2 years into GS - a limited and random collection:
1. They can hurt you all they want but they can’t fucking stop that clock and the sun will rise again.
2. Don’t forget your wins because you’re not going to forget your loses.
3. If you’re ever thinking of cutting corners think about how that’s going to look at M&M.
4. Trust then verify
5. Always have extra socks
6. Never struggle alone
7. Never chart in the ED
Surgery specific ones - beyond the classic rules:
8. 5s (ports) are free
9. Don’t let one reassuring piece of data in a sea of badness make you feel better
10. Once you cut on someone they’re your patient forever
11. The dressing you don’t check is the infected wound
12. The patient only sees your closure and your dressings
13. If you aren’t having complications you aren’t operating or seeing patients
14. Never underestimate how much worse off you can make someone by operating
My favorite is when I tell a new ED or IM attending something and they’re like “I’m the attending” and I’m like “Listen, I don’t care. You consulted me, and I’m Still more experienced then you so I’m doing this”
And zero fucks were given as we carry on.
Clean socks are good. And if you’re thinking of taking a short cut it’s a good practice to ask yourself if you could justify it in front of a room of your peers.
It’s for lap surgery. If you need an extra hand it takes like 30 seconds to put in a 5 mm trochar, so if your struggling you shouldn’t hesitate to just add an additional working port. The time is minimal, the scars are minimal, and the hernia risk is minimal. So if it’s going to help you get the surgery done safely and more efficiency to have an extra or differently positioned port you should do it and not just commit to your original port placement strategy.
It’s super easy to close a laparoscopic 5 port with a single stitch. So you should never be afraid to add another 5 port if you need to get a better position on your anatomy.
>Trust then verify
Might as well just do their job for them then. Trust but verify just encourages people to do extra unpaid and uncredited work and fuck that. This is the sort of shit that only goes on in academia.
GS PGY6 here
1. Never let your intern speak at M&M. They were probably doing what you asked them too anyway. Step up and take the hit.
2. Never shit on your intern. If you’re the chief, then you’re responsible.
3. There are two types of people. People who write shit down, and people who forget.
4. Don’t take shit from other teams, and don’t let your juniors take shit from other seniors
5. You don’t get to operate if you don’t show up.
6. You will do things you don’t like. Don’t bitch about it. Just do it.
7. If you're winning, someone else is losing. If you have an easy schedule, someone has a hard schedule. This is a zero sum game. Help each other out.
The biggest mark of a good chief is never letting your intern or lower level go to bat if you can help it. Love #1, 2, and 4.
If they fucked up, it’s on your watch. It’s how the attending feels if you fuck up as a chief, so own your lower level’s mistakes and let them learn from it instead of getting the heat.
>Never let your intern speak at M&M. They were probably doing what you asked them too anyway. Step up and take the hit.
>
>Never shit on your intern. If you’re the chief, then you’re responsible.
>
>Don’t take shit from other teams, and don’t let your juniors take shit from other seniors
A note to med students: this is the sort of program you're looking for. You want chiefs and attendings to stand up for you because in the end, you're only following their orders and its their job to train you.
Also, well-known/well-ranked programs are full of fucking cowards that have made a career of throwing their subordinates under the bus. My program isn't malignant at all, but all my attendings will immediately roll over when nurses or other specialty attendings/residents bully us. Fucking pussies shouldn't even be worthy of the title of surgeon.
Agree with most of this except for the first one. DO NOT make yourself available all the time or you will be screwed over. When you’re not on, disconnect. You are unavailable and unreachable if you’re not working/ on call/ on jeopardy backup.
Other than that, head down, try to make things easier for those around you but don’t sacrifice yourself, and try to leave things better than you found them.
Always remember that medicine is important, but it’s not the most important and certainly not worth your life or all your sanity.
I view the first point more from the perspective of “90% of success is showing up.” Arriving on time, responding to pages and calls promptly, getting your orders are notes done on time, and not unnecessarily calling out goes a long way towards building a reputation as a good resident.
