Well, this is the first step in that process. If you are a nurse, a patient, a caregiver, or really anyone who comes in contact with physicians, this is your opportunity to offer some advice. Over time, depending on the response, I will make this into a more robust, far-reaching project. I will select the best of them and redistribute them.

A word of caution… This is for sincere advice only. This is not a mouthpiece for attacking specific individuals, the healthcare industry or for lumping people into groups and labeling them. (There’s plenty of that in the news media) This is for sincere advice from one human to another.

I thought it appropriate to cover something you will never be taught about your pager… at least not formally, anyway. So here it is:

It’s really quite simple. When wearing scrubs, you only have this semi-thin drawstring that doesn’t really hold a pager too well.

SCRUBS: If you wear your pager on your scrubs, it will flop around and sometimes unclip itself depending on your position.

WHITE COAT (side pocket): If you put it in your white coat side pocket, you will leave it on during conferences or you will not feel it vibrate. You also run the risk of it slamming into a door or wall as you walk.

WHITE COAT (top pocket): If you put your pager in your top pocket of your white coat or of your scrubs, well, that’s just inexcusable… it will fall out when you bend over & it will be impossible to reach if you wear a gown.

So here’s what you do (see the video at http://youtube.com/RookieDoc):

1. Tuck in your shirt – all the way – even in your underwear
2. Face your pager in towards you (not outward like you would if you were using a belt)
3. Clip the pager around your scrub bottoms drawstring AND your underwear

That’s it. I hope it helps

You see, I have 5 kids – 4 girls and a boy. A few minutes ago my wife forwarded me a link to this YouTube video. I’ve heard this song a thousand times… but it’s like I was hearing it for the first time.

Why am I posting this here? Why now?

Well, many of you are on rotations right now where you might be reluctant to ask for time to spend with your family at this time of year. I’m putting this here as a reminder… 20 years from now your chief resident won’t matter… 20 years from now the attending on the rotation you’re on right now will be an afterthought.

Now, of course, you do have responsibilities to your patients, so fulfill them. But it doesn’t hurt to ask or to suggest a different schedule to afford your family some important time with you.

It’s going to happen from time to time, that you miss important family events, sure. That goes with the territory. But there’s a difference between missing something and neglecting someone.

The key is balance.

And too many of us in the health professions are missing it. Don’t be one of them.

I have received several questions about how to respond after getting an interview for a residency program. And although most people are aware that thank you letters should be sent, many seem confused about what comes next.

In particular, I saw a question on a forum that seems pretty typical of some of the questions I’ve received lately. You can see the question below and how I responded to it:

Question (unedited): I was wondering if you get replies from the ppl you send a thank you note to , cuz somehow they never write back to me . Is that normal ? or does that mean they hate me ?

My Reply: Don’t expect them to reply.

There are several reasons why I have never replied to thank you letters written to me after I interviewed someone.

1 – There are so many
2 – Because there are so many, my reply would not be very specific for each individual (think form letter)
3 – There’s room for misinterpretation of what is written or for me to misrepresent the opinion of the Program as a whole
4 – I never thought anyone expected a reply

Email… different story. I have replied to some emails with generic things like “Wish you the best”, but I’ve regretted it, because I thought that person might be sitting at home saying, “What does that mean?!… Wish you the best? Is that like ‘have a nice life’ or is it like ‘I really thought highly of you and I wish you the best’?”

So, it’s not about being polite or not.

By the way… I really do wish you the best

Dr. Tori
RookieDoctor.com

Anyway, in an effort to help some of the people out there stressing about interviewing for internship and residency, I jumped onto several forums and began answering some questions.

Most of the concerns and fears centered around actually getting interviews or how to answer the interview questions.

However, there were several threads where people were whining and complaining about their contacts at various residency programs “not coming through”, “leaving [people] high and dry”, “forgetting where they came from”, etc. Basically, several forum goers were complaining that they weren’t getting the favors they thought they were entitled to and were easy to give.

So, I posted the following response. I hope it helps you on your interviews for internship, residency, fellowship, and jobs…

Question: Hey guys do contacts help? One of my friends got an interview through some contacts, problem is i don’t have any!!lolzz

Answer: Contacts do help. I have done it for some and not for others, so you might want to understand why… what goes through someone’s head when you ask them?

