Next Generation is a BWH Clinical & Research News (CRN) column penned by students, residents, fellows and postdocs. This month, Wilfredo Matias, MD, a resident physician in the Department of Medicine, shares advice for incoming Brigham interns. Some of the details in this column have been changed to protect patient privacy.
I’ll never forget the wave of emotions that came over me when I heard the ring of my pager for the first time and read the message that followed:
FYI Pt: Jones/10b K 3.1. can you replete? thx.
Just a few months prior, I was traveling the world, celebrating Match Day – when I had first heard the good news that I would be doing my residency at the Brigham – with my loved ones, and dreaming up grand plans to care for the sick and solve the problems of global public health.
Now, standing in front of a computer on my first day of intern year, amidst the noise of the 10th floor Integrated Teaching Unit at Brigham and Women’s Hospital, I shuddered at the magnitude of the decision I had to make. My patient’s potassium level (the “K”) was low. I needed to “replete” it by giving her more potassium. My stress response kicked in. “What dose should I give?” “I did this as a medical student, so why does it feel so hard now?” “What if I give too much?”
So much has changed since that first page. The months that followed were ones of tremendous growth and learning that slowly but steadily turned my perceived lack of knowledge into experience, and my insecurities into confidence.
Although there is still much to learn, throughout this first year I have relied on the following bits of age-old wisdom from my patients and co-residents, nurses and mentors, that have guided me through my first year as a doctor. I’m excited to share this advice with the interns that will soon begin at the Brigham, and hope it’s as helpful to them as it has been for me.
- Make checklists and automate tasks
The amount of information you must triage and the tasks you must perform daily are often overwhelming, and most of your energy will be spent on accomplishing them efficiently. Customize your electronic medical record, create a systematic approach and make checklists for tasks to be done during pre-rounding, for admissions and during emergencies. These will be the tools of your trade; sharpen them, use them repeatedly, and soon they will become second nature so you can focus on the things that really matter.
- Trust your teams and ask for help
Remember: You are not alone. The work of caring for patients is the responsibility of many. Nurses are the ones on the front line; they will spot changes in clinical status long before you do, will often have more experience than you, and will regularly offer sound guidance. The pharmacist will help you dose medications and monitor your orders. Consultants will help you solve diagnostic dilemmas and guide more sophisticated management. Social workers and care coordinators will coordinate the complex social dynamics surrounding specific illness. Your co-interns, junior and senior residents and your attendings will always be by your side. The knowledge of large groups is vast and rarely wrong. Asking for help when you don’t know and tapping into the wealth of knowledge of those around you will rarely fail you.
- Spend time with your patients
As obvious as it may seem, remind yourself that your patient is at the center of everything you do. At the end of each day, sit with one or two patients for a while. Listen to their stories, learn about their lives and appreciate the humanity behind the diseases you’re treating. You will quickly forget about the minutiae of the day and leave rejuvenated by the privilege of serving others.
- Be kind to yourself
All the above is impossible if you don’t take care of yourself. Be as dedicated to your well-being as you are to your work. Call your loved ones regularly and spend time nurturing your relationships. Though challenging, try as best you can to exercise, sleep and eat healthily. Recognize that your time off is sacred and be fierce about filling it with rest, adventure, learning and the things outside of medicine that bring you joy.
- Reflect on how wonderful your job is
Be grateful for the privilege of having a view into other people’s lives and caring for your patients. When life gets difficult, remind yourself that you have a stable paying job, and that you’ve been blessed with the opportunity to think critically and creatively and have a positive impact on the lives of others. Remember that this is only the beginning.
The night before you embark on your first day of intern year, take a picture of your white coat, pager, ID badge and stethoscope and share it with your loved ones. Trust in the process and know that in a few short months, you will be thinking thoroughly and critically about differential diagnoses and treatment plans, and you will handle emergent situations from sepsis to acute hypoxia with confidence and poise. Your patients will call you “doctor” and others will look to you for guidance on next steps. With kindness, dedication, humility and the support of those around you, there is nothing that you cannot do.
So, when you get that first page, take a deep breath and replete the K. Then, introduce yourself to your first patient. You have come so far, and you have so much more to accomplish.