A doctor’s advice to medical students

It’s been six years since I graduated from internal medicine residency. Enough time to give me some perspective, but short enough to still remember the highs and lows vividly. I recently had the opportunity to talk with a bright and energetic group of medical students. (Really, though, is there any other kind?)

The conversation turned to any advice that I had or maybe I felt obligated to give some as part of the natural discourse between the novice and the survivor. These students were smart, so they already knew to work hard, get good grades, get into a good residency.

So I decided to be honest.

1. People die; it’s not a personal failure on your part. Our interventions and therapies can make disease more manageable and prolong life, but death will always be the ultimate and natural conclusion of our efforts.

1. Your choice of specialty will not determine your ultimate life happiness. You are not doomed to misery should you chose not to sub-specialize nor are you guaranteed happiness if you do. Choose something you enjoy, something in which the mundane doesn’t zap your will to live. Choose a specialty that provides a lifestyle congruent with your values. But don’t confuse intellectual intrigue with life happiness; there is so much more to the latter that has nothing to do with medicine.

1. Remember what it means to be a normal person. To retain a sense of awe in what you now get to do on a regular basis. To be able to explain things in non-medical terms the way you learned them before being indoctrinated. To feel — sadness, joy, grief, loss, elation. To remember the viewpoint of suffering.

1. Keep friends outside of medicine.You’ll be more human. And more interesting.

1. Guidelines are helpful, but they are not strict rules. Don’t try to meet every guideline while losing site of the big picture. You wouldn’t want your 95-year-old grandma on a high dose statin to prevent a heart attack “some day,” metformin for the elevated fasting glucose only apparent within the past year and three blood pressure pills that make her feel dizzy all the time to achieve some magic number that no one agrees on anyway. Don’t subject someone else’s grandma to that either.

1. Retain your humility. When family members say, “Something’s not right with Grandpa,” listen. They are usually right. Ask questions when you don’t know the answer. It can be especially humbling to do so in front of your colleagues, but your pride is no longer your priority, it is the best care of your patient.

1. Be kind in your comments about the “outside community doctor.” There is a high likelihood you will be that person at some point in your career. They usually aren’t as dense as you might think; they are just struggling to provide the same perfect care you are in a very imperfect system.

1. Burnout is inevitable. Plan for it. Write down what drew you to medicine in the first place and review on a regular basis. And then review some more.

1. Other services are not your enemy. Be kind when someone calls you with a “dumb consult”; you have likely called one yourself.

1. Avoid perpetuating the cycle of abuse. Just because you were demeaned and humiliated as a student or resident does not mean you are entitled to do the same to your younger colleagues. They are no more “unmotivated,” “lazy,” or “arrogant” then you were.

1. Think about how your orders affect your patient. How they may actually contribute to their suffering and discomfort. Nurses have been asking for us to do this for years; it’s time we took note.

1. Be mindful of the habits you cultivate. How you speak to patients, families, nurses. How you treat your family when you are stressed. Your eating habits, your spending habits, your sleep habits. These will follow you past residency, for better or for worse. Make sure they have been chosen with intention.

1. Medical training has likely put you in debt. Just because you have a big salary out of residency, doesn’t mean that you are wealthy. Wealth = assets – debts. Do the math and avoid the temptation to increase your debt further immediately on graduation with a huge new house, car or other toys. A few years of frugal living will pay dividends later on.

1. It doesn’t automatically get better after residency. Hate to break it to you, but it’s the truth. But it can be great if you prioritize what’s really important. Just pick those priorities carefully.