Excellent post. Take advantage of every minute. Accustomed to 30 - 36 hour stints in the hospital every 4 days- I got sick 3/4 the way into my internship but got promoted anyway - It made a difference by the time I got back to residency as I was definitely behind my contemporaries.
As you say - if it’s drudgery then look for something else to do. That doesn’t mean it won’t be difficult but nothing is worth anything, or has any meaning, if it’s easy or rote.
Internship can be such a stressful time. It only lasts for a year. It is not the time to get married or divorced. It is not the time to have a child or buy a house. Defer these major life decisions to later in training when you are not faced with all the newness and stress of internship. This was the advice I gave my incoming interns when I was chief resident. I expect it is still good advice.
A few other useful tricks that it took me many years to learn as a hospital based general internist:
1. When diagnosis uncertain or facing the confusion of taking over a patient admitted by someone else, look back at the Emergency Department triage notes. They provide the original undiluted history (at least for most people who are straightforward in telling their story). Sometimes it's obvious where others have got the story wrong after that initial encounter.
And triage notes are concise. EHS (ambulance) notes are also sometimes very helpful.
2. When in doubt or frightened in a situation where others expect you to know what to do, a respectful and innocent question to anyone in the room: "Anyone else have ideas?" This invites surprisingly simple or helpful ideas, e.g.: "She may be bleeding internally;" "What about lowering the head of the bed?;" "Do you think it's worth trying naloxone (or epinephrine)?"
3. If you think diagnoses in a list of "Past Medical History" or "Discharge diagnoses" or "Admission diagnoses" may be incorrect, you're probably right. How many people get labeled falsely as having "dementia," "Alzheimer's," "epilepsy," "seizure disorder," etc. etc. etc. Anyone experienced and good in medicine will have corrected many such "diagnoses." Don't expect to be rewarded for this (more likely criticized) - but if anyone does praise you, it may be an indication that their medical standards are higher than most.
4. Same thing for medication reviews and persuading people to reduce smoking/drinking/cannabis, etc. One of the easiest (and often the only) way to improve a patient is to get rid of harmful, expensive, or pointless prescription drugs or harmful substances. You are unlikely to be praised or rewarded, but can have the satisfaction of knowing that you may have profoundly changed someone's life for the better, saved them enough money that they out to have paid for your vacation, and that they will remember you!
5. Challenge residents/fellows who ask you to order pointless lab tests, by asking "what will this change." Pointless lab tests are unethical, because they cost money, waste time, an often hurt. If you order few of them, it will be less work for you to check results, and you can spare colleagues from pointless "scut work" when they cover for you. If a superior criticizes you for thinking logically, why not ask them if they would like to be awakened early, poked, or transported for the same test under the same circumstances. "I was wondering if ..." is a polite Canadian way to introduce such a question.
Tom Perry MD, FRCPC (Canada, an independent country to the north of USA)
Love the one about asking others for ideas. As a med student I’m often intimidated to speak up, but it’s an act of humility to ask for more input, and allows learning to take place. I’ll carry that into my residency!
I have a few more. Remember, as an intern and resident, you are still a student. Graduating medical school was the beginning of your education. Now, the real training begins. It's exciting to have that MD after your name and be called "doctor". But dont let that go to your head. You are about to gain the clinical experience of graduate medical education. An MD degree without GME won't get you a medical license. It is GME that makes you a clincian. Without it you lack the clinical perspective necessary to opine as an expert in clinical matters. You are not done. You are just beginning. Stay humble and learn.
I always told my patients when completing drug and alcohol rehab as we passed the coin around that they now have their license to learn. I feel like I know less after 25 years! Still learning!
During my year of internship at Penn back in 1965 I stayed on call in the hospital every other or every third night. I don't know that house staff do things like that anymore. But I was 27 years old and could do it. What I got for it was $150/month and a heck of a lot of experience.
Excellent post. Take advantage of every minute. Accustomed to 30 - 36 hour stints in the hospital every 4 days- I got sick 3/4 the way into my internship but got promoted anyway - It made a difference by the time I got back to residency as I was definitely behind my contemporaries.
