Lauren Van Scoy, MD currently serves as the Chief Fellow for Pulmonary and Critical Care in Philadelphia. She wrote Last Wish: Stories to Inspire a Peaceful Passing independent of her work at Drexel University College of Medicine and Hahnemann University Hospital. The opinions expressed in her book are her own and not the opinions of her employer or her training institutions.
If you’re a medical student, an intern, a resident or a fellow, then you can skyrocket your learning and your Boards preparation without adding time to what you do already.
You already go on rounds with your attending. You already attend conferences, classes, and morning report. You already go to Grand Rounds. And you might already go to Boards prep courses.
Well, check this out… with one tweak, your learning experience can go from okay to phenomenal.
If you want to get this amazing pen, you can order it from Amazon.
If you are an institution (a medical school, a residency program, etc) and you would like to learn more about how this concept can help your organization go from good to completely awesome, then go to NapkinRounds.com.
(In the interest of full disclosure: some of the links in RookieDoc posts are affiliate links, meaning that I might get a small commission if you purchase them through my link.)
One of the RookieDoc members shot me an email asking me about the pharmacology references I recommend to carry around in your white coat as an intern or a resident.
Here was a portion of our exchange:
I noticed you recommended Tarrascon Pocket Pharm – which edition is better, shirt pocket or lab coat pocket? I know the shirt pocket is a lot smaller, but will that be enough? It would be nice not to have to tote around a bigger book…if you could let me know what you think that would be great! Thanks again! I appreciate you getting back to me so quickly.
You’re right, it’s better to carry around the smaller book.
Heavy stuff in your pockets eventually causes neck pain, back pain & headaches… and it usually takes people 6 months to a year to realize that that’s the problem.
Too many sources of information can be distracting.
Too many sources of information can be a time suck & leads to inefficiencies.
The more you can learn to use the resources around you, without depending on a single resource, the better… this isn’t necessary early on, but eventually, when you’re out in the working world, it will be priceless.
Internet access is everywhere – check to see if your program has access to some of the online resources – the online version of ePocrates, UpToDate, etc.
If you have a phone or a PDA, I’d skip the book & get ePocrates (even if you just get the free one)
Lastly, along the way, stay conscious of those times you say “Darn, I wish I had such&such”. If that occurs more than once, go out and get such&such.
Whatever you buy, save the receipt… and submit it for reimbursement if you have an education stipend.
What should you do now that the NRMP Match is over and you’re preparing for your internship and residency? Well, I just posted some quick residency preparation tips for things you should do (and things you should not do). Here’s the video from YouTube:
Residency tips and pearls should be a little more accessible than having to ask all of the time. Especially because there are some questions people are reluctant to ask… like about stress. Here are some coping tips for internship and residency…
No baby yet, so I had time to address some questions… One question was posed (on a forum) about extreme levels of stress and anxiety in internship and residency. Here was my response. Some of these tips and pearls come from the free report you can signup for at the right (just put your name & email in there & follow the directions… easy-peasy). Some of the other tips & strategies come from RookieDoc members-only videos. And some of the others were specific to the questioner. Anyway, check out my response and let me know if it helps you.
What you have expressed is ultra-common. It is, by far, the biggest thing I deal with every year from May to about October. I give talks to and provide services for new interns… I’m not going to plug my stuff here, but I am going to give you some background and a little proof that it is common.
When I started internship, I came in pretty average or slightly below average. I felt like any minute I was going to be declared a fraud & that somehow this whole medical school thing was actually a mistake. I was also immensely fearful of hurting someone.
Because of those two things – harming someone & being declared a fraud – I was always the first one in… always the last one to leave… At night I was dreaming about my patients. During the day I had palpitations, fatigue, reflux, etc. And throughout the day I was dreading any situation in which I could be called on or humiliated. Now, I wasn’t paralyzed with fear and I did my best not to show it, but I was definitely burning out.
So much so, in fact, that there was an intervention. Two attendings pulled me aside and took me under their wings.
One & a half years later I was Resident of the Year, then Chief Resident, and now I hold a prestigious position at my institution. Now the unfortunate thing is that not everyone gets attendings to guide them through it all (despite the whole idea behind our training). The fact is, you’re right, many people do talk about specific interns behind their backs. Some even pigeon-hole them into categories and give them labels that stick with them throughout their training – passed from attending to attending.
