In the earlier article about your medical internship year, I mentioned the Big Four and The Golden Rule (if you haven’t read it yet, go here first).
At the end of it, I said there were also other things that matter.
Smaller, maybe, as compared to the Big Four. But no less important to you, in a real sense, during your internship year.
Here’s a list of them:
- Time Management
Let’s talk about each of them in more detail.
It’s sad that this has to be listed high among things a medical intern must be aware of. Yet it’s very practical in the charged environment doctors operate in today.
Violence against doctors, including medical interns, is an unfortunate reality.
Reports aren’t widely circulated. Public outrage against it is sporadic, at best. But for an individual doctor, as well as collectively to the fraternity, this practice is a serious dampener.
All doctors are painfully aware that at least a part of their focus should be on avoiding ‘problem situations‘, ones which may make them targets of a mob’s ire.
So as a medical intern who will often be on the front line of patient care, you should be aware of this constant danger – and take due precautions to avert flare ups and potentially explosive situations.
It’s just as sad that your personal safety has to be prominently addressed in any internship checklist. Yet it is true that interns are often placed in risky, even dangerous situations that could leave you vulnerable.
Do not make the mistake of assuming that a hospital is as safe as a medical college. It is not!
Apart from work-related safety measures – like wearing protective clothing and gloves/masks, handling sharp instruments carefully, being aware of the health hazards of contagious material and such like – there are also safety measures you must take against assault (sexual or otherwise) inside the hospital.
Being sleep-deprived and under stress leaves your judgment unreliable at times. The emotional trauma of treating ill patients can make you edgy or anxious, sad or angry. And this leaves you vulnerable to predatory elements that exist in any unusual ecosystem – like a hospital.
Risks may come from colleagues and co-workers. They may come from patients and their attenders. And they could even come from authority figures.
Every medical intern is just as much at risk as any other.
It is critical that you
- establish safety precautions,
- build your own networks of trusted people,
- inform yourself about the geography of the workplace,
- evaluate how safe and secure a given location or position will be,
- avoid getting stuck in places where you may be at risk, and
- take all necessary steps to stay safe while you work.
A rested mind and body is infinitely more productive. Yet rest and internship rarely go hand in hand.
Yes, you can complain about it… or you can choose to see it differently, as essential practice for rare occasions where you may be called upon to perform without rest in a professional context, when only your skill and action can save lives.
With that being said, try and get as much sleep as possible – without compromising on your patient-care duties.
There’s an old wartime adage for soldiers, that serves interns and residents well.
“Don’t walk if you can stand; don’t stand if you can sit; don’t sit if you can lie; and don’t lie if you can sleep!”
Bedbugs and unfamiliar surroundings, interruptions and worries about your responsibility, emotional stress connected to patients, and unfamiliarity with your daily routine can combine to make it hard to sleep. But getting used to this is part of your training to become a doctor.
So try your best to sleep well.
Eating is another casualty of a medical internship.
On a busy stint, you may not have time to grab even a quick meal. So it has to rank high on your list of priorities to nourish yourself as best as possible.
Lacking energy, low on immunity, weak from hunger is a horrible frame of mind to deal with an intern’s slog. Prepare and plan to get your calories and nutrients right.
If you lose too much weight, you’ll be susceptible to infections which could quickly become life threatening. Take care.
All these issues collectively bring up another important element of being an intern.
You need to develop discipline.
It isn’t everyone’s favorite word. Yet to an intern, it must become a rule of life.
Being disciplined in how you eat, sleep, work, study and handle your patient care tasks is the only thing that can keep you healthy, safe and happy during these busy days over the year ahead.
Over most of your time as a medical student, the lack of discipline might have been a minor nuisance, with few consequences if any. During a hectic internship, it can mean the difference between efficiency… and complete chaos.
More importantly, if you don’t care to develop a disciplined approach during this early phase of your medical career, it gets infinitely harder as your life grows more complicated and multi-faceted beyond this point.
As you progress in your career, your professional tasks will remain just as intense – or even grow more demanding. And you’ll have to juggle them with others, such as managing a relationship, getting married, raising a family, caring for aged parents, and advancing your career.
As this complexity grows and becomes more tangled, your lack of discipline will have increasingly serious negative consequences.
All of this can be avoided by laying the foundation of a disciplined approach – right during your medical internship.
Time Management is a vital skill to acquire during your internship.
You’re often called upon to handle several tasks as an intern. Each takes time and effort. Your list of things to do will seem formidable. And you need a systematic approach to finish your duties every day.
You could muddle along through it all, rushing from one crisis or urgent situation to another, stressed and anxious all the time.
Or you could devise a system to prioritize correctly, assign time for each task, and work your way through the list in a calm, collected way.
Which approach you choose to adopt as an intern will very likely signal how your future as a doctor unfolds. There are both kinds in the world. You’ll easily be able to tell… by how irritable, short-tempered, rushed, stressed and ineffective they are – or not.
Now until this point, I’ve addressed general areas for growth during your internship year. They apply equally to EVERY intern today – and even those who’ll begin their internships in the future.
What follows is more of a personal reflection on an intern’s role.
It states opinions I hold, and that you may well disagree with. Take it or leave it, as you will. But these are also areas that an intern may choose to focus on with advantage, to become a better physician.
