Attending Physician Guest Author and Contributing Writer Emeritus
Intermountain Healthcare
Justin Jones is an outpatient primary care physician in Utah. He completed his residency in 2018 in Colorado and wrote for in-House during residency. He blogs at Residency Hacker.
Realizing that we have both inpatient and outpatient months, which require different skill sets, I feel that it would be better to split these lists into both outpatient and inpatient suggestions. After a few month of being on outpatient rotations, here is my list of eight things to master in order to break the successful intern barrier in the outpatient world.
I got an email recently from one of the faculty at my program who prompted us to each evaluate the question “what does success in intern year look like?”
Twenty minutes of cardiopulmonary resuscitation. Fifteen beats per minute. Seven nurses. Five doctors. Three paramedics. Two anesthesiologists. One transcriber and me. And then the eerie silence of the trauma room as the death was called.
“Hey hey! How are you?” someone calls out as I walk into the fluorescently lit emergency department I call home. “Living the dream,” is my habitual answer, and it’s only half facetious.
Despite EBM’s role as an incredible advancement in the history of medical care and patient management, there remains many challenges that young clinicians must face when attempting to implement EBM into their respective practices.
Everyone warns you that intern year is hard. It’s a year of little sleep, a rollercoaster of emotions both good and bad. Frustration and guilt in wanting to know everything now because everything you don’t know might be what matters for this patient, this time. And tremendous successes. Some of the things I did this year, I really can’t believe I was able to do. And survive.
Sometimes, it’s difficult to recall that single defining moment or person that sends you on the path you’re meant to take in life. I was fortunate in that I found that experience halfway through my undergraduate career at the University of California, Davis. I had recently lost my grandmother — although I’d wanted to help, all I’d been able to do at the hospital was translate for her. That overwhelming sense of helplessness I felt due to my lack of medical knowledge fueled my desire to help and serve others as a physician.
I feel like there are so many things to work on in medicine. I need to be more efficient at taking a history; I need to gather morning data more quickly; I should be better at chart review when I get a new admission; I need to be more thorough at following up on labs; I could write the H&P more quickly, and so on. I also feel, from time to time, I do poorly on one thing — maybe I stay at work way too long writing my H&P — and then I obsess over how I can get faster at it.
It’s 2 a.m., and the patient’s blood pressure is beginning to rapidly decrease. Every IV line is occupied by an antibiotic or IV fluids, and we are in need of a vasoactive medication. The nurse comes to my computer and sternly states, “We can no longer avoid it. I think the patient needs a central line.” I quickly say “okay,” but I don’t move. I am momentarily frozen by my unease with the bedside procedure ahead.
I recently recreated a now-famous business school study on a subset of residents in my internal medicine residency program. In the original study, researchers asked students to read a case of the real-life venture capitalist Heidi Roizen, who expertly leveraged an extensive professional network to forward her career. Half of the students read the original case; half were given a case in which Heidi’s name was switched to Howard — a fictional male persona.
In an ideal world we would all die at home with our loved ones caring for us, slowly slipping away in our sleep into the placid beyond. But why doesn’t it happen this way? There’s a dignity to that way because of its organic simplicity. It’s how people used to die prior to modern medicine and before we started needing to always “fix the problem.”
Danielle Ofri, MD, PhD, is a physician at Bellevue Hospital, the oldest public hospital in country. She writes about medicine and the doctor-patient connection for The New York Times and her writings have been featured in the Los Angeles Times, The Washington Post, the New England Journal of Medicine, the Lancet, and on CNN.com and National Public Radio. She is the author of four books, numerous essays, and the co-founder and editor-in-chief of the Bellevue Literary Review.
Peer Reviewer Emeritus
Brown University
Sasha is thrilled for the opportunity to combine her interests in writing and medicine. She has been writing since she got her first journal in second grade, and editing since she ran her high school newspaper. Her interest in medicine evolved through travel, studying the brain through the lens of social science as undergraduate at Boston University, and together with her interest in yoga and dance. Sasha gets inspired on long runs and looks forward to few things more than hiking with her mom.
