Congratulations… Doctors.

Wow, what a roller coaster of emotions at this time of year, huh? Finally finishing medical school – a little nostalgia, and lots of relief. For a few weeks being called “Doctor” is going to be pretty awesome. And a few weeks after that, well, it’s going to be pretty scary (and awesome at the same time).

Well, if any of you are looking for gifts medical students (or for yourself), here are some gift ideas for medical students and new interns:

(In the interest of full disclosure: these are affiliate links, meaning that I might get a small commission if you purchase them through my link. It will not affect your cost at all. Alternatively, you can search Amazon, or something and order them directly. I still highly recommend these gifts.)

You go through all of this training to get where you are and then you find yourself in a situation where you are 100%, completely, and utterly dependent on technology to make a diagnosis… Well, Sapira’s Art and Science of Bedside Diagnosis can change all of that. And not only that… it can make you stand out as being light years ahead of your peers.

It’s not essential for “surviving” internship, but who is only interested in “surviving” anyway?

Too many people tell you which books to get… and too often (you know how it goes)… those books just end up on the shelf and you use them more like reference books. Well, this is the only textbook-sized book I actually carried with me while I was on-call. The ICU Book. It’s that good.

Seriously… this book is the real deal. It’s easy to read… not because it is dumbing-down the material, because it isn’t. It’s easy to read because it has just the right amount of information. Not too much and not too little.

This is the line of stethoscope I use (and hey, I work primarily on cardiac floors): Littmann Master Cardiology. There’s a pretty good review of this stethoscope at HolterMonitor.org.

Some people prefer the amplifying stethoscopes. I do not. At this point they’re a little too bulky. Maybe as technology improves, so will the size and weight. But who needs more heavy stuff to carry around with them? Plus, you better learn on the standard stuff and only use the souped up technology to supplement. Too many people are already losing diagnostic skills and relying too much on technology (… but I digress).

You can get funny medical humor gifts like mugs, shirts, hats, bags, etc at the GiggleMed.com Store. There’s even a funny infection control humor book, Bugs on Scrubs, that pits a doctor and a nurse against each other -arguing over who is spreading infection – hilarious, evidence-based advice in rhyming Dr Seuss-style text.

Funny stuff. A great stress reliever… even if you don’t buy something… there are things to forward along, especially at high-stress times. You can really make someone’s day with appropriate humor.

OK… shameless plug time… Of course, there are some awesome gifts from this very site. If you want to “Wow” your graduating medical student friend or family member, give them a RookieDoctor.com Membership or an Internship Survival Skills Audio CD. The timing couldn’t be better in light of that emotional roller coaster I mentioned above. These RookieDoc products are designed for the medical student from 3rd-to-4th year transitioning into internship.

If you have other ideas for gifts for medical students, post them in the comments below.

I was going to use today’s post to provide links for useful gifts for medical students, interns, and residents. Instead there’s a far more important gift that I’ll explore here…

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.

Medical school, internship, and residency are particularly busy times. If you’re a doctor in training or someone who cares about one, you can send a quick eCard to let them know you care.

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.

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 hope this is helpful.

Let me know if you need anything else.

Dr. Tori

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)

You’ve been labeled. Even if you’re still a medical student, an intern or a resident… you are “one of them”, “one of those doctors who sleep on bags of money”. At least that’s what a lot of people think, anyway.

When you bring up your debt or how long your training is, it doesn’t matter. It’s irrelevant that everyone else enters the workforce 8-10 years before you. You’re still one of them. It says so right here, in such-and-such a magazine that your average salary is XYZ.

So guess what? You’re gonna pay more. Period.

Well, that’s how the Doctor Tax gets you. Now it’s time to change all of that. Check out this video. You’ll learn why you’re charged more and how to stop that from happening. I’m not saying you should be stingy… I’m just giving you the tools to have a little more control over your money. And the first step is to know the who, the why, and the how of the Doctor Tax.

Debt sucks. And if you’re like me, you probably chose to sort of ignore it at first. That’s what I did… early on anyway. At first, I bought into the fact that doctors were higher wage earners, in general, so I assumed that I would have no problem conquering my debt after residency training.

Well, in my third year of medical school, I began to overhear occasional conversations by attendings and upper level residents complaining about their debt. I saw some of my non-medical friends from college begin to buy houses and cars. And I thought… if the debt burden is already going to be huge, how is that new doctors are able to buy homes right after their training? Do they just add more on top of their already large mountain of debt?

What would happen if there were a life-changing event? A chronic disease? A severe accident? Or a delicate family issue that needed tending to? There’s no way they could leave their jobs, even for a short while, with all of that debt… right?

Well, I saw something horrible happen. A third year resident in internal medicine had begun to develop strange neurologic symptoms. After extensive testing, it was discovered that she had multiple sclerosis. I watched her deteriorate in typical step-wise fashion from a fully functioning resident… one of the best, in fact… to the point where she needed braces to walk. I hear that after I left that hospital that they allowed her to complete her residency even though she couldn’t really finish all of the rotations. Although she probably had several options after her training – consulting, writing, etc – I couldn’t help but think… what if that were me?

What would happen to my wife and kids if my debt came due and I couldn’t work? Anyway, I digress. Let’s get to the next video.

In this video, I show you how I rapidly… and I mean rapidly… got out of debt. This is Part 1 of a two-part video. Even though Part 2 is only available to members, this one gives you the exact step-by-step plan I followed. Click this video’s image to get started. (It might take a few extra seconds for the video to start. The file is a little large.)

After a great response from those of you on my “new release priority notification list”, the RookieDoc Membership program is being opened to anyone that is interested. Here’s a short intro video to show you some of the things that are part of membership. If it sounds interesting or useful, click the link below the video to find out more.

The images of CDs, books, and DVDs in this video correspond to downloadable products.

If you could sit down with me and ask me any question about being successful in your internship or residency, what would it be? I’ll answer some questions on upcoming RookieDoc FAQs – these are occasional phone conferences for RookieDoc fans and members where I discuss a hot topic or answer questions.

Ask Me About Internship or Residency

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, or in the Audio Tips series.

By the way, the RookieDoc membership is undergoing some upgrades and will open to new members soon. Stay tuned. In the meantime, though, get your question in. Go ahead, click the link above.