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Pages: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 Scenario #4 - Debbie Demoralized(Debbie has recently had a string of deaths on the ward service.) Debbie: I think he is experiencing paroxysmal atrial fibrillation. Attending: So, what do you want to do? Debbie: I don't know. I should probably anticoagulate him, but if I do that, he will probably have an hemorrhagic stroke. I don't know. I just don't know how to handle a situation like this when I think the patient has a high risk for intracerebral hemorrhage but the recommendations are to anticoagulate them. Attending: What would help you to make that decision? Debbie: I really don't know. Attending: Do you know what the incidence of intracerebral hemorrhage for patients on chronic anticoagulation therapy is? Debbie: I think about 1 to 3 percent. Attending: That’s about right. Do you know what the incidence of an embolic stroke from atrial fibrillation would be for your patient? Debbie: Yes, I have a general idea. Attending: Then, what other information do you need to make the decision? Debbie: I really don't know. Dealing with Debbie
Residency is a time filled with much self-doubt issuing froms experiences in which patients have bad outcomes (related or unrelated to the medical learner's actions), where the attending physicians may berate them inappropriately, and where they receive little feedback, whether positive or negative, leaving them wondering if they are fit for their duties. Reinforcing what was done correctly can provide the basis to regain confidence and enhance learning.
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Community-Based
Teaching Benefits - Strategies for Teaching in a Busy
Practice Page last updated:
February 24, 2003
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How
would you enforce correct behaviors?
