“My first day and I went crazy. Any advice?”

This question cracked me up because it reminded me of my first day as a clerk. Dr. AG asks, “I just started as an intern and I feel like I don’t know anything. the medical students seem to know more than me. My first day and I went crazy. Any advice for a new intern.”

Hmm. Lots. To be honest when on my first day at clerkship and internship was like the first day at any medical practice at any job. It’s going to be the same everywhere. So the advice I give you could be well applied to any future first job.

I can well remember the first day of my clerkship was in Pediatrics at JBL, San Fernando, Pampanga, Philippines. It was the height of Dengue season, two dengue wards were full. I had no clue what to do, where the lab forms were, where the lab was, where the residents slept and what to write. Patients kept bringing their children to me with IV out’s, children with nephritic and nephritic syndromes needed urine outputs monitored and there was a q15 BP monitoring in place for both dengue wards. I won’t lie, by the end of the day I cried. I hated pediatrics. I didn’t ever want to go back to medicine ever again. By the end of the month our top 1 ranker quit medicine completely. She just couldn’t go through it.

When I went into internship I knew what it would be like but on my first day in Medicine, I still ended up crying.

My advice to new interns is this:

-If You Don’t Know, Ask

The teams know you’re new. You may think you’re annoying them by constantly asking them for advice but actually they quite like that you’re dependent on them. They’d rather  prefer you want to learn and be cautious than seem like a Mr-know it all.  Ask many times. If you don’t understand, say so.  Do it once but do it right. Don’t be afraid or embarassed to ask.

-Be Patient

You won’t know everything on day 1. It will take time. I didn’t know how to do pediatric IV insertions right till my 29th day of rotation. I didn’t do good admission conferences in pediatrics on any morning when I was on wards. I always got hazed and torn apart till my last day of rotation. Learning takes time.

-Stay Humble

You will be corrected many times, repeatedly and often in front of nurses, ward boys and patients. Don’t react. Be humble. Learn from your mistakes. The hazing will end. Believe me it’s good preparation for the real world. Patients are often worse taskmasters than your attending. Smile and don’t let your ego get in the way.

-If You Have Nothing Good To Say, Shut Up!

Don’t malign your colleague, attending, nurse or anyone else. News travels fast in the small world of a hospital. And payback is a (you know what.) If you have nothing good to say, then keep quiet.

-Develop A Learning Attitude

This is fertile ground for practice. So watch and learn from everyone. the med techs, nurses and respiratory therapists all are experts in their fields. Soak up everything you can from them like a sponge. Ask questions, take an active interest in what they have to say, show they that you’re teachable and they will teach.  They would be happy to advise you with their expertise.

-Befriend The Staff. 

I remember after developing camaraderie with the nurses, they always had my back, even in front of an attending. They will go to war for you if they like you. Don’t suck up. Be genuinely nice. Hospital work is hard. If you make it easier for everyone it gets easier for you. Seek their opinion and include them in decision making. empower them by asking for advice.

-Never Lie To Your Patient

Always tell them the truth. They deserve it.  If you mess up or the attending is late, whatever, always tell the truth. I’ve seen many residents lose their job over trivial lies that didn’t need to have been said.

-Eat And Sleep Well

Don’t forego meals. Eat healthy and on time. Do this at the very beginning of your residency. Arrange a schedule with your co-interns on night shifts so each of you can sleep for a few hours while someone else covers the shift. Often the nurses will tell you to do so. They understand.

-Carry Your Pocketbook With You

It serves as a quick reference guide when you’re in a pinch. Whether an e-version or a physical copy carry one with you always. I used the Oxford manual of Medicine back then and now use the Washington Manual General Internal Medicine Consult. I’ve also heard rave reviews about the  The Massachusetts General Hospital Handbook of Internal Medicine

-Making Referrals

Know everything about your case before making the referral and I mean EVERYTHING. You should memorize the entire history, physical exam, and pertinent labs when you refer to a consultant and attending.

-Don’t Panic

Never! There’s no need. You’re in a hospital. You can handle this. Someone will step in for you if you don’t know what to do but don’t panic. Having a giant brain fart when you see a cervical cauliflower lesion or anal prolapse is going to make your patient panic as well. So calm down. You can always get help. Remember that song “Pokerface?” That should be you.

-Get Over Yourself

So you have to go back and refer to your consultant every time. So you have to present each case in front of the med students. So you got hazed. Get over yourself. It’s not about you. It’s about the patient. Take the advice you get, learn from your mistakes and move on.

-Keep Notes

This is hands down the best advice I can give you. Makes notes of what your learn everyday on rounds with attendings or otherwise. Often this will be part of your board exam or rotation exams. You always can refer to your notes later when you practice. It will also help you chart your own learning curve. I still have my notes from my IM rotations. I learned a ton there and sometimes refer to it for the basics when I need to brush up.

Relax. A year from now, you’ll be laughing at yourself for stressing so much. Enjoy the journey. Count yourself lucky. You have an opportunity to learn that so many haven’t received.

Does anyone else have advice for new interns? Feel free to send it in. Cheers!