Saturday, March 28, 2009

M.D. = Make Decisions

When I was a fourth year med student doing my Emergency Medicine rotation, one of the ER docs told me, "M.D. means Make Decisions."  I've always been pretty wishy-washy.  I have a hard time making decisions about the most trivial things.  Take my iPhone for example.  I spent about an hour in the AT&T store trying to decide if I wanted 8GB or 16GB, black or white (I ended up getting 16GB in black, in case you're wondering... after switching between white and black several times).  But now I'm a doctor and I'm supposed to make decisions everyday - sometimes tough or tricky decisions.  This is one of the key components of being a good doctor, and I've observed this in some of my favorite attendings.  The ability to make a decision and commit to it.

It doesn't come naturally to me (obviously, since I spend hours deciding on things like phone colors).  But every time a decision is placed in front of me as a doctor, I consciously remind myself, "Make a decision, Linda, and stick to it."

Yesterday I sent two kids to the PICU.  The first one was a 12 month old girl who had pneumonia and was working hard to breathe.  I did my assessment and decided I wasn't quite comfortable with her staying on the floor.  She's doing fine and her labs were reassuring... but she ended up on continuous nebs which is a reason to go to the PICU.  So maybe I made the right decision by chance.  Then in the middle of the night I got called for a 2 year old boy who was having difficulty breathing after being extubated (he was under general anesthesia for a small procedure).  When I got there he looked bad.  He was sucking his chest down to his spine and had a barking cough.  I told the Anesthesia guys, "Yes, he needs to go to the PICU" and together we came up with interventions for this little guy's upper airway problems.  He started looking a lot better and by the time he got to the PICU he looked 100% better.  I felt a little silly bringing a comfortable, crying baby to the PICU, but considering what he looked like when I first saw him, I felt very justified in my decision.  And I committed to it.  It was a good feeling.

I'm in a transition period now where I'm getting towards the end of my second year.  In July I will begin my third and final year of residency.  I will be expected to make decisions all the time.  I will be the senior resident on call and I'll have first and second year residents looking to me for answers.  It's a little scary, but I think I'm ready.  Or at least, I hope so.  We'll see!

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