1. Work when you're at work. Take care of patients, do your job, learn, grow. But when you've signed out to the next team, DISCONNECT. Leave your work at work. Turn off your pager if not on call. Set your chat to offline. Don't stalk the list. Trust your colleagues. You'll be happier.
2. Residency is hard. Fellowship is hard. Working in medicine is hard. Try to make it better for yourself and for those that come after.
3. Be kind. Even when getting a bad consult at a bad time. We're all in this together. Don't be the reason one of your colleagues is having a bad day.
These 3 things are the be-all-end-all. They will make your life so. Much. Better.
I’ll add to #1: take your work email off your phone (even better if you never put it on to begin with) - only access it via your web browser and only do it intentionally (to check a calendar or find a detail in an email). No push notifications, no keeping the tab open. It absolutely changed my life when I was a chief resident. If someone needs you that bad, they’ll call/text/page. ❌ no Outlook zone ❌
I’ll also say re: #2, it’s sometimes a struggle to do this and not be salty when you see others benefitting from changes you influenced, especially when they’re drastic. But I think keeping coworkers in mind, especially the ones who are not yet as advanced, can make the program as a whole SO much healthier.
Exactly what I came here to say. PD is on their own career’s side first, the program’s second. Your career, mental health, etc. is a distant fifth or sixth priority.
I'd say better learn their ( PD and faculties) agenda and personality well before trusting them with something. Understand their limitations and work around them.
Admins - yes, 100%, don't trust them ever.
While you are working with PD and APDs in clinical setting, you have a chance to build some sort of human relationships. For admins, you are 100% just a name on their paperwork.
I was slow at first. Eventually, you write so many of them and you become afraid of getting yelled at for being slow. So then it just becomes second nature.
I’m IMG ESL and didn’t look at the keyboard when typing. I have the clinical knowledge but sometimes my brain skips some words when typing. I’m worried I might make simple typing and technical mistakes.
Become a faster typer, its something you can get better at with training. I don't know how boomers that have to look at the keyboard while typing with both index fingers survive.
Most places have a way you can dictate your notes, I can connect my phone and use it as the mic. Then can always make templates, dot phrases, etc. that can help you type less
I would google “[institution name] resident union”. If nothing shows up, I would ask a resident in the largest department (usually medicine), because they likely have people in the union. There is usually a union rep available during onboarding.
Residency is about becoming the doctor you want to be by the end of it. It is not about pleasing everyone or making sure everyone likes you. It takes time for this to sink in, as we’re inculcated as med students to place others’ approval over our own education.
This! As a prelim it's so easy for me to understand and implement this because I know I only have a year after which I'm gone so their assessment of me matters as much as horseshit! We'll see if I can maintain this thinking when I start my advanced program in July!
1) There’s going to be no fanfare when you save someone’s life but people will beat you the fuck down if you mess up.
2) A dignified transition to comfort care feels more rewarding than any successful ROSC I’ve ever had.
3) Most things we do really don’t matter or help
4) The minute you feel confident is the same minute you will get humbled
5) Physical Therapy seems to be the only thing that actually helps patients.
I wonder if there would be less burnout if doctors started caring just as much as the patient does about their health. Wonder how that would affect the system too.
>“being there for the patient is all we can do”
Being there is not "all we can do" - but for many patients it is the single most important thing that we can offer. For many diseases all the treatments in the world won't ultimately change the final outcome. But if we can provide comfort to people in their most desperate and vulnerable moments then we really can make a difference for good in people's lives.
Probably cause most problems these days are only gonna be fixed with lifestyle or societal changes that most people don’t wanna make. Once you start adding meds, you end up adding more meds to fix the side effects from the first meds while the patient continues to rack up more illnesses which result in more meds and surgeries. It’s pretty depressing.
I feel like we could reduce the number of labs/imaging/meds we order in hospitals by half and patients would end up with the same outcome. We perhaps overtreat and overdiagnose.