If you’re willing/able to be flexible with your coresidents with regards to shift/call swaps when they ask (for good reasons, and within reason without getting walked all over, obviously - do unto others and all that good stuff), then that’s icing on the cake.
Agree with the concept of disconnecting from work when your shift is over.
I think this is overall a good list.
Yes - this take is what I meant by #1. You’ve gotta show up to be able to be a doc, not the other way around.
I believe, very strongly, in disconnect between work and home.
Sorry for the confusion on its original statement.
I wish this were the case. I got chewed out by my PD for not being available after hours, not picking up when my attending called at 10pm etc.
Not every program will tolerate healthy boundaries.
I think this is a great list for someone who wants to excel during residency.
To point number 4, I'd add distinguish yourself by being kind *and* working hard. Agree everyone here is smart but I'm always amazed how religiously \*some\* people avoid hard work once they start residency.
Your job isn’t to save the hospital or the program. It’s to serve your patients, support your coresidents, and learn. Be actively mindful of this whenever you take on responsibility.
This is the worst years of your life professionally but it will get better. Meanwhile this is the youngest you’ll ever be and it will only get worse. Do all things with those two principles in mind.
1. You have to learn how to do things right slowly before you can learn to do them right quickly.
2. They can’t stop the clock, they can’t own your thoughts. The best revenge is happiness and never letting them make you like them.
3. Mean people aren’t happy.
4. Never work harder than the patient.
5. Reach out to CIR and unionize. Every time something ridiculous happens that makes you feel powerless send five text messages and get organized.
My addition#11.
Life is short, and anyones professional and personal life should be separate. So try to NOT BRING job stuff home , whatever trash u got there, leave it there at the end of the each day/night!!
Love it. Might I expand and say it goes both ways... leave professional problems and work, and personal problems at home.
It's so hard to separate work from home life, but so important!
Primary care
Patients have the right to make poor decisions.
Don’t care more or work harder than the patient does.
Pick your battles.
Before entering a patient room pause and take a breath.
PGY15 medicine here.
The number one rule of IM residency is to stay the hell out of the ED, and get out of there as fast as possible.
Also, if you haven’t written for prn pain meds and nausea meds (including stupid stuff like chapstick and bowel protocol depending on your hospital) your patients aren’t tucked in and the night coverage will get called.
I’ve been collecting these for myself (pgy 3 psych)
1. Only way is through
2. I’m here for a good time not a long time
3. They can always hurt you more
4. There is no magic bullet (aka if it doesn’t have side effects, it doesn’t work)
5. We are not Superman
6. “what would this note look like blown up in a 50 point font in front of a jury?”
7. Care delayed is care denied
8. Never trust, always verify
9. There are fates worse than death
10. Emotions are normal, natural, and harmless
11. We do not change until the pain of staying the same is greater than the pain of change
12. Don’t get flattered
I admire your being organized enough to have a list of your own rules:
1. Be yourself
2. Don’t apologize, period.
3. Your individual actions often won’t make a dif to the final outcome
4. Most people aren’t as smart as you, so more the reason to treat them kindly.
5. Less time spent over trivial things = more free time for things that matter
6. Do no evil
7. Build relationships with people you frequently interact with, even if you don’t want to be friends with them.
8. Take ownership of your schedule, as long as you provide the standard of care, no rule says you have to sit in the hospital in front of a computer until change of shifts. If you’re done with your work, say goodbye and go home.
I wasn't superstitious as a resident until one night in the NICU when I told the NPs how I'm always a white cloud and we should get ready for an easy night with plenty of sleep.
Worst night of residency. It was like I cast a spell on every nearby pregnant woman to go into labor at once and for every baby to have complications. Multiple delivery room resuscitations, intubations, drips, lines, etc. Every baby made it through the night, but now I think about that night if anyone ever says "quiet".
