At our first official day of medical residency orientation today, several rising second-year residents shared some of the stories and lessons that had been burnt into their brains over the course of their intern year:
- While performing a procedure (similar to placing an nasogastric tube) one resident accidentally caused a pneumothorax in a patient. Thankfully, the patient was cared for and recovered. Remember that not one of the interventions done in the hospital are benign. All carry risks.
- Speaking of procedures, when placing central lines, hold the guide wire up after removing the catheter is placed and say aloud to yourself “Here is the wire!” This ritual may save you much anxiety over uncertainty whether the wire was sucked into the patient’s body when you have trouble finding that piece after the procedure is complete.
- Be polite and respectful to nurses. They can make your life easier or so much more difficult.
- When a nurse (or whoever) call your phone or page you, you do not have to answer their question or concern immediately. You are not magic. Don’t be afraid to take time to think about the answer or discuss the question or concern with a senior physician. Ask if you can call the nurse back and then take care of the problem.
- When a nurse pages you, go see your patient.
- Measure twice, cut once. If you feel the slightest hint of uncertainty regarding some element of a patient’s status or hospital course, be humble and look it up, even if that slows your workflow. Figure out ways to reference that information if it becomes a habit. Do not lie. Do not guess.
- Similarly, trust but verify. Always politely ask why people are saying what they are saying, doing what they are doing, ordering what they are ordering, or asking you to order what they are asking you to order. Patients–people–have died based on assumptions that we as residents make.
- Ask for help. Your senior resident is there to guide and support you. Use them, and then pay it forward when you are yourself are a senior.
I’d like to thank those rising second-year residents who shared their insights with us. What are other tips do you recommend for incoming interns?