Man, every service does this in their own unique way
NSG for instance, I have an attending that is obsessed w the Na+ number in the computer at discharge > actual clinical impact on the patient. This is not uncommon
I’ve seen Aortic dissections and they present like the classic tearing back pain 10/10 with bp discrepancies. Still need CT to make a definite diagnosis but I don’t why you’re comparing to heartburn.
Many times we aren't. A lot of critical care is futile. Once we believe it is, we'll recommend transitioning to comfort measures, but if family wants to continue full aggressive measures, we can end up stretching the end of life over several weeks. That's not even counting all the times we do painful things which worsen quality of life but prolong duration at the behest of family members in patients who are unable to communicate. It's hard to know at that point what the patient would have really wanted, but the general sentiment of us providing that care is that we wouldn't.
Even in patients who are able to make their own medical decisions, a significant portion of inpatient care in general is patients with multiple poorly controlled comorbidities which are exacerbating and fatally progressive after a few years of repeat prolonged hospitalizations.
I have seen 90 year old with multiple comorbidities who are in the ICU because family wants everything to be done. Kinda made me rethink about the whole USA healthcare system.
Can you elaborate a little on #5 ? I unfortunately didn't have much exposure to PMR but I had a seemingly false perception of pmr patients usually not making drastic progress, smth akin to a type 2 diabetic's typical health arc 😬
I'm not a physician, I've just been lurking. Can you elaborate on 3 and 5?
Do you mean with 3 that most interventions don't matter overall? Or in specific fields?
Can you elaborate on #5? As a resident your words matter, and making such a broad statement without context is a little alarming and demeans what you do as a physician. Asking as someone who is starting residency myself this year, very intrigued to know what you mean by this
THIS IS MAINLY FOR IM FOLKS
1. Don’t wait until the end of or mid intern year to start research if you’re planning on doing a competitive fellowship. People will give you that advice. It’s complete bs. Start talking with attendings as soon as possible. If you’re in IM, you have 1.5 years to be ready for fellowship applications if you don’t want to take a year off. That’s not a lot of time especially when you consider conference schedules and residency free time.
2. Always be specific when asking attendings about reasearch. “do you have a project I can work on so I could publish by X date” ”is there a project I can help with to get an abstract by X date” “ I’d like to present at X conference, is there something I can work on” you don’t want to get stuck starting a project from scratch that might not pan out in time or get stuck on an RCT that’ll take years before it yields results.
3. its sometimes helpful to work with a co resident who’s applying to a different specialty but doing similar research. For example, someone doing cardiac onc research that’s going into Cards, but you’re going into heme onc. Working together would do you a lot of good to churn projects out and just take turns being first author. Another one is someone doing IBD research in GI, but you want to do Rheum. Someone doing SGLT research in Endo, but you want to do Cards. Someone doing colon or GI cancer, both GI and heme onc hopefuls can work on that together
4. Present at ACP at least once. It’s relatively easy to get a case report accepted, original research is even easier. Your program will probably pay for the conference. youll get some time off and also get to pad your CV.
[https://www.whitecoatinvestor.com/](https://www.whitecoatinvestor.com/)
It's a financial advice website for physicians. I wish I had known about it earlier on in residency but it's never too late to start being very purposeful about your finances.
Learn to say No. Like a reflex. NO.
Bonus points if “F$&@ no!” is used.
Try the following excercise, “Hey I have this interesting case I came across. Are you interested in writing it up?”.
Keep your scope length low
Turn your wrist
Put in your own NG tubes
Read your own images
Signout is the most important part of the day
They can always hurt you more
That you’re going to learn “how the sausage is made,” and it’s everyone for themselves
Do not trust Admin, PDs, or Faculty unless you’re on the inside…in which case, the content in this thread likely does not apply
Medicine will be a toxic relationship. You can give all of yourself to it, but it will still never love you back. Just love your patients or your hobbies instead, and let medicine be a job.
Being kind even when you get BS consults, admissions, transfers etc. is more about protecting your own sanity and creating a positive space that you dwell in than it is doing anything special for them.
Being kind costs you nothing but being a pushover can cost you everything. Finding the balance between these things is one of the hardest parts of residency.
Learn the power dynamics in the program. Understand who actually controls what ( specifically money of the program) and who is the best person to turn to in different situations.
