The calendar has turned to June, another class of medical students has graduated, and they will soon begin their residency training. What better time to dish out some unsought advice.
From a retired physician, remember that it is a privilege to care for another person. Be grateful every day for this blessing to connect with other people and enjoy it. Ultimately the days go by so fast and the next thing you know....you're retired.
This may be dated: Never write anything in the notes that would be embarrassing if read in court. Things like "FLK" for funny-looking kid. or "Attractive female, appearing stated age". Keep descriptions accurate, but dry.
I still think the "never put anything in the notes that would be embarrassing if read in court" still holds in almost the inverse fashion - if you document, say, "2+ dorsalis pedis pulses" in an amputee, "good judgment" in a comatose patient, or "no rashes" in a guy with cellulitis, that is embarrassing.
I fear nowadays almost the opposite is true. All the notes are auto-generated templates, 99% filler. I would almost challenge the opposite - "include at least one detail in the history or physical that demonstrates that either you or the patient (or both!) are actually human."
But, yeah, that can get dicey if you lack prudence. :-)
Amen Christopher! Learn to make a differential diagnosis and ultimately THE diagnosis and then treat the condition appropriately. What I have seen over my 41 year horizon is the loss of this foundation of medicine and in my case surgery. So often what is treated is a series of symptoms without a diagnosis with the hope that “this works”. Be diligent, go down the rabbit hole when necessary and develop a working diagnosis. You will set yourself apart and your patients will benefit immensely.
A physician must make hundreds of decisions every day, from the trivial to the profound. Practice making those decisions on rounds. Have a specific plan, and present it boldly. If you are misguided, your senior resident, fellow, or attending will correct you. No harm done. Be grateful for their guidance. You just learned something. Without committing to a course of action, it's like looking at the practice test and skipping to the answer before writing down your own.
“The key to clinical medicine is careful attention to detail”. This was told to me on my first medicine rotation at Baltimore City Hospital by Dr. Arnold Wald. Everything else you’ve written descends from this. It was true in 1976 and remains so in 2026.
I would try really hard to find the beneficial good in the menial. Being an emergency med resident on thoracic surgery rotation, I was the lowest of the low. My chief assigned me the daily task of unpacking and tediously packing a mediastinitis wound. Every morning for 4 weeks. I learned a heck of a lot from this patient. He was a WWII vet, and he had a lot of good life advice. I think he liked having someone to talk to as well. I resented the scut work at first, but I soon looked forward to it - although it often meant I missed the first surgical case of the day. You have to find the good in everything you do, even if seems rather boring or meaningless.
From a retired physician, remember that it is a privilege to care for another person. Be grateful every day for this blessing to connect with other people and enjoy it. Ultimately the days go by so fast and the next thing you know....you're retired.
Great list. I’d add—
Medicine is a craft (not an Art), residency is a time to develop the lifelong habits for learning while having a safety net.
Work-life separation (balance) only leads to discord and mediocre medicine.
Find the joy in medicine, usually first found in small moments
Once you discover the joy, keep having joy, regardless of whether you are on the clock.
This may be dated: Never write anything in the notes that would be embarrassing if read in court. Things like "FLK" for funny-looking kid. or "Attractive female, appearing stated age". Keep descriptions accurate, but dry.
I still think the "never put anything in the notes that would be embarrassing if read in court" still holds in almost the inverse fashion - if you document, say, "2+ dorsalis pedis pulses" in an amputee, "good judgment" in a comatose patient, or "no rashes" in a guy with cellulitis, that is embarrassing.
I fear nowadays almost the opposite is true. All the notes are auto-generated templates, 99% filler. I would almost challenge the opposite - "include at least one detail in the history or physical that demonstrates that either you or the patient (or both!) are actually human."
But, yeah, that can get dicey if you lack prudence. :-)
Ok, so the hyperlink under bullet point ten is gold. Well-played. *tips cap*
kkk... I looked at it after your comment... Very Good!
Amen Christopher! Learn to make a differential diagnosis and ultimately THE diagnosis and then treat the condition appropriately. What I have seen over my 41 year horizon is the loss of this foundation of medicine and in my case surgery. So often what is treated is a series of symptoms without a diagnosis with the hope that “this works”. Be diligent, go down the rabbit hole when necessary and develop a working diagnosis. You will set yourself apart and your patients will benefit immensely.
A shower in the morning after being up all night on call will get you into the afternoon.
"Put your chips down on rounds."
A physician must make hundreds of decisions every day, from the trivial to the profound. Practice making those decisions on rounds. Have a specific plan, and present it boldly. If you are misguided, your senior resident, fellow, or attending will correct you. No harm done. Be grateful for their guidance. You just learned something. Without committing to a course of action, it's like looking at the practice test and skipping to the answer before writing down your own.
I think No. 9 is missing . . . ?
Thanks! I fixed it.
Adam
“The key to clinical medicine is careful attention to detail”. This was told to me on my first medicine rotation at Baltimore City Hospital by Dr. Arnold Wald. Everything else you’ve written descends from this. It was true in 1976 and remains so in 2026.
I would try really hard to find the beneficial good in the menial. Being an emergency med resident on thoracic surgery rotation, I was the lowest of the low. My chief assigned me the daily task of unpacking and tediously packing a mediastinitis wound. Every morning for 4 weeks. I learned a heck of a lot from this patient. He was a WWII vet, and he had a lot of good life advice. I think he liked having someone to talk to as well. I resented the scut work at first, but I soon looked forward to it - although it often meant I missed the first surgical case of the day. You have to find the good in everything you do, even if seems rather boring or meaningless.