A Typical Day in the ICU

For a couple weeks this month, I've been an ICU team fellow. The role is designed to be a junior attending role where I direct rounds, run a team, teach, and oversee big picture questions for our patients. I arrive a little before 7 to get sign-out on my patients. The list usually runs somewhere between 12-20 patients so it's quite manageable, and every night, I expect about 5 or so new patients. I see the sicker patients before rounds at 8. As an anesthesiologist, my modus operandi is to do quick and efficient rounds. I have simply lost the capacity to do never-ending rounds in the way infectious disease or neurocritical care runs, though I do respect them a lot for it. I try to come up with a few five-minute teaching pearls because I think it helps me solidify my knowledge and its the best way to get information to stick with the residents and students. After observing different attendings run rounds in their own distinct way, I've adopted a style where I try very hard not to interrupt. I also give residents as much independence as is safe to make clinical judgments and decisions. I read a recent JAMA article about this - how attending micromanagement is becoming the norm - and I'm trying to find a middle ground. The best way to learn is to make decisions, and it's how I became confident with my clinical skills through my training. So rather than tell my residents what to do, I try my best to guide and nudge them to figuring things out themselves.

I try to get through rounds in an hour or two, and then I give residents space to get work done, write notes, and decompress. In a way, I think of Ender's Game where a captain needs to know when to give her team space. On the computer, I hover in the background, making sure things are ordered and labs followed up. I attend multidisciplinary rounds. I meet families. Before noon, we have radiology rounds where we review all the imaging studies on our patients. Then, we attend noon conference. In the afternoon, I tie up loose ends, supervising procedures, determining whether interventions we made in the morning helped, and attending meetings. My attending and I divvy up the work so that by sign out rounds at 3, most of our patients are tucked in. Usually we start getting new admissions in the afternoon, but I actually rely heavily on my co-fellows to stabilize the new patients while I take care of the old ones. After sign-out rounds, I make sure my non-call residents can go home and my call resident feels comfortable. I usually stay in the hospital a few hours afterwards to work on presentations and teaching materials. To be honest, the day is not bad at all, and much easier than a resident's life. But I really enjoy it, and this month, I've been lucky to have a great team.