10 Commandments for Intern Year

I’ve been inspired by the #TipsForNewDoctors trend on social media. I’ve decided to start posting some thoughts and advice based on what I have gone through on my blog.

These are simply recommendations I can make for any first year residents based on my own experiences and observations over the past 8 months of intern year. I don’t have any evidence to support my words, though I hope they might help others.

1) Thou shalt be a team player.

You should make it your priority to be courteous and respectful to everyone you encounter. This isn’t limited to your immediate resident colleagues, medical students, or attendings, but includes custodial staff, administrative assistants, patient care techs, transport staff, literally anyone. Make it a goal to get to know as many names as possible. Many of my heroes like Dr. Amal Mattu and Dr. Michael Winters have emphasized that learning names positions you to be a leader.

2) Thou shalt take care of thyself.

If you are chronically sleep deprived, sick, or emotionally unstable, you not only put yourself at risk of burnout and further health problems, but you put the lives of your patients in danger. Imagine when you are on call in the ICU, in many hospitals making critical decisions for your patients without direct oversight at times. Seek help early if you start to find you are struggling. Every residency program must guarantee resources for physical and mental wellness.

3) Thou shalt read daily.

This is a tough one for me to do myself, but I guarantee you that if you can keep this one up, you will excel. Success as a resident, attending, and beyond does not require marathon study sessions in the library. Leave that in medical school where it belongs. Read about 1 patient you care for daily. It can be FOAMed, a review paper, or even discussion with a colleague. Something. Every day!

4) Thou shalt not incur debts.

While it may seem pointless to be fiscally responsible if you have hundreds of thousands of dollars in debt like me, do not be fooled. You will have limited month to month cashflow, and any extra debts you incur, especially for purchases you don’t need, will cause you unneeded stress when bills are due. Every penny you don’t spend is going to make a difference as a resident. Be wise with your money and you will be glad in the end.

5) Thou shalt put the patient first.

It may seem silly to emphasize this point, but entitlement and privilege are pervasive among medical students and physicians. Because of the hard work and sacrifices we all endure, the bumps along the way can be tough to deal with. Avoid giving into the urge to make everything about you. The day you became a medical student, and especially the day you start residency, you are truly making the rest of your life about your patient. You had many years to make up your mind about being here, but your patient, especially when they are sick, did not ask to be in the hospital. Maintain compassion for your patients and their families. We sometimes take health and healthcare for granted because we see it from the physician perspective. Try to see the situation through your patient’s eyes and you will understand it can be frightening and overwhelming to navigate the system.

6) Thou shalt not sign out loose ends.

Trust me, if you don’t know what I’m talking about, you will know soon enough. Do not be that resident in your program who develops a reputation for awful sign outs. Sometimes you have to stay late past your shift or call night to close the loop. Resist the tendency to think of it as doing procedures or examinations you don’t want to do; instead think of it as better for patient care. Nothing is worse for your patients than poor quality sign outs. If you need to call a consultant, perform a procedure, complete an examination, or finish a discharge or admission, be the resident that stays to take care of it. It’s not just a good habit to develop. It’s better for patient care, and that’s ultimately your first priority.

7) Thou shalt be professional with everyone.

This is a huge one. There are going to be times when you have a sick patient and you might feel like staff around you are not helping you with their care. There will be moments when you need help from a consultant or colleague in a different specialty or field and that physician may disagree with your plan or concerns. There are frequently situations when you will feel unsupported and like you are the only person who wants to care for your patient. You are not alone, and it is never, ever acceptable to be rude, discourteous, or nasty to others. It is never okay to raise your voice, swear, speak profanity, or speak rudely to another person. It doesn’t matter who that person is, whether a colleague, staff member, patient, or other human being. You are now held to a higher standard, and you must accept that, or you will flounder.

8) Thou shalt be early.

I must admit, this one is challenging for me even to this day, because I have trouble being organized. I am working on it though. That being said, it doesn’t matter what kind of residency you are starting, being early is the new “on time.” Showing up on time demonstrates work ethic and everyone remembers if you are late. If you develop a reputation for being late, it can be hard to overcome this moving forward. It sends the wrong signal, which is that you don’t care about your work. You most definitely do care about your work, and you have worked hard to get to this point. Don’t screw it up by being late.

9) Thou shalt surround thyself with positive influences.

Wise people rarely become wise by their own virtue. They simply understand that they are influences by those around them. If you seek out uplifting, motivated, and success oriented individuals to spend time with, get advice from, and learn with, you will 100% benefit from this. As you move forward, understand that not all health care providers are created equally. Some of them ended up where they are by mistake, are unhappy, and will try to get you to join their complaint corner. I say, find a senior resident or attending you admire early on, and reflect on what makes them so good at what they do. What qualities do you appreciate about them? What about their personality or professional life do you wish to emulate? Then, go one step further and identify where they may be able to improve. Write all of this down, and you have your road map for your own growth and development.

10) Thou shalt remember you are human.

At the end of each day, you need to take a deep breath. Being a physician, nurse, physician assistant, nurse practitioner, patient care technician, EMT, paramedic, or any other staff member that cares for patients, will be hard on your mind, body, and soul. You are not perfect. You have limitations. You should aspire to be your best but accept that you will have some bad days. Perhaps many bad days. Learn to laugh at yourself. Develop a tough skin to receive criticism and use it as an opportunity to improve. When you see patients and their families suffer, allow yourself to feel their pain and empathize with them. Humanism is sorely lacking in healthcare today. Patients, doctors, and everyone around can tell. Bring humanism back to medicine.

If you have any feedback, suggestions, comments, criticisms, or advice, or if you want to add your own commandments to this list, please comment or reach me at sspatel@umem.org or @S_P_MD!