Tuesday, June 29, 2010

july in the hospital

things i wish someone told me at the start of residency
it's a slightly mean and overused joke that july is the worst time to get an operation or bring your sick kid to the ED. actually, i beg to differ -- everyone (including the attendings!) is on guard in july. there is probably more close supervision on every level during this month than any other time.

to any brand new intern reading this (and i'm guessing there are a few?), congratulations! you are about to embark on the journey of a lifetime. it will be crazy, tiring (perhaps not as tiring now with the upcoming demise of the 30 hour shift?), but worth it. you now get to have a REAL JOB with purpose and it really does feel amazingly different than medical school. sometimes (like during a snowstorm), it sucks to be an 'essential' employee, but most of the time it's a good thing. and the paycheck isn't half bad, either!

anyway, now a veteran of the process, i thought i would just throw out some things i wish someone had told me when i started. other medical-peeps (who else is reading out there?), feel free to throw in any of your own words of advice in the comments!

1. it's okay that you don't know things. really. don't feel embarrassed or stressed about this; it's just the truth and it's normal! your seniors are fully aware (some of them went through exactly the same thing 1 year ago), and they will help you. they will also watch over you and your patients. a good senior will figure out a way to do this sort of 'behind-the-scenes' while others will just play overt micromanager. at the beginning, don't take it personally -- just work on absorbing the details.

2. write it down. and when i say 'it', i mean . . . practically everything. a clipboard or hard-backed notepad (that you can stick your list on top of) is an intern's best friend. you are going to be bombarded with little pieces of information for the next 3 years and how you manage these tidbits can make or break you! hopefully, your residency has some sort of survival guide to carry around that has lots of useful info (medication doses, algorithms, phone #s, and the like). but don't stop there -- you can annotate it to your heart's desire! if you didn't get something like this, it might be good to start one of your own.

3. take your time. be efficient, but really it's better to do a good job than to rush. you may not be moving at warp speed from day one, but you will improve. if you can manage to do so without violating duty hours, get there nice 'n' early at first (you can slide into senior slackerdom later! trust me . . . ). setting yourself up with quality prerounds will set you up for success all day.

4. bow down to the holy checky-box
first, a moment of silence for this much-beloved icon:

ahhhhhh. being an intern (and often a resident) is just one big to-do list. keeping a neat and detailed one and reviewing it throughout the day to prioritize is key. in my experience, the best interns had their pens poised at all time to write down that next list item, and the absolute worst ones acted like they could remember all of the little minutia without the aid of this tool.

5. figure out a system for learning. don't worry -- it's okay if studying/reading isn't the highest on your priority list this year (survival - of you and the patients - can come first!). but it's a good time to start building a framework for how you are going to embark on your learning, which is a lifelong (or at least career-long) process in medicine.

dedicating just 15 minutes a day to reading about something relating to one of your patients might be a good plan, or spending a few minutes each morning reading about topics related to the rotation you are on might work for you. at the very least, try to pay attention in conferences -- you get out of them what you put into them! and if your pager stays quiet, it's a great way to have education built right in to your busy work day.

6. don't be afraid of procedures. um, like i was. (am?). just get in there and do it. the more you do, the better you will get, the more you will enjoy and not dread procedures. example: i rock at LPs, because for some reason i did not fear them. honestly, i will actually miss sticking needles into baby's backs! however, i feared (and avoided, and dreaded) intubations, and i still don't feel comfortble with an ET tube in my hand. luckily, i have no intention of putting an ET tube in my hand, so it all worked out. but if i had taken a better approach from the beginning, perhaps that wouldn't be the case today. don't be like me!

7. take care of yourself! of course you knew i had to put this in here! in fact, it might belong at the very top of the list in terms of importance. YOUR mental and physical health have to continue to be a priority in your life, no matter what anyone else says. from experience, i can say that as long as your program adheres to duty hour restrictions (and it should!), i promise, it is possible to work out, eat decently, and enjoy SOME time with your loved ones during during residency. all it takes is realistic planning and prioritizing. start out with this mindset from the beginning and don't listen to anyone telling you otherwise.

to anyone starting -- feel free to email me or write in with any questions! not that i'm some sort of authority, but i feel like i managed to survive and even enjoy much of the past 3 years.

and now it's off to work to get some advice from someone a lot more famous:

probably will be the most crowded peds grand rounds ever . . . but i'm psyched to hear what coach K has to say!



workout: 4 miles @ 9:13/mi pace, 0.5% incline

reading: 1 hour board review on hem/onc


  1. As a nurse, I actually look forward to the influx of the interns! They're not too jaded. :)

    My tip would be to ask the nurses on the floor for help, especially with little crappy stuff like where to find supplies. As a new RN, I wasted so many cycles LOOKING for stuff. Save yourself a few precious moments (they add up over a 12- or 30-hour shift), and just ask a nurse where the tourniquets, butterfly needles, Tegaderm, etc. can be found.

    Best wishes, new crop o' interns!

  2. This is really good advice for just about anyone starting off in a new profession. I'm about to start field work for my teaching program, and these tips translate almost perfectly to education. Ah, except for the procedure part.

  3. Anonymous10:15 AM

    very good advice. going to have to print it out for the way future :)

    and soooooo jealous of the coach k lecture!

  4. Love love love this advice. It's so nice to hear that it will be possible to maintain a healthy and somewhat social lifestyle in the next few years. I'm starting medical school this fall and I'd love to read your advice on medical school or your experiences there too!

  5. Anonymous2:05 PM

    I am not yet an intern but this is great advice...one more year this time (!)

  6. MSB just started rotations. First day of psych today!

  7. Meredith3:35 PM

    Just started intern year a week ago and right now I'm post 30-hr call. You give me hope!

  8. I love your blog, it's rather addicting. I once had EVERY intention to go to Medical School, and kick myself every minute that I didn't persue it. It sounds like an amazing adventure!

    On another note, In defense of Food is a great book. I found it to be very factual at times and hard to stick to but I really enjoyed it in the end.

  9. I love this post! I start on Wednesday. I should print this and keep it in my pocket!! Congrats to you as well as you move on to fellowship.

  10. Wow! So jealous that you got to meet Coach K:)

  11. I agree with everything you say! Two additional life savers for interns...Tylenol - 15mg/kg Q4, Motrin - 10mg/kg Q6! :-)

    How about a check list/advice for new upper levels???! I have the joy of starting July 1 on wards...hopefully, I remember what I've learned as an intern.

  12. Thank you so much for the advice! I do research with residents in an ER and love listening to all the wisdom they can possibly bestow.

  13. atilla6:53 AM

    I want to know what coach k had to say

  14. That fabulous advice for almost anyone starting out on a new journey! And, seriously, Coach K?! I'm jealous. How come we didn't ever get him to come over to the law school when I was there...

  15. Anonymous3:35 PM

    Yay Match Day! I'm so excited to read your post for July interns, but I think I will save it for closer to the day because it's time to live it up! Or rather, it's time to figure out how to relocate myself! Matched in medicine at MCW in Milwaukee. Woo hoo!