The Butterfly Promise Practicing medicine not only provides clinicians with intellectual fulfillment — but allows them to bear witness to inspiring life stories. voices.nejm.org/doi/full/10.... @nejm.org

The Butterfly Promise

Practicing medicine not only provides clinicians with intellectual fulfillment — but allows them to bear witness to inspiring life stories.

voices.nejm.org

In a new blog post, Dr. Michelle Kittleson (@mkittlesonmd.bsky.social) writes that AI can be a helpful tool for physicians, but only if you know what questions to ask. Read “Authentic Intelligence” and sign up for email alerts: https://voices.nejm.org/doi/full/10.1056/VOICESpost2600022

At the end of the day, what patients really want to know is: 1) Can I trust you? and 2) Am I going to be okay? @mkittlesonmd.bsky.social explains how to recognize and address the emotions behind those questions. Learn more and sign up for email alerts: https://nej.md/4yr0LGU

A jar of marinara sauce taught me that, at the end of the day, what patients really want to know is: 1) Can I trust you? and 2) Am I going to be okay? voices.nejm.org/doi/full/10.... Sign up for email alerts so you never miss a post-- access is free, with no subscription to @nejm.org required :)

The Locus of Control

At the end of the day, what patients really want to know is: 1) Can I trust you? and 2) Am I going to be okay?

voices.nejm.org

I have NO clear plan on how to optimally incorporate AI in patients care-- but there are times when AI isn't enough. Don't forget to sign up for email alerts so you never miss a piece- no subscription to @NEJM required- access is free! voices.nejm.org/doi/full/10....

Authentic Intelligence

AI can be a helpful tool for physicians, but only if you know what questions to ask.

voices.nejm.org

In a new blog post, Dr. Michelle Kittleson (@mkittlesonmd.bsky.social) recalls a moment when a heart transplant patient taught her symptoms aren’t always medical. Read “Life Is a Series of Dogs”: https://voices.nejm.org/doi/full/10.1056/VOICESpost2600017

This is Walter, the best dog in the world. Read about him in my newest @NEJM Voices piece, Life is a Series of Dogs. voices.nejm.org/doi/full/10.... And sign up for email alerts so you know when a new piece is posted-- it's free, no subscription to NEJM required!

Life Is a Series of Dogs

A heart transplant patient taught Dr. Michelle Kittleson that symptoms aren’t always medical.

voices.nejm.org

In a new blog post, Dr. Michelle Kittleson writes that clinical decisions should be driven by the patient’s medical needs, not by physician concerns about their status, expectations, or perceptions. Read “Very Important Patients”: https://voices.nejm.org/doi/full/10.1056/VOICESpost2600016

What's my take on VIP medicine? Find out here, in my new NEJM Voices piece. You can sign up for email alerts so you never miss a piece, and access is FREE (you don't need a subscription to NEJM)! voices.nejm.org/doi/full/10....

Very Important Patients

Clinical decisions should be driven by the patient’s medical needs, not by physician concerns about their status, expectations, or perceptions.

voices.nejm.org

The Right Approach- For Whom? Check out my latest on NEJM Voices: A cardiologist learns that end-of-life care is an iterative process. And please sign up for FREE email alerts (link below) so you're always aware when a new piece drops! voices.nejm.org/doi/full/10....

The Right Approach — For Whom?

A cardiologist learns that end-of-life care is an iterative process that begins with honesty and trust.

voices.nejm.org

🎇 🔥 Exciting breaking news! 🔥 🎇 NEJM Voices features essays grounded in real-world practice -- including pieces by me (!!) that will appear every 2 weeks. Check out my inaugural essay, about how a country-music star made me a better doctor. I hope you like it 😊

NEJM.org@nejm.org · 4mo ago

In a new blog post, Michelle Kittleson, MD, PhD, explains how a patient’s reference to a late-70s country hit inspires a framework for shared decision-making. Read “Kenny Rogers and the Art of Shared Decision-Making”: voices.nejm.org/doi/full/10....

#TipsForNewDocs Rules of vasoactive agents in shock 1) The right combination is what works (to achieve goals of MAP, CI, filling pressures) 2) When what you're doing isn't working, pivot quickly to a new strategy Pragmatic, nimble, flexible = success #kittlesonrules

Monday's tweet was about using powers of observation to aid in diagnosis. More details in Chapter 4. Mastering the Art of Patient Care. link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs When I’m in the hallway between pts, I try to pay attention to how the next pt looks as they walk into the exam room. Stooped, short of breath, teetering, alone, w/family? You’ll get a sense of their well-being even before the visit begins. #kittlesonrules

#TipsForNewDocs When you're not sure what to do, break it down by first principles: Will the test change management? Will the intervention made my pt feel better and/or live longer? Let the Golden Rules of medicine guide you. #kittlesonrules

Do you fear giving talks? I learned from experience on how to give an effective one-- check out my tips in Mastering the Art of Patient Care. link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs If a HF patient is undergoing diuresis and K < 3.5, stop diuresis with loop/thiazide diuretic until K improves. ICD shocks attributed to diuretic-induced hypokalemia is a form of iatrogenesis imperfecta best avoided. #kittlesonrules

Monday's tweet focused on one aspect of consult etiquette. Check out Ch 6 Mastering the Art of Patient Care for more details. link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs Consult etiquette when referring a patient to a specialist. Bad: I’m sure they’ll see you this week. Good: Medically, anytime in the next month is fine. If a consult isn't urgent, say so. If it is, call the consultant and let them know! #kittlesonrules

There are many, many reasons to write a good note. Here are my tips! Mastering the Art of Patient Care link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs In the cath lab yrs ago, I couldn't engage an RCA. The experienced tech offered help. The next time, I taught a new tech and fellow. Experience trumps education. Always take the help! It'll benefit you, your patient, and those you teach. #kittlesonrules

How do you navigate the boundaries of the patient-physician bond? Read more in Mastering the Art of Patient Care. link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs The art of performing a consult: 1) be prepared: know as much as you can before you walk in the room 2) be an expert: no unhelpful generalizations like "avoid nephrotoxins" 3) be useful: provide timely communication with the referring #kittlesonrules

The 5 highest-yield questions to make a diagnosis. Mastering the Art of Patient Care. link.springer.com/book/10.1007... #kittlesonrules

#TipsForNewDocs When I care for seriously ill pts, I say: "If there was something more you could be doing, I would tell you. This is not your fault." Do your best to relieve the burden of self-recrimination felt by very sick pts and their families. #kittlesonrules

#TipsForNewDocs On night call, I used to answer: “What's the emergency?" Then, I needed on-call peds for my kid- his first words: “How can I help?" That’s how I respond now. Not being nice won't limit calls, it just makes them unpleasant for all involved. #kittlesonrules