No, I’m not talking in the socio-political sense here – but of personal tolerance.
Tolerating your own self.
Because if there’s anything constant about internship, it’s this.
You Will Make Mistakes
Often, many of them. It is inevitable. Because you are still learning. There’s a trite aphorism in Tamil: “He who has killed a thousand is half a doctor!”
Well, don’t take that too literally. But also be accepting and forgiving of yourself.
Don’t blame yourself or feel guilty about your mistakes. Just make a promise to yourself – that you’ll never repeat them again.
Also, don’t forget or ignore them. If you brush them aside, or make excuses for why/how they happened, chances are you will end up repeating them in the future.
- Learn lessons from every experience.
- Spend time to review what happened.
- Determine what went wrong, and why.
To not do this adds insult to injury. A patient (usually) suffers the consequences of your mistake… and if your introspection protects other patients from the same kind of suffering, then at least something good has ensued.
On the day I joined my training program in heart surgery, our professor met the new candidates. Among other things, he told us:
“There are no new mistakes under the sun. Any complication you create here, someone else has already done before. So don’t worry about making mistakes. Just learn from them.”
Those wise words went a long way in lowering the stress of entering a new specialty – where even tiny mistakes could be punished by the loss of a patient’s life.
Also, the realization that everyone makes mistakes at this early learning phase of their career should encourage you be be kind, gentle and forgiving – with yourself.
Don’t become overwhelmed by guilt or anxiety.
That way, you’ll do your job better – and save many more lives over your career as a doctor than you ever harmed through your newbie mistakes.
For many like you, internship will be the first intimate acquaintance with death.
Maybe you’ve experienced the loss of a loved one before. But with very rare exceptions, the internship year will be the first time when your own actions and decisions become related to death, when death is felt to be the consequence of something you did – or did not do.
That can be traumatic and tough to deal with.
French surgeon René Leriche said:
“Every surgeon carries within himself a small cemetery, where from time to time he goes to pray.”
I have mine. Maybe, over time, you’ll have yours, too.
It’s a way to keep us grounded, remind us of the terrible cost of becoming over-confident, arrogant or careless. It makes us better doctors, watchful and wary about what we do.
But there’s no point wallowing in guilt over a patient’s death. Almost never is your (in)action the sole cause for the loss of a life. It’s not usually in your hands.
A disease’s severity. A patient’s overall health. A procedure’s effectiveness. A medicine’s efficacy. Other unknown variables.
All of them determine the outcome.
Too much guilt and self-criticism is a luxury you cannot afford as a healthcare professional. You must move on to help others, using lessons learned from the experience around a patient’s death.
Guilt won’t help. Careful and critical introspection will.
And in time, you’ll evolve your own relationship with the idea of losing some patients.
Be patient with yourself. And don’t let it overwhelm you.
This is especially important for interns who are beginning their tenure in the middle of the COVID pandemic.
Seeing death all around you can be disconcerting and depressing. You need to be strong, mentally and emotionally, to deal with it – and carry on with your important, life saving work.
Remember – almost always, it’s not your fault.
In the Bhagavad Gita: Chapter 11, Verse 33, Lord Krishna tells Arjuna:
“These warriors stand already slain by me, and you will only be an instrument of my work, O expert archer.”
YOUR PERSONAL PHILOSOPHY
Right at the start of this long essay, I called the internship year…
Your Most Important Year Of All!
If I had instead called it your toughest, hardest, most challenging year of all, it wouldn’t be too wrong.
Most doctors will agree that their own year of medical internship is when they changed, grew and evolved as doctors – more than any other comparable period of their life, before or afterwards.
It’s also usually a time of personal turmoil.
You’re thrown out of the warm, secure womb of medical college, right into the roiling waters of a hospital-based healthcare system.
You’re forced to recall stuff you learned from textbooks and classrooms, and use it to treat disease and save lives.
And meanwhile, other important things are happening in your life.
- Maybe you’re in a relationship, and wondering how it’ll go.
- Or maybe you’ll soon be married, and worry about that aspect of your life.
- Or you might have made plans which get derailed by circumstances beyond your control.
- Maybe ailing grandparents are unwell.
- Parents might be entering a phase of poor health.
- Siblings may need guidance or encouragement.
- Financial needs may have to be met from your earnings.
- Your own career has to be plotted and planned.
- Post graduate entrance exams loom in the distance.
In the midst of it all, here you are… struggling to find your feet in a new environment – where the price for careless, ignorant or uncaring action is a human life!
Not easy. Nope.
And that’s often when you seek a guiding philosophy that helps you make sense of your life.
It may be religious or rational, social or something else.
You’ll seek explanations and try to find meaning. And in the tumult and confusion of all that’s happening during the internship year, that philosophy will itself evolve.
To fit changes you see. To match experiences you’ll have. To offer credible explanations for new events and observations you’ll now be a part of.
It sounds difficult.
And maybe it is. But here’s the good news.
At the end of this year, you will be a new person.
A tougher person. A stronger person. Wiser, calmer and more caring.
Yes, you’ll be a DOCTOR.
Anything worth getting and keeping is worth a fight and struggle.
Becoming a doctor is worth it all.
At the end of the coming year, you’ll agree.
Come back then and tell me all about it.
Here’s wishing you all the very best – in your career, and in your life.