You spent 13 years in K-12, four years as an undergraduate student, and four years in medical school, plus/minus whatever other education or sidequests you may have been on. You survived writing a personal statement and going through interviews, creating a rank list, and the age-old ritual of opening that envelope to find out where you will undergo residency training.
It’s July 1. It’s the first day of residency training.
The first day is overwhelming. There is no way to soften the blow. It doesn’t matter how prepared you are, what medical school you went to, what specialty you chose. The first order will trigger the imposter syndrome everyone worries about.
First and foremost, you must remember that YOU ARE NOT ALONE. Medicine is a team sport. Even ten years into practice, I regularly discuss patients and cases with my colleagues and mentors. There is never any reason to try and impress people by proving you can figure it out without help. The balance of medical knowledge and the rate with which we learn new things is too outstanding for any human to know everything there is to know about medicine. Knowing what you don’t know is infinitely more important than any fact you can learn.
For proceduralists, there is more to it than knowing the limits of your knowledge. You must also understand the limits of your skills. At first, all of the procedures are new. You read about the steps. You learn the relevant anatomy. Then, you watch. Then, you perform while supervised. Finally, you will be able to perform a procedure independently.
Remember, a patient is on the other end of whatever procedure needs to be performed. Procedures almost always have the capacity to cause the patient pain. There are potential complications. Treat pain. Be honest with patients about what you need to do to help them get better and what can possibly go wrong. Use words the patient can understand. Patients appreciate doctors who communicate with them and are humans instead of robots.
Take a little time to learn something about your patients beyond what is written in their H&P or daily progress notes. Get to know who makes up their family, what they do for work, and where they go to school. What hobbies or sports do they enjoy? Do they enjoy traveling or seeking out good food? Again, a human connection will go a million miles when you reach a difficult point in a patient’s care or encounter a complication that needs to be managed.
The patients are important, but to take great care of them, you need to be organized. There are many different methods. Perhaps you learned some while a student. Someone may have explained a good method during orientation or shadowing before the beginning of residency. Maybe you don’t have a suitable method. Make this a priority. Find a system before you finish reading this blog post.
Are you all ready to make a list and check it twice? Now, it’s time to evaluate patients, determine a diagnosis, and develop a plan. You’ll come back later to ensure we implemented the proper plan and look for the results of your actions.
This won’t always go as smoothly as you might think. Hospitals are complex places. There are many different hands involved in patient care. Tests require a patient (or perhaps some specimen collected from that patient) travel around the hospital. Orders have to be written and then acknowledged to be completed. A well-thought-out system is required to ensure the sometimes not-so-well-oiled machine does what it is supposed to.
Organization is not the only thing required to get this done. A bit (or maybe a lot) of tenacity is essential. Write an order and make sure it’s in. Connect with a nurse or a pharmacist to ensure the order was acknowledged. Double-check with a scheduling clerk that the procedure has a time. If the transporters can’t get the patient somewhere, sometimes you have to wheel the patient there yourself to make sure they are on time. In an emergency, you might have to insist someone get out of bed and drive to the hospital to provide the patient’s required care.
Again, these are times when you must remember that you are not alone. Taking care of patients will come with conflict. It is unavoidable. Responding to and mitigating conflict is a skill that takes time to learn. You will be right sometimes. You will probably be wrong more than you are correct at the beginning. Take a deep breath, listen to the other person, consider their knowledge and experiences, and react accordingly. Assume the best of intentions. If you aren’t sure of the source of the conflict, ask some clarifying questions. Perhaps there is just a misunderstanding. Remember, everyone is there to make patients better. If you need to talk something out, don’t do it in front of patients!
If you aren’t sure of the best response, run the scenario past someone more senior. Discuss the issue and a strategy to respond. Don’t respond to scenarios when you are mad. If the conflict is being discussed over email, write your response and sleep on it. Have someone read over your response, and then send it. One of the best ways to defuse conflict is just simply to let time work its magic!
One final thought. (Yes, there could be so many more in a blog post like this!) You can’t take great care of patients unless you take care of yourself. You may hear people talk about spending a long day caring for patients and not taking time to eat, drink, or use the restroom. Do these essential functions. If you need five minutes to walk outside and get some air, TAKE IT! If you have an important phone call or need to talk with your significant other or a best friiend at an important moment, DO IT!
There is always going to be work. There are always going to be patients. It is a never-ending stream. We all want to be great teammates and avoid passing work on to others. The reality is, you are probably never going to be able to hand off a clean slate. Look for the best transition points, and choose moments when you must stay until a task is completed wisely. There are some times when the extra time is important to you and your patient. You’ll figure those out as you go.
Remember, we call it practice for a reason. We’re all trying to be perfect. Very few of us, if any of us, have made it there!
Good luck!