Some rules for interns

Some of your job as an intern is only indirectly related to patient care. While the rules below don’t tell you how to operate better, they will help you to be a more effective team member and colleague. These elements are important for any medical specialty, but especially in surgery where the stakes are that much higher.

Get along with the nurses. The nurses know more than you do about the codes, routines, and rituals of making the wards run smoothly. In the beginning they often know more than you do about how to treat the most commonly encountered problems. They may not know as much about pheochromocytomas and intermediate filaments, but about the stuff that matters, they know a lot. Acknowledge that, ask politely, and they will take you under their wings and teach you a ton.

Stay in the loop. In the beginning, you may not feel like a real part of the team. If you are persistent and reliable, however, soon your residents will trust you with more important jobs.

Talk to your patients. Chatting with the patient is one of the places where you can soar to the top of the team. As an intern, you have the opportunity to place the patient’s chief complaint into the context of the rest of his or her life. Talk to your patients about everything (including their disease and therapy) and they will love you for it. You can serve a real purpose as a listener and translator for the patient and his or her family. While it isn’t appropriate to do this in the middle of morning rounds, you can often have these conversations in the afternoon as you check on your patients.

Say “Thank you.” When you are lost (and you will be), the most effective answer to many questions includes a “Thank you.” Like enthusiasm, gratitude is an invaluable tool on the wards.

Say “Thank you,” revisited. Thank you can also be used to avoid making a bad situation worse. In general, most clinical questions can be answered with a “yes,” “no,” “I don’t know,” or “thank you.” The “thank you” is for those times when all the other answers seem wrong. This takes practice and can initially feel awkward. For example, let’s say you were told to do something by your senior resident but were later called by the attending who was not happy with this action. She asks, “Is that what you always do in this situation?” There are no good answers to this question, only answers that are less bad. If you say no, then you are going to ultimately get cornered and end up having to throw your senior resident under the bus (always a terrible idea). If you answer yes, you are needlessly sabotaging yourself. The best option is to simply say, “Thank you for the feedback, I’ll make sure it doesn’t happen again.” This usually works to diffuse the situation, and demonstrates humility, an interest in learning, and concern for the patient.

Be punctual. Type A people don’t like to wait, and most surgeons are nothing if not type A.
Be clean. You must look, act, and smell like a doctor. You owe at least that much to your patients and your colleagues.

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