Saturday, August 16, 2008

Valuable principles for my upcoming clinical year

I've heard that on the words, nurses can be your best friend, and your worst enemy.

I have also heard that the more careful attendings, when asked to write a reference letter for you, ask your residents, nurses and other hospital staff about their experiences with you when the attending wasn't around... and you should therefore always act as though your attending is right beside you. Rumors can travel fast in hospitals, especially small ones.

This week I experienced a situation that reinforced both of these points quite well.

I was job shadowing an anaesthesiologist in the OR, and our second-last case of the day was the cutest ten-year-old girl, who charmed the socks off every single person she smiled at. She was such a sweetheart that everyone was disappointed when we had to put her under for her tonsillectomy.

Later on, when we were bringing our last patient into the recovery room, the nurse there came right up to me and took a good look at my ID badge. She then turned to the doctor who was supervising me, and told him, "You should know that your medical student Vitum is outstanding. He came in and checked on that little girl with the tonsillectomy to see if she was awake yet, and I was so impressed with him."

That would probably have really impressed my supervising doctor, had he not known the truth. But he did, and I couldn't take the credit and explained to the nurse: "Thanks, but I was just doing what I was told... the anaesthesiologist asked me to check on the patient!"

While I still believe that sometimes the things you do that go unnoticed are the most rewarding, the reality of medical school is you need those writing your evaluations and reference letters to be able to put down something tangible and positive if you want to to get where you want to go.

So maybe this is a third good principle for me to take with me to the wards in third year: it's sometimes the little things, just as much as the brilliant life-saving interventions, that will impress your supervisors...and more importantly, your patients.

Let me know if you have any more nuggets I should keep in mind next year on the wards!


Anonymous said...

Absolutely spot-on about nurses... I had a pair of interns on Medicine who were like Jekyll and Hyde - nurses loved the first and mysteriously he got sleep during call nights. The other intern just got crapped on constantly at 3 in the morning. Bed 4 wants tylenol, can he have it?

Also, from a cynical point of view, you can never go wrong telling your docs "I don't know what I want to do, but I'm actively considering {their specialty here}". The one rotation I didn't say that for I got shafted on every single evaluation.

Anonymous said...

You'd be amazed how many brownie points you earn by simply doing what you're told, and by accurately conveying information from Dr X to Dr Y. (The corollary is: you'd be amazed how many med students and residents do not do what they're told, and do not accurately convey information about patients.)

However, the most important thing you can do on the wards is: be honest. If you are presenting a patient's history or clinical story to an attending, and the attending inquires about something you should have done but didn't, DON'T LIE.

Students and residents who make stuff up ("No, Mr. Schmengie isn't a smoker... no, his chest pain wasn't relieved by rest... no, he's never kept parrots...") get a reputation as lying scumbags who can't be trusted. You do not want this person to be you.

The second most important thing you can do is: don't be a jerk. When I was a student, there was a guy in my class who came off as such an a-hole that the residents in one program wrote a collective letter to their program director saying: "if you accept this guy into our program, we'll quit."

Needless to say, he didn't get a spot.

So: do what you're told, tell your attending what actually happened, don't lie, and don't be a jerk. In short, be the kind of person YOU would want to work with for the next 5 years.

- signed: The Prof Who Reads Your Blog