Here's What I'd Say

Hi everyone,

Now that orientation is behind us, I’ll admit I was worried. With COVID keeping us apart, I couldn't see how we'd pull off workshops, boot camp, ACLS and central line training, and all the getting-to-know you events. Clearly, I underestimated our team.

We'll have to make up for the picnics, though. There’s no substitute for pizza, hot dogs, cold beer, and gelato. Unscripted conversations, meeting partners, learning where everyone’s living and how they spent their fourth years. Sharing how excited we are that the interns are finally here.

Inevitably, these conversations wind their way to tips on how to be a successful intern. There's a generic answer: show up, work hard, and don't worry, you're going to be great. But if you’re looking for specific advice, here’s what I’d say:

1. Take your own histories. Charts are rife with inaccurate and missing information. Key exposures, mounting symptoms, and details patients held back- until you asked. To paraphrase Osler, patients will tell you the diagnosis, if you listen.
2. Think for yourself. We have brilliant consultants, but you know your patients best and no one has a monopoly on wisdom. Be respectful and consider what others have to say, but at the same time, look things up and think critically. In the end, your patient’s care is your responsibility.
3. Be concise. Long notes and presentations are hard to follow. Don’t bury the message. Filter, focus, and get to the point.
4. Beware of copying and pasting. Too many notes overflow with rubbish, like plans to order MRIs that are already done, or questions about diagnoses that are already made. Don’t risk your credibility. If you copy and paste, proofread carefully, and never ever copy someone else’s note.
5. Circle back. Visit your patients at the end of the day. Did they pee? Did the albuterol help? Do they have questions? Your patients want to see you again.
6. Schmooze. Ask patients about their kids, their pets, and their hobbies. Discuss the weather. Smile and laugh. Non-medical conversations build trust.
7. Call the PCPs. Keep outpatient physicians in the loop. Many have known their patients for years and can share insights and historical details (see #1 above). They may have already addressed the issues you’re wrestling with. Route your notes to them in EPIC or give them a call so they’re ready to see their patients after discharge. It’s a welcome courtesy.
8. Avoid PRNs. Remember you may not be called when PRN orders are given. Don’t you want to know why your patient needed Tylenol or Ativan or why the oxygen had to be increased? When you write PRN orders, you’re signaling you don’t need to be called. Is that really the message you want to send?
9. Document. Whenever you see a patient, write a note. Every time. Don’t make the covering teams wonder why you ordered a head CT, sent blood cultures, or got an EKG. Describe your findings, your concerns, and your plans. Event notes are precious.
10. Ask questions. If you don’t understand something you’re probably not alone. What’s an ESBL? What’s organizing pneumonia? Is there a disorganizing kind? Word to our attendings and senior residents: please role model humility. No question is silly or too simple.
11. Search for the root problem. It’s no great accomplishment to diagnose poorly controlled diabetes and to order insulin. The best physicians discover the patient is living with homelessness and can’t afford her meds. What good is it to prescribe insulin if she doesn’t have a refrigerator or money to fill her prescription?
12. You’re right, it’s hard. Interns have a weird tendency to think they’re the only ones struggling, or that they’re not going to survive the year. I felt that way. So did your attendings and seniors. Be open with each other. It’s easier to climb this steep hill together, and we’re all going to reach the top.
13. Have fun and take care of yourself. We have a long year ahead of us. Enjoy the learning. Relish special moments with your patients. Nourish friendships. Take pride in your expanding skill sets. And remember the four tenets of wellness: eat, sleep, exercise, and socialize.

There’s more, but I’ll stop there and save some tips for the meals we’re planning over the summer. We’ll be in touch soon.

Enjoy your Sunday, everyone,

Mark

PS This week, I’m heading for the Eastern Shore of Maryland for a mini-vacation before starting as Fitkin attending on July 6.

MDS