I learned five things during my intern year:
1. Embrace being wrong.
As an intern, you’re going to be wrong. Day after day, rounds after rounds, you’re going to be wrong. The presentation will be out of order. The labs you reported are yesterday’s labs. You’ll confuse Light’s criteria with some other bodily fluid calculation. It is going to happen! You will inevitably see a patient in the ER or on the floor that you examined and took a nearly perfect and detailed history and physical. You will staff that patient with your senior and attending, and by the time you get down to the ED, your “straightforward” patient is headed to the ICU after a code blue or rapid response.
What I challenged myself to do is stop making excuses. If something goes wrong, own it. Say it out loud for everyone to hear. “I’m sorry I missed it, my mistake, won’t happen again.” What I vowed not to do is blame someone else. “I didn’t admit the patient; it was the night resident; this was an overnight admission; those doctors in the ER are so incompetent.” Every patient you have on your list is yours. Own that. Own the responsibility, so that when things go south, you can learn to be accountable and grow. And when you’re right, you’ll know it was because of you, not the night resident.
2. Your insecurities are yours; the patient will never know.
The power of the white coat goes beyond the length of the coat or fact that you now have an MD behind your name. The power it carries is that it transforms an MS4, with all the associated insecurities and fears, into an MD with the same insecurities and fears. Your patient doesn’t care — your patient needs a doctor, and that’s you. He were randomly selected to be with you, the doctor. Of course, it’s true that you’ve been a practicing physician for less than 48 hours. It’s true your future hours will be filled with insecurities and gaps in knowledge because, well, you’ve been a practicing physician for less than 48 hours. As an intern, you’ll have gaps in knowledge, just like your senior, just like your attending, and just like every practicing physician in this country. Trust less in what you know, but rather on how you will find out. One of the phrases that caught many of my patients off-guard was: “That is a really great question, I don’t have the answer to that, but I’ll find out.” Trust yourself, you’ve come all this way. You are supposed to be in that room with that patient.
3. No one is beneath you.
In the 11th month of my intern year, one of my patients was getting a bone biopsy in the morning and needed to be NPO for the procedure, so I placed an NPO order. During morning rounds, I watch as the food delivery man walked casually into my patient’s room with a tray of food. My patient said he was NPO and didn’t eat. I felt proud of my patient, but I was angry at the food delivery man. I walked up to him and said, “You realize that he’s going for surgery, he’s NPO.” The food delivery man looked at me and said, “I’m so sorry, doctor, it’s my first day, I don’t know what NPO means.” I remembered back to my first day, starting on the medical floors and having to look up multiple acronyms that I didn’t know. Never forget that, at some point, everyone is training. Everyone has a first day. Be humble; you’re not better than anyone in the hospital. It’ll be your first day on multiple services throughout your career, too.
4. Every scenario is part of training, even the ones you dread.
Medicine goes beyond the pathophysiology and the guidelines you just “Up-to-date-ed.” It feels good to do that central line or lumbar puncture. Of course, it’s fulfilling to tell your patient that the biopsy came back negative. But I challenge you to deliver the life-shattering news to your leukemia patient that her bone marrow has 30% blasts and the induction failed. Or, to tell your patient’s family that their daughter is brain dead. Tell the patient you just admitted for weakness and hoarseness that he has widely metastatic disease and his prognosis is terrible. You won’t find those emotions in a textbook and you won’t find those feelings in a simulation. You need to experience the scenarios you dread, even if you’re terrified. That’s part of training. The same way you develop your unique method to read an EKG, you’ll find your unique way to break bad news — but only if you put yourself in those situations. Be willing, so you can eventually feel comfortable in the uncomfortable.
5. Take a detailed history.
From the first year of medical school until the day you hang up your white coat for the last time, the answer is always: “detailed history and physical.” Of course you’re going to ask the questions that you memorized during medical school to get a good HPI, but also ask the uncomfortable questions. Ask your patient how he got addicted. How she got her drugs. Ask your homeless patients how he was able to afford their drugs when he had no money. Most importantly, a detailed history humanizes the osteomyelitis patient in room 332, into the young woman with osteomyelitis who is a recovering heroin addict, who relapsed after a complicated C-section and prolonged hospital course, who was discharged with Percocet. Know that learning how humans think and function is just as important as learning the most common pathogen. Be curious about the disease, but be just as curious about the patient.
Comment below with things you learned during your intern year (and throughout residency) to help others.
Armando Alvarez is an MD/MPH completing his preliminary year in internal medicine. He will be completing his residency at the University of Miami/Jackson Memorial Hospital in physical medicine and rehabilitation.