So I started giving talks to new interns and started some web sites and services. In the process, I have interviewed or surveyed well over 1100 interns anonymously and as a coach/counselor.
And guess what? Most of them list those same two top fears that I said I had. (My surveys always ask for the 3 top fears… and these 2 are the most common) Fear of harming someone is always number one… and fear of being the weakest link or worst of your peers or exposed as a fraud – almost always number two.
So what you are feeling is more common than you think. Actually, it’s probably normal.
Now, is it as intense as you describe? Not usually.
Now, on to some things to help cope…
1 – You are not alone. You know when you’re sitting around with the whole team – the students, the interns, the residents, maybe fellows, and the attending? And you know when the attending starts throwing questions out to the group? At that moment, everyone is secretly hoping they’re not called on. Everyone is eager to blurt out an answer when they know it… because they want to be absolved from answering the ones they don’t know. (Incidentally, because of this fear, I always start with the students, then the interns, then the residents when I’m asking questions to my team)
2 – The 10-Year Litmus Test. Ask yourself, “10 years from now, will any of this matter?” And the answer is no. It will not.
3 – Strengthen Your Strengths. This might sound like an odd suggestion & maybe even unrelated, but it is not. Most people are worried sick about their weaknesses. But think about this… How are you going to stand out? How are you going to provide the most value to your program? How are you going to forge the career you want, that’s in line with your passions and goals? Do you think you will do these things by working on your weaknesses? No.
If you want to stand out… If you want the people around you to say good things when you’re not there… If you want to like the company you keep… and if you want to make an impact in your patients lives or even on the world at large…
Then you should strengthen your strengths. Provide value to your program and your patients and your fellow interns with the areas you are strong in. (Related to medicine or not)
4 – Compare Yourself To Yourself. Too many of us worry where we stand relative to someone else. Like you said, “i will compare myself to my class mates and convince myself that they are all so much better than i am”. You are comparing what you know of yourself to what you do not know of others. You have no idea what they are thinking… what their fears are… or even what attendings think of them… or the vibe that patients get from them… or whatever. The best comparison to make is “This is where I am now – am I better than a few months ago? And how much better do I want to become?”
5 – You Are Not At The End Of The Road. Just because you are a doctor doesn’t mean that you are done. You are not at the “end of your training journey”… you’re right in the middle of it. You’re in the middle of the process. Trust the process a little bit.
Thousands of interns have come before you and thousands will come after you. All have their strengths and their weaknesses. This process helps make those weaknesses into competencies (maybe even strengths depending on you and your program). But the ultra-successful ones will be the ones who leverage their strengths.
So trust the process and add value along the way.
6 – It’s All About Communication. It’s not about knowing the right answers or even ordering the right tests the first time around. Those things come with time.
The best doctors are the best communicators. (By the way, so are the best wives, husbands, parents, etc) More on this another time.
7 – Avoid Complainers – Steer clear of complainers. Complaining is infectious. And whining will get you nowhere.
I get hundreds of questions about residency training, internship, and the clinical years of medical school. Lately, it seems that I have been getting more & more questions pertaining to preparing for residency when you have babies at home.
Well, here’s one email response to such a question. This is Tip #29 from the Residency Tips Series.
If you’ve got a question of your own, just ask. (I will not publish your name or other personal identifiers unless you’re giving me a testimonial & you give me permission to use your name.) In fact, you can ask the questions anonymously if you want, but I won’t be able to get back to you unless you leave your email.
Anyway, on to Tip #29…
I received your question from the RookieDoctor.com site and I wanted to offer some insights.
(“I have an 11 month old baby, Would I be able to manage my work and my family?”)
First of all… congratulations on the baby
Is it possible to manage your work and your family with a little one in the house?… absolutely. However, it takes some planning and it will be a source of some stress at times.
My wife and I were in the same class in medical school. And we had a child at the beginning of our third year of med school, and another at the end of our internship, and yet another right before residency ended. So, we’ve dealt with a lot of the same things you are about to go through. That being said, your situation is unique to you.
The first thing would be to assess your support structure and your “allies”. Possible support includes your family, your spouse’s/significant other’s family, your spouse, close friends, your siblings, your parents. Again, I don’t know your situation. But, don’t assume that others are unable to help in some way. It may not be watching your child during the day or call-nights, but for some it may be as simple as picking them up from someone else’s house, or picking up diapers the next time they go to the store, etc. It will be difficult to ask for help in some cases, but you may just have to.
