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Can I have a sip of the magic Kool-Aid?

Discussion in 'Surgery and Surgical Subspecialties' started by Dr JPH, May 15, 2007.

  1. Dr JPH

    Dr JPH Banned
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    So as I sit here counting down the hours to graduation and internship, I am realizing I am not a smart guy. Dont get me wrong, I did well in school and matched at my top choice, but I just feel inept sometimes.

    I find myself forgetting the simplest things and having a tough time remembering the most basic of concepts. Talking to some of my pre-intern friends they all say the same thing. I just chalk it up to being nervous about starting in July.

    So is there some sort of magic potion that we drink during our internship orientation? I'm going to need some.

    Which flavor is best?

    I hope its a mix of "dont f*#k up call" and "nurses will like you"
     
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  3. FionaS

    FionaS Kitty sitting

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    A combination of "Don't forget ABC" and "If in doubt, nil by mouth" seems to work for me...
     
  4. Winged Scapula

    Winged Scapula Cougariffic!
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    Drink up - there's no crying in surgery!

    "Don't worry, I've seen worse"
     
  5. BurnOnMyYeeeow

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    Everyone stresses to death about starting internship. Those who don't get shocked rudely. Your first month you are going to lean heavily on your senior residents. To them it will seem like you can barely roll over, let alone crawl or walk.

    It's July, they should know and expect it. My dad has a saying: Frogs forget what it's like to be tadpoles.

    If you have time, read Charles Bosk's 'Forgive and Remember.' It's his sociology PhD thesis: he studied surgery teams at the University of Chicago (disguised in the book) like he was studying a primitive tribe. He focuses on punishment, team building, ethics, errors. Much of it remains true to this day. It's a very thin book.

    He describes:
    Technical errors - Forgivable if recognized early and rectified.
    Judgement errors - Same
    Ethical/moral errors - Not forgivable. Making a technical error, such letting go of the wire during a central line, have it disappear into the patient, then not telling anyone out of fear and leaving it in the patient, then having the team discover it two days later on CXR, is conversion of a technical error to an ethical error, is bad. That resident is now working in a flower shop, not because they messed up with the wire, but because of how they handled that situation.

    One of the doctors in it, rumored to be Dr. George Block, is quoted as saying: I want from a resident these three things: Availability, affability, and ability, in that order.

    Things I remember (I just graduated last June):

    Reputations snowball. People categorize interns into 'strong' and 'weak.'

    Strong: You'll never go wrong if you go to see the patient.

    Strong: Write everything down. You will probably round and be given 3-5 thing to do on every patient. Write it down. You will not remember. Nobody does. Come up with a system, a patient list with check boxes every day, something, anything. If your chief sees you writing down all the tasks every AM, and you forget something, it'll easier to be forgiven than if he or she never sees you write anything down.

    Strong: Learn early how to prioritize. A patient being kept waiting till 4PM for discharge orders when you decided on AM rounds to d/c, while the patient not going home today got his staples out and steri-strips on in the AM, not good. If you're having trouble, check with the chief. I used to tell my 'terns, if you get three things done before 10AM, they should be...and I want to know this CT result by 1PM... soon, I didn't have to, they just knew.

    Strong: Action, reaction. If you do something, follow up on it. Don't bolus a liter for oliguria then 8 hours later find out the urine out put didn't pickup and now the patient is anuric. Don't write orders for 2 units on the patient with cardiac issues and four hours later get called for hypoxia and wet crackles. Don't be asked on afternoon rounds, so what did that CT show? And say uh... and find out radiology bumped you to the end of the line and it may not even get done today now.

    Strong: Don't procrastinate. You don't want to get pulled off service because you have 100 discharge summaries waiting for you in medical records.

    Weak: Your body and emotions are your own worst enemy. Your desire to eat lunch, rack for a few more minutes, letting your hatred of a particular nurse cloud your judgement when they call you with 'this guy doesn't look right' is where you will get burned, not from lack of intelligence or even lack of knowledge.

