Keeping Your Cool

I think it is important to recognize that these young doctors are under a lot of stress. And it is essential that they recognize this in themselves. The training is challenging and can be quite demanding, both physically and emotionally. Everyday is filled with experiences that require a deep emotional reservoir to help one cope with the psychological demands of the day. Patients are in pain, they are ill, they may be suffering. And we, as caregivers, need to provide comfort, encouragement and hope. It is not enough to be polite (and sometimes even that may be a challenge); physicians need to be empathetic and compassionate. And to our co-workers (and loved ones for that matter) we must remain kind and pleasant. It's easy to lose one's cool when you're tired and stressed-out. I am hopeful that these young doctors will answer the phone call from the nurse, for example, with the same friendly tone at the end of the year as they do at the beginning. It's what we call, being professional. Read more.

Finding Time for One's self

While the life of an intern can be particularly demanding, one of the things I personally try to encourage is "extracurricular" activity. All these individuals are multi-talented and have outside interests that have been an important part of their lives, whether it's sports, music, art, literature, family, religion, etc.

In certain respects, medical school and residency (to some degree) prolong their "adosescence." They have to put their lives on "hold." Residents' lives become extremely focused on their work. They may lose touch with those things that have brought them pleasure and happiness (not to say that the practice of medicine is not fulfilling) - things that contribute to their general well-being.

I try to encourage our residents to pursue their outside interests and passions - to continue to grow and blossom as individuals; to find themselves again. This, in turn, makes them more real, in touch, and perhaps, better doctors. Read more.

Dr. Dale Ellenberg: “A Doctor?”

     While a Transitional Year Residency is a one year internship meant to teach skills that bridge these residents from medical school to their advanced training in subspecialty fields, like radiology and anesthesia, there is another aspect to this transitioning process which I find interesting to observe – and that is, the passage from student to doctor.
     At the very beginning of the year these young people are rather uncomfortable with their new appellation, “doctor.” Some of them are even embarrassed to be called doctor or introducing themselves as such. Yet, at some point they all come to grips with their appended name. But it’s not simply the title they’re adjusting to - it’s the responsibilities (and the awareness of those responsibilities) that come with that new title.
     Now for some, this transition is a subtle one, one that develops practically unnoticed over time. However, for others, it comes as an Epiphany – a moment in time that they realize, “Hey, I’m a real doctor!”
     I would encourage our readers to ask of our three residents what their experiences have been thus far and to follow this thread over the year. The experiences of our past residents and those of other young doctors in training are also more than welcome.
      -- Dr. Dale Ellenberg, resident supervisor Read more.

Dr. James Knutson: Working to find the right diagnosis for young girl epitomizes first four weeks

     People ask me how my intern year is going, and I think this entry is a case-in-point. Four weeks have already gone by, and I've finally found a free moment to take note of some stuff. There's also letter and packages waiting to be mailed, and phone calls from mom that need returning - something about time management comes to mind.
     This week was especially tough, probably b/c my week started Sunday morning on call. Things were going smoothly until I got a call about one of my colleagues patients - young girl w/ a headache, shouldn't be a problem. That is, until I read her chart and realized her constellation of symptoms didn't fit any clinical picture:
     1) abdominal pain - was it appendicitis (which means emergency surgery) or just cramps?
      2) low blood counts - cancer, autoimmune disease, or simple anemia?
      3) "worst headache of my life" - a bleed in the brain (but she had a normal head CT scan that morning) or meningitis?
     We needed to evaluate her headache, and to diagnose meninigitis requires a lumbar puncture (LP), a procedure that sounds scarier than it really is (probably easier for the person holding the needle to say). However, her platelets (the cells that help blood clot) were low so she needed a platelet transfusion - but transfusions can make some autoimmune diseases worse. Rarely does real life medicine resemble TV medicine - "either we do X and she lives, or we do Y and she dies." And yet when you don't know the diagnosis, it sure can feel that way.
     By then, it was time to sign out to the night shift - we agreed that before we gave platelets, I'd run down to the lab to look at her blood smear to see if her immune system was chewing up her cells. I had already changed into my street clothes, and it was long past time to go home, but there I was in the lab, hunched over a microscope, not seeing any "schistocytes," chewed-up cells. Give the platelets, do the LP, and hopefully we'll have our diagnosis by morning.
     I left feeling a little better that we had a plan, but not knowing someone's illness is scary, especially when it's a healthy patient with loved ones who are also scared. When I got home, I looked at the clock - my alarm would go off again in 5 hours. I think I spent those 5 hours divided between "wide awake" and "nightmares."
     I hope she's OK.
      -- Dr. James Knutson, resident Read more.

Dr. Justin Routhier: Opening up during a free moment

     My name is Justin Routhier and I am a medical intern at the Brockton Hospital.
     My wife and I recently moved to the area from Rhode Island. If you have any questions, please ask and I will try to post answers when I get a free moment (which may be rare, as I am starting on a surgical rotation for the month of August and 14-hour work days are average).
     I agreed to be interviewed by the media so that readers may try to get a sense of what it is truly like to train as a new physician. If you are curious, please drop a line and I'll try my best to respond.
     Be healthy.
      -- Dr. Justin Routhier, resident Read more.