By assessing your allies, I mean people that you may not be close to right now, but can offer some support in some way. One ally might be an upper level resident who previously went through the same thing. They know the residency program you are in… they know who is easy to approach about this subject and who should never be approached… they know local resources… they may know of an attending that lets residents leave for family reasons, etc. You might say, well, I didn’t start yet and I don’t know these people. Guess what? A great resource for who is who is the department secretaries. They know the gossip. Ask them… “Has anyone recently gone through this program with a baby at home? I just need some tips.” You can also ask them, “What do you recommend?”
Another ally might be the chief resident… Let’s say you know your spouse has a particularly busy time of year coming up… you can ask for lighter schedule/electives around that time… Vice versa… if you know you’ll have more support at a particular time of year, then see if you can do your harder rotations during that time. Again, this takes planning. You’ll need to review your yearly block schedule and try your best to make arrangements as early as possible.
And the more stuff you have pre-packaged, the better. Let’s say you want to do a critical care rotation in December because you will have more support at home… well, look for someone that has critical care in December and ask them if they’d be open to switch (most would prefer not to have a call month near their holidays). If they are open to switching, then just mention that to the chief resident or whoever controls the block schedules. The less they have to do, the more likely you’re going to get what you want.
Another thing is… don’t waste any time. When you’re at work there is going to be downtime. You should take care of things you can during that time… you need to pay your bills, work on a presentation, arrange a doctor’s appointment, signing charts (if you have to dictate), filling out forms, etc. Surfing the internet, gossiping, etc are all completely a waste of time and will take you away from things that will free up time at home. Very important.
There are two very important things to prepare yourself for:
Communication is of the utmost importance. Your non-medical family and friends (your support network) will not understand what you are going through. They won’t understand that even though you’re at the hospital or office a lot, you may have to come home and read or prepare a presentation, etc. They need to know this and they need to know why it is so stressful for you. And I mean a sit-down-heart-to-heart “Mom, I’m worried” “Honey, I’m scared.” etc.
Communicate with your co-residents and your chief resident. Apologize when you inconvenience someone. And don’t assume that you know the answer. You might surprised what happens when you just ask.
Guilt is probably the toughest. You will miss things like bedtime, bath time, important milestones, etc. You will have to deal with crying when you leave (your child and occasionally you).
I was just in a semi-severe car accident on Friday. And if there’s one thing that’ll change your perspective on life, it’s a near-death experience. I will be making a video on my thoughts before, during, and after the crash… my thoughts as a husband, as a father, as a son… as a patient in a hospital, as a doctor, and as a human in general. Until, I finish that video, I found one that is a must-see.
If you’re a parent or if you have parents (which means you), you must watch this video. Although it is not in English, there are very few words… and it has subtitles. The lesson is priceless.
Because of the time constraints we face as physicians and healthcare workers, we run the risk of harming our loved ones. Don’t take them for granted… they may not understand the pressures of being post-call, preparing for presentations, applying for fellowship, etc, etc. They’ve supported you through the years… don’t go through your clinical years of medical school, your internship, and your residency assuming you will have time for family and friends when these milestones are passed. You may be harming them in the meantime.
Watch this video… it’s only a few minutes. Then take a few minutes more and ask yourself the following question: “What can I do today, right now, to improve a relationship with someone I care about?” (even if it is small)
I’ve started a Residency Horror Stories series. The point is not to get you nervous about your training or being on-call or anything like that… In fact, it’s quite the opposite.
Most people think they learn best through experience. That’s true, for the most part… but there’s another piece of “experience” that is even more important than the experience itself… and that’s “the story”. We remember things as stories. We further ingrain the memory by retelling that story. And each time we retell it, there’s an opportunity to extract new insights from it and an opportunity for the listener to benefit from your story.
Now some of the medical establishment (the Old Boys Network) may be a little upset with me for saying this, but… the dry, factual version we often present on rounds is not always optimal.
Which one are you going to remember?:
49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, hypotension, and diaphoresis. Her EKG demonstrated 3mm ST segment elevation inferiorly. Cardiology was consulted and she was emergently taken to the cath lab. After a brief Vtach arrest requiring 260 Joules for return to sinus rhythm, her right coronary artery was successfully stented with two Taxus stents with good angiographic results. She was transferred to the CCU in stable condition with an intra-aortic balloon pump, IV heparin, Plavix, and aspirin.