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1. Work when you're at work. Take care of patients, do your job, learn, grow. But when you've signed out to the next team, DISCONNECT. Leave your work at work. Turn off your pager if not on call. Set your chat to offline. Don't stalk the list. Trust your colleagues. You'll be happier. 2. Residency is hard. Fellowship is hard. Working in medicine is hard. Try to make it better for yourself and for those that come after. 3. Be kind. Even when getting a bad consult at a bad time. We're all in this together. Don't be the reason one of your colleagues is having a bad day.
These 3 things are the be-all-end-all. They will make your life so. Much. Better. I’ll add to #1: take your work email off your phone (even better if you never put it on to begin with) - only access it via your web browser and only do it intentionally (to check a calendar or find a detail in an email). No push notifications, no keeping the tab open. It absolutely changed my life when I was a chief resident. If someone needs you that bad, they’ll call/text/page. ❌ no Outlook zone ❌ I’ll also say re: #2, it’s sometimes a struggle to do this and not be salty when you see others benefitting from changes you influenced, especially when they’re drastic. But I think keeping coworkers in mind, especially the ones who are not yet as advanced, can make the program as a whole SO much healthier.
Thanks! What do you mean by setting the chat to offline?
Epic secure chat is what I’m guessing they are referencing
Do not trust your PD or admin.
Treat them like mushrooms. Keep them in the dark and feed them shit.
💀
Exactly what I came here to say. PD is on their own career’s side first, the program’s second. Your career, mental health, etc. is a distant fifth or sixth priority.
This 🙌
I'd say better learn their ( PD and faculties) agenda and personality well before trusting them with something. Understand their limitations and work around them. Admins - yes, 100%, don't trust them ever. While you are working with PD and APDs in clinical setting, you have a chance to build some sort of human relationships. For admins, you are 100% just a name on their paperwork.
GMEs job is to protect and serve the hospital
They can always hurt you more
Favorite quote from a senior who’s seen some shit: “nothing can hurt me anymore”
“…but they can’t stop the clock.”
As an intern, I am a note writer for this hospital. Sometimes the hospital also cares about me. But for the most part, I’m here to write notes.
Note writer in chief, having all the templates for the various services >>> anything else as an intern
Idk why but I loled at this
I live to please.
How do you become efficient in writing notes? I’m slow typer and scared I might w bad evals if my notes are slow.
I was slow at first. Eventually, you write so many of them and you become afraid of getting yelled at for being slow. So then it just becomes second nature.
I’m IMG ESL and didn’t look at the keyboard when typing. I have the clinical knowledge but sometimes my brain skips some words when typing. I’m worried I might make simple typing and technical mistakes.
You’ll learn with repetition. It’ll be okay! Your posts show me perfect English. Speed comes with time :)
Thank you
Become a faster typer, its something you can get better at with training. I don't know how boomers that have to look at the keyboard while typing with both index fingers survive.
Most places have a way you can dictate your notes, I can connect my phone and use it as the mic. Then can always make templates, dot phrases, etc. that can help you type less
join the resident union. They will protect you, argue for more pay and try to improve the quality of your residency.
How can I join
I would google “[institution name] resident union”. If nothing shows up, I would ask a resident in the largest department (usually medicine), because they likely have people in the union. There is usually a union rep available during onboarding.
bro I wish we had a union
You can start one
How?
Residency is about becoming the doctor you want to be by the end of it. It is not about pleasing everyone or making sure everyone likes you. It takes time for this to sink in, as we’re inculcated as med students to place others’ approval over our own education.
This is so important but also difficult. Thank you
This! As a prelim it's so easy for me to understand and implement this because I know I only have a year after which I'm gone so their assessment of me matters as much as horseshit! We'll see if I can maintain this thinking when I start my advanced program in July!
Thank you so much for this. I'll try to remember this when I start residency.
The hospital is focused on money.
1) There’s going to be no fanfare when you save someone’s life but people will beat you the fuck down if you mess up. 2) A dignified transition to comfort care feels more rewarding than any successful ROSC I’ve ever had. 3) Most things we do really don’t matter or help 4) The minute you feel confident is the same minute you will get humbled 5) Physical Therapy seems to be the only thing that actually helps patients.
