(formerly futurekelsoMD)

Hi there, anon!

I don’t know this physician but based on what you said, I do not think you are ridiculous when you say she is possibly burnt out and she is perhaps being both tough/honest which comes off quite often as negative. I believe that this physician is trying to be honest with you, but a lot of times, when we as physicians try to be honest with pre-meds or non-medical individuals, it sounds more than a little scary. 

My dad used to do this a lot. He loves being a physician but he’ll be the first to admit its exhausting. Growing up, I felt like he was intentionally trying to scare me or tell me I’d never be good enough to be a doctor whenever I asked him about medicine as a profession. He’d say a lot of the things you brought up: long hours, long training, the daily grind. I used to feel really down whenever he brought up medicine, because I felt like he was always telling me subtly that I’d never be able to do it. Ironically, that backfired pretty hard, as we can all see.

Now that I’m on the other side, I see that a lot of doctors talk about our profession this way. Is this good or bad? It’s both, it goes both ways. Doctors have to find a better way to connect and explain our life to non-doctors. Those who are outside of the profession must be allowed to see the profession for what it is: an expertise, not a service profession. A string of sacrifices in a simultaneously dynamic yet rigid culture that is undergoing massive shifts and struggles. 

This physician sounds like she’s got a lot on her plate. There’s nothing wrong with your excitement. I agree with limiting to shadowing duration to 2-4 hour chunks. As to shadowing tips, you can check out what I’ve written before on the topic here! 

Best,

Donald Trump gets attacked by an eagle.

Rule #1: Don’t lose yourself in the system.

This is important. Intern year was, by far, the most difficult thing I’ve had to do. This includes cancer, grad school, and medical school. It’s really fucking hard. The hours are long and, often times, inhumane. The patients can be incredibly mean and unappreciative of your time and care. The learning curve is near vertical. This is near impossible to handle alone. Rely on your support system. Try to hold on to at least one non-medicine related activity. Regardless of what the medical education system seems to be saying, remember that you are a person, having a life outside of the hospital doesn’t make you a bad doctor, and you are allowed to put yourself first. YOU SHOULD NOT HAVE TO SACRIFICE YOUR HEALTH FOR THE SAKE OF YOUR PATIENTS. Seek out the support you need. Utilize Jeopardy as needed. This will be a hard year; take care of yourself and take care of your co-interns. Don’t let anyone around you drown, especially if that “anyone” is YOU.

Rule #2: Rely on your upper level residents.

Accept help when it is offered. Ask for help when you need it. This is harder to do than it seems. After four years of pain, you finally have that MD (or DO) behind your name. Your patients and assorted hospital staff are calling your doctor. You feel like you’re supposed to know what you’re doing… but you don’t. THIS IS OKAY. Medical school doesn’t prepare you for this. You are supposed to be stupid. If you came into intern year already knowing how to care for patients then residency would be a moot point. Absorb as much knowledge as possible from your upper levels. Ask all the questions. Quite literally there is no such thing as a stupid question during intern year. If you are drowning and feeling overwhelmed to the point of being unable to accomplish your work, SPEAK UP. No one is perfect, and your upper level may not recognize that you’re drowning. Remember, half of your upper levels were interns just a few hours/days ago. We are all still learning. Make your needs known, and accept our help when it’s offered. Especially early in the year.

Rule #3: Organization is the name of the game.

Your primary objective as an intern is to get shit done. Simple. You can’t do that if you’re disorganized. So, first things first, get yourself a system of organizing your patient-related tasks and stick with it. Write down everything. EVERYTHING. Afternoon urine output check on a heart failure patient? Write it down. Told a patient you’d drop back by his room to clarify some questions? Write it down. Need to remember to write your daily progress note? Write it down. Need to enter in daily labs for tomorrow? Write it down. You get the picture. I personally used the folded side of a printed patient list, but any organization system that prevents tasks from falling between the cracks is golden. Good interns aren’t the ones who know everything. Good interns are the ones who let as little as possible fall through the cracks. Book knowledge, knowing the next step in management? Overrated. That comes with time and repetition. This is how you get there.

