Chapter 3.3: Dot the i

When a patient’s lungs are hooked up to a machine, it pays to be detail-oriented.

It might sound obvious, but I think it summarises my time on ICU. It’s a bustling hub of numbers, machines, tubes and drugs and provides a very different challenge to the less-critical ward environment. ICU staff- be it doctors, nurses or other professionals- deal with small margins; subtle changes to drug doses, tweaks to ventilator settings, monitoring fluid input and output. It makes sense when you consider ICU is essentially a place where organs go to take a break.

I’ve never been particularly detail-oriented. I’ve always preferred concepts- processes you can talk through and draw out. As a result, my essays are usually decent but multiple choice questions are generally not a strength of mine. However, over the past year or so I’ve seen the impact of being thorough and meticulous, which has been compounded by this recent placement.

The value of detail

I witnessed a small but powerful example of where attention to detail had a real impact, which I’d like to share with you. A patient on ICU was experiencing delirium (impaired awareness usually due to a reversible problem, like an infection) and the consultant in question was working through their process of tackling this. As part of it, they mentioned how there can be peripheral issues that can make delirium worse, which are often overlooked. This includes simple things like if the patient has any hearing or visual impairment.

One quick phone call to the patient’s family later, and it turned out the patient is severely hearing impaired and had lost her hearing aids. This was new information that would certainly have been lost in the process, and would have resulted in the patient remaining disoriented even if the underlying cause of the delirium had been found and treated.

For the consultant this was a familiar scenario, but for me it highlighted the importance of being thorough, working through a process and not cutting corners. After all, how many times had that same phone call been made without anything to report? In medicine, with such limited time and such a plethora of tasks to tackle, it can be tempting to find shortcuts. Sometimes it’s unavoidable, and may actually be useful, but I think those who are less detail-oriented (such as myself) can be prone to taking this slightly too far. In the end, it will cause things to be missed and standards to drop.

What’s my action plan?

I’ve decided to try to focus on this aspect and improve my attention to detail. I think it will ultimately improve me as a budding doctor and will have good overlap with other aspects of my life. Some easy steps I’ll take will be:

  1. Taking the time to ask doctors what their thought process is when approaching a problem. Do they have a logical way of sorting through diagnoses, investigations and treatments? Can I appropriate some of these for my own use?
  2. Speak more to nurses! Nurses have a wonderful capacity for considering patient minutiae and their wider care. I think we can all benefit more from their wisdom, but this is a particular area where I think I can gain a lot of knowledge.
  3. Put it into practice by tackling difficult concepts and topics in an MCQ setting. This one is especially important seeing as I have finals coming up!

On that last note, I had the opportunity to practise an emergency scenario during simulation training. I think it threw up a lot of these action points (such as being more thorough with my ABCDE approach), but I was pleasantly surprised when I was given a non-standard adrenaline concentration and I managed to identify this and respond appropriately.

I still have a long way to go, but maybe taking a more detail-oriented approach will enable me to get closer to the type of doctor I ultimately want to be: one that dots the “i”s and crosses the “t”s with a pen stolen from one of my wonderful nurse colleagues.

Don’t worry, they always remember to get it back!

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