Attendings: what do you wish you knew?

[SandP]

Before you became an attending. Can relate to medicine, happiness, relationships, or life in general. Any nuggets of wisdom you'd like to pass on to us youngsters?

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[doc05]

Before you became an attending. Can relate to medicine, happiness, relationships, or life in general. Any nuggets of wisdom you'd like to pass on to us youngsters?

Don't worry. You'll learn everything in residency.

 

[Doctor-S]

At times, gotta spend even more time dealing with admin stuff (it just won't go away).

So a 10-hour day can easily turn into a 15-hour day.

 

[DrSnips]

For me it's more about the things I wish I didn't know. Prior auths. Administrators. Discharges by noon. Turfing of patients. The ER admit button. Press-Ganey.

 

[Iz_FtB]

For me it's more about the things I wish I didn't know. Prior auths. Administrators. Discharges by noon. Turfing of patients. The ER admit button. Press-Ganey.

Clerkship has been a revelatory experience. The honesty put on display by my attendings has been both refreshing and disconcerting.

 

[mvenus929]

Don't worry. You'll learn everything in residency.

It’s okay that you don’t know everything. Just know enough to discuss the plan with your patients and look stuff up or talk to your colleagues later.

 

[Angus Avagadro]

Get rid of your watch. The more you look at it, the more frustrated you will become.

 

[NotAProgDirector]

Don't worry. You'll learn everything in residency.

Not sure if serious, but my advice is the exact opposite.

No matter what residency you do, you will only learn 50% of everything you need to know.

You will learn the next 25% in the first 6 months of your job.

You will learn the last 25% over the rest of your career.

Not understanding this resulted in 2 deaths and 1 very unnecessary surgery in my first year of practice.

[To be fair, those two people were probably going to die no matter what I did, but I certainly did the wrong thing.]

 

[Tenk]

Snowboarding is the best thing ever.

 

[getdown]

Finances. Wish I knew my options coming out of med school in terms of loans. If you're coming out with tons of debt consider consolidating them and refinancing to a lower fixed rate if possible during residency. This may save you quite a bit of change especially if you're doing a longer duration residency and fellowship. There's options to refinance again as an attending. Weigh these towards the public service loan forgiveness things (if it still exists when you come out). Be frugal, start a roth IRA if able.

 

[BigRedBeta]

If you have a difficult patient or family, its usually better to spend more time with them than less

Being able to avoid speaking jargon or technical terms helps your interactions with everyone - patients, families, nurses, other consultants. Never assume that your physician colleagues are going to understand what you mean when you start talking patho/physiology...they'll glaze over, nod yes, but then make a decision that completely ignores your recommendations.

Reminding spouses and family members that a great many people travel for business and are unavailable for things at home on occasion can help soothe hurt feelings when you are on-call, working nights/weekends. Doesn't work as well around the holidays if you are in a field that still requires your presence at those times, but is great for putting things into perspective for the non-medical people in your life.

 

[314117]

That everything in health care is controlled by the same people who control everything else - corporations, banks, etc because they control all of the money.

Practicing medicine is following protocols that are designed by corporations in order to maximize their profits.

 

[Dave1980]

Don't worry. You'll learn everything in residency.

Agree with aProgDirector. 100% disagree with this. Maybe it was a joke...?

 

[OrthoTraumaMD]

I wish I had known how much mental exhaustion residency would impose on me, and I wish I had started working out much sooner than I did.


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[SandP]

I wish I had known how much mental exhaustion residency would impose on me, and I wish I had started working out much sooner than I did.


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Any way to prevent against the mental exhaustion? Or is it inevitable? (for the surgical residencies)

 

[OrthoTraumaMD]

Any way to prevent against the mental exhaustion? Or is it inevitable? (for the surgical residencies)

Inevitable if you give a crap about what you do.
You can’t prevent it, you just have to learn how to live with it and work around it. Hence... exercise. Good habits. Taking a few minutes each day to de-stress. Not being a jerk to your loved ones. Etc.


