We have an intern on our ICU, who will be a physician in a few months. She asked me what can I do to lose my fear? “Fear of what?” I asked.
“Fear of having my first day at work. Here during my internship I follow you around, I watch, sometimes I put in needles. But having the responsibility for all these patients? The whole unit? That is totally different from what I do here during my internship. So what can I do to prepare better for “day one”?” She replied. Here is my 5 step strategy:
There are two kinds of fear:
Fear of the things we know: grizzly bear, fire, bullets.
Fear of the unknown: new technology we don’t understand and for all medical students: first day at work, when we might be confronted with things we don’t yet know, tasks we have never done before, problems we have never solved.
Fear of grizzly bears is totally adequate and we should make no efforts to lose it.
Fear of the unkown is -our first day at work- can only be overcome by getting to know the unknown.
So what can we do to lose this fear and get to know the unknown?
Most of the situations involve sick patients and their further workup and treatment. There is only one way to lose this fear. Go into these kinds of situations over and over again in times when there are still people around that you can ask.
Pretend like you are all alone and call your mentor when you get in trouble. Follow these simple three steps to lose your fear:
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Pick one patient.
This is now YOUR patient. Round on him, study the history, the exam results, know every result of every exam of this patient that has been performed. Know every detail. Obsessively! If you don’t know an exam that was performed: Look it up. Don’t waste your precious time with your supervisor asking him to explain things that you can look up in Wikipedia or pubmed! Your time with your supervisor should be used to ask questions that ONLY HE can answer.
Do a thorough history and examination on him. Compare your results with the results the doctors before have acquired.
This should easily take two hours when done thoroughly.
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Prepare your presentation
To make sure you have understood this patient and haven’t lost focus you should prepare for presenting this patient to your supervisor. Prepare a presentation of three sentences. In three sentences the key information of even the most complex patient should be presented. Of course by studying this patient two hours you have probably acquired enough information to talk twenty minutes about him.
But to keep your focus on what is important right now and to prepare for your talk with your supervisor you need a three-sentence-summary.
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Make a plan: Further work-up
When I started off I made the following mistake: I thought: “OK, I did the history, the examination, I studied all the results. I did my part. My supervisor is going to be really thankful and now it’s his time to do some work too. He’s gonna tell me the solution and the further workup of the patient. He is going to be really thankful that I did the work and he is going to tell me what to do, right?” No. Turns out most attendings like it, when you don’t stop thinking after the rectal exam.
Even though there are attendings, who will do that (“Do a CT scan and Meropenem 1g every 8 hours”), most of them –the better ones, who want to teach you being a grownup doctor- will ask you for your diagnosis and your workup plan.
So prepare for that too: Think of three differential diagnoses and the appropriate exams. What kind of therapy regimens have to be started right away? Antibiotics? Volume status? Electrolyte imbalances? Blood transfusions? This will take another 30-60 minutes.
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Have a talk with your mentor:
Then call your supervisor (probably a fellow or a resident): Present the case to him.
Tell him your further workup and treatment plan.
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Ask questions.
But ONLY those, that you cannot answer yourself by doing your research.
If you do this over and over during your internship, you will learn a ton and your first day at work won’t be that scary.
By the way:
You don’t even have to do an internship for this. If you know a great mentor, ask her, whether she could give you one patient you could study. And afterwards have a twenty minute conversation with her about this patient.
Question: What is your greatest fear before starting your career as a physician? Leave a comment below.
