Sonia Singh: Morning Report
Selected Excerpts
“As you walk to your workroom, you mentally map out the most efficient route for seeing your patients. It’s 7:30. You have half an hour to review labs and vital signs on the computer, then 2 hours to see your patients before morning report — less than 10 minutes each to see how they’re feeling, perform an exam, and check in with their bedside nurse. Three of your patients still think you are the bedside nurse, but that is the least of your worries.”
“You hadn’t accounted for the six relatives who each had questions about Ms. B.’s pneumonia, or the 20 minutes you waited to get a Tongan interpreter to explain to Mr. L. why he has to use his insulin. Meanwhile, the pager on your hip buzzes every few minutes — Mr. H. wants to leave against medical advice although he needs 6 more days of IV antibiotics; he’d been drinking 2 pints of vodka daily, and withdrawal is starting to kick in. Ms. S., on the other hand, doesn’t feel ready for discharge. Wouldn’t it be better to stay an extra day and make sure her oral medicines manage her pain? Can she just get one more push of Dilaudid before leaving?”
“You choke down a few sips of lukewarm instant coffee, and it makes your thoughts even more manic than usual — the iron on at home, the Dilaudid you need to order, the baby you haven’t seen, the interpreter waiting for you, Ms. T.’s trembling lips. You’re having trouble focusing on the case. Coffee and chronic stress have given you reflux, but you’ve learned to live with it, if this can be called living.”
Discussion Questions
“Morning Report” takes us through an intern’s busy morning hours leading up to a didactic session. Is there a moment in this piece that resonates with your experience as a clinician and/or a patient?
Singh writes, “Over the past 3 hours, you’ve placed more than 50 orders, answered 17 pages, listened to 14 hearts and 28 lungs, talked to countless patients, nurses, residents, and social workers, but you realize that this is the only real doctoring you’ll do today. These are the 60 seconds that will matter.” How do you define “the 60 seconds that matter”?
What do Picasso’s “Head of the Medical Student” and Singh’s “Morning Report” reveal about managing expectations of ourselves and others in health care?
Reflections from #MedHumChat
“This essay brought up my daily terror of prerounding. Each day felt like a negotiation of which way I'd be inadequate. Not reading each consult note, not talking to the family, not getting the interpreter, not arriving on time for conference. . . and then the place my brain would often go to: ignoring all the things I did so well and using the inadequacies as evidence that I was a terrible intern.”—@colleenmfarrell
“Personally I think it speaks to the hidden workload associated with residency. Not only the patient care responsibilities, but the feeling as if your life is on hold while you train. It's a beautiful piece that makes me wonder if I'll ever be ready for intern year.”—@pskantesaria
“As physicians/med students I think we all have moments where we have the distinct feeling that something we said or did, even a small gesture, has brought comfort to a patient - when we recognize a real human need & respond to it w/ compassion. That matters.”—@SoniaSinghMD
“The moments that resonate with me, the ones that make me feel like I am really doctoring, are the ones where I am present with my patient— where I can leave everything else outside of the exam room door and where nothing matters but the soul in front of me. Those seconds matter.”—@MaaloufMD
About this #MedHumChat
“Morning Report” was paired with “Head of the Medical Student,” a painting by Pablo Picasso, for a #MedHumChat discussion on November 6, 2019 exploring Managing Expectations.
We were honored to be joined by two special guests. Sonia Singh, MD (@SoniaSinghMD) is an aspiring writer and primary care physician at Stanford Health Center. Jennifer Adaeze Okwerekwu, MSc, MD (@JenniferAdaeze) is a resident physician currently training at the Cambridge Health Alliance in Psychiatry. You can learn more about her here.
The pieces for this chat, along with the discussion questions, were selected by Anoushka Sinha.
About the Author
Sonia Singh, MD (@SoniaSinghMD) is an aspiring writer and primary care physician at Stanford Health Center. Her interests include wellness, burnout prevention, and quality improvement. You can learn more about her, and read more of her writing, here.