Lessons for July 1st: My Takeaways from Residency

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I remember my first day of residency, ten years ago. Naturally, excitement and nervousness had me waking up earlier than I intended, so I decided to drive to the hospital early, and hang out in my car until it was an appropriate time to arrive. I journaled to pass the time, and can still remember staring at this brick fortress of a hospital, realizing the gravity of this day—July 1st—would mark the start of a long and fruitful career.

Here are some tips that will get you ready for the start of the new residency year.

1. Practice the 3 A’s: affable, able, and available.

If you haven’t heard this from your mentors yet, you will soon. The 3 A’s are something for physicians to strive for. You need to be affable. Certainly, this is not the first word that comes to mind when describing some surgeons I’ve met along the way. But being an approachable and friendly person will only help your patients.

Physicians who are degrading and difficult to approach are doing their patients no favors. They’re harder to interact with, and more dismissive of legitimate concerns. Being a world-class clinician and a generally likable person aren’t mutually exclusive. Don’t let the stresses of sick patients and long hours make you forget to be a good person and colleague.

Able/ability goes without saying. Granted, as an early PGY-1, you won’t be able to manage a full patient list. But you should be able to do the tasks assigned to you by your seniors. Ability will come in time.

Being available is the most underrated necessity here. Nothing grinds my gears more than a colleague not answering their phone when I need them immediately. When I get the phone call for a stat C-section and I call my colleague to go staff the case, if they don’t pick up their phone, I’m both stuck and furious.

Sometimes, when you’re knee deep in a dressing change or epidural, your hands might be occupied, but have someone else answer your phone! Don’t disappear. You should (while on duty) always be available or have someone around to explain why you’re not.

2. First you’ll learn how to manage patients, then you’ll learn how to manage people.

One of my favorite mentors taught me this in regards to anesthesiology, but it holds true for every medical specialty. As you ascend the ranks, and the patient care becomes more about pattern recognition and efficiency, you can focus more of your bandwidth toward working well with colleagues and teams.

As a partner and partial owner of my practice, so much of my day-to-day is in managing people and personalities. These include visiting students, CRNAs, schedulers, surgeons, administrators, and more. Eventually, you’ll be a senior resident, and you’ll need to learn how to manage the team under you. This includes finding ways to make them help one another, empower them, and recognize their achievements and shortfalls. This can help reframe your practice from the get-go. Communication and interpersonal skills are as important as being able to assemble your differential diagnosis.

3. Only you can triage your own life.

You may have heard the adage that you only get to pick two of the following three things: sleep, free time, and studying. While I find that statement to be somewhat misguided, residency is indeed a time when you’ll have to devote a lot of time to work. Naturally, you’ll have to decide what’s most important outside the hospital and find a way to prioritize that.

As a fitness enthusiast, it was disheartening to find out how hard it was to keep up with workouts when I had a newborn at home and a 60-80 hour work week. Family came first, and while I didn’t become completely out of shape, I had to sacrifice some exercise sessions to maximize time at home and lighten my wife’s load.

People may not always understand the decisions you make when it comes to triaging your life, but, depending on the circumstances, I wouldn’t worry too much about that. For example, I still remember presenting a poster at a Saturday conference here in Philadelphia. I stuck around for as long as I felt I could, but I wanted to get home to see my son.

When I was leaving, I was quizzically interrogated at the door by the seminar’s organizers, who said, “You’re leaving now? But…” And while departing halfway through the seminar may not have been the most “professional” thing to do, I made the decision to go home and see my 3-month old son. It was an easy decision, but one that still felt strange at the time. My point is that no one can tell you what the most important things are in your life, except you.

4. Personality issues are hard to fix—plugging gaps in medical skills is easy.

This lesson rings true every day I’m at work. Personal reputation at the hospital is huge, and is almost always correct. Some colleagues have a reputation for being difficult to work with, or for hiding when something might be required of them. And some of them are known to be the hardest workers, the never-complainers, the most proactive and helpful members of the entire team. Everyone knows who falls into which camp. And if someone’s personality is the issue, that’s a hard problem to fix.

If, on the other hand, someone has a good personality but is a bit lacking when it comes to medical knowledge and procedural skill, that can all be taught and learned. Some people pick things up more quickly than others, but just about everyone is able to figure out how to do the cerebral and tactile parts of their job pretty well, given enough time to work on it.

But people that have personality issues will probably continue to have them throughout their career. These are the colleagues that don’t know how to work well with others, that blame others when things aren’t going their way, or that are just plain rude.

Unfortunately, you’ll have to learn to work with difficult people, a challenge that everyone in every career faces. Look in the mirror and make sure that person isn’t you. No amount of clinical acumen is enough to make up for being a jerk.

5. Asking for help isn’t a sign of weakness.

I’ve been out of training for six years, and I still find myself asking for help. Sometimes it’s for a tricky spinal in a 90-year old, arthritis-ravaged spine. In situations like that, I’m calling the guy who has done ten times more spinals than I have to come take a shot. Sometimes it’s trying to navigate a complex surgical schedule, and deciding who I can provide anesthesia to now, and who will have to wait. I ask the department chair for help, who has made this decision countless times in the past. Even when it’s something that’s within my skill set, but I’m too tied up to take care of, I’m phoning a friend.

I made lots of phone calls to my senior resident as an intern, and while sometimes it might be a bother, it’s a much smaller evil than making a big guess and a wrong decision. There’s a systematic hierarchy in place for a reason. If you don’t know the answer to something, that’s fine. Figure out what you can on your own, and ask for help when needed.

But before you do any of this, go and see the patient. It’s a real pain to do when you’re sleeping in your call room, but if you have the slightest concern about something, go see the patient before enlisting help from others.

Final Thoughts

Residency will challenge you in ways you can’t yet imagine, but it will also shape you into the physician you’re meant to become. Show up, stay humble, and keep learning every day. Carry these five lessons forward, as I have in my career, and you’ll be better for it.

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By Brian Radvansky, MD