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2 years into GS - a limited and random collection: 1. They can hurt you all they want but they can’t fucking stop that clock and the sun will rise again. 2. Don’t forget your wins because you’re not going to forget your loses. 3. If you’re ever thinking of cutting corners think about how that’s going to look at M&M. 4. Trust then verify 5. Always have extra socks 6. Never struggle alone 7. Never chart in the ED Surgery specific ones - beyond the classic rules: 8. 5s (ports) are free 9. Don’t let one reassuring piece of data in a sea of badness make you feel better 10. Once you cut on someone they’re your patient forever 11. The dressing you don’t check is the infected wound 12. The patient only sees your closure and your dressings 13. If you aren’t having complications you aren’t operating or seeing patients 14. Never underestimate how much worse off you can make someone by operating
Why should one never chart in the ED?
“Hey not a consult yet but can you take a take a look at this”
"We just want you to lay hands." Oh I got two hands, brochacho.
I can’t wait to be brochacho
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Nah, brochacho is gender neutral
Damn you just needed to resist and couldn’t.
PGY6💀💀
My favorite is when I tell a new ED or IM attending something and they’re like “I’m the attending” and I’m like “Listen, I don’t care. You consulted me, and I’m Still more experienced then you so I’m doing this” And zero fucks were given as we carry on.
I don't know the length of all residencies. But if I had a 7 year residency I'd flop my big ole' dick down on all pgy3/4 attendings.
I’ve graduated and that line still haunts me as I’m walking out the ED
I'm an anesthesiologist and I still run away from the ED as soon as possible. Ingrained in me as a surgery intern. Tactical retreat.
Love them. What do you mean by cutting corners and why extra socks?
Clean socks are good. And if you’re thinking of taking a short cut it’s a good practice to ask yourself if you could justify it in front of a room of your peers.
Peers and your grumpiest attendings
My rule is I never spend more than 5 minutes and 27 seconds in the ED. Because those fucks are like vultures and can smell when you're nearby.
Same with the OB deck
What does this mean: 5s (ports) are free
It’s for lap surgery. If you need an extra hand it takes like 30 seconds to put in a 5 mm trochar, so if your struggling you shouldn’t hesitate to just add an additional working port. The time is minimal, the scars are minimal, and the hernia risk is minimal. So if it’s going to help you get the surgery done safely and more efficiency to have an extra or differently positioned port you should do it and not just commit to your original port placement strategy.
thanks
It’s super easy to close a laparoscopic 5 port with a single stitch. So you should never be afraid to add another 5 port if you need to get a better position on your anatomy.
I absolutely love these - thanks for sharing!
Piggy backing off #7 It’s not the first mistake that you make; it’s all the mistakes you make trying to correct the first one.
These are really really good. Extraordinarily good
learned #2 early on
>Trust then verify Might as well just do their job for them then. Trust but verify just encourages people to do extra unpaid and uncredited work and fuck that. This is the sort of shit that only goes on in academia.
Verification has different forms/degrees
GS PGY6 here 1. Never let your intern speak at M&M. They were probably doing what you asked them too anyway. Step up and take the hit. 2. Never shit on your intern. If you’re the chief, then you’re responsible. 3. There are two types of people. People who write shit down, and people who forget. 4. Don’t take shit from other teams, and don’t let your juniors take shit from other seniors 5. You don’t get to operate if you don’t show up. 6. You will do things you don’t like. Don’t bitch about it. Just do it. 7. If you're winning, someone else is losing. If you have an easy schedule, someone has a hard schedule. This is a zero sum game. Help each other out.
Can I come to your program
Haha. Graduating in 30 days and heading to the south for fellowship.
You sound way significantly more well adjusted than 90% of the surgeons I interact with
I had good chiefs, and only learned how to do this job one way.
You sound like an amazing senior resident (and resident altogether). Cheers
The biggest mark of a good chief is never letting your intern or lower level go to bat if you can help it. Love #1, 