One internist's recipe for survival during residency

A young female Canadian general internist wrote this for me. As an emergency physician for 20 years, I get to see many specialties and one of the toughest was internal medicine. Internists get some of the sickest patients to deal with. Their on-call can be brutal. I used to advise them to do 24-hour shifts in hospital. Say you had 13 doctors on your call roster you could work for 24 hours every 13 days and take the day off after it. Remember that the first sign of burnout is anger, not depression and the three symptoms to recognize early are emotional exhaustion, cynicism and feeling ineffective. Be proactive about caring for yourself first and foremost and address chronic stress by insisting on control over parts of your schedule, minimizing interpersonal conflict, avoiding political subterfuge, managing patients’ expectations, lowering office overhead and learning how to create efficiencies within your electronic medical record. Create an identity outside of medicine and, if need be, have an exit plan (i.e., how to pay off your debts early, other career, financial independence by having varied income streams and retire early). If you want to survive residency, consider the following: 1. Take time to go to loved one’s weddings, birthdays, funerals and other special events. Missing out on these moments detracts more from your life than you realize and in a few years you’ll wake up not remembering what it feels like to have a support system because you were never there for them. Read: How to best care for super seniors: A portrait of a favourite patient group 2. Don’t lose sight of what makes you, you. Continue to play an instrument or sport, dance, go to concerts, plays, travel, etc., Often, this is what grounds you and allows you to connect with patients as these make you relatable. 3. Manage expectations. You are your own worst enemy and critic. Forgive yourself for not knowing all the different ways multiple myeloma can cause renal failure. You are in training and the knowledge will come. Forgive yourself for not remembering something, it’s called sleep deprivation. 4. Figure out what type of learner you are (kinesthetic, musical) and optimize retention of knowledge by remembering that perhaps hands-on experience or the order of words, not just the content matters. Read: ‘I’m only human after all. Don’t put your blame on me’ 5. To build resiliency and achieve longevity in your career as staff, consider that most people don’t have any idea what it’s like to manage your cognitive load. Therefore, reduce the extraneous decision making to a minimum: i.e., have your groceries delivered to you as pre-portioned meals and have your partner meal plan. Recycle the same outfits from a two-week wardrobe so you don’t have to pick out something in the morning. I try to wear an indestructible black jean or variant of it, tank top and blazer. I will also leave a blazer or cardigan in the office so I can just switch that out. Have your dry cleaning delivered to you. 6. Most of the stressors in the workplace stem from interpersonal conflict, therefore create boundaries and stand firm in the face of pressure. 7. Remind patients and their families that you have both an office and clinic practice and that you will reassure, update, etc., when you have new information to convey. 8. Say no to hospital commitments if they are not in your contract and only participate in the committees wherein you feel you can make a difference (however long it may take). 9. Figure out at what point you develop compassion fatigue in your office. How many patients can you see in a day before losing this ability? What kinds of patients are you more likely to have compassion for and therefore are willing to be their go-to internist? 10. Remember the law of diminishing returns and that perfect is the enemy of good. 11. Don’t let your medical office assistant over-schedule you. I round in the morning and do clinic noon-to-5 pm only 10 days a month to be able to manage paperwork and before I develop compassion fatigue. I don’t ask my secretary to fill cancellations and I do not see someone urgently if they don’t need to be seen urgently which can be ascertained by triaging your referrals. 11. Stand your ground. Not having conviction and allowing administrators, colleagues, etc., to undermine your decision making when you feel you are ethically or clinically justified is important to your mental health and resiliency as there is always pressure to conform to someone else’s standard. 12. Learn how to be good to yourself and what “self-care” means to you. I have learned to: Start the day by having a good breakfast with a strong coffee and not rush through it. Don’t look at your phone. Once you’ve had a moment of peace and have had an executive meeting with yourself then tackle the task that you have been putting off and dread the most. Take sleep vacations. I tend to do this once a year and will book a luxurious hotel room for two or three nights. Go without the kids or even your partner and just sleep in, order room service, watch a movie and go back to sleep to try and make up for that sleep deficit. Get a massage, manicure and pedicure. Try to schedule regular exercise and know how long it takes for you to achieve a purely calm and worry-free state. For me, it’s a brisk walk in the forest with my dogs and after an hour and a half I am ready to tackle the anxieties of the day. Practice good sleep hygiene. Ear plugs, cool, dark room, no lights whatsoever, minimize moving things in the bed, etc. 13. Try to negotiate an office lease based on weekly usage (since we are not there half the time due to in hospital duties) and share your office to lower your overhead. Work smarter, not harder. 14. Work in an office where your colleagues are mindful of containing costs and listen to you during your office meetings. Don’t work with bullies or personalities that really grate on you. 15. Use templates and get your secretary to add the allergies into the chart. Read: Half-hour online training session helps teenagers deal with academic-related stress: study

One internist's recipe for survival during residency

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