It was my first week as a second-year resident and I was on-call in the CCU. I was called stat to the ER for a CCU admission that was described as a “49 year-old obese female with a history of type 2 diabetes and smoking who presented to the ER with severe chest pain, shortness of breath, and diaphoresis.” I was told that cardiology was consulted via phone & they recommended transfer to CCU after a VQ scan.
I went to see the patient & there’s a morbily obese lady lying in Trendelenberg, IV fluids wide open, heart rate in the 40s, and huge “tomb stone” STs on the monitor. I introduced myself and told her that we would take good care of her. She looked up at me and said, “Son, I’m gonna die tonight if you don’t do somethin’.”
I went to the ER doc and said, “This lady’s clearly having a huge RCA MI! She’s bradycardic, hypotensive, complaining of chest pain, & her EKG… well, look at it! We can’t send her to the unit with a VQ scan.”
He responded, “Well, I talked to the cardiologist on-call.” And I asked, “Well, are sure he understood what we’re looking at here? I mean, no offense, but sometimes it’s all in how we say it. I think you should call him back.”
Well, he did… the ER doc called back the cardiologist on-call and got screamed at… loud enough for me to hear it through the phone from about 4 feet away. “I said!… Admit to CCU and get a VQ scan!”.
He hung up. There I am, a new second year, one of my first nights with any kind of real responsibility and I’m disagreeing with the ER attending and the subspecialist. What should I do?
Well, there was no question… that lady said to me, “Son, I’m gonna die tonight if you don’t do somethin’.” So I did… I firmly asked the ER doc, “I’m not comfortable with this! Are you comfortable with this?!” He said, “No… No, I’m not.” So, I asked, “Well, how about TPA?” He paused… so I snatched the EKG out of his hands and ran 3 floors up to the telemetry floor. There was a cardiologist (from a competing group) and I shoved the EKG in front of him and said, “49 year old lady in Room 8 in the ER, tons of risk factors, heart rate in the 40′s, telling me she’s going to die… no labs back yet.”
He said nothing to me. He picked up the phone and called the cath lab. Together he and I wheeled her into the lab. While we were lifting her to the table, she arrested….
So which one are you going to remember? Which one will give you strength to do the right thing when the time comes. Both of those versions are true. I lived through it. More importantly, so did the patient, but not before her night got much, much worse. I’ll tell you the full story and the lessons learned in the second video for “Residency Horror Stories”… the first video will be in the next few days.
Do you have a story we can all benefit from? Tell us. Here’s the link again:
Debt sucks. And if you’re like me, you probably chose to sort of ignore it at first. That’s what I did… early on anyway. At first, I bought into the fact that doctors were higher wage earners, in general, so I assumed that I would have no problem conquering my debt after residency training.
Well, in my third year of medical school, I began to overhear occasional conversations by attendings and upper level residents complaining about their debt. I saw some of my non-medical friends from college begin to buy houses and cars. And I thought… if the debt burden is already going to be huge, how is that new doctors are able to buy homes right after their training? Do they just add more on top of their already large mountain of debt?
What would happen if there were a life-changing event? A chronic disease? A severe accident? Or a delicate family issue that needed tending to? There’s no way they could leave their jobs, even for a short while, with all of that debt… right?
Well, I saw something horrible happen. A third year resident in internal medicine had begun to develop strange neurologic symptoms. After extensive testing, it was discovered that she had multiple sclerosis. I watched her deteriorate in typical step-wise fashion from a fully functioning resident… one of the best, in fact… to the point where she needed braces to walk. I hear that after I left that hospital that they allowed her to complete her residency even though she couldn’t really finish all of the rotations. Although she probably had several options after her training – consulting, writing, etc – I couldn’t help but think… what if that were me?
What would happen to my wife and kids if my debt came due and I couldn’t work? Anyway, I digress. Let’s get to the next video.
In this video, I show you how I rapidly… and I mean rapidly… got out of debt. This is Part 1 of a two-part video. Even though Part 2 is only available to members, this one gives you the exact step-by-step plan I followed. Click this video’s image to get started. (It might take a few extra seconds for the video to start. The file is a little large.)