Dear newly minted doctor,
You did it! You graduated medical school. Now, you are getting ready to embark on the next phase of your training. Looking back to a year ago, I can clearly remember how I felt — excitement mixed with anxiety. I had no idea what to expect. Like all recent medical school graduates, I knew wanted to provide the best patient care possible.
A medical school advisor recently commented, “There’s no real way to truly prepare medical students for intern year, is there?” To some extent, I think that is true. Intern year is difficult because you are inundated with intellectual/emotional challenges while also losing sleep, food, and social interaction. And despite all this, medical interns go in every day, striving to be the best healers that we can. During this time, I learned meaningful lessons about two types of care: patient care and self-care.
Lessons on patient care:
1) Always introduce yourself to everyone in the room. A single interaction had a profound effect on me when I had a loved one in the hospital. The doctor came in and didn’t really acknowledge the family members in the room. Two of us identified ourselves as healthcare workers. From that moment on, the doctor only acknowledged us, and before leaving, only shook our hands. This left a poor impression on everyone. While introducing yourself to everyone in the room may seem obvious, you will find that the pressures of the hospital can unfortunately erode common courtesies. Since that experience, I have always made sure to introduce myself and shake hands with everyone in the room.
2) Sit down. In the beginning, I always felt like I was in a rush. However, I began to mentally remind myself the importance of sitting down and being present with all my patients and their families, particularly for serious conversations. Studies have even shown that sitting leads to higher patient satisfaction about the interaction.
3) Don’t lose focus of the big picture. Mistakes often happen when you anchor on one piece of information (whether that’s a single lab number or a diagnosis already doled out by another physician prematurely). Remember to keep your differentials broad — always think, “What could harm or kill this person?”
4) Leave your preconceived notions at the door. “The patient is difficult.” “The family is crazy.” These are words you might hear before even meeting the patient. I’m not saying you have to be naïve — there will be difficult patients and families. But remember, on the other side is a person with hopes, fears, and baggage you do not know about or understand. Don’t let your first interaction be tainted; try to go in with a clear and empathetic mind. This can be especially difficult when you are tired and overwhelmed. It’s okay to stop and take a deep breath before walking in. For me, I would also recall how much anxiety I felt when my loved one was in the hospital, which helped me immediately empathize.
5) Know your biases. We all have implicit biases. Analyze your thoughts and actions; push back at the structural biases that have been built into the system. The history of medicine is fraught with injustice towards minority groups, leading to unacceptable disparities in care. As newly minted doctors, we have the opportunity to be part of the change we hope for in our field.
6) Love your nurses, pharmacists, respiratory therapists, physical therapists, speech therapists, and social workers. Let’s be honest. You will be tired. They will be tired. Sometimes the interactions are suboptimal. Never forget you play for the same team — helping the patient. These are the people who will catch your mistakes — learn from your mistakes and thank those who catch them.
7) Learn from your patients. You can read all the books in the world, but nothing will cement a clinical picture in your head like seeing it in the flesh.
Lessons on self-care:
1) Find a buddy. Doesn’t matter if it’s a co-intern, a resident, or a friend in a different program. We have to rely on one another to get through difficult experiences. Your buddy is the person who you can talk to about loss — from expected deaths to code blues that end poorly.
2) It’s okay to cry. Crying outside the hospital is always appropriate, and it’s okay. Hours are long. Cases are difficult. We witness the worst day of someone’s life over and over again. It’s okay to cry with patients and their families. We are human, and we naturally form emotional attachments.
3) Eat, sleep, socialize when you can. It’s not easy to find time. Try. You’ll fail. Try again. At the very least, have one simple pleasure that you can rely on when the going gets tough. Maybe it’ll be drinking your favorite latte. Or petting the hospital’s therapy dog.
4) Forgive yourself. You’re not perfect. You’ll make mistakes. We all do. And if you make a mistake, always be honest with the patient.
5) Tell those you care about that you love them. After the number of surprise cancer diagnoses and sudden unexpected deaths I’ve seen this year, I go out of my way to let my family and friends know how much I care about them. Even if it’s just a text message.
6) Mental health issues affect a large percentage of healthcare workers (one study shows a prevalence of 29%). Watching tragedies unfold over and over again erodes at your wellbeing. Add to that sleep deprivation, poor nutrition, lack of regular exercise, and a marked decrease in social interactions, and the problem is compounded. If you find this taking a toll on your mental health, you are not alone. Seek help from your chiefs and program directors to get plugged into resources — many of us have needed help in our darkest times. If you see a friend or colleague struggling, speak up. We are all in this together.
Good luck, soon-to-be intern! This year will be filled with great difficulties and great victories. There is no better feeling in the world than being able to help someone and to serve as a healer. The best advice I got before starting intern year was from my academic advisor, an amazing retired transplant surgeon who said, “Never forget, this is about taking care of people.”
Roxana Daneshjou graduated from Stanford School of Medicine with an MD/PhD. She completed a medicine intern year and is currently a resident in dermatology. You can follow her on Twitter @RoxanaDaneshjou.