For The PGY-1s

Prelude: In the medical world, the new year begins on July 1st. This typically marks the day when brand new first-year Residents all across the country officially begin their jobs as Doctors. Ask anyone who's worked at a hospital long enough, and they'll probably tell you to try and stay the heck out of the hospital in the month of July as the new docs settle into their roles. Suffice to say, July is a nerve-wracking month in the medical world, and especially in the lives of the PGY-1s.


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Dear Doctors,

For the past two weeks or so, I've been in a weird place. It's been bittersweet and a little weird, "watching" all of you heading off to your new Intern/Resident orientations where you've no doubt had to sit through countless hours of BLS and ACLS, suffer through scrub orientations, computer training, etc. I've also seen/heard/listened to a lot of talking/tweeting/status updating about stuff like "who decided it was a good idea to let me be a doctor?" and "I'm not ready to grow up yet!" and basically just a lot of people coming to the realization that in a few days, this doctor business is all going to get REALLY real. Of course for those of you who have already begun, it's already gotten real, and I apologize for the delay in this post.

I'm certain that if I was in your position, I'd be feeling the exact same way. But I'm not, so that gives me a little bit of perspective. Sure you've put in four years of schooling and a crapton of studying, but up until now, you've been the student. There's always been some one watching out for you, who double and triple checks your work and makes sure that you're not going to screw up your patients too badly. You've written your A&Ps but nothing gets done until everything has been fine-tuned by a higher power. As a student, the final decision is never yours. So it's pretty weird then to flip a switch and to suddenly go from that student to the Intern who is responsible for everything. Obviously there are senior Residents and Attendings but for the first time, the onus of truly making and implementing patient care decisions lies on your shoulders. That's pretty terrifying. I get that.

But here's the thing- it's also awesome. To have that capacity, to have that privilege- of being able to truly work to save patients' lives- that's amazing. It's what we've worked for, not just for the past four years, but in more or less every moment leading up to this one. Do you remember what you wrote in your personal statement when you applied to medical school? If you don't, I urge you to re-read it and remind yourself why you set off on this path to begin with. Or just read the quote in my header- you love this playing field.

I know that the prospect of finally beginning your career as a full-fledged doctor is scary, but that's how it's supposed to be at the beginning! First days are always terrifying, and yet they almost, always get better. Plus quite frankly, if you weren't anxious, I'd be kind of scared for your patients. A little bit of fear is good- it keeps you on your toes and it forces you to do more and to do better by your patients.  You wouldn't be here if people thought you didn't have the capacity to handle it. You will figure out what you're doing and you will learn to do it well.

You're not going to know everything at first- unless you do, in which case, tell me your secrets! But seriously, don't be afraid to admit when you don't know something- chances are the quality of patient care you deliver will be vastly improved if you take the five seconds to look something up or ask a Senior a question. Project confidence, but remain humble. Know when to ask for help- your patients will be grateful. Pay attention to the details. Don't be an asshole to your co-Residents. Follow up on your labs. Don't leave grunt work to the covering Resident. Treat your med students well-a month ago you were in their place. Don't be complacent. Don't have a stick up your butt either. Read up on stuff you're not familiar with. Eat breakfast. Stock up on your favorite pens. Stock up on some Ibuprofen too while you're at it. Stay hydrated. Have a system for approaching each of your patients and stick with it! If you're overwhelmed, ask for help. Don't be late to sign-outs. Be nice to the nurses- they probably know more than you do at this point. Kill people with your kindness. Or er, on second thought, given the field you're going into, don't think about killing people at all. BE NICE! But not so nice that people take advantage of you. When you have a day off, detach yourself from the hospital and remind yourself what it's like to just be a human being, sans the MD. Visit your families, go out with your friends, play with your kids, explore your new town, catch up on all that TV you missed, write me a letter (hinthint)...whatever it is- do something that makes you happy.

I know that some of you might be reading this and thinking- she has no idea what she's talking about. And yeah, it's not like I've been through an Intern year or know what it's like to be a Resident. My "advice" really just comes from the experiences I've had as a third and fourth year medical student. We've all worked with a lot of different interns, residents, and Attendings and I'd like to think that in doing so, we've formed our own idea of what being an effective physician entails and what it does not.

I ran into an old Intern of mine a few weeks ago. I was her very first medical student when she began her Intern year, and we had a hectic three weeks together. Three days into her Intern year, an extremely sick patient of ours coded. As much as we went into medicine wanting to save lives, a huge part of this is learning how to deal with death. Everyone's first patient death is tough to handle, even in this particular case where it was mostly inevitable, not entirely unexpected, and not at all anyone's fault. We just don't like to admit that we can't save everybody. All I could tell her, repeatedly, for those first three weeks was that it would get better. Fast forward to 2 weeks ago, when I ran into her again and found her effortlessly managing 85 patients on a nightfloat shift without breaking a sweat. Gone was the uncertainty and confusion. It was replaced with confidence, skill, and experience. I pointed out to her "See! I told you it was going to get better!" and she smiled at that and said "Yeah. It definitely got a lot better."

It gets better guys. It really does.

So go forth and be awesome! You've got this. You really do. And as much as I may believe that, truly it's YOU that needs to believe that deep down inside you have exactly what it takes to be a great physician. It's going to be a bumpy road at first, but you will get there. You're going to survive Intern year and go on to become Residents, Chiefs, Attendings, Department Chairs, Residency Program Directors...whatever your heart desires. This is YOUR playing field and now is your time to shine. Again, I don't know who reads this, but I can unequivocally state that I am truly happy for and proud of each and every one of you brand new doctors. Congratulations again!

No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man, and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less.  

- Harrison's Principles of Internal Medicine, First Edition

Much Love,

S