My social media idol, Amalia Cochran, has “gone dark“, for at least another couple of days. She’s previously given some excellent advice to medical students, residents, and practicing surgeons. There’s been other excellent advice for all those new residents starting on July 1, equally applicable to those third-year medical students just starting clinical rotations. Specialty specific advice is rampant, but Skeptical Scalpel’s realistic, pragmatic, and timeless advice is applicable to all the new residents starting this week.
Not one to be left off the bandwagon, I’ve got my own advice for new residents. It’s just as pertinent to the newly ward-based medical students, as well as to those of us who have been practicing for a few years and need an occasional reminder. The advice isn’t as extensive as those lists given by my colleagues, and is probably less pragmatic because I don’t, quite frankly, have a reasonable way to help you implement the advice in your daily education and practice, and I don’t have an algorithm for working through the difficulties associated with it. It’s simple and complicated at the same time, and is something I struggle with every day.
Don’t lose your humanity. I’m burned out, cynical, jaded, and—to be frank—kind of a dick. I love working on critically ill intubated and (lightly) sedated patients in the ICU, and I love operating on patients who are under general anesthesia. I’m annoyed when patients interrupt my efficient rounds by asking questions or expressing gratitude, and more so when my anesthesiology colleagues choose to (appropriately) place a patient on whom I’m performing a minor procedure under light or moderate sedation rather than knocking them out and thus allowing me to speak freely rather than hold a conversation that the patient won’t remember anyway while removing cyst or lipoma. I make snarky comments to the rest of my team on a regular basis, and am well aware that new residents and medical students likely see me as someone who doesn’t care about people, someone who’s just ready to go home or go back to my office. Distressingly, they probably don’t realize that I’ll likely think less of them if they behave the same way.
Brian Goldman talked about this phenomenon of jaded appearance, snarky comments, and inappropriate patient– and colleague–bashing in his excellent The Secret Language of Doctors [disclosure]. He very reasonably blames physicians for being jaded at the same time as blaming the system for being one so frustrating that the physicians use these defense mechanisms to get through their days. Like Dr. Goldman, I’ve witnessed horrible things said, and even more horrible opinions expressed by things not said, something in a physician’s glare or the role of her eyes. These things have an effect on teams, an effect on colleagues, and an effect on patients, an effect of presenting the appearance that one doesn’t care, that one doesn’t want to care, and that one’s caring is a display of weakness rather than strength.
Don’t lose your humanity. I’m not asking you to refrain from the occasional snarky comments. I’m not asking you to avoid expressing your frustration altogether. I’m not even asking you to treasure the opportunity to converse with the intoxicated (and handsy) college student who comes to your trauma bay after a trip and fall resulting in a nasty scalp lac from his first night on the town. Rather, I’m asking you to consider why the disdain arises in you from time to time, and to do everything you can to prevent that despair from negatively impacting your patients and the rest of your team. I’m asking you to reflect on what the “difficult patient” has been through and (try) to adapt accordingly. It’s hard to do at any point, it’s nearly impossible to do in every interaction, and it’s still critical.
Don’t lose your humanity. The residents and medical students I have the pleasure to work with are occasionally surprised by my humanity. They’ve expressed downright shock when I have allowed it to be clear that a suboptimal outcome has upset me, when I’ve demonstrated regret that I was unable to save a patient’s life or limb, when I’m bothered by, well, anything. My partners see a massive variety of critically ill and injured patients, and they come to me, upset or even in tears, when they’ve made a mistake or a patient’s clinical course hasn’t gone the way they’d hoped. (I assume this isn’t because they particularly respect my opinions or because I have a knack for consoling them, but only because there’s a couch in my office.) Time and again, I have given them the same advice when they ask whether they should leave medicine: it’s when you stop feeling this way that you should quit.