June 28, 2017

A Letter to My PGY1 Self

This reflection was first published on LinkedIn for Match Day with advice to those who just learned about where they would be doing their residency training. Intern year training starts July 1 for hundreds of doctors around the country. The next phase of training will bring a mixture of emotions – it will be exciting, unnerving and unforgettable! Below are my reflections, shared on Match Day, about my experience as a PGY1 just a few years ago.

Milestone: an action or event marking a significant change or stage in development.

In other words, the experiences that punctuate, often vividly, our everyday moments. Remember your first kiss? That feeling of moving away from the safety of home to build your own? Being accepted to medical school? That rotation, or patient, where things started to feel… right? Well, here comes the start of PGY1 training. And, yes, you’re going to bucket it with those other items. Residency, and intern year, is going to teach you a lot. When to order a test. Just as importantly, when not to. Learning to trust that instinct that “something’s not right,” and methods to chase down the answer when it isn’t. Adeptly applying that deep fund of scientific knowledge, gracefully, will be the hallmark of the most skilled resident. Man, it’s hard! You need to be right while being friendly. When you’re sleep deprived. And hungry. Probably both. You’re going to get a call at 4:00 AM – 18 minutes after your head hit the keyboard – to admit an individual that you might otherwise classify as “less than desirable.” But, here’s the deal: when you walk into that ER bay – after gelling your hands outside – remember it’s a privilege to be there. This summer marks five years since I completed my Internal Medicine residency. I’ve spent time as a hospitalist, a chief hospitalist, a hospital medical director, an entrepreneur, a market medical director, and currently, a Chief Medical Officer of Transitional Care, matrixed to over 2,200 hospitalists in 38 states. It’s been a great run. As expected, I’ve learned a few things along the way. As with most things, though, those lessons were learned the hard way. If I may spare you, notes to the new trainees…

One day you’re going to cry.

That’s OK, though. Figure out now whose shoulder you want it to be on. It’s because you missed something. You breezed over the physical exam at 4:00 AM. You noted the patient was on 14 medications when you reconciled the home medications but forgot #12 when you ordered DVT prophylaxis. Whatever it was, someone got hurt. You made a mistake. And you’re going to want to quit that day. Don’t. Own it – it’s called integrity. And, yes, you’re going to remember the patient’s face. Her name. Cruel or not, it’s a reminder that you’ll never make that mistake again.

You’re on a Team.

A care team of specialists, nurses, phlebotomists, physical therapists, case managers. Your job is to learn your part to the best of your ability, then perform it with consistency. All in sync, teamwork. Many times yes, but it doesn’t always work out that way. So remember, teams need a captain. An individual, just one singular person, who is an amalgamation of knowledge, strategy, excellent communication, and emotional support not only to the patient, but the rest of the team. That’s you now. Think about the person you love most in the world. Now every time you meet a patient pretend she’s that loved one. Do that and you won’t forget to speak up when you need to… and be quiet when you need to.

Come closer. A little closer. I need to tell you something.

If you’re in it for fortune and glory, you chose poorly. This gig is like the CIA. Nobody hears about the hundreds, thousands of ‘saves.’ Nope, only about the misses (see #1). The amazing thing is overall you’re going to do a lot of good. You’re going to prevent a life-changing event for a patient and his family. Sometimes you’ll get thanked. Often not. That’s OK, too. Take pride in your work. You will labor to assuage or prevent the suffering of others. It’s called service. It’s a calling and a privilege.

Learn your craft.

Like most things, you’ll get out what you put in. Also, like too many things, you get one shot. So work hard. Don’t have regrets. Don’t push back on that admission unless you have a good reason. Don’t kick the can down the road and address the preventative screening on the next visit. The foundation of quality and lifelong learning will be laid in the next few years. Do it right.

Be innovative. Always.

While the vast majority of the medical literature is binary in what is correct or incorrect – and you need to learn that and heed its advice – never forget the person in front of you. A man with wants, needs, and fears. A sense of humor. A favorite cuisine. Someone who loves, and if lucky, is loved back. What ‘better’ looks like to him sometimes looks very different than that randomized trial you just read. Your value is knowing what the literature says and what your patient says. Then putting it all together to create his perfect solution. One of the most valuable lessons I’ve learned, though, is that this mantra applies not only to individuals but organizations as well. Congratulations on finding your place. For reaching another milestone. The next one will be graduating residency. And, yes, just to be clear, it is all about how you choose to spend the time between…

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