Countdown to July 1: Attending

The last July 1st with any significance is after the last year of residency. At that point, a resident (AKA house officer, physician in training, indentured servant, scut monkey, etc.) completes his training and is board eligible. If you ever wondered what BCBE stands for, it's 'board certified / board eligible.'

Uniformly, residents discover that they have a limit to the amount of residency they can take. After a certain point in time, residency becomes intolerable. It is a continual nightmare having your judgment questioned continuously, and having your clinical decision making process derailed by someone who potentially knows less than you. In fact, most residents in their final year may know as much if not more factual medical knowledge than their superiors.

But practicing on your own is a different beast. There's no one questioning what you're doing, but there's also no one to offer advice or reassurance. There's no superior to appeal to.

It is an intensely isolating experience, and all those years of medical school and residency suddenly feel very empty. I thought that I was ready to be an attending when I was done with residency, but what I discovered was that there is no preparation for being your own doctor. At some point, you have to trust that you are right, and that can be hard to come by.

Advice to the new attending:
-Sometimes making any decision is more important than being right.
-Never let them see you sweat.
-Do not pull the 'Who's the doctor? You or me?' card unless you really mean it.
-Most importantly, trust no one.

Countdown to July 1: PGY1

It is somewhat common knowledge that if you're going to pick a day to avoid the hospital, July 1 is the day. The hospital is awash with not only new interns but also senior residents still green with inexperience. And if you are a PGY1, welcome to Hell.

I remember the day after I graduated medical school, I was driving down the highway and saw a car run off the road and crash. As I drove by, I thought to myself, 'That person could really use a doctor...' Then it occurred to me: OH FUCK, that doctor is me!

The nightmare of intern year has been immortalized in the book, 'House of God' by Sam Shem, and I am sad to say that for the most part it still holds true after 30+ years. Intern year is still the singular worst one year period of medical education.

It is dehumanizing. It is humiliating. It is frustrating. And it wipes away any confidence or boldness carried over from medical school. MS3's complain that they've never felt so stupid as during third year, but that pales in comparison to intern year. At least during third year, your ignorance didn't hurt anyone but yourself. Now, what you don't know kills people.

The training goals of intern year are to learn patient care and disease management. However, what I walked away with was this: I learned what kind of doctor I am. The intern will learn what kind of doctor he is. Is he someone who fudges records? Does he take shortcuts? Does he stay late every day to tie up loose ends? Is he overly confident? Is he gun shy? By the end of PGY 1, an intern will know what kind of doctor he is, and he will spend the rest of his career either accepting that fate or fighting against it.

Some advice for new PGY1's
-If you can, wear scrubs all the time.
-Making friends with the nurses will improve your Rounding-Fu*.
-When you go home, leave the patients at the hospital.
-Make yourself a 'Laws of the House of God' checklist.
-Finally, but most importantly, the most valuable thing I learned during intern year was: sleeping is more important than eating.

*Rounding-Fu: How badass you are during rounds

Countdown to July 1: MS3

Anyone familiar with the medical education process knows the significance of July 1st. It is the day that everyone moves up a peg. MS2's become MS3's. MS4's become PGY1's. PGY3's (or 4's or 5's) become attendings. There's a lot of significance wrapped up in July 1st.

Third year of medical school is a funny thing. It is an unpredictable experience. It is rough and wonderful and glorious and terrible. It is amazing and disturbing. And the thing about the third year of medical school is that it changes people. At the beginning, everyone starts bright eyed and eager, and by the end, students are profoundly different.

We all imagine that if we were in battle, we would be leading the charge, but what we may discover is that we are the ones hiding in foxholes, shitting ourselves. And that is what you find out about yourself in third year. You find out who you are. You discover if you are vengeful or vindictive, apathetic or aggressive, kind or cantankerous. Your own true nature is revealed.

There are many reasons for this. The MS3 is sleep deprived. He is rotating through different rotations and always a little disoriented. He has not eaten breakfast in 10 months. He has not seen the sun except through patient room windows. He has been constantly pimped about every piece of medical knowledge currently known.

Although we have been trying to change the process of medical education, the MS3 experience is still one of being crushed down, and then being rebuilt better than before: better, stronger, faster. However, that means that some soul crushing has to take place... As nice as it is to be done with the process and look back on MS3 with nostalgia, having your soul crushed is a uniquely painful experience.

Some words of advice to the new MS3:
-Take a shower, no matter what.
-Work hard, play hard.
-No one likes a kiss ass.
-Wear comfortable shoes.
-Your attending wants 3 things from you: honesty, enthusiasm, and diligence (if you have none of these qualities, learn to fake it).