I remember the fervor of my first day of internship: expecting a daunting yet exciting time lay ahead and I was finally going to be of some use to people. (And to my parents, relatives, and neighbors: “Oh, you’re finally a doctor.”) I felt like Tom Cruise on the airstrip of Miramar racing an F-14 with Kenny Loggins’ Danger Zone as he was about to join Top Gun.
However, these cinematic visuals soon came to a halt as I felt grossly unprepared for this new responsibility. I had to be adept with not only medical knowledge, but also the electronic health record (the labyrinth that never ended), assimilate plethora of patient data, learn to communicate this effectively and make management decisions. I was the first point of care for a person: a real person. This weighed heavily on me, since I imagined that when the time came, I would be proficient in all these attributes.
The clocks have flash forwarded, and here I am supervising incoming interns on the 1st of July (which for the past two years has fallen on a weekend). As a frenetic day has finally come to a close, and a walk along a park where the trees have acquired a new color as the sun sets, I cannot help but reflect on my initial days of internship. I am glad for all the initial lessons, but I wish I had a head start to ensure a great initiation, rather than relying on serendipity.
So here goes.
1. Time management. This ties in prioritization and the EHR. It can be easy to get lost in the avalanche of information you are subjected to. Learn to go after the critical and immediate straight away and be on the constant watch for these as your day goes by. Have a standardized method of navigating the EHR; we always have the temptation to go straight to the results tab. Try employing the following in this order: vitals, notes (including RN, PT/OT etc.), medications/orders and results. This helps to capture essential information and its ensuing assimilation.
2. Befriend thy nurses. The most overlooked secret to a great internship. They are the backbone of successful patient care and will be your go-to for a lot of the things you will not know in your nascent years and beyond. Be the amiable intern, and they will bail you out of most troubles that may befall you.
3. The 360 you. For this one I’ll take a page out of Ray Dalio’s (one of the most successful hedge fund investors of all time) book: It’s important to hear everyone on the team since each person brings a diverse view to the table and this might benefit us in acquiring a position of vantage. We all like to appear capable to ourselves and others, and thus, might shut others’ opinions. Even the Scientific American has shown in the seminal article: “How Diversity Makes Us Smarter.”
4. Drown the complainer. Sometimes, nothing feels better than a good rant. As a barrage of uncertainty predominates the fledgling, we can drift into a habit of complaining, which thrives in the herd mentality of the hospital. Atul Gawande, in the postscript of Better, forewarns us regarding this peril. Researchers at Stanford have shown that complaining can shrink the hippocampus. An antidote to this has been suggested by a study in JAMA where physician discussion groups incorporating elements of reflection and shared experience consistently improved meaning and engagement at work.
5. Ask and you shall deliver. In a bid to avoid appearing incompetent to our seniors, we forget about the timeless lesson of the apprenticeship: Asking for help is a sign of strength and integrity. Having initiative and learning to figure things out can be a great attribute, but if the spidey sense tingles its alright to shine the bat sign.
6. Strike a dent in the universe. A phrase that Steve Jobs espoused. Our patients deserve work that resembles flawless art. The work that is awe-inspiring to them and galvanizes our peers to deliver more.
7. The minute that matters. As technology has weaned time away from the bedside, we should strive to maximize our time with the patients. The conversations (especially the ones laden with undivided attention) with the patients will always be the most redeeming part of your day. Use them as a rejuvenator of your daily purpose. And also, as Mark Reid emphasizes: Make sure you first have the conversation you feel like ignoring the most.
On a parting note, as time goes on you will encounter some patients who will have the hospital as the last institution to turn to. Life may have dealt them a bad hand, but you have a chance to reshape that.
Sam Kant is a chief internal medicine resident and can be reached on Twitter @kantsmd.
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