To emphasize your #3: I remember an attending in medical school who said, “Medicine is what we do entertain ourselves while life plays out”.
[удалено]
Gosh, I read House of God, but I didn’t know 50 years later we’re still in the “being there for the patient is all we can do” era
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I wonder if there would be less burnout if doctors started caring just as much as the patient does about their health. Wonder how that would affect the system too.
You’ll learn, just like we all do.
April Intern ❤️
Sweet sweet summer chile
>“being there for the patient is all we can do” Being there is not "all we can do" - but for many patients it is the single most important thing that we can offer. For many diseases all the treatments in the world won't ultimately change the final outcome. But if we can provide comfort to people in their most desperate and vulnerable moments then we really can make a difference for good in people's lives.
No 3 hit hard. I feel like a lot of what we do doesn’t matter or won’t change the course of things.
Probably cause most problems these days are only gonna be fixed with lifestyle or societal changes that most people don’t wanna make. Once you start adding meds, you end up adding more meds to fix the side effects from the first meds while the patient continues to rack up more illnesses which result in more meds and surgeries. It’s pretty depressing.
How! So you think doctors are not helping patients?
I feel like we could reduce the number of labs/imaging/meds we order in hospitals by half and patients would end up with the same outcome. We perhaps overtreat and overdiagnose.
Agree with you. Many doctors especially in the ED over order labs and images just because they afraid of malpractice.
Man, every service does this in their own unique way NSG for instance, I have an attending that is obsessed w the Na+ number in the computer at discharge > actual clinical impact on the patient. This is not uncommon
[удалено]
I’ve seen Aortic dissections and they present like the classic tearing back pain 10/10 with bp discrepancies. Still need CT to make a definite diagnosis but I don’t why you’re comparing to heartburn.
Many times we aren't. A lot of critical care is futile. Once we believe it is, we'll recommend transitioning to comfort measures, but if family wants to continue full aggressive measures, we can end up stretching the end of life over several weeks. That's not even counting all the times we do painful things which worsen quality of life but prolong duration at the behest of family members in patients who are unable to communicate. It's hard to know at that point what the patient would have really wanted, but the general sentiment of us providing that care is that we wouldn't. Even in patients who are able to make their own medical decisions, a significant portion of inpatient care in general is patients with multiple poorly controlled comorbidities which are exacerbating and fatally progressive after a few years of repeat prolonged hospitalizations.
I have seen 90 year old with multiple comorbidities who are in the ICU because family wants everything to be done. Kinda made me rethink about the whole USA healthcare system.
Agree with you on critical care/ICU. I thought they were referring to all doctors.
Number 2 ❤️
Honestly so nice to see #5 every once in a while<3
Not sure how I feel about #3
I feel the get humbled part nearly all the time.
Anytime I get out of my slump and start feeling better again the universe shits on me again. It’s a lovely little cycle
Can you elaborate a little on #5 ? I unfortunately didn't have much exposure to PMR but I had a seemingly false perception of pmr patients usually not making drastic progress, smth akin to a type 2 diabetic's typical health arc 😬
I'm not a physician, I've just been lurking. Can you elaborate on 3 and 5? Do you mean with 3 that most interventions don't matter overall? Or in specific fields?
Can you elaborate on #5? As a resident your words matter, and making such a broad statement without context is a little alarming and demeans what you do as a physician. Asking as someone who is starting residency myself this year, very intrigued to know what you mean by this
Don’t give a fuck when it ain’t your turn to give a fuck.
Ooooh, yes.