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[MickyMyki]

Inevitable if you give a crap about what you do.
You can’t prevent it, you just have to learn how to live with it and work around it. Hence... exercise. Good habits. Taking a few minutes each day to de-stress. Not being a jerk to your loved ones. Etc.


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ok thanks. and do you mean mental exhaustion in the sense of worrying all the time? or do you mean it in the sense of using brainpower to solve problems at work?

 

[OrthoTraumaMD]

ok thanks. and do you mean mental exhaustion in the sense of worrying all the time? or do you mean it in the sense of using brainpower to solve problems at work?

Tiredness from the hours, anger from not spending enough time with your loved ones, fear you’ve done something wrong, worry you won’t know enough to treat people properly/make a mistake/get sued.

But regardless, it’s worth it. See my post on the allopathic sticky threads of “essential wisdom for medical students,” or here:

It’s worth it. (And a story.)


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[gyngyn]

I wish I had realized that all the extremely weird cases we managed were case reports!

 

[group_theory]

For a lot of patients (and families) ... it doesn't matter if you cite evidence and clinical trials about something ... they heard from a friend that his neighbor tried something and that it worked so they want to try it too

Saying "I have a patient who did this and it worked for him" is more impactful than saying "clinical trials out of Cleveland Clinic have shown that doing XXX over YYY confers a statistically significant survival advantage"

A lot of patients don't care about academic pedigree or are not impressed by them ... some actually distrust academic medical centers. They trust word of mouth, and your professional standings/relations among your peers more than your background/bio

The meetings never stop. There are more meetings than in residency/fellowship. You will have to show up early, stay late, or skip lunch to attend these meetings, while carrying a full schedule (in the office) or full clinical load (when on service). Seldom do anything productive come out of these meetings.

The PCPs are your referral base ... treat them well and they will treat you well

 

[Merely]

Not sure if serious, but my advice is the exact opposite.

No matter what residency you do, you will only learn 50% of everything you need to know.

You will learn the next 25% in the first 6 months of your job.

You will learn the last 25% over the rest of your career.

Not understanding this resulted in 2 deaths and 1 very unnecessary surgery in my first year of practice.

[To be fair, those two people were probably going to die no matter what I did, but I certainly did the wrong thing.]

He meant that you don’t need to know anything entering residency because you will learn what you need there. No need to stress out that you’re clueless as a 4th year Med student

 

[mimelim]

www.hpmor.com

There are so many lessons that I have learned and applied over the last 2-3 years from this. I have read and re-read close to 15 times now. I suppose that you could take several philosophy/logic classes, but this was far more enjoyable.

Planning falacy
Hesitation is always easy, rarely useful.
Milligan experiments

****, the list goes on and on and on.

 

[NickNaylor]

Medical school is simply a small part of a long path that is not at all reflective of what being a physician is actually about.

Go into something that you genuinely find interesting but which also fits your other motivators (salary, lifestyle, etc.). You're going to be spending a lot of time doing whatever it is you're going to, you damn well better enjoy it or at least find it intriguing.

 

[Raryn]

Not sure if serious, but my advice is the exact opposite.

No matter what residency you do, you will only learn 50% of everything you need to know.

You will learn the next 25% in the first 6 months of your job.

You will learn the last 25% over the rest of your career.

Not understanding this resulted in 2 deaths and 1 very unnecessary surgery in my first year of practice.

[To be fair, those two people were probably going to die no matter what I did, but I certainly did the wrong thing.]

I'll agree with this.

I was pretty confident at the end of my fellowship. Got >90th percentile on my in-training exams, could quote the relevant guidelines, everything else.

I still probably learned more in the first 6 months of practice than I did my second year of fellowship.

 

[OrthoTraumaMD]

I'll agree with this.

I was pretty confident at the end of my fellowship. Got >90th percentile on my in-training exams, could quote the relevant guidelines, everything else.

