Wednesday, June 23, 2010

Passing the Torch

As we welcome in the new interns this week, I pass on my position as the new kid on the block. What better way to make that transition than to hand down the valuable lessons I’ve learned throughout the year? As such, here is my survival guide to life as an OB/GYN intern:

1. Don’t take anything personally. In our field, people have many reasons for being grumpy: lack of sleep, hunger, stress. As an intern in any residency, you will inevitably be the one who gets lashed out on. Sometimes it will be justified. Most of the time it won’t. The key to getting through your newfound role as Lowest-Person-On-The-Totem-Pole is not taking it personally. When you feel the sting, remember. It’s not you, it’s them.
2. Residency is four years – for a reason. You WILL make mistakes. You WON’T always know the answer. You may not be able to find that cervix. You may not be able to deliver that head in a c-section. You may not be the one to resolve that shoulder dystocia. It is OKAY. Beating yourself up will not change this. Take a deep breath and use it as a learning moment instead.
3. If you don’t know, ask. Dovetailing off the previous point, don’t be afraid to ask questions. Your senior residents and attendings have tons of experience – and pointers. How do they usually handle a tight nuchal cord? What’s their trick to getting the baby’s head out of the uterus?
4. Read like the wind. Okay, so this is a tough one. Who has time as an intern to read? As daunting as this goal might be, the payoff is twofold. First, the benefit of learning is obvious. Second, the act of learning something new is just as much a boost to your confidence as it is to your knowledge base – and when you spend the majority of the day feeling like you just don’t know enough, your confidence will need all the boosting it can get.
5. Anticipate, anticipate, anticipate. Part of being a good physician is being prepared for badness. With every patient, you want to think about the worst case scenario possible and prepare for it. That patient with the Estimated Fetal Weight of 9lbs? As you walk to her delivery, you should be thinking about every step of management in a shoulder dystocia. A patient who is a grand multip who has delivered 6 babies before? You want to be prepared for a postpartum hemorrhage and have the doses of all the drugs you would use memorized. Not only does being prepared help you keep your cool in an emergency, but it also wards off bad juju. Murphy’s law, you know? Badness happens when you’re least prepared for it.

Take the torch. No, really, take it!!! 
6. Play nice with others. This especially includes the hospital auxiliary staff. Nurses, scrub techs, nurse assistants, cafeteria workers, housekeeping - they can make your life heaven or hell. If they like you, they can make you look really good in the OR or labor room. They can make things happen for your patients quickly. They can be the shoulder you cry on when you’re having a bad day. These folks have a wealth of experience and knowledge that you don’t in this stage of the game. So be nice. Value them. Make the effort to learn their names. And be humble. Having an MD behind your name does not make you entitled to anything.
7. Be a team player. If you have any gunner-ish tendencies, pack them far, far away now. Intern year is not an independent endeavor. You need your co-residents to get through it – both literally, figuratively, physically, and emotionally. If you see a resident struggling, help out. There will invariably be a time when the roles are reversed and you need some sort of help. Karma definitely exists in the world of medicine. The next time you are swamped in clinic or need a call switch made, you’ll be glad you have people to call on.
8. Remember, everyone has a story. Just like out in the real world, you have people that only ask for help when they really need it AND you have people who whine like the sky is falling. It is hard to be compassionate with the non-pregnant vaginal discharge patient who rolls into Triage at 4am. But if you take that moment to sit down with her, open your mind, and listen, you’ll hear that she just found out her partner has been unfaithful and is paralyzed with anxiety with the thought of having a sexually transmitted infection. All of a sudden, instead of passing out diflucan like candy, you can use this as a good teaching moment about safer sex practices. The chief complaint is usually just the tip of the iceberg. Being an effective physician means taking the time to learn the bigger story.
9. Exercise: Residency is busy. You don’t eat regularly and when you do, it’s easy to eat crap. “I haven’t eaten in 8 hours, of course I deserve these fried chicken strips!” You don’t sleep regularly. You don’t always release stress in appropriate ways and it often builds up, builds up, and builds up inside you. Exercise can be a life saver in dealing with every single one of these issues. It has been my lifeboat in the world of insanity. I honestly attribute 50% of my positive work attitude to the couple of hours I take per week to pound the pavement in my running shoes. Besides, how can we preach healthy living to our patients if we can’t do it ourselves?
10. Remember to be you. Think about the person who filled out those residency applications. That person who prides herself on her cooking skills, who has traveled the world, who played tennis in college, who was a kick-ass salsa dancer. These things make you you. And as easy as it is to let these hobbies fall by the wayside when you work 80 hours per week, you’ve got to do everything in your power to keep this from happening. You will become a very sad, sad person in residency otherwise. Think about it. Your self esteem, no matter how healthy it is now, will take a serious bruising intern year. To keep yourself balanced, you’ve got to have a couple of areas of your life where you feel like a success. Trust me, it’s worth the sacrifice in sleep. You are a doctor now, yes, but don’t forget the dozens of other things you are as well.

Finally, for extra credit, HAVE FUN! What we do day in and day out is such a privilege! Enjoy it!

* Readers, any tips you'd like to add? Add them in the comment box!

1 comment:

  1. What a great list. I'll be done with my third year of med school tomorrow (surgery shelf), and the only thing I could add on is to have food on you at all times. In my white coat is always a couple granola bars and a bag of almonds, and if I don't get a break for 8 hours at least I won't pass out from hypoglycemia.

    I really enjoy reading your blog and I actually linked to one of your posts in my own blog dealing with burnout ( Thanks for all your smart words!