Here’s the thing… Your contacts are being asked every year by tons of people to do this same favor. And while you might think it’s because they “don’t deliver”, or “they forgot where they came from”, or whatever… it’s actually not that.

If they recommend everyone who asks, it dilutes the power of their favor. And, if they don’t really know the person, they run the risk of being blamed for having lobbied for bringing that person in (if that person sucks).

So here’s the difference between which of your contacts will make a curbside reference for you and which ones won’t…

… ready?

… it’s not “contacts” at all… so, stop looking for contacts.

It’s RELATIONSHIPS. Just knowing someone’s name or having met them once or twice is irrelevant… However, if you stood out in some way (not just answering questions on rounds)… if you just focus on answering questions right, then you run the risk of not showing the real you… people don’t just care about your medical knowledge… they care about how you fit in as well. What other things will you contribute to the Program, besides medical knowledge?

Let me give you an example… one time in my training, I was taking a break leaning on a wall talking to the janitors and maintenance guys about football (American football – Go Eagles!). While I was leaning there, the Chief of Medicine walked by with a huge glob of white coats behind him. (Inside I was like O my God! My chances here are done.) He stopped in his tracks… stood right in front of me… and just looked at me. The other med students and interns looked at me like, “You’re toast”. While the Chief was looking at me, I shrugged and said, “What?… Football rounds.” and I smiled.

He cracked up laughing and kept walking. Later he struck up a conversation with me about football and later about some other stuff we had in common… cities we’ve lived in, universities attended, etc. When I interviewed at that program and other programs in that city, people said that he mentioned me.

Now, I never asked him to mention me, but he did. The reason… it’s easier to remember a relationship than it is to remember a contact.

So, when you’re on your clinical rotations of 3rd and 4th year, or when you’re on observerships, etc, don’t just concern yourself with answering medical questions. It’s the relationships that will be noticed… relationships with docs, nurses, administrators, secretaries, and patients.

And one last HUGE tip… Focus on what you can do for them, not what they can do for you. If you provide value wherever you go, people will notice in a good way. If the first question in your head is how can this guy help me, people will notice in a bad way.

I hope that helps.

If you have a question for me, Just Ask.

==> Ask Me About Your Residency Interview

I may not get to every question directly, but may be able to post important answers here, in special RookieDoc reports (PDF), on the RookieDoc Squidoo lens, etc.

Here’s the link:

Revisiting the Intern’s Survival Guide

And here’s what I posted in the comments section back in June:

Great post.

For many, the appearance of arrogance actually comes from an intense fear of failure and fear of being exposed as someone who somehow slipped through the medical education cracks.

Unfortunately, some people try to cover or hide the fear, rather than saying, “You know what? I’m nervous. This is new to me. What has been your experience?”

“Smart interns forge alliances with the nursing staff” – great quote. If interns and nurses don’t see their missions as the same, they’re missing the boat. There’s a difference between a mission and a role. Both play different roles in the same mission.

And yes, there are too many new docs who start internship with an air of arrogance and, at times, downright rudeness. But, there is also a large pool of nurses that start off assuming there’s a turf battle. And both of these continue the cycle.

This probably sounds a little fluffy, but it would all be a lot smoother if we assumed the best in others.

For interns:
– Don’t assume you have to know everything.
– Don’t be afraid to ask for help
– Nurses know their job better than your attendings
– Social workers know their job better than your attendings
– The more you understand others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

For nurses:
– Interns are nervous, & everyone expresses it differently
– Be patient with the new folks
– Be especially patient with new interns from other cultures
– Don’t start off assuming a turf battle… sure defend that last piece of pizza
– The more you understand about others’ jobs, the better off you’ll be
– Ask
– And when you ask, be polite about it.
– Communication is everything… more than words said, communication is an exchange.

Also, be on the look out for an awesome freebie coming from RookieDoctor.com… very soon. The quantities will be limited because I can only ship out so many (before I go broke .

They’re easy… they’re fast… and they’re free…

I just posted several ecards and this video tutorial showing you how to send them. Check it out.

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.

Also, if you have a question for me, Just Ask.

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.

8 – Avoid the backbiters.

9 – Laugh a little bit. Check out sites like GiggleMed.com’s Medical Humor Blog, Placebo Journal and Q-Fever. But find humor only in appropriate things related to work – not in individuals or demeaning things.

Anyway, I hope this helps.