As you say - if it’s drudgery then look for something else to do. That doesn’t mean it won’t be difficult but nothing is worth anything, or has any meaning, if it’s easy or rote.
Avoid those who are cynical.
Internship can be such a stressful time. It only lasts for a year. It is not the time to get married or divorced. It is not the time to have a child or buy a house. Defer these major life decisions to later in training when you are not faced with all the newness and stress of internship. This was the advice I gave my incoming interns when I was chief resident. I expect it is still good advice.
Wonderful snippets of advice! I especially like #1, #5, & #6. I supervise pharmacy residents and some of these are definitely transferrable.
Great synopsis of the many things it takes to become a good physician.
A few other useful tricks that it took me many years to learn as a hospital based general internist:
1. When diagnosis uncertain or facing the confusion of taking over a patient admitted by someone else, look back at the Emergency Department triage notes. They provide the original undiluted history (at least for most people who are straightforward in telling their story). Sometimes it's obvious where others have got the story wrong after that initial encounter.
And triage notes are concise. EHS (ambulance) notes are also sometimes very helpful.
2. When in doubt or frightened in a situation where others expect you to know what to do, a respectful and innocent question to anyone in the room: "Anyone else have ideas?" This invites surprisingly simple or helpful ideas, e.g.: "She may be bleeding internally;" "What about lowering the head of the bed?;" "Do you think it's worth trying naloxone (or epinephrine)?"
3. If you think diagnoses in a list of "Past Medical History" or "Discharge diagnoses" or "Admission diagnoses" may be incorrect, you're probably right. How many people get labeled falsely as having "dementia," "Alzheimer's," "epilepsy," "seizure disorder," etc. etc. etc. Anyone experienced and good in medicine will have corrected many such "diagnoses." Don't expect to be rewarded for this (more likely criticized) - but if anyone does praise you, it may be an indication that their medical standards are higher than most.
4. Same thing for medication reviews and persuading people to reduce smoking/drinking/cannabis, etc. One of the easiest (and often the only) way to improve a patient is to get rid of harmful, expensive, or pointless prescription drugs or harmful substances. You are unlikely to be praised or rewarded, but can have the satisfaction of knowing that you may have profoundly changed someone's life for the better, saved them enough money that they out to have paid for your vacation, and that they will remember you!
5. Challenge residents/fellows who ask you to order pointless lab tests, by asking "what will this change." Pointless lab tests are unethical, because they cost money, waste time, an often hurt. If you order few of them, it will be less work for you to check results, and you can spare colleagues from pointless "scut work" when they cover for you. If a superior criticizes you for thinking logically, why not ask them if they would like to be awakened early, poked, or transported for the same test under the same circumstances. "I was wondering if ..." is a polite Canadian way to introduce such a question.
Tom Perry MD, FRCPC (Canada, an independent country to the north of USA)
Love the one about asking others for ideas. As a med student I’m often intimidated to speak up, but it’s an act of humility to ask for more input, and allows learning to take place. I’ll carry that into my residency!
This needs to be pasted into every resident’s laptop. I just hung it in my studio because it applies to music, too.
I have a few more. Remember, as an intern and resident, you are still a student. Graduating medical school was the beginning of your education. Now, the real training begins. It's exciting to have that MD after your name and be called "doctor". But dont let that go to your head. You are about to gain the clinical experience of graduate medical education. An MD degree without GME won't get you a medical license. It is GME that makes you a clincian. Without it you lack the clinical perspective necessary to opine as an expert in clinical matters. You are not done. You are just beginning. Stay humble and learn.
I always told my patients when completing drug and alcohol rehab as we passed the coin around that they now have their license to learn. I feel like I know less after 25 years! Still learning!
During my year of internship at Penn back in 1965 I stayed on call in the hospital every other or every third night. I don't know that house staff do things like that anymore. But I was 27 years old and could do it. What I got for it was $150/month and a heck of a lot of experience.
#'s 2 and 7 were the most important to me and my sanity.
Thanks. Love that Huxley quote.
As Aldous Huxley said: “experience is not what happens to you in your life, but rather what you do with what happens to you in your life”
Knowledge is rife, wisdom is rare. Dr. Cifu you have the latter in spades!
Ben Hourani MD MBA WHAT