Challenges in the transition from resident to attending physician in general internal medicine: a multicenter qualitative study.

BACKGROUND: The attending physician in general internal medicine (GIM) guarantees comprehensive care for persons with complex and/or multiple diseases. Attendings from other medical specialties often report that transitioning from resident to attending is burdensome and stressful. We set out to identify the specific challenges of newly appointed attendings in GIM and identify measures that help residents better prepare to meet these challenges. METHODS: We explored the perceptions of 35 residents, attendings, and department heads in GIM through focus group discussions and semi-structured interviews. We took a thematic approach to qualitatively analyze this data. RESULTS: Our analysis revealed four key challenges: 1) Embracing a holistic, patient centered perspective in a multidisciplinary environment; 2) Decision making under conditions of uncertainty; 3) Balancing the need for patient safety with the need to foster a learning environment for residents; and 4) Taking on a leader's role and orchestrating an interprofessional team of health care professionals. Newly appointed attendings required extensive practical experience to adapt to their new roles. Most attendings did not receive regular, structured, professional coaching during their transition, but those who did found it very helpful. CONCLUSIONS: Newly appointed attending physician in GIM face a number of critical challenges that are in part specific to the field of GIM. Further studies should investigate whether the availability of a mentor as well as conscious assignment of a series of increasingly complex tasks during residency by clinical supervisors will facilitate the transition from resident to attending.

[Addiction patients in emergency departments]. / Suchtpatienten in der Notfallstation.

Addiction patients in emergency departments are common assignments from the rescue services. Often there are recurring images of the same patient. Patients with acute intoxications are passed from the emergency services in different constitution to the emergency department. The challenge to the treating emergency team and the infrastructure is correspondingly high. Nevertheless, the emergency treatment should include a comprehensive initial somatic and later psychosomatic treatment regim in these patients, this treatment option should always be offered and discussed again and again. Furthermore patients who are admitted to the hospital on emergency wards because of general medical or surgical problems, have in up to 10 % of cases a problematic behaviour with respect to their alcohol consumption, but are "compensated" at the time of entry. It is thus appropriate for all emergency patients who need to be hospitalized to perform a screening for a problematic alcohol consumption. there are appropriate questionnaires that take little time and can also be performed on emergency rooms, but you have to remember!

Mixed intoxication with Aconitum nappellans (monkshood) and Digitalis grandiflora (large yellow foxglove).

BACKGROUND: Intoxications are frequent and relevant medical problems in emergency units. CASE REPORT: We report of a mixed intoxication with monkshood and large yellow foxglove. A 39-year-old mentally ill drug addict, intent on committing suicide, swallowed an undefined amount of chaffed monkshood and large yellow foxglove. The typical symptoms of an intoxication occurred, including high-grade ventricular and supraventricular tachyarrhythmias, colic abdominal pain, and peripheral paralysis. After activated charcoal was repeatedly administered as well as FAB digitalis-antibodies, a lasting normalisation of the heart rhythm set in and a release of the clinical symptoms could be observed. CONCLUSIONS: FAB antibodies are a safe antidote for herbal digitalis intoxication. Therapy of choice for an aconitum poisoning is activated charcoal and intensive monitoring.