New Year's Resolutions

New Year's Resolutions

Robert S. Miller, MD, FACP, FASCO

Jan 02, 2011

My careful study of the latest social media trends has uncovered the fact that many bloggers and others like to impose their personal lists of grandiose and highly stylized New Year's resolutions upon their readers around this time of the year. As one who never knowingly misses the opportunity to follow the crowd, in no particular order, here is my list of (professional) resolutions for 2011: 

  1. I will listen to my patients more when I am in the exam room with them. How many studies have shown that physicians usually interrupt patients in a matter of seconds during the office visit? While it is probably not realistic nor desirable for the typical oncology visit to have the patient direct the entirety of the encounter, I will try to hold my tongue more. I think I can count on most of my patients to tell me what is important.
  2. I will try harder to understand how each treatment toxicity affects that patient in his or her daily life. It's easy for me to say that Grade 1 neuropathy from Taxol is no big deal, and it will usually resolve in a few months, but I will try to do a better job in imagining how it would feel to put up with numb feet for 6 months, especially if the incremental benefit from the treatment is borderline.
  3. I will try to solve at least one problem during each office visit. I may not be able to fix alopecia from Adriamycin or fatigue from TCH or the frightening reality of progressive metastatic breast cancer, but I am sure I can say or do at least one thing at every office visit to satisfy one concern or problem of my patient or her family.
  4. Before I prescribe adjuvant chemotherapy for a patient with a receptor positive breast cancer, I will stop and reflect a second time whether hormonal therapy alone might be sufficient. Like most of us, my use of cytotoxics has dropped for ER positive patients in recent years, thanks to Oncotype use in some populations and a better understanding of the biology of hormonally sensitive disease. I tell these patients that (contrary to what I did when NSABP B-20 first came out) my goal is to find reasons not to give them chemotherapy. I still struggle with node positive patients or younger patients, and I look forward to the day when the use of predictive markers is even more routine.
  5. I will try to document toxicities in my notes using the NCI CTCAE scale, even when the patient is not on a clinical trial. This standardization is good practice on a number of levels, but it is hard to have the discipline to use codified data like this, especially if you do not have a fully functional EHR where this is built into the encounter. By the way, support for the use of the CTCAE scale was part of the proposed CCHIT criteria for oncology EHR certification (pdf here).
  6. I will read every abstract in every JCO. My clinical practice is almost exclusively breast cancer now, so it has become perhaps too easy to skip over the non-breast cancer articles. I must not left myself go down this path (plus there is that unpleasant reality called board recertification due for me in 2011).
  7. I will make the time to go to one of the annual AMIA (American Medical Informatics Association) conferences this year. Part of my job at Johns Hopkins is medical information officer for the Kimmel Cancer Center, so I am deeply involved in EHR implementation and other informatics projects. AMIA is the premier professional society for biomedical and health informatics, and their journal and conferences, like ASCO's, are top notch. I regret not attending the 2010 fall AMIA conference (it was in Washington, DC - doh!), since in reading the proceedings and listening to the podcasts, I can see all of the great science and practical tips I missed. 
  8. I will multitask less, particularly when I am with other people, even if it is on a conference call. It's easy to fool myself into thinking I am more productive when I do multiple things at once, but too often I realize I am doing all of them badly. I was inspired by a blog post by Ed Marx, who is CIO of Texas Health Services.
  9. I will be distracted less by the Internet when I am working. This is a corollary of #8 above and is probably the hardest one to keep, but to be more productive when writing or researching, I will try harder to avoid the obvious temptations of surfing to unrelated sites (ESPN and YouTube, I am speaking about you).
  10. I will post to Twitter every day. I understand that many physicians probably don't get Twitter - and it may seem like an example of what I am trying to avoid in #9 above - but as I have written previously, I find Twitter an incredibly useful tool to further my twin professional interests of the clinical care of breast cancer patients and medical informatics. I learn a lot from the other people I follow on Twitter by hearing their opinions and more importantly reading the links they post. The more I post, the more followers I have and the greater the chance that someone will respond to one of my posts with content of their own that is relevant and extends my original idea.
  11. I will write faster. I am too much of a perfectionist when I write an article, review, blog post, or even a tweet, and it takes me longer than it should to put the words down, since I probably spend too much time crafting the language. To be more productive, I will focus on generating the content first and editing later.
  12. I will exercise in the morning before work. While this sounds like a personal New Year's resolution and not a professional one, I have always found that I am more energetic and less drowsy in the afternoons if I go to the gym first in the morning, so I will be more productive and deliver better care. And, ahem, I should say that I don't have much of an excuse for this one, since my gym is about 100 yards from my office entrance!
  13. I will sort every piece of paper that crosses my desk into one of four categories, as soon as I get it - Trash, Filed (done with it but still want to keep it for future reference), Hold (waiting for someone/something else for completion), Action/To Do (my top priority folder). This is a variation on David Allen's "Getting Things Done" (GTD) workflow optimization scheme. I already use this process, sometimes called Inbox Zero, for my email, and it works pretty well.
Well, those are my random resolutions for the new year for those of you hardy enough to have read this far. Stay tuned for my June 2011 blog post, to be created with data-mining tools and decision support,  where I describe my adherence to these resolutions at the six month mark (or not).


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