I came into work last night for the last time. Though I was on a service full of sick patients, I was not nervous. After three years of this, three years of people trying to die in creative ways, and my friends and I trying to stop them — I have no nervousness left. There is just nothing left for the hospital to throw at me. “Dan,” I asked my intern, “what do you want to learn tonight?” I like to teach. It makes me feel smart. Dan thought for a second and then asked, “Do you have any wisdom you’ve accumulated over three years? How should I learn medicine? What do you wish you had done differently?” It was a good question (three, technically), and I felt like I should have a concise answer. But I was looking more for “Hey, can we talk about the cytogenetics of AML?” rather than “How should I best use my time in residency to become a doctor?” The UpToDate page for the latter is decidedly sparse. But, I know this: of all I have learned in three years going from newly minted MD to someone who can unselfconsciously call himself a doctor, one thing is more important than the others: Don’t burn out. Brilliant, I know. You’re welcome! I’ll see myself out. But nothing else is quite as important for your development as a physician as maintaining your passion for what you do, and burnout is the ultimate destruction of that passion. It is almost impossible not to learn something new every day as a physician, unless you are too emotionally exhausted to do so. The more specific “hows” of this process, which resident bulletin you read or what sources you turn to refresh your memory on a given disease process, these things matter so much less than this — cultivate your passion for medicine, and let that drive your learning. So, don’t burn out. But that answer is impressively unsatisfying to those looking for actionable advice, so I’ve distilled my own experience into three points because three is a good number of things for a list. First, let me pause to ask you to please forgive the inherent hubris of someone who has been a doctor for all of three years doling out advice. But being so close to my residency gives me a perspective that may fade with time, and I want to share it. 1. Hold yourself to a high standard, but make sure it is your standard. Impostor syndrome is a real problem for all of us. The job is impossibly hard, and you will frequently wonder if you are doing it “well enough.” This gets much more pronounced when someone gives you feedback that isn’t exactly glowing. But real feedback, feedback with teeth that gives you better insight into your own shortcomings, is the best opportunity for growth. As an intern, I had one attending who just seemed to hate me. Everything I did was wrong. To her credit, she gave me regular, in-depth feedback in which she described how I could do better in her eyes. When confronted with an inventory of your faults, one natural response is to shut down emotionally. It is inherently painful to consider things you have done wrong, especially when they have impacted the lives of real people. We all know someone who has closed themselves off to the opinions of others as a means of protecting their ego, and I sympathize. When you are sleep deprived, overwhelmed and emotionally fragile, it is easy not to listen. And yet it is important that you do. What I have learned is this: be mindful of the fact that feedback always has at least as much to do with the person giving it as it does the person getting it. Appreciate the insight that feedback offers into your practice and how you might improve it, but do not feel obligated to accept on its face the conclusion that you need to make a given change. The standard that matters is your own. If you are honest with yourself and believe that you are working as hard as you can at getting better every day and giving your patients the care they deserve, that is enough. Carry that spark of assurance around with you. It can give you enough resilience in the face of negative feedback to either not shut down and stop listening or to not break down and cry, but rather to say, “This person sees a problem. How can that perception inform my practice and help me improve?” And if you look at yourself in the mirror and just can’t be sure that you’re giving the job the effort it deserves? Talk to your mentors and seek out advice. Because if you aren’t sure you’re doing a good enough job, that’s normal. But if you aren’t sure you’re putting in enough effort, that could be a sign that you need help. 2. If you don’t like a patient, be sure that you love them. The people we help are the reason we keep going. When they are nice, kind people, it’s easy to remember why we do what we do. But if you allow yourself to like only the patients it’s easy to like, you will resent the patients who are manipulative, who take you for granted, or who are just, for lack of a better word — jerks. And there are plenty of them, as jerks are a well-represented demographic among human beings. If you start disliking the jerks, you start to feel your time with them is wasted time. And then even though you continue to have wonderful human beings as patients, you start noticing only the jerks. You start perseverating on how the people you care for don’t appreciate it. If this doesn’t sound familiar, I don’t believe you went through a medical residency. This is toxic, and the only solution is to love the jerks too. Everyone can be humanized, and this is all the more important for those with whom you don’t immediately sympathize. If you learn their stories, you will cultivate your empathy. Ask non-medical questions. Ask about their military service, their family, their job. Find a connection. Do it for them, but most importantly do it for you. Because if you don’t love the people you care for, the lengths to which you go to care for them will start to feel like an undue burden, and you will burn out. Yes, I’m saying that empathy is a selfish act here. That’s OK. You get credit for caring for others even if you’re doing it for you. 3. The hospital can only eat what you feed it. There’s a Scrubs episode in which the hospital itself is depicted as a monster, dedicated to consuming the lives of all who enter. The hospital really will eat sleep, healthy lifestyles and more than a few relationships. But it can only eat what you feed it. Because we care for real people, we can have a tendency to stay late and do more, to sacrifice even more of our own time to patient care. But you have to do this job well for about 50 years. If you start to feel it sucking away at things you care about, time with your family, your own health, you will resent it and burn out. You owe it to the people you care for to avoid this, not only for your own sake but for the sake of continuing to provide excellent care over the long term. So, sign out a sick patient. Stay and make sure the transition is smooth, but don’t stay to care for the patient. There are other doctors for that. Go see your kids, have dinner with your boyfriend, see your sister while she’s in town. This will make you a happier human, which will make you a better doctor. The hospital may try to take these things from you, but it cannot do so unless you are complicit in the theft. Leave. The. Damn. Hospital. The best job in the world Being a doctor is hard, but the field is blessed with a ton of resources and support to help you get better at it every day. The only way you can really fail is if you stop trying, and the most common reason to stop trying is burnout. So: hold yourself to a high standard that empowers you to take others’ feedback as formative rather than judgmental, care about your patients as people (especially when it is difficult to do so), and protect your personal life so that you can continue to give of yourself to others. That is the wisdom I have gained, such as it is. It is a privilege to have a job worth doing well. And a job that’s never boring is priceless. But man, it is hard. I can’t think of anything else I would rather do. Source
