Brett Biebelberg, MD
@bbiebelberg.bsky.social
IM PGY1 @ Penn, researching sepsis @MGH/BWH, gun violence prevention advocate, EMT, via Harvard. 🗣evidence-based medicine, QI, public health, humanity in medicine.
Career changer & proponent of physician leadership.
#medsky #emimcc #pccm 🫀🫁
Career changer & proponent of physician leadership.
#medsky #emimcc #pccm 🫀🫁
8) Growth. Flipping your body's schedule, triaging an overwhelming amount of cross-coverage requests, admitting patients w/o much supervision, doing procedures, and running rapids all were scary before this rotation. But I feel amazing growth & confidence after just 2 weeks.
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November 23, 2025 at 5:16 PM
8) Growth. Flipping your body's schedule, triaging an overwhelming amount of cross-coverage requests, admitting patients w/o much supervision, doing procedures, and running rapids all were scary before this rotation. But I feel amazing growth & confidence after just 2 weeks.
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In one case, it was 3 AM, but a patient was acutely decompensating and I knew we had to call the attending on a consulting service. When he picked up the phone, I began with, “I’m sorry to wake you up, but I’m worried about this patient and I need your help.”
November 23, 2025 at 5:16 PM
In one case, it was 3 AM, but a patient was acutely decompensating and I knew we had to call the attending on a consulting service. When he picked up the phone, I began with, “I’m sorry to wake you up, but I’m worried about this patient and I need your help.”
Speaking of shit hitting the fan: this will happen. Patients got dangerously sick fast. If you're in a time-sensitive situation and don’t know what to do — and if you’re an intern, you often won’t — your job is to call for help from people who do. Your senior, the ICU, a consultant, etc.
November 23, 2025 at 5:16 PM
Speaking of shit hitting the fan: this will happen. Patients got dangerously sick fast. If you're in a time-sensitive situation and don’t know what to do — and if you’re an intern, you often won’t — your job is to call for help from people who do. Your senior, the ICU, a consultant, etc.
We felt safe asking each other questions. And when shit hit the fan, we stopped what we were doing and had each other’s backs.
November 23, 2025 at 5:16 PM
We felt safe asking each other questions. And when shit hit the fan, we stopped what we were doing and had each other’s backs.
7) The people you work with matter. On night float blocks, there really isn’t much time outside the hospital for anything besides eating and sleeping. You invariably lose contact with friends and family. My night co-residents became my friends and support system.
November 23, 2025 at 5:16 PM
7) The people you work with matter. On night float blocks, there really isn’t much time outside the hospital for anything besides eating and sleeping. You invariably lose contact with friends and family. My night co-residents became my friends and support system.
Likewise, when the night team signs out a new admission to you, spare them your curiosity. Unless you have a question that would change your pre-rounds management, you have more time during the day to dig into things than the night team did.
November 23, 2025 at 5:16 PM
Likewise, when the night team signs out a new admission to you, spare them your curiosity. Unless you have a question that would change your pre-rounds management, you have more time during the day to dig into things than the night team did.
And for day teams — don’t Monday-morning quarterback your night team’s management. They don’t have the luxury of time and focus that you do in the afternoons. As a friend says: “Nights are for survival. Plans are for the day team.”
November 23, 2025 at 5:16 PM
And for day teams — don’t Monday-morning quarterback your night team’s management. They don’t have the luxury of time and focus that you do in the afternoons. As a friend says: “Nights are for survival. Plans are for the day team.”
And our attention is constantly being pulled away overnight by cross-coverage for the 40 patients already admitted. So I have new-found respect for any overnight resident who is able to produce an even half-coherent H&P.
November 23, 2025 at 5:16 PM
And our attention is constantly being pulled away overnight by cross-coverage for the 40 patients already admitted. So I have new-found respect for any overnight resident who is able to produce an even half-coherent H&P.
6) It’s really hard to admit new patients overnight. Not just from fatigue, but because doing so requires intense thought and focus to wrap your head around their history, presenting complaints, all of their objective data in order to make diagnoses and plans.
November 23, 2025 at 5:16 PM
6) It’s really hard to admit new patients overnight. Not just from fatigue, but because doing so requires intense thought and focus to wrap your head around their history, presenting complaints, all of their objective data in order to make diagnoses and plans.
And I’m really grateful anytime someone in the ED has already called relevant consults and received/acted on recs before handing them off to us to admit them.
November 23, 2025 at 5:16 PM
And I’m really grateful anytime someone in the ED has already called relevant consults and received/acted on recs before handing them off to us to admit them.
Because of boarding, you’re often getting sign-out from someone who was not involved in their triage or initial treatment. If there’s something urgent you need done before admitting their patient, like a repeat lab, they’ll be happy to order it for you.
November 23, 2025 at 5:16 PM
Because of boarding, you’re often getting sign-out from someone who was not involved in their triage or initial treatment. If there’s something urgent you need done before admitting their patient, like a repeat lab, they’ll be happy to order it for you.
The job of an EM doctor is not the same as an IM doctor. EM’s role is to resuscitate acutely sick patients, decide whether to admit or discharge, and keep flow moving through the ED. Their attention is also being pulled in all different directions.
November 23, 2025 at 5:16 PM
The job of an EM doctor is not the same as an IM doctor. EM’s role is to resuscitate acutely sick patients, decide whether to admit or discharge, and keep flow moving through the ED. Their attention is also being pulled in all different directions.
5) Admitting new patients from the ED. The ED is a hard place to work. I know first-hand because I did two EM sub-Is when I was still undecided before settling on IM. So be kind to your EM colleagues who are handing patients over to you.
November 23, 2025 at 5:16 PM
5) Admitting new patients from the ED. The ED is a hard place to work. I know first-hand because I did two EM sub-Is when I was still undecided before settling on IM. So be kind to your EM colleagues who are handing patients over to you.
If a nurse asked me to see a patient, I always tried to. Part of this requires triage, and if I determined it wasn't urgent, I’d let the nurse know that I’d be by to lay eyes on the pt the next time I was on their floor. If nothing else, it helped to build trust.
November 23, 2025 at 5:16 PM
If a nurse asked me to see a patient, I always tried to. Part of this requires triage, and if I determined it wasn't urgent, I’d let the nurse know that I’d be by to lay eyes on the pt the next time I was on their floor. If nothing else, it helped to build trust.
4) Going to bedside. Because of the aforementioned duties, I can only come to bedside for patients requiring time-sensitive clinical reassessment, and my determination of who requires that may not always be the same as a nurse’s. That said, take nursing concerns seriously.
November 23, 2025 at 5:16 PM
4) Going to bedside. Because of the aforementioned duties, I can only come to bedside for patients requiring time-sensitive clinical reassessment, and my determination of who requires that may not always be the same as a nurse’s. That said, take nursing concerns seriously.
Nurses don’t always know the ins and outs of our complicated and ever-changing schedules, so I found that offering a polite reminder that I was covering 40 patients and admitting new ones helped to address a perceived delay in addition.
November 23, 2025 at 5:16 PM
Nurses don’t always know the ins and outs of our complicated and ever-changing schedules, so I found that offering a polite reminder that I was covering 40 patients and admitting new ones helped to address a perceived delay in addition.
3) Appreciating grace from nurses. If we take a while to respond to a non-urgent message or seem short in our replies, don’t take it personally. We're getting bombarded with msgs about our other pts while also trying to get tasks done, resuscitate sick pts, and admit new pts.
November 23, 2025 at 5:16 PM
3) Appreciating grace from nurses. If we take a while to respond to a non-urgent message or seem short in our replies, don’t take it personally. We're getting bombarded with msgs about our other pts while also trying to get tasks done, resuscitate sick pts, and admit new pts.
If a patient had a vital sign abnormality eg tachycardia: did you repeat it? How are the other vital signs? Are they having any symptoms? If they have a new rash or blood in their emesis/stool, send a photo. Good nurses give this context up front which makes triaging and decision-making faster.
November 23, 2025 at 5:16 PM
If a patient had a vital sign abnormality eg tachycardia: did you repeat it? How are the other vital signs? Are they having any symptoms? If they have a new rash or blood in their emesis/stool, send a photo. Good nurses give this context up front which makes triaging and decision-making faster.
2) Gratitude for nurses who manage up. Given time constraints and lack of familiarity, context is helpful. So if you’re reaching out because patient is in pain, it’s helpful to also know: is this pain new or similar to prior? Have they received their PRNs? Did any of them help?
November 23, 2025 at 5:16 PM
2) Gratitude for nurses who manage up. Given time constraints and lack of familiarity, context is helpful. So if you’re reaching out because patient is in pain, it’s helpful to also know: is this pain new or similar to prior? Have they received their PRNs? Did any of them help?
1) Good anticipatory guidance is gold. I didn’t know these patients nearly as well as their day teams do. I’m grateful Penn uses a dedicated platform for this because clear guidance from primary teams for pain, agitation, or decompensation made for a smoother and safer night for all.
November 23, 2025 at 5:16 PM
1) Good anticipatory guidance is gold. I didn’t know these patients nearly as well as their day teams do. I’m grateful Penn uses a dedicated platform for this because clear guidance from primary teams for pain, agitation, or decompensation made for a smoother and safer night for all.
Like most night float rotations, I covered those 40 patients in addition to admitting new patients and responding to rapids in the hospital.
Some observations and reflections:
Some observations and reflections:
November 23, 2025 at 5:16 PM
Like most night float rotations, I covered those 40 patients in addition to admitting new patients and responding to rapids in the hospital.
Some observations and reflections:
Some observations and reflections:
I covered the 40 patients on our inpatient pulmonary and hepatology services. Our pulm service is a de-facto MICU step-down unit and our hepatology service is comprised mostly of patients with decompensated cirrhosis or acute liver failure. So these were all very sick patients.
November 23, 2025 at 5:16 PM
I covered the 40 patients on our inpatient pulmonary and hepatology services. Our pulm service is a de-facto MICU step-down unit and our hepatology service is comprised mostly of patients with decompensated cirrhosis or acute liver failure. So these were all very sick patients.