Kevin Cao
As I’m approximately a quarter into my intern year, I find myself privileged to be surrounded by coworkers that have provided me a strong foundation to succeed here in the wards. Did you notice something in the previous sentence that may have seemed “off?” I said coworkers. I did not outright say coresidents. I want to make this a critical point that should be noted. While it is almost universally understood that having great coresidents to work with is important, it is even perhaps more vital to understand how everyone else is in their relation to patient care. Who’s everyone else? Nurses, pharmacists, administrators, social workers, custodial staff, transport services, nutrition, and the list goes on and on. As I have exchanged my suits and oxfords for scrubs and not-so-fashion-forward Crocs, I realized that I continue to utilize my administration know-how from my days before medical school . As a former administrator, I learned that information is gold. Such information may trickle down to you, but it’s better to find the source. Where’s the babbling brook? From office politics to the latest memo from your buddy trapped in a cubicle, there is always something to be gleaned. While everything you hear may not be useful, like Phil’s night out, you can often get a glimpse of how your teammate seizes their day. Medicine has been, and will always be, a business with various cogs and gears. By understanding how the machine that is medicine works, I realized there are things that can be done to gain that trickle-down information from the source. This will help you practice medicine more efficiently and safely as an intern.
- Tip #1: Water Cooler Talk
- Tip #2: Interprofessional Synergy
- Tip #3: Team Morale
- Tip #4: First to Come, Last to Leave
Tip #1: Water-Cooler Talk
Let’s face it, you’re going to be busy as an intern. My head is practically on a swivel at all times – orders, tracking said orders, following up on said orders, and adding more orders. Did I mention orders? All of this is going on, while you’re actively observing dynamic changes in your patients. But eventually, you have to be free at some point in the day. During those precious moments where you have some down time, I found that water-cooler talk to be quite helpful in unwinding and learning. As a former business administrator, water-cooler talk was often critical for obtaining the inside scoop on ongoing projects and gossip about clientele. Such casual discussions in residency are useful for obtaining information on how to make you a better resident and team player. While there may not be a water cooler on the floor, you can find your teammates at the lounge or hydration station.
Although these talks are a bit informal, I found that I have been able to glean useful information from other residents, nurses, physicians, etc. on how I could be more efficient. I even dare to say water cooler talk is more useful than didactics at times. I mean, how do you hold your attention span during a lecture with hundreds of things running through your mind? Kinda like when you were required to attend lectures during medical school only to only relearn said material on your own time because you dozed off. Kinda like this shameless plug for Physeo being a significantly better tool to study for the boards than those in-house materials? But I digress.
Experience is often quoted to be the best teacher. And quite frankly, it is true. This is where water-cooler talk is so helpful. For instance, I had a patient with uncontrolled hypertension in addition to a litany of other ailments. As a result, his blood pressure was drastically changing over time as he was too unstable. By working out the algorithm over these brief, informal talks, I started to understand the reasoning behind it – from pathophysiology to pharmacology. There is a method to the madness.
Tip #2: Synergy
For the uninitiated, business administration loves buzzwords as much as USMLE. A few examples of such buzzwords in the business world include “SEO”, “next generation”, and my personal favorite — “synergy.” What is synergy exactly? According to the Oxford Dictionary, it is the interaction or cooperation of two or more organizations, substances, or other agents to produce a combined effect greater than the sum of their separate effects. Back in the corporate world, I would often have to work in conjunction with other departments to execute a business strategy or a pitch. In medicine, it’s probably a well-understood concept that teamwork makes the dream work. However, I didn’t truly realize how my role as a resident has expanded beyond “just” the clinical duties. As medicine is a business, I find myself relying on business acumen and how it can be utilized for improving teamwork.
In the business world, people often interact with each other on different planes, where interactions may be more indirect than direct. Within corporate America,there are various departments like accounting, supply chain, and HR that all move the gears in unison. In medicine, analogous to these departments are the teams that include nursing, laboratory services, social work, and the list goes on. In order to be a better intern, I learned their workflow. For instance, morning labs are drawn at 6AM by phlebotomy before the nurses sign out at 7AM for the end of the 12 hour shift. By understanding when things start to bottleneck, you can work around their schedule and coordinate orders to ensure things move smoothly. It’s better to flow with the current than to create waves when you can avoid it. The world does not revolve around the physician, and most certainly not the intern. As one orbits around the nursing pods, one starts to realize everything is in tandem. We are all riding the same wave.
