Even though my own internship was a decade ago, I vividly remember the transition from student to resident. Residency was monumental in my path to becoming a physician. There were obvious changes; people now called me “doctor,” my misshapen short white coat was upgraded to a comforting full length one, and I was often the first one paged to respond to patient problems. Coupled with the positive aspects though, I also faced some challenges. I struggled with depression, my relationship with my girlfriend was strained, and I felt overwhelmed as I contemplated switching specialties after my second year (from ophthalmology to internal medicine).
Despite the stress, I look back with fond recollection and a realization that the tremendous experiences and camaraderie can never again be replicated. As a resident, I was privileged to help take care of an underserved population in New York City, learned from inspiring teachers, and worked hard alongside talented co-residents (some of whom will undoubtedly be lifelong friends, and one of whom I married).
This is my advice for thriving during your own residency odyssey:
This sounds obvious but not enough residents make this a priority. News headlines and blogs are exploding with discussions about physician burnout (and sadly also the prevalence of physician suicide). It’s imperative that we begin investing deliberate effort into physician wellness. My four cups of coffee per day, depression-fueled binging on cookies at midnight, lack of exercise, and suboptimal sleep did not make for good health. By the end of residency I weighed nearly 15lbs more than at the start. The simple fact is that if you don’t take care of yourself, then you won’t be able to effectively take care of your patients. Whatever challenges you face, you must seek help from loved ones, peers and professionals to actively manage them. Too many highly-functional intelligent professionals try to power through obstacles and then one day shatter because they refuse to tackle problems in the manner as they would advise their patients.
This starts with your patients. Mrs S is not just “some demented lady in bed 3.” Taking time to truly learn about the patient will help you maintain empathy, and get you through the brutal paperwork, bureaucracy and inefficiency that is omnipresent in healthcare. This attitude should also extend to your coworkers, nurses, techs, and all the non-physician professionals that make healthcare possible. You’ll have to interact with these nice folks for at least a year (and maybe 7 years if you become a neurosurgeon). Finally, learn their names and introduce yourself. As Dale Carnegie teaches “a person’s name is the sweetest sound to that person.”
Realize it takes time and effort to acquire knowledge. A brilliant critical care attending once barked at me “reading UpToDate is not the only reading you need to do.” I scoffed at the time because I was looking for a quick-fix, but of course he was right. Making a sincere consistent effort to learn despite your difficult day is a real challenge. Did you do well in medical school and on Step 1, 2 and 3? Congratulations, but now all of that is behind you. Having a baseline knowledge is a prerequisite but not the end point. Remember that you’re not being judged by your performance on a multiple choice test anymore… real patient lives are on the line.The best residents I’ve seen begin reading board review materials as they go along during their training, rather than trying to cram in learning at the end. Malcolm Gladwell notes that 10,000 hours of “deliberate practice” are needed to become world-class in any field.
Repeat after me: I will have a life outside of being a physician. You of course already know that there are no guarantees in life and time only moves in one direction. I am telling you very frankly that physicians can become patients at any moment, and that the future is actually quite uncertain. During residency I made it my mission to go overseas during every single vacation I had. I ate a lot of instant noodles to save up for these adventures, but it was well worth it. I also made time every week to reunite with old friends for a relaxing dinner. Many people do make time for things they love, but there are a few that seem to never escape the pull of the hospital. These physicians seem to be at greater risk for burnout. Plus, neglecting the outside world doesn’t guarantee that you’ll be smarter or save more patients than if you step away to energize during your time off. I implore you to not abandon your other passions for your medical work. Make sure you live all aspects of your life.
Every place you will ever work will have its own culture and set of rules. If you’ve made it this far you’ve probably realized that healthcare can feel like a dog-eat-dog world; with a hierarchy and rituals that must be respected. Dr A likes labs presented a certain way, Dr Z likes interns to be at the front and center of case presentations, but Dr Q wants you all to shut up, be invisible and listen to the attending. All of it is irrelevant in the end, and yet all of it is vitally important for your survival in training. Millions have come before you through this gauntlet. Learn the rules of the game, and you will thrive.
When I was an intern, I responded to a rapid response that turned out to be a presyncopal episode in a patient that had just finished dialysis. I examined the patient, analyzed the labs, talked to the nursing staff, and initiated an appropriate plan (a small bolus of IV fluids). Immediately after I was finished, the private attending appeared and berated me in front of everyone. “You are the worst intern I have ever encountered!” I was frozen, I felt like crying, and I could feel my entire face quivering. What had I done that was so terrible? I knew I wasn’t encyclopedic in my medical knowledge but “the worst” seemed harsh. He was basically angry that I had touched “his patient” despite the fact that it was my job to go to rapid responses. Many will undoubtedly recall similar stories of people unloading their frustrations. You have little control over the personal lives or toxic personality traits of others. Learn from your mistakes, pay attention to actionable criticism from superiors, but don’t let random angry ramblings get you down.
Having now worked as a hospitalist in a dozen different hospitals around the US – I’ve made it a goal to improve my interactions with coworkers. Despite this, I’ve had my momentarily despicable episodes. In one of my first attending jobs I became extremely irate with a nurse after she openly questioned my management in front of a patient’s family. I cut her off mid-sentence, presented her with the science, reiterated my sound treatment plan and then stormed off rather dramatically. However, I returned to the unit 10 minutes later to apologize for my actions. I remembered how horrible some of my residency interactions made me feel and realized that she was speaking out in the interest of the patient’s safety. I obviously should have acted differently. It takes conscious effort to not become that which you despise.
The Hippocratic Oath may have been conceived in ancient times, but it is still sacred and relevant. Every year the media is flooded by some inconceivable story of professionals doing bad things: scandals, billing fraud, unnecessary procedures, taking kickbacks… the list is endless. Strive hard to not to become one of these people. It’s bad for your career, it’s horrible for your family, and it is a complete waste of your talents and sacrifice.
I wish you well in your journey!
Varun Verma M.D. is an internal medicine physician and hospitalist at Jefferson Health New Jersey. He believes that healthcare is a human right, and has worked internationally in resource-limited settings, and around the United States. As the CEO of Medofi, he is currently working on improving healthcare I.T. by decreasing chaotic communication within the healthcare team. You can connect with him via his blog http://www.varunvermamd.com or Facebook https://www.facebook.com/PhysicianV or Twitter https://twitter.com/VarunVermaMD