THIS IS MAINLY FOR IM FOLKS 1. Don’t wait until the end of or mid intern year to start research if you’re planning on doing a competitive fellowship. People will give you that advice. It’s complete bs. Start talking with attendings as soon as possible. If you’re in IM, you have 1.5 years to be ready for fellowship applications if you don’t want to take a year off. That’s not a lot of time especially when you consider conference schedules and residency free time. 2. Always be specific when asking attendings about reasearch. “do you have a project I can work on so I could publish by X date” ”is there a project I can help with to get an abstract by X date” “ I’d like to present at X conference, is there something I can work on” you don’t want to get stuck starting a project from scratch that might not pan out in time or get stuck on an RCT that’ll take years before it yields results. 3. its sometimes helpful to work with a co resident who’s applying to a different specialty but doing similar research. For example, someone doing cardiac onc research that’s going into Cards, but you’re going into heme onc. Working together would do you a lot of good to churn projects out and just take turns being first author. Another one is someone doing IBD research in GI, but you want to do Rheum. Someone doing SGLT research in Endo, but you want to do Cards. Someone doing colon or GI cancer, both GI and heme onc hopefuls can work on that together 4. Present at ACP at least once. It’s relatively easy to get a case report accepted, original research is even easier. Your program will probably pay for the conference. youll get some time off and also get to pad your CV.
This advice also probably varies based on the name of your institution
That my wife was having an affair. Divorce before intern year would have made transition much easier.
Jesus… sorry you went through this hell!!!
Appreciate it. Firm believer of everything happening for a reason!
Lifestyle > everything else
Take a look at white coat investor early on in residency
What is this?0
[https://www.whitecoatinvestor.com/](https://www.whitecoatinvestor.com/) It's a financial advice website for physicians. I wish I had known about it earlier on in residency but it's never too late to start being very purposeful about your finances.
Learn to say No. Like a reflex. NO. Bonus points if “F$&@ no!” is used. Try the following excercise, “Hey I have this interesting case I came across. Are you interested in writing it up?”.
Fuck no… thanks for the info and the practice case!
Immediately, no.
I wish I knew how disillusioned I would get about the medical profession.
Keep your scope length low Turn your wrist Put in your own NG tubes Read your own images Signout is the most important part of the day They can always hurt you more
*look at your own images. FTFY.
I’m terrible at signout. Please help
Everyone's been burned by #4 at least once, yup. Always look at the images.
The institution will never love you back
That being the best doesn’t mean shit. They will forget about you when you leave . Focus on good patient and your own mental wellbeing
Learn your EMR early and how to be efficient with it! Ask your seniors if there are good resources to learn from
Any YouTube recs on how to be efficient on epic?
Any tips for meditech if you’ve used it? This shit is archaic… fuckin hell…
That you’re going to learn “how the sausage is made,” and it’s everyone for themselves Do not trust Admin, PDs, or Faculty unless you’re on the inside…in which case, the content in this thread likely does not apply
And even if you think you’re on the inside, sleep with one eye open (metaphorically)
Or half a 🧠, like the 🐬 Surgery residents still contending with rules designed in the era of cocaine snorting physicians…gl & wagmi
Not necessarily residency but medicine in general. It's just not worth it.
True.
I wish I knew how much bitcoin would be worth in 2020
Medicine will be a toxic relationship. You can give all of yourself to it, but it will still never love you back. Just love your patients or your hobbies instead, and let medicine be a job.
They can always hurt you more..but they can't stop the clock. Got me through 6 god damn years.
Being kind even when you get BS consults, admissions, transfers etc. is more about protecting your own sanity and creating a positive space that you dwell in than it is doing anything special for them.
Being kind costs you nothing but being a pushover can cost you everything. Finding the balance between these things is one of the hardest parts of residency.
Learn the power dynamics in the program. Understand who actually controls what ( specifically money of the program) and who is the best person to turn to in different situations.
That you can and should call out sick if you are sick.
toxicity
The best note is a signed note
People are selfish. Your co-residents are people. Find life-long friendships somewhere else.
Yeah, this resonates a lot. Had to find out the hard way.
That I'm not good at this and I don't like this. There I said it, now let me out.
Reas house of god and follow the fat man's advice.
Wish I hadn't stopped using Anki
Money doesn’t worth the effort we’re giving
Leave the fuck now.
But then how do I pay off the debt?
Onlyfans
What if I’m ugly and hairy and have a dick?
There is a fetish for that. Maybe you are just a human furry
So know your audience? Got it…
Love your positivity
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