Tip #3: Team Morale
We discussed quite a bit about teamwork so far, but what about… well, about the actual person behind the mask and scrubs? While we may feel like we’re on autopilot at times through routines, it’s important to remember that they’re humans too. There is a common saying that is often preached in the workforce – happy employees equals happy customers. While we aren’t sales, team morale goes a long way in terms of productivity. It’s important to function efficiently, and one way of doing so is making sure everyone is in harmony.
As an intern, I am the lowest on the totem pole. However, it does not mean I am not a part of the team. Beyond clinical duties, an important role of the intern is to act as the glue that holds everyone and everything together. Often, I would be used as a “point man” in relation to other services and personnel, bouncing around as messenger and errand boySince this would involve me following up with several people, I could also address everyone’s needs as I went.. For instance, during my inpatient medicine service, I was responsible for my panel of patients. As I would round with my attending, I would serve as the first person to make contact with just about everyone – the nurses, consultants, and the patients. This would mean I would have to take charge and work on the fly if things changed quickly. This would involve putting in orders for further diagnostic workup, trend labs, or perhaps even changing the plans entirely and starting from scratch. Whatever the case was, I would take initiative and address each request. As each concern is addressed, we gained some traction towards managing our patients. It helps to be cognizant of each person’s specific role, so that I can understand what their job is, how it affects me, and ultimately the patient. It’s literally the “let me help you to help me” kind of thing. Not only does it go a long way clinically, it shows consideration of the other persons’ time. No one likes wasted time, and simple manners like this help.
Just think of the Golden Rule. How would you want to be treated?
Tip #4: First to Come, Last to Leave
It’s almost a given, but as interns we are very green. Just like my previous job in administration, showing up early helps immensely. During my administration days, I would often show up early to get the lay of the land. Is there any new development? New items of business? Any correspondence that needs following up? Regardless of what I found each morning, showing up before everyone gave me the time needed to form a game plan and tackle the day. While this is very helpful for myself, it is even more useful for my teammates and patients as I help determine how the day will progress.
Having a head start allows you review any overnight events and/or reports that may have occurred. By showing up at least half an hour early, you can get a head start and not get blindsided. With this time window, orders can be added or modified to address any new concerns. Alright, but what if there aren’t any new things to address? Just getting a head start on notes and documentation can help save significant time throughout the day. Or perhaps you have a chance to follow up on morning labs or late imaging studies. Or maybe you can get a glimpse of the signout process amongst the night and day teams. There’s always something to be done and something that can be learned. The faster it is acknowledged and completed, you are able to help the patient move one step closer to the right path of management and treatment of their ailments.
As you progress the morning and afternoon, your day will start to slow down as loose ends are addressed. Eventually, you’ll check off your daily to-do list and be “done.” Occasionally, you may find yourself staying back longer to address social work concerns or perhaps following up with family members as COVID-19 prevents hospital visitors. While no one wants to stay or volunteer to stay late, it is often a rite of passage as the intern. Staying back at times can help you grow as an intern. Just like in Corporate America, I have to earn my stripes. When I started working in the business world, there were a plethora of things that I did not know. From Microsoft Excel spreadsheet wizardy to market analysis, I was constantly arriving early and leaving later than my counterparts to catch up. By grinding a little harder, I was able to become more proficient and eventually able to hold my own. I had confidence that I was able to tackle emerging problems and help create crafty solutions. Although I am still learning, I do find myself being more familiar with the workflow and how the hospital operates as I continue my due diligence. Although I am not staying back daily, there is always something to be learned before and after hours.
Intern year is a hustle, but so is the rest of residency and beyond. As I am a constant work in progress, I realize that we will ascend the ladder together as a team. While the grind does not stop, neither will you. Stay relentless. Stay hungry. Go for it.