OK… Today’s a very special day for me. (Actually yesterday, but the idea came to me when I was way to tired to carry it out.)
Yesterday afternoon, my wife gave birth to my 5th child… yes, 5th… that’s not a typo. Many of you know from my stories of raising kids during internship and residency, that (a) I have 4 girls, and (b) my wife was pregnant with #5.
Well, it turns out that #5 was an 8lb 12oz baby boy
Now… with all of these kids, what’s a guy to do, but hold a baby sale? Check out this video for details.
Click here right now to see what your RookieDoc Membership will do for you.
I just saw one of my friends who happens to be one of the four main developers of YottaLook.com - a radiology search engine. Seeing him reminded me of the site, which I tend to jump to when I need a quick radiographic image to teach a resident or a nurse practitioner.
But it hadn’t occurred to me until today that I should share this site with the RookieDoc community.
Anyway, YottaLook is pretty cool and it is starting to gain some steam. It was recently listed as one of the Top 100 Alternative Search Engines… #16, in fact.
If you need to look up a serious radiology question, but you don’t want to wade through a yotta junk search results, then RookieDoc recommends YottaLook.
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.
Although it’s great that so many people are joining RookieDoctor.com’s Exclusive Membership Program with such enthusiasm (and jitters about starting internship), it’s not so great because some people will have to be left out. I may have to close the membership program to new members, so that I can continue to concentrate on the existing members.
The questions and worries and concerns pick up around this time of year (for obvious reasons). For me that translates into more time with members.
Plus, as I write this, my wife’s contractions are 15 minutes apart (not sure if tonight’s the night for baby #5 or not, but I wanted to get this message out before that).
So here it is… Check out this video… If it looks like something you might be interested in, click the link below it. But do it now, while this is still available.
Click here right now to see what your RookieDoc Membership will do for you.
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…
Hello
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
* Guilt
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)
There are several aspects of receiving feedback that are ultra-important during your training. The first is recognizing completely useless feedback. Unfortunately, most residency programs do nothing more than get your attending preceptors to fill out evaluation forms. And like a lot of things in healthcare, a number is assigned… something measurable, sort of. The problem with this approach is that these attendings are never given instruction or guidance on exactly HOW to evaluate or exactly HOW to give good feedback. So, it is important for you to recognize useless feedback.
Once recognized as useless, you should be able to turn it around and extract something useful… something you can build on. (I give you the exact scripts to use to accomplish this - in the members area).
Now those two are about getting feedback… the next thing you have to do is receive that feedback…
And finally, know what to do with it.
Well, I found an article that is nice a short and does a good job of providing an overview for accepting feedback. Here it is. It is used with permission from EzineArticles.com:
Workplace Communication - Accepting Feedback
By Ken Okel
Receiving feedback or criticism is a funny thing. When it’s good, we accept it and when it’s bad, we doubt its accuracy. Lost in all the emotions could be some good information that could help your career. Here are some suggestions for getting the most out of someone’s comments.
Just Listen: When you’re being told something that you didn’t do well, it’s very tempting to immediately interrupt and start defending yourself. Resist the urge. Listen to the comments and think about them for a moment before you say anything. When you do speak, say something neutral like, “Thanks for telling me that.” Remember, you’re on a quest for information that can help improve your skills. You may want to follow up with a question designed to let you know what you should do the next time you’re in a similar situation. “How would you handle the situation?” is a good one in that it gives you an example to follow.
Analyze Your Successes: When you receive positive feedback, it’s easy to start congratulating yourself but not think about what you did right. Here the ego takes over. But sometimes, it’s possible to stumble into success with no idea of what you did well. To get the full story, ask some questions like, “What could I do better?” which can keep the discussion going.
Don’t Carry Around Comments Like Luggage: It’s easy to hold on to feedback long after it can be useful. Listen to the information, consider how you can improve or continue a good practice, and then, move on.
Consider the Source: Most advice comes from a well meaning place but that doesn’t mean it’s always right. Upon listening to it, you may know immediately that it’s worthless (make sure you’re certain of this) but it’s still important to listen and then thank the person for the feedback. Just the act of listening shows respect to the other person. Sure, their advice may be bogus but if you overreact, then they’ll likely never again give you feedback, which could hurt you later on if their observations improve.
In his presentation, “Stop Crying in Your Cubicle” Ken Okel helps companies communicate better, become more efficient, and smile a whole lot more.
For his free newsletter and special report, 7 Communication Mistakes that are Costing You Money, go to his website at http://www.kenokel.com
You’ll also be able to see a video of Ken’s famous police dog attack story.
I just posted another video to YouTube… This one is the second video in the RookieDoctor.com series on Residency Horror Stories. You might be wondering where the first one is… Well, it’s a little long and has some embarrassing information in it, so it’s only available to members. (Yes, even more embarrassing than this video.)
In this video you get to see how I screwed up telling someone that they were dying. Horror for me… but, good for you, because I extract several important lessons from this story for you. In fact, that’s the very reason I’m sharing these horror stories with you… You can take the good and leave the bad and it’s told to you in a way that you won’t forget… a story.
So please take this stuff with you through your clinical training years and apply it. You will be a better doctor for it and, of course, your patients will benefit too.
I would really appreciate your comments… You don’t have to tell me how much of an idiot I was, though I learned my lesson… Hopefully you learned my lesson too.
Anyway, let me know what you thought about the video and if you have any horror stories of your own. There’s many more where this one came from… but thankfully not all from me.
If you submit any stories about your training or someone else’s please do not include patient identifiers or institutional identifiers. Of course, if you do, I’ll remove them from the story and I will alter some of the details for the sake of anonymity and privacy. But if you share your stories, others might benefit from the lessons.
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?:
THIS?:
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.
OR
THIS?:
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:
OK. This might seem a little out of place. To some of you, it might even seem like one big load of crap. But it’s neither.
The early parts of your training (medical school, internship and residency especially) can feel very forced and directed at times. Go here. Do this. Get that. Well, you can actually take back control of your experience with this one touchy-feely brainstorm exercise.
This is an exercise that a friend of mine who is into psychology and marketing sent to me. And after trying it myself, I initially thought, wow… let me share this with my blog readers and members. Then a little naysayer voice in my head conjured up thoughts of what everyone’s reactions would be. So, I sort of left it for a while. It’s touchy-feely, in a way. It deals with your wants and your fears.
Well, things have come up lately that required me to look back at the results of my previous exercise/brainstorm. And, wow… it’s right on target… providing clarity. So, I decided to share it with you after all. This is the type of thing that would be immensely beneficial if done early in training. But it has to be done sincerely and honestly.
If you know what you want, you can work on the right things. If you’re at all like me, when you’re in the thick of things, sometimes you get caught up in the task at hand and forget the “why”. At some point you stop and say, “Wait a minute. This just isn’t worth my time, my energy, my attention, and certainly not worth me worrying over it.” So you re-evaluate. Not necessarily in some formal sort of way, like this exercise, but you re-think it. Stopping and re-thinking is great… But what if you could “pre-think it”? That would be infinitely better.
Anyway, enough rambling. You’ll either thank me for this or just think I’m a tad weird.
It’s a little long (67 minute video), but if you do the steps, it’s well worth the time spent watching the video and doing the exercise. It takes a minute to load… Here it is:
