July is a very special time of year in the medical community. We welcome thousands of newly minted physicians donning their spotless white coats and nervous smiles as they begin what will be one of the most difficult but also most rewarding and exciting times of their lives. Reflecting back on that first day as a brand new intern, I can’t help but think of how nervous I was over how I would be perceived as the new physician on the floors. Based on all the stories I was told when I was an impressionable medical student, I often feared the idea of whether I would gain the respect of nurses and other clinical support staff while behaving in ways that didn’t make me seem condescending or arrogant. Navigating the world of gaining independence and confidence in yourself as a competent physician while maintaining healthy relationships with those on your team can be daunting for all new interns across all specialties. These are a few pieces of important advice I’ve received in the past and continue to pass along to new interns and junior residents.
Answer your pages in a timely manner. Even if you don’t know the answers right away, return the page so they are aware you are working on it. Thank them for bringing issues to your attention, and let them know if you think there will be any delays in putting in an order or coming to see a particular patient. People appreciate when their concerns are acknowledged, and you will also get fewer reminder pages as a result.
Seek out your charge nurses. I learned more from the nurses in my first several months as a physician than anyone else. Try to meet with them occasionally and ask for their feedback on how you can improve. They can discuss with you concerns from other nursing staff and how to strengthen your professional development.
Help out when you can. If you happen to reach a point during the day when all the work seems to be done and things are running a little slower, check in with the nursing staff on your unit to ask if you can help with any orders or tasks. This will not only gain you a lot of respect from the nurses, but you’ll also get to learn other skills that maybe we don’t get to do as much as physicians like placing IVs or NG tubes.
Recognize that you are often a relay center as the intern. You will be told to make things happen by your senior residents and attendings such as discharging a patient. Sometimes, there are details and barriers to a patient’s discharge that your seniors and attendings may not be aware of such as getting report from the physical therapist about their concerns regarding the patient’s safety in their home or the social worker who lets you know that this patient lacks appropriate family support and may need to be placed in a rehab facility. It’s important to listen to your team and get help from your senior residents regarding how to navigate these situations to ensure patient safety.
It’s easy to become aggravated with someone you’ve never met when you talk with them over the phone, especially when you’re exhausted or having a bad day. It’s very important to maintain your composure and treat everyone cordially no matter what you think about a consult or an issue that may or may not need to be addressed. Someone is calling you because you are the expert, and they need your help. Try to remind yourself of this and own it. Be a good person because, at some point, you’re going to be asking for help, too.
Compliment those who do a good job. Medicine is sometimes an unforgiving culture, and showing some appreciation for your team members can go a long way. Acknowledging when someone helps you will promote a more collegial environment, and it’s common knowledge that we all tend to do better jobs when we feel happy and supported.
One of the most difficult things to learn early on is how to become comfortable with saying, “I don’t know,” especially given the punitive culture that most medical students have historically experienced when they were faced with questions that they didn’t have the answers to. Becoming an intern requires a change in attitude in regard to admitting when you don’t have the answer or when you need help. Some of the most highly respected people are the ones who are not afraid to admit when they are wrong or ask their colleagues for help when they need it. Humility goes a long way in medicine, and both your patients and colleagues will respect you more for it.
Last but not least, probably the most important piece of advice I can give is to listen. Listen to your entire team, the nurses, the respiratory therapists, the physical and occupational therapists, case managers, social workers, etc. These team members have practiced many more clinical hours of medical care than you have, spend much more time at the bedside than you do, and have valuable insights into patient care than can not only help you in the management of patients but can also teach you along the way. Make sure you always make an effort to ensure them that you have heard their concerns, and always ask for their input on what may be useful. Work together with your team to address clinical issues and promote an environment in which every team member feels safe to speak up. As a physician, you’ll be expected to be the captain of the ship, but a good captain knows that the entire crew is necessary to make it safely to shore.
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