    Weak: Continual conflicts with support staff. Getting stressed and yelling at the nurses doesn't help. It just makes the rest of the rotation harder and your attendings will hear about it. In many cases, the attendings have known that nurse for much longer than they have known you.

    Strong: There is a difference between efficiency and cutting corners. One will get you time to go to the operating room and get you home at a reasonable hour. The other may get you home in the middle of the day, without a job.

    Strong: The enthusiastic and cheerful resident tends to have an easier time than the sullen, complaining shirker who the nurses always see is calling from the call room: you do not want to graduate and at your Chief Roast win the 'Napa Valley Whine' award.

    Strong: Your chief will only look as good as you let him or her look.
    Strong: corollary: never blame anyone else, accept responsibility and also put forward a plan for how to fix the mistake.

    Weak: Constant excuses and explanations for why something didn't get done.

    Strong: Your only allies are your fellow interns. Don't screw them over. Build a team and syngergy can result. Every once in awhile a program seems to get someone who thinks they can get out a little earlier, make their own life a little easier at the expense of their co-residents. You work together too closely and for too long for people not to figure out pretty fast that someone smells, and not long after, who the stinker is. Life for that person tends to get considerably harder after that.

    We used to fight over sign out before the days of 80 hours, and when we had Q2-3 call.

    Sign out to me!
    No! I'll be done with everything in another hour.
    Just gimme your list! I'm here all night anyway!
    No, you've got enough to do and I'm almost done!

    Turns out our chairman was around the corner, med student stumbled into the chairman and was like, the boss is right around the corner listening to you guys. A week later, we were out having drinks at a local hotel lounge, someone said they thought they saw the chairman. Later, we were mystified when we were told our tab was already covered. (8 residents and s/o's, it was a big tab). When we asked who?... they showed us the receipt.

    People appreciate what you do. They just don't tell you 99% of the time. It's the last bit of the old school left, IMO.

    I had a code called on a patient who was accidentally given too much IV beta blocker. Ran there, gave her atropine, got her to unit, no lasting adverse events. Attending slapped me on the back and I feel good. Later that day, he yell at me about something and asks if I've done anything at all to advance the care of his patients that day!!??! So I mention that earlier incident. He says, 'That was five minutes ago. What have you done lately!?' then he laughed and chilled out.

    So my final advice to you is: Let it roll off, like water off a duck's back.

    A person who climbed the highest peaks on each continent did Everest last, and said the last stretch of Everest was the hardest to keep going up. You are on that last stretch. Don't give up now, be confident but not arrogant, work hard and care, and you'll be fine.
     
  6. totallygone

    totallygone New Member

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    That was excellent BURNoutMYEOWW.......very inspirational. I think that team work is very essential in order to get through in any aspect of medicine.:D
     
  7. Dr JPH

    Dr JPH Banned
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    I needed that. Thank you. :D
     
  8. MossPoh

    MossPoh Textures intrigue me

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    I have to say that might be one of the most inciteful 4th posts during the history of SDN. Much of that is applicable in regular life situations as well. As cheesy as it sounds, much of the stuff mentioned is along the lines of Fox's books "How to be a rainmaker" and "How to be a great boss". Speaks of confidence, accountability, sticking with your group, "everybody is someone's somebody" (aka don't yell at people if you can't help it.) All the stuff mentioned there in some form basically....Good luck, and if I come into the hospital don't kill me. ;)
     
  9. SurgSoon

    SurgSoon New Member

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    sage advice given to me on day #1 of internship:
    "you're damned if you do, and damned if you don't"

    this will shift over time, but as a newbie intern, just remember that you will never please everyone. you will never live up to all expectations. you will never be able to be perfect. and that is par for the course. so pick your battles. and be reasonable with yourself and your expectations.

    AND DO THE RIGHT THING FOR YOUR PATIENTS.

    when in doubt, be a good person. do right by your peers and residents. this will pay you back the most in the long run.

    act. do not merely react.
     
  10. Winged Scapula

    Winged Scapula Cougariffic!
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    Wonderful post by BurnOnMyYeoww. Everything I would want to say but couldn't so eloquently. Thank you...
     
  11. RichL025

    RichL025 Senior Member

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    BurnOnMyYeoww - excellent post. Needs to be laminated & handed out next month.

    Kimberli, what's the chance of that getting a sticky?
     
  12. Winged Scapula

    Winged Scapula Cougariffic!
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    I agree its a valuable sentiment but there's recently been a call for a moratorium on Stickies. You may have noticed that I have removed some from this forum...when you get too many stickies, the regular posts fall farther down the page and users sometimes get frustrated.

    Obviously surgeons don't get frustrated about such a little thing because we've got many more frustrating things to worry about, but we at SDN are trying to make an effort to reduce the number of stickies.

    What I can do is place that information/advice into either a Wiki or into my Stickied "Surgery FAQs". This summer I'll have some time while waiting for my AZ license to come in so can work on getting everything straightened out. In the meantime, I agree with above - print it out and stick it in your coat pocket handbook.
     
  13. Winged Scapula

    Winged Scapula Cougariffic!
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    I do the same thing, as if surrounding ourselves with books will reduce the anxiety and increase our knowledge level.

    I've found myself buying surgical atlases telling me how to do procedures in case I forget...I won't have anyone in the room to tell me how to do the procedure in a few week!

    I'm sure you'll be fine!
     
  14. driedcaribou

    driedcaribou Senior Member
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    Very inspiring. Thanks for the post.
     
  15. Sweet Tea

    Sweet Tea Girl Next Door
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    Thanks, BurnOn. I'm going to be printing that list out, too.
     
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  17. MediCane2006

    MediCane2006 Living the dream
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    That's bulletin board material right there. Thanks!
     
  18. Tigger14

    Tigger14 Ready to move

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    All of this post was excellent, but this sentence should be highlighted and underlined and NEVER forgotten. Everyone will make mistakes, and at every level. Own up to your mistake as fast as possible after you recognize it.

    At the resident level, you will be known as being trustworthy, and that is critical to the attendings. One of my attendings recently criticized an order I had written (rightfully), but said that while he has seen me make mistakes, he has never heard me lie.

    As an attending the most common reason a doctor is sued is because they were not straightforward with the family. Do not try to "finesse" a patient error; the majority of patients and families will see right through it. I have been scrubbed in cases with technical errors, and when the attending spoke with the family, they were thankful that the issue was quickly recognized, addressed, and mitigated.

    BurnOnMyYeeeow's advice was fantastic, but it will not matter if you are smart, nice, timely, a hard worker, or appear caring if you are not trustworthy.
     
  19. Winged Scapula

    Winged Scapula Cougariffic!
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    Just adding my voice of agreement and experiences to that of Tigger's above:

    when I was a junior resident, one of the more senior residents from my program was fired. In chatting with the PD about a mistake I made, I wondered aloud if I would be fired like resident X was. He point blank told me that the reason the other resident was fired had nothing to do with making a mistake (and it certainly had nothing to do with his ABSITE scores since they were consistently 99%tile) but rather for lying about his mistake, a lie on top of many other lies throughout his residency. He was simply untrustworthy.

    Furthermore, said PD (now my former PD) and my current fellowship PD both told me that when they were giving references to potential employers almost all they (potential employers) cared about was whether I was honest, whether they could trust what I said and whether or not I recognized when I needed help. There was seemingly much less concern about my surgical skills (as long as they were average and I was "safe").
     
  20. hans19

    hans19 I'm back...
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    Magic Kool-Aid?!? I think your looking for the 'purple drink'!
    http://en.wikipedia.org/wiki/Purple_drank
     

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