Tenets for Internship and Beyond

Sonja Van Hala    by Sonja Van Hala

There are few times in life that rival internship, the first year of residency, in its intensity.

It has been well over a decade since I completed internship, but I remember it well.  I have developed a few tenets relevant to the new physician, and perhaps even to those more seasoned.  These tenets are less about working as a doctor, and more about living as a doctor.

Some exercise is better than none.  Sure an hour-long run would be luxurious, but today I’ve got just enough time for a 15 minute “tempo run”.  I feel better already.

Eat good stuff.  I spent a few rotations eating those gummies out of the big bowl in the call room.  I didn’t feel so well.  As the saying goes: “garbage in, garbage out”, and I wanted to be living a different mantra.  I keep it simple – fruit, veggies, yogurt, nuts, whole wheat crackers, water.  Easy to buy, easy to pack, easy to eat.  And good to my body.

Take a nap.  Sleep.  You will have more reserve to be resilient during the tough times.

Wash your hands before you eat and do not eat at a computer.  Think germs, and lots of them.  Do not put them in your mouth.

You are responsible, but you are not alone.  Help is only one person away, as a senior, an attending, a consult, a colleague.  Share it.

Communicate, communicate, communicate.  There are plenty of examples of lapses in communication linked to error.  Excusing the harm of waking someone, I have never heard of harm caused by over-communicating, especially as events unfold or new issues develop.  Your nurses, senior residents and attendings will be more effective as a team and as supervisors.  Your patients and their families will feel informed and engaged.  Take this extra step.

Do “today’s work today”.  Visit something once and get it done.  This is especially true with clinical documentation; you will be most efficient right now.  Dictate in front of others if needed.  Always write down the dictation code number.

See a doctor in a clinic.  You will observe your colleagues do otherwise.  They will ask you for advice and for medication.  They will give each other medication.  They will prescribe for themselves.  Do not allow for shortcuts here.  Just consider the range of bad outcomes (missed meningitis, as one example).  Go to a clinic and be appropriately evaluated.  Take your kids to the doctor.  Insist your colleagues do the same.

Invest in people.  People and relationships will help you stay connected to the meaning of your work.  Get to know your patients.  They will feel cared for, and you will feel fulfilled.  Tend to your friendships and your family.  Do not expect perfection here; just reach out, and these connections, however brief, will ground you.

Take time off.  On your day off, play.  Use your vacation, and unplug.  Really.  If you have a baby, take the paternity and maternity leave.  The residency extension is well worth the 12 weeks of learning how to parent.  Go to funerals of those you loved, and take time to attend to illness in the family.  The work can wait or be adjusted.  Your relationships are more important.

“I can do hard things.”  A close friend in hospice work gave me this mantra.  I use this often.

Practice gratitude.  You will witness remarkable moments:  the tenderness between new parents and the baby you just delivered, the peaceful death of a man with his family all around, the recovery of a woman from colon cancer you diagnosed, and the daily patient appreciations manifest as handshakes, hugs, and heartfelt thank yous.   Embrace each moment and be grateful for the opportunity to be in it.

Welcome to this most remarkable of professions!


Sonja Van Hala, MD, MPH is the Residency Director at the University of Utah Family Medicine Residency.

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