7 Tips I Learned During Residency

Posted on Wed, Mar 02, 2016
7 Tips I Learned During Residency

By Steven Mahon, D.O.
It was July 2011, and I was just sitting down for my emergency medicine residency orientation. Wearing slacks and a tie, I had my new white coat clean and pressed with three uniform pens in the chest pocket. Those pens were sitting just above my name, the new letters “D.O.” appearing as an alien addition. A rather weathered old attending rose to the podium and congratulated us on completing one of the most difficult journeys of our lives. He commended us on the embarkation of our young physician careers and said that our days as residents would be “over in the blink of an eye.”
Well, here I am almost a year after graduation. I'm wearing a scrub top pulled from the "I think it’s clean" pile of my closet, a red marker is the only writing utensil in reach, and I haven't seen my white coat in at least two years. I look back to those early days and reflect on residency, which was not easy, and most certainly it wasn’t quick.
There were some very long nights, frustrating cases and endless reading. It’s a grueling time meant to teach young doctors everything they need to graduate as competent, confident emergency department attendings. During that time I had the benefit of working with many great attendings who imparted words of wisdom. Some were good, some were not, but there have been many “one-liners” which have stuck with me throughout the year, and I now find myself repeating them to my own students. These are a few of my favorites:

  1. “The eyes cannot see what the mind does not know.” Essentially this boils down to the core of residency, to keep reading and expand your core knowledge. As EM physicians, we are tasked with the overwhelming responsibility to diagnose the undiagnosable. While no one is expected to regurgitate the treatment plan for perivenous encephalomyelitis (don't be afraid to look it up), you do need to be familiar with what is out there. You cannot diagnose or even look for a disease that you don’t know even exists. So plain and simple, read as much as you can and pick up as many cases as you can handle. This will allow your mind to reveal what your eyes are seeing.

  2. “As a resident, pick up cases which make you uncomfortable.” Everyone has their happy place; their zone of comfort where nothing can go wrong. We all love treating a classic chest pain and the five year old with ear pain. However as the ER physician, especially in a solo-covered shop, you’re going to have to pick up cases regardless of how comfortable you are. It’s important to expand your comfort zone as much as possible while you have an extra pair of hands to back you up. So rather than pick up yet another chest pain, instead pick up something where you have no clue how to work it up, something that makes you sweat a little. Discomfort now is better than discomfort later.

  3. “I don't care how you treat them, just don’t harm anyone.” This is one of my favorites, spoken by a rather jaded attending in a high-volume ER. A kidney stone will probably turn out the same whether you use opiates or NSAIDS, so don't sweat the details on the little stuff. Just know your dispositions, who is staying and who is going home, and do your best not to cause any harm. I think Hippocrates had something to say about this.

  4. “The room is yours, kid.” A terrifying thing to say to a young resident, but it’s sometimes necessary to push home a point. Eventually, we will be the only ones sitting at a desk, managing a room full of sick people. We are the captain of this ship; our crew is here to support us and we keep it moving. As a resident, it’s important to practice moving a busy room and keeping all the plates spinning, especially as you near your final year.

  5. “If the stomach works, use it.” A short one, but a good one. It means that in a room full of vomiting people (cold and flu season anyone?), if you can control and rehydrate orally, spare the IV. Both your staff and your patients with thank you in the end, not to mention that the room will move much quicker.

  6. “Trust your nurses.” The bottom line is that in the ED, we’re all in the trenches together. When “it” hits the fan, we’re exclusively reliant on our nurses to get the job done, and trust is key. I’m friends with almost all of our department’s nurses. I know their families and socialize whenever I can. The department always runs smoother on a road without potholes.

  7. “What you do matters.” A good one for final thoughts, which maybe doesn't need to be said, but maybe it does. One of the biggest enemies of ER physicians is burnout, essentially treating the endless droves of patients with coughs, colds and bruises in the waiting room. But remember that three year old with a simple ear infection you just discharged, which probably shouldn't have even been here? Her mother was terrified when she got the call from daycare, and she was crying when she left work early to get her daughter to the ER. Those five minutes that you just spent rolling your eyes while you tried looking in her daughter's ears were probably the most important minutes of that parent’s day, maybe even the most important minutes she has had being a mother up until that point. What we do matters, whether it’s pulling a last-minute “Hail Mary” and saving someone's life, or sitting down and giving 30 seconds of reassurance to a worried parent. We are in the business where nothing should be routine. 

So I hope some of my favorite one-liners stick with you as they have stuck with me. In reflection, residency is a time to absorb as much as you can. Read, practice, make yourself uncomfortable, be friendly and compassionate, and certainly do no harm.
Steven Mahon, DO

Steven Mahon, D.O., received his medical degree from the Chicago College of Osteopathic Medicine and completed his emergency medicine residency at St. James Midwestern University, Olympia Fields, Ill. He is an attending emergency physician at St. Anthony's Hospital in Crown Point, Ind.

Thank you for the post. Sounds like you had some great attending's!
3/3/2016 9:58:38 AM

Ray Iannaccone
Great post Steve. You learned a lot more than clinical medicine in residency. #7 is my favorite especially since it sounds like you said it with a load of humility. Servant leader-like. Kudos.
3/3/2016 3:59:40 AM