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

Hardass

I thought I put this up a while ago, but I guess not. Here we go. I wrote this like a year ago...

When I was a medical student, I worked with one senior resident, Dr Hardass. He really pushed us, and it was a really tough month. He did however teach us almost continuously, and he made us really excited about medicine. I couldn't say enough about the guy. He was what I wanted to become. I wanted to be that good, and that dedicated. He was the ideal senior resident. I wanted to do well to prove myself to him.

So, when I became a senior resident, I thought of him while working with medical students and interns. I was tough on my interns, and I held my interns to a high standard. Some complained, but others really responded to the tough love.

In the end however, I felt vindicated. Some of the students and interns thanked me. They were so happy to be held to a high standard. I would tell the students that they had it easy, and they challenged me. They took on bigger patient loads, wrote sharper notes. It was impressive.

It was my belief that I have to hold people to a high standard, not just acceptable but excellence. If you only ever expect passable effort, that's all you'll ever get. Holding people to excellence breeds excellent effort.

There are no exceptions, especially for myself. I set out to be like Dr Hardass, and I think I did a decent job getting there, and now I'm considered by a lot of students to be their favorite resident. It's an honor.

The weird thing about being a resident is that it's a chance to be a mentor, and that really is a sacred duty, because your actions are the basis for students' view of what being an excellent resident is.

One of my friends told me that I'm an exceptional leader because I listen to others, always try to do my best, and trust others to rise to the occasion. And those who've worked with me felt they should excel too, not just for the sake of excellence, but also because they didn't want to let me down. That's an awesome feeling.

Yeah, I'm a hardass, but that's DOCTOR Hardass to you.