Rule #4: Use your med students.

Let’s be honest here. By the time intern year starts, the third years are starting to get into a groove. They’ve been around for a couple of months at least, and, chances are, know way more about logistics of the hospital and the basics of the EMR than you do. The AIs are an even more seasoned source of info. Use these guys to your advantage. Given how useless you feel on any given day as a med student, I found it kind of nice to be able to help the new interns. 

Rule #5: Don’t let anyone rush you into making a non-urgent decision!

This was really hard for me to grasp. I felt like a failure every time I’d get paged about a cross-cover situation that I couldn’t immediately handle. It’s fine, guys. Very few situations require an immediate answer. Take your time. Paged about a patient with hypotension? As long as they’re mentating appropriately, take a few minutes to see where the trend of their blood pressure over the day. Check to see if there’s a recent TTE to determine if they can handle a big IVF bolus. You have time. Don’t let anyone try to pressure you into making an immediate non-critical decision. It’s totally ok to admit that you need to look at the patient’s chart first and you’ll call them back in a few minutes. This isn’t a weakness. This is you practicing good medicine.

Rule #6: Play well with others.

Medicine is a team sport. Your part, while important, it only one piece of a larger whole. You’re going to have a bunch of different, though usually complementary, professions surrounding you in the hospital. Getting along in a team sport is all about appreciating everyone’s POV and contribution. Never, ever, ever dismiss someone’s input. If your nurse is telling you that she is concerned about a patient, ask her why. Try to understand. Don’t just blow her off as being paranoid. This sounds ridiculously basic but, trust me, that reaction is really tempting when you’ve got notes to write and seven other patients who also need your attention. Disagree with a nurse’s request for pain meds, anxiolytics, an ekg, x-ray, etc? Think out loud. Explain your reasoning. One of two things typically happen. One, she already knows everything you’re telling her and just had to pass along the request to get the patient denied from “the doctor”. Two, you teach her something. Beyond nursing, you’ll also be interacting with pharmacists, nutritionists, respiratory therapists, etc. Strike up a conversation with any of these guys and you’ll be AMAZED what all these professions can teach you. Trust me… it’s a lot.

Rule #7: Don’t let bad interactions taint your view of an entire profession.

You’re going to meet asshole nurses. You’re going to meet asshole doctors. You’re going to meet asshole patients. It happens. Difficult as it may be, don’t let one interaction taint your view of an entire population. 

Other Tips and Tricks:

My method of organization (https://tmblr.co/Zzhx1h2M0rPsM)

Paging etiquette (https://tmblr.co/Zzhx1h2N9W0Fn)

What is my number 1 tip for new interns?

Followthrough. YOU have to be the one to make sure things happen. It is up to you to make sure things happen in the hospital.

Followthrough everything, but especially if it is important. 

You’d like to think that if you order something it magically happens but sadly this isn’t true. Yes, you will be waiting 3 hours for that stat lab if you don’t follow up on it, call the nurse, then the lab to make sure it happens.

If you are waiting on one more x-ray before discharging someone, YOU are the one who has to make sure it happens so the patient can go home.

Yes, you’d like to believe that your colleagues are competent but you need to follow up on everything to make sure. Yes, it’s in the note that the patient is on xyz meds but you need to check to orders to make sure they’re actually ordered for.

A task isn’t done once you’ve done the initiating step, it’s done when it is completed. Yes, you paged to let the primary team know something but until you hear a reply back from them it is not “done.”

I know this because I made all of these mistakes.

Why did you leave residency 

this whole blog is about why i left residency so i won’t rehash it here, but this is the short version, this is the professionally edited version, and this is the very long version. 

and what are you doing now? 

by day, i run content and do some product management for an online medical reference / tech company. by evenings and weekends, i enjoy life!

Do you have debt? 

i sure do. and i’ll probably have it for awhile. it’s just another monthly expense to me, like rent. i am financially and emotionally comfortable.

Was it scary realizing you wanted to leave?