts into a strict format, I could tell the story in a way that made sense to me and allowed me to best convey the patient’s experience, concerns, and priorities. All the information was there, just not with so much pomp and circumstance.
I do recognize the need to develop good presentation skills, but the aggressive insistence on formal presentations has been frustrating to me. I think it is possible that more productive, efficient presentations and discussions might occur by other means. Interacting with patients is often more of an art than a science; maybe presenting the patient should be more about storytelling than rote recital.