I still probably learned more in the first 6 months of practice than I did my second year of fellowship.

Agree. It was like drinking out of a fire hose my first year. For ortho it’s definitely true (unless you’re doing super specialist work like joints, where the cases are pretty much the same) that only 30% of what you see will be something you treated in residency or fellowship. The rest is like, well it looks like this other thing I saw... let me get a book.... oh wait the book doesn’t have this exact injury...ok let me check the journals... the journals are mixed on what to do.... ah f—- it, let me get in there and see what it looks like


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[SurfingDoctor]

The winning lottery numbers to the next Powerball

 

[OrthoTraumaMD]

I’m gonna post this. I wish I knew about “privilege” and been a nurse instead... jk jk.... but I just about peed my pants at “big nursing.” Gomerblog really knocked it out of the park.

https://gomerblog.com/2019/01/introducing-the-medical-specialty-privilege-hierarchy/


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[Bacchus]

Agree. It was like drinking out of a fire hose my first year. For ortho it’s definitely true (unless you’re doing super specialist work like joints, where the cases are pretty much the same) that only 30% of what you see will be something you treated in residency or fellowship. The rest is like, well it looks like this other thing I saw... let me get a book.... oh wait the book doesn’t have this exact injury...ok let me check the journals... the journals are mixed on what to do.... ah f—- it, let me get in there and see what it looks like


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Haha. Worst case for me as PCP is place strict restrictions, use some type of DME and refer to PT. Check imaging if necessary, especially if concern PT could cause a catastrophic outcome. Refer to sports or gen ortho if no clue.

 

[OrthoTraumaMD]

Haha. Worst case for me as PCP is place strict restrictions, use some type of DME and refer to PT. Check imaging if necessary, especially if concern PT could cause a catastrophic outcome. Refer to sports or gen ortho if no clue.

You should develop a relationship with an orthopedist you can call if not sure. Most Ortho issues do not need, and in fact are worse off, with strict restrictions. Patients have a wonderful ability to self-protect... if it hurts, they don’t walk on it. If they can walk, they probably should. I see a lot of tiny fractures, sprain equivalents who were made strict non weight bearing. They are shocked when I remove all their splints and say, have a nice life... I feel like if more pcps just texted me an Xray (not a report) and said “hey this patient is gonna see you, can they walk?”, I can save the patient a lot of trouble and potential issues with stiffness later on.


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[Bacchus]

You should develop a relationship with an orthopedist you can call if not sure. Most Ortho issues do not need, and in fact are worse off, with strict restrictions. Patients have a wonderful ability to self-protect... if it hurts, they don’t walk on it. If they can walk, they probably should. I see a lot of tiny fractures, sprain equivalents who were made strict non weight bearing. They are shocked when I remove all their splints and say, have a nice life... I feel like if more pcps just texted me an Xray (not a report) and said “hey this patient is gonna see you, can they walk?”, I can save the patient a lot of trouble and potential issues with stiffness later on.


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I do benefit from being able to text a friend who is sports med and luckily fractures can be seen within 48h usually.

 

[dpmd]

Agree. It was like drinking out of a fire hose my first year. For ortho it’s definitely true (unless you’re doing super specialist work like joints, where the cases are pretty much the same) that only 30% of what you see will be something you treated in residency or fellowship. The rest is like, well it looks like this other thing I saw... let me get a book.... oh wait the book doesn’t have this exact injury...ok let me check the journals... the journals are mixed on what to do.... ah f—- it, let me get in there and see what it looks like


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Don't forget checking you tube to see if there is a video of how to do a procedure you never saw before.

 

[OrthoTraumaMD]

Don't forget checking you tube to see if there is a video of how to do a procedure you never saw before.

VuMedi baby


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[dpmd]

VuMedi baby


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Fancy.

 

[MediCane2006]

Don't forget checking you tube to see if there is a video of how to do a procedure you never saw before.

I’m so glad it’s not just me....