July 1st is almost here, and across the country newly minted doctors will be starting their internships. The first night on call there won’t be an intern – anywhere in the country – who will sleep. Every new intern is absolutely convinced that the beeper is going to go off and they won’t know what to do. (You get over this by about the 2nd or 3rd call night, by the way).
Graduating from medical school and starting your internship is probably the most profound transition you will make in your professional life. You have an MD after your name, and even though you initially feel like an imposter, you really are a doctor. (Just to let you know – It takes about a month to stop looking behind you when the nurse turns to you and says “Doctor, what would you like to do?”)
Not too long ago a friend of mine (also an attending in surgery) shared his rules for residents:
- Write it down.
- Do it now.
- Call for help.
- Listen to me. (i.e. the attending)
- Don’t mess up. (this is a slightly more polite version of the original rule.. )
If you follow these rules you’ll do fine. But if you want to be known as the best intern in the house there are a few things you might not have thought about….
Be a doctor
- Interns have a huge amount of scut work. It’s easy to get lost in the trees and forget the “forest” – which is learning how to manage patients. It’s very easy to gather the data, write the notes and wait for the senior residents and attendings to develop the plan. But that’s not the best way to learn. If you want to do this right, force yourself to pretend that you are the only doctor seeing the patient…. What would you do next? If you are ordering a drug, what are the side effects you might see? If you are ordering a test, what do you expect it to show? Take a minute to use UpToDate or PubMed to help you develop a plan. When it turns out that the attending has a plan that’s different than what you thought you should do, figure out why!
- At any given moment in time, be ready to present any patient in your care to your senior residents or attendings – all their history, all the pertinent physical findings, all the labs and imaging. (Obviously, this means developing a system to have that data at your fingertips – more posts on that later) For critical data, try hard to be the first person to get the data and deliver it to the resident/attending.
- Forget the hierarchy if something seems wrong. Do what’s right. If there is something in the “cockpit” that looks like it might lead to a crash – let everyone know.
- Remember, you are taking care of people, not a scut list. The classic example of completing the task (rather than caring for the patient) is writing all the discharge orders and notes, but not telling the patient they are going home. Kindness matters. Be the kind of doctor you would want taking care of you.
Show up (and be on time)
- Be a real team member. Every chance you get – look for ways to help your fellow residents. Before you leave for the day, call the other interns and ask them if there is anything you can do to help them. You want the reputation of “covering the back” of your fellow residents and doing more than is expected of you. It’s the golden rule of residency – Help them the way you’d like to be helped.
- Try to be the first one at work, and the last to leave (within the constraints of the rules!).
- Be prompt for rounds (or any meeting with your senior residents or attendings). If you are running late for a good reason, make sure you text or page the team to let them know why and when to expect you.
Teach the students.
- You were just there! It’s about attitude, not time. It only takes a moment to include the students in your work. Explaining things you just learned to the students on your service will benefit you more than them (try it if you don’t believe me).
When (not if) you make a mistake, be totally honest.
- You are not expected to be perfect – you are expected to care and to try your best. Do not EVER lie – even about tiny, seemingly insignificant data. If you don’t know the results of the test, say you don’t know (then run to look it up!).
Master your field.
- If you are in a three year residency you have about 1000 days to become a master in your field… if you take away the days off, and the vacations, it drops to around 900. If that doesn’t scare you – it should! Use it as motivation!
- Read the most important textbook in your field cover to cover during your internship. Develop a system for tracking what you have read so you can stay on schedule with your reading.
- Make it a goal to learn 3 new things from every patient you see. You’ll also need to develop a system that lets you find and review that information. (more posts on that later)
- Take personal responsibility for your learning. Make a conscious decision that you will stay excited about learning – even when you are tired.
- Being an intern is stressful, but stay as upbeat as you can. Don’t participate in gossiping and complaining – it drags down the team. If there is a problem to be addressed, define it and talk about solutions with your colleagues… but don’t just complain.
- Take the time to step back and look at what you are doing from a bigger perspective. It is incredibly cool… not to mention the fact that it’s meaningful work. This is a tough year – no one will deny it – but it’s a very special year, too. Keep some perspective on the big picture when you get tired.
This is why you’re the best, Dr. Brandt. I particularly liked the notion of “pretend you will be the only doctor taking care of the patient” idea as well as “learn 3 new things from every patient”. It is a frame of mind that keeps one from turning the art into a job. It promotes learning and self-sufficiency, but with the knowledge that you are in training. However, that also leaves the idea that you COULD be the only doctor treating somebody very soon after your intern and resident years. I’m years away from this, but these words will stick.
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