So you made it through school and you’re finally in your first year of residency. You’re psyched to play all of the knowledge cards you spent years acquiring, to have a paycheck, to finally be called that most respectful of terms, “Doc.” Then intern year hits you, and within a week, you feel like every likable character at the end of Rogue One (spoiler alert: the original death star vaporized you.) All of the nonsense I discuss in my other posts, like staying in shape, earning money on the side, and having hobbies suddenly do not apply to you.
You are going to learn a shoot ton this year, and I don’t need to enumerate it here. You may have the title of doctor now but the crucible of intern year will mold that fresh doughy education into a polished bocce ball of medical practice (it’ll take years to refine into something more efficient and useable; a bowling ball will suffice at this point).
Okay down to business–the pottery analogy ends now. All of the above is true, but that doesn’t mean the life skills we learn during these difficult years of training can’t translate into a more developed, balanced life afterward. To save you the trouble, here is what I learned during my intern year, besides all of the clunky clinical knowledge. I use each of these all the time to make me a better doctor and to accomplish my outside goals.
#1: Get sh*t done. As an intern you really don’t have the option to decline tasks that are uncomfortable or will make you look like an ass. Your upper level asks you to call a consult to the infectious disease service to ask what antibiotic to use? Even if you still remember it from Step One, you have no choice but to make that call, and right away. So you page somebody who listens to your question, gives you the answer you already knew, and throws in the non-verbal cues that say “I can’t believe your entire team is that dumb,” but you suck it up and check it off your list. Your attending wants you to call medicine because a patient’s blood pressure is 136/90? Better do it. Or, the inverse occurs. Someone else calls you with a question you both know is dumb, making the conversation more awkward than a sixth grade dance. But you know the intern on the other end of the line is in the same position as you, just doing what is needed to learn and move on. It’s a tremendous lesson in humility but should also teach us not to fear asking dumb questions, not to worry about looking foolish, and that everything is still accomplished faster just by getting someone on the phone. I don’t mean to imply that you always will know the answer. The other humbling part of being an intern is knowing less than almost everyone else.
The other thing we learn from this experience, oddly, is important in negotiation. We are taking part in a conversation in which we have minimal control–if our attending or upper level decided something, we can’t change it. That fact alone makes it easier to tell the other side a hard truth, because you are not the ultimate decision maker. They won’t be tempted to try to change your mind. Most likely they’ll just do what you ask, because it’s even more trouble to run it up the chain and have to ask their attending to deal with it.
When you finish intern year you will rightly never want to play this role again, but the skills you inadvertently picked up will serve you well. Don’t be afraid to pick up the phone, don’t be afraid to ask for what you want or need, and don’t be afraid to act the middle man when it serves you. By this point you’ve done it a thousand times.
#2: There are less true excuses than you think.
Last year, our hospital and university had a sizable snow storm that prompted a school-wide closure, one that also applied to non-vital hospital personnel. The roads were icy and a lot of people who did venture out ended up on the side of the road or in minor fender benders. That includes the residents, physicians, and nurses, who are all vital personnel. And guess what? Everyone made it to work. The hospital ran smoothly. I was on the trauma service, and we were slammed. A ton of people who had school or work off thought it was still perfectly fine to drive to bars and get in knife fights. I’m not kidding. But because the “vital personnel” made it to work, we were able to take care of everybody.
In a similar scenario, our service had a grand total of three sick days taken last year. Three, between 21 residents, in a 12 month period. This in spite of work hours that were beyond reasonable and stress levels equatable to those of moderate Republicans when Donald Trump won their nomination. Now, we were very fortunate that no one had a serious illness or injury. A program in Kentucky lost a resident to cancer last year, and my home program had someone miss a ton of time with lupus and RA flare ups. Those are real problems. Colds, generalized malaise, upset stomachs, being hungover (the most likely cause of feeling bad in people our age) would generally cause most of us to take a sick day. As an on service resident, however, taking a sick day means loading your friends down with your work, above and beyond the already onerous demands, which is why it rarely happens.
My point is not to look down at anyone who has ever taken a sick day when they weren’t gravely ill; despite appearances, I think our healthcare would be better off if we also cared for our health. But it does show the difference between a real excuse and a contrived one. It is rare that we cannot accomplish what truly needs to be done. Most of us can push through physical discomfort, make our way to work in adverse conditions, find someone who can watch the kids, etc. So we shouldn’t let those contrived excuses prevent us from doing what is really important to us. If you want to get in shape or read more or write or spend a day a week with your kids, then don’t let something that could be an excuse develop into one. Think like an intern, like there is no one else who can cover your work, and just Nike that sh*t.
#3: Eliminate dead time to increase your efficiency
As a resident, much less an intern, you have a to-do list that seems a mile long each and every morning. Not only do you need to accomplish all of it, you need to do it with accuracy because someone’s life might depend on it. You won’t spend any time staring at the computer with your mind wandering, because you can’t. If you put off anything it will cost you when more things get added to the list later, or worse, someone else will do it before you and make you look incompetent. But right now you have your list in front of you, so you’ll go to the top and systematically work your way down until everything is done. You’ll probably double check it as well, and someone else on your team will also review the important things.
What’s the takeaway? Tackle your personal tasks the same way: systematically and as soon as possible. They may not be as straightforward as orders and notes, and sometimes you might not know how to go about them, which is where we lose the most time: reasoning becomes thinking becomes daydreaming becomes inaction. So develop a system (mine involves Haitian bwats and tips from Mormon missionaries to account for this difficulty–more on that in a later post) and attack it with the same vigor you would if it was 6 am before a long day in the OR. If it’s the accountability that helps you function with your team, then have someone else to be accountable to for your personal goals–a friend or significant other. But make sure they are somewhat of a hardass. It’s something you’ll already be accustomed to.
#4: Economy of movement: not the same as efficiency
This is a term that one of our attendings is always bringing up, because nowhere is efficiency more important than in the OR. His goal is to have the surgery planned down to each discrete step, to do each step in its totality before moving on to the next, and to use an instrument only once in each step–once you pass it back, you’re done with it. I probably don’t need to explain why this is important. Total time under anesthesia and how long a surgical wound is open both contribute to post-operative morbidity. The cost of OR time in today’s large medical centers is staggering– one figure I’ve seen quoted is $147 per minute. And then there is the surgeon’s time. He wants to do more cases, to gain more experience, help more people, and yes, make more moneys. It works for him; it’ll work for us.
You can apply this concept to myriad avenues. To state it as simply as possible, don’t do the same step or use the same tool more than once. One way to implement this is email. Sure, I have email on my phone. But if I constantly check it and read it, what happens? I delete a few, read a few, and ignore others. Then later when I sit down at a computer to actually process and respond to them I end up reading them all again. So I try to only check email when I have time to sort through them and respond accordingly. This prevents re-reading emails, missing important ones, and forgetting to respond to those that are more subacute. We can apply the same concept to other tasks by batching them. Write notes or thank you cards all at once, when you have the envelopes and stamps out. Cook large portion sizes when you have all of the ingredients out, and the requisite tools. When you take the time to get gym clothes on and drive to the gym, make damn sure you have a good workout. Easy.
Reading back over this post, it seems like thinking about intern year made my tone less accommodating. I also seem to have dropped more curse words than I’d like. I thought about changing it, but the reality is, life as an intern or a resident is hard–and people under stress treat each other that way. This is part of why I feel comfortable recommending actions that most undergraduate students, professional students, etc. would think is overdoing it–you’re going to have to do it eventually. I have the advantage of experiencing medical school after being an intern, and that’s allowed me to raise a kid, care for a dog, write this blog, and work on evenings and weekends while in school. You will learn that kind of work ethic sooner or later–you might as well benefit from it now! Plus, if you spend your undergrad years hustling, and work selectively in professional school, the hardest stretches of school or those first months of residency won’t hit you as hard as they do those who coasted at every opportunity. That’s how an upper level resident would say it. Probably with more swear words.
