Residents, attendings, and the physicians who remember training writing on KevinMD about residency: intern year, duty hours, supervision and autonomy, pay and unions, having a family during training, mistreatment, the Match for international medical graduates, and what physicians say should change about how residents are trained. Many contributors write anonymously, and many write while still in training. For a maintained record of what residents and attendings have said about residency itself on KevinMD since 2004, from intern year through the end of training, attributed by author and date and organized by question, see Residency: what residents and attendings say, in their own words. For what international medical graduates have said about the Match, visas, and being foreign in American medicine, see Immigration and medicine: what physicians say about immigrant doctors and immigrant patients, in their own words. Medical school itself is a separate record.
During Christmas holidays, many medical students, interns, and residents will not be celebrating the holidays with their families. Instead, they will be on call, or night shifts, or just long schedules, taking care of patients.
For life and death, sickness and health, do not take holidays, and nor should our compassion for taking care of those who are in trying times. I recall working last year on Christmas Eve at …
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During the holidays, our goal should be to provide a holiday for our patients
I recently spoke with some people about medical systems—the actual processes involved in providing health care to patients. Story ideas involving systems sparked in my head: What about the guy who makes your sandwich at the deli? What if he had to grow the tomatoes? and cure the meats? and chop down trees to fashion the cutting boards? and weld the freezer parts together? etc.
All the ideas looked much better …
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To help patients, physicians must rely on systems
One of my readers astutely pointed out in the comments section of my blog that “nurses will make your life a living hell” if you treat them badly. Some will make your life a living hell, no matter what. As in every profession, there are nurses with a chip on the shoulder, as well as those who are simply counting down to retirement. But for the most part, nurses …
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Improving the relationship between intern and nurse
For years, I supervised residents. They would come in each week and tell me about a patient in crisis. If no one was in crisis, they’d say all their patients were fine and they didn’t know what to talk about, even though I had told them to pick a patient they saw weekly and either audio-record the sessions or take detailed process notes. Psychotherapy, I would say, is a …
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Psychiatry residents need to learn psychotherapy
Over the years, I have come to the painful realization that I am not perfect.
Ok, all you other surgeons, close your eyes and ears, because to admit to being less than perfect is a sign of weakness (like asking for help). Don’t read this, patients, because you wish even more than I do that I were perfect (especially when I’m operating on you). But it’s true.
Long ago, I remember feeling …
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Perfect is the enemy of good when it comes to work-life balance
This is another installment on how to ingratiate yourself with your new colleagues as a freshly minted MD intern (or medical student, for that matter). These are just observations on behavior that nurses tend to notice, which can really make a difference on how you’ll be received. I hope some of my suggestions are helpful in making you appear like the Star Intern that you know you are.
Introduce yourself. There is …
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How to be a star intern, from a former nurse
July is the month that new resident physicians begin their training all across the United States.
Our future family physicians and pediatricians, neurosurgeons and emergency physicians, plastic surgeons and laser tattoo removal specialists (ok, not really a specialty, just a side-line) will begin learning how to be physicians, having completed four years of expensive college and four years of even more expensive medical school.
Anxiety-filled and debt-ridden, they will embark on …
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Practical tips for new July resident physicians
Debates over resident autonomy are nothing new. Informed patients are sometimes reasonably concerned about just how much responsibility for their care will be delegated to their doctor’s trainees. Care within academic medicine, especially acute inpatient care in a public system, can and does sometimes mean going a whole admission without meeting the attending physician presumably responsible for your care as a patient. At least in my limited experience. This as …
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Resident responsibility at a Level 1 trauma center
My patient, whom I’ll call Jane, had a neurologic disorder that prevented her from emptying her bladder properly.
She required a permanent urinary foley catheter to help her urinate. Jane landed back at the hospital with yet another urinary tract infection – her third in one month. She had pus draining from her catheter and was infected with a multi-drug resistant strain of the bacteria Proteus. Our lab ran tests (sensitivities) …
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Insurance companies cutting corners puts patients at risk
As intern year winds down and all of the giddy 4th year medical students are shelling out 200 dollars to rent that a robe for one day of pomp and circumstance, all of us interns are impatiently waiting for the fresh meat to arrive.
Having just experienced every single emotion under the psychological rainbow this year, I am going to give a …
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Tips for medical students entering intern year
“Code Blue ICU … Code Blue ICU”
I was greeted by the PA system as I walked into the hospital this morning. A shiver ran down my spine as I quickened my pace. The days of running to codes are long gone. But since I have a patient In the ICU I was curious and just a little bit worried.
As I walked through the sliding doors I passed the room full …
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How real life medicine is less glamorous than residency
The Theresa Brown furor has got me thinking. To be honest, I don’t think the doctor’s apparent offense was really that bad. I remember giving and taking worse.
When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition. Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job. But the …
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A tough disposition is required to endure physician training
On the night of October 4, 1984, a young girl named Libby Zion was admitted to New York Hospital in Manhattan for fever, agitation and strange jerking movements. No one knew that her death the next morning would, 27 years later, drastically change the quality of physician training, for better or worse.
When Libby was evaluated in the emergency room that night, neither the ER physician nor her family physician Dr. …
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New ACGME work hour regulations for interns: friend or foe?
I interview approximately 60 prospective physicians for medical school over the course of the year and 40 physicians who are applying for the residency program. The pre-med students (almost all of whom are the age of my children) tend to have pretty good interview skills and are trying very hard to get into medical school (“I’ve wanted to be a doctor for as long …
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3 resident interviews for family medicine
fatigue |fəˈtēg|
noun
1 extreme tiredness, typically resulting from mental or physical exertion or illness : he was nearly dead with fatigue.
• a reduction in the efficiency of a muscle or organ after prolonged activity.
No, this post is not a part of my twenty six installment Psychiatry A to Z series.
You’ll have to wait for the next one in that group, which by the way will be looking at a “T” word. …
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Should doctors be like workers on factory assembly lines?
It is hard to imagine that someone can emerge from intern year – 12 months of chaos, little sleep, and hours upon hours spent responding to pages and putting orders in a computer – and know something, anything, about medicine. I did not believe in this training system until now, after my first night as a supervising resident. The knowledge I have absorbed over the …
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Gratitude from patients and their families
Darshak Sanghavi recently wrote an excellent piece in the New York Times summarizing the controversy over resident work hours.
