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As you complete the final stages of medical school it is now time to turn your thoughts to that next stage: internship and residency. This chapter will introduce you to some common issues faced in that stage and give you some basic guiding principles.

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A Case of the Jitters

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We were all nervous when we started our internships. In fact, it would be frightening if you weren’t nervous—those are the interns who are dangerous! But you should also have some confidence not only in yourself but also in your co-residents, your attendings, and the system. You are not alone, and nobody expects you to know everything your first day. They do expect you to care about your patients and to do everything in your power to “do the right thing.” Often that means asking for help. Contrary to what you might think, an intern who asks for help is held in much higher esteem than the one who avoids calling (whether out of embarrassment, an inappropriate concern for the feelings of the supervisor, ignorance, or just plain laziness). The worst thing that somebody might think about you if you call is that you don’t know what you are talking about. And, well, there is some truth to that. Sorry. But the sooner you come to accept the limitations in your knowledge, the faster you will learn and the better you will be for your patients. Of course, there will come a point where you do need to start working through things on your own, but the first day of internship is not that time. Until then, try and revel in the excitement and awe that you are about to become a surgeon. You deserve to be proud. Just not too proud.

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Getting to Know Your Patients

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This is the fun of medicine. Patients are people with wonderful stories. A patient with lung or pancreatic cancer who has a daughter about to graduate from law school will likely respond very differently to “standard therapy” compared with a Norwegian bachelor farmer whose immediate future is completely encompassed by the snowy winter of his discontent. Clinical medicine is not like physics, where when you drop a brick out of the window, you expect it to go down every time. In medicine it is frankly surprising when 2 patients with an identical diagnosis respond to “conventional therapy” in the same manner.

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Patients’ symptoms are their perceptions, and perceptions are more important than reality. You have a role in helping to shape their perceptions, especially if you work to understand and care about what they think. Patients want to trust and love you. This trust in surgical therapy is a formidable tool. The more a patient understands about his or her disease, the more the patient can participate in getting better. Recovery is faster when the patient helps.

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Similarly, the more the ...

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