The practice of medicine is fundamentally different from the study of medicine. Right now, you’re being rewarded for memorizing and test-taking. But being a good doctor is about communication, clinical judgment under uncertainty, and treating whole humans in context. The skills that get you through preclinical years aren’t the ones that make you excellent at the bedside. Start developing those now: learn to really listen, to tolerate ambiguity, and to see patients as people with complex lives. Clinical skills matter more than you think right now. Those physical exam sessions feel silly when you’re drowning in biochemistry, but being competent and comfortable at the bedside is what makes you useful. It’s also what often makes medicine satisfying, the actual human interaction and detective work. Practice on real patients whenever possible.
Ask questions, especially the “dumb” ones. Most people remember being where you are and genuinely want to help. That question you think is stupid? Someone else is wondering it too. And the attendings who make you feel dumb for asking are the exception, not the rule.
Know your non-negotiables early. What kind of medicine do you want to practice? What are you unwilling to compromise on? For me, it’s evidence-based practice regardless of pressure from patients or the outside. For others it’s time with patients, a specific population, or work-life balance. You don’t need your specialty figured out, but knowing your core values helps you make better decisions about training, jobs, and practice settings. The system will push you away from what you love about medicine; be intentional about protecting it.
Your boundaries are part of good patient care. Being a good doctor doesn’t mean always saying yes, being available 24 hours a day, seven days a week, or giving patients whatever they ask for. Learn how and when to set expectations: about what you can do in an appointment, what’s evidence-based versus not, and what your role is. Clear, respectful boundaries actually build trust and prevent burnout. Meeting people where they are isn’t the same as agreeing with them. I set expectations with my patients before we even start working together.
Different practice settings teach different things. You should think broadly and not just chase the most prestigious name. Military medicine taught me resourcefulness and working with constraints. Academic centers expose you to rare cases and research. Community hospitals teach you to be comprehensive. Private practice teaches you the business side. Where you train shapes what kind of doctor you become, so stay open to anything and everything.
Stay true to why you went into medicine. This is my guiding north star. Most of you entered wanting to know patients deeply, practice thoughtful medicine, and make a real difference. The system will try to make that impossible: 15-minute slots, documentation burden, and insurance battles. But there are ways to build a career that aligns with your values. It might take years, it might require risks, but it’s worth being intentional about. Don’t let the path of least resistance define your entire career; this is why I made the path I did for myself.
Integrity isn’t negotiable. This is one reason why I joined the Air Force; the core values resonate with me: integrity first, service before self, and excellence in all we do. Your medical license and clinical judgment aren’t for sale. Whether patients are paying out-of-pocket at a concierge practice or you’re at an academic center, you practice evidence-based medicine according to your best judgment. You can be fired by patients, you can fire patients, but you also set the terms of what kind of medicine you’re willing to practice. Do not ever compromise on this.
Jessica Favreau is an internal medicine physician.
