As spring turns into summer, I prepare mentally for our brand new interns. I (and I’m sure I am not alone) remind myself to transition from a hand’s-off, strictly-advisory role in May or June, to an in-the-trenches, double-check the orders role come July 1.
I still remember my father, a retired surgeon, telling me after my graduation from medical school “Congratulations, you now have a license to kill.”
What he was referring to, of course, was not a new career as a sexy British spy, but to the fact that I was entering a time where (especially in those days) my orders did not need to be reviewed by anyone before they were executed. And that a doctor can, through ignorance or poor judgement, make decisions with grave consequences.
Much has been written about medical care at this time of year. There are studies of the “July effect.” I remember warnings about interns who naively ordered everything on the patient’s medication list to ill effect, because the patient wasn’t really taking all (or any) of his medications regularly.
I remember the dread I felt during intern orientation: would I be the hapless intern missing important signs critical to my patient’s care? Ordering the wrong dose of medications? Ordering the wrong medication altogether, causing a lethal cascade of events?
I also remember how, strangely enough, nothing tasted good during those first 6 weeks of internship, and how hard it was to get things ordered at this new hospital where I had not trained. How often my pager went off with a request to order something, or talk to family, while I was still in the middle of dealing with the last request. I cried in a stairwell about 32 hours into a call weekend, convinced I would never get to go home, and would just have to keep going until Monday ended. (I didn’t.)
I also remember the camaraderie I enjoyed with my fellow interns, and the grateful family members who bought me a small thank you present, and the wonderful taste of a tuna melt with milkshake when my appetite returned one weekend in August.
Time passes. It has been many years since I was that scared, overwhelmed, excited, passionate learner. My classmates are all grown up, many of us faculty supervising new doctors today.
To the first day interns, I write: I have had the privilege of working with July interns for a number of years now. I assure you that with time–one to six years, in fact–you can be as skilled and knowledgeable as those residents and fellows you deal with today.
Welcome to internship, doctor. You will learn more than you can imagine this year. Listen to the nurses, especially if they have been doing this longer than you have been alive. Ask questions, get answers–whether in books, on the Internet, or from your residents.
You may or may not work harder than you ever have before–after all, medical school is no walk in the park. But your responsibility will be heavier. You are the doctor, you have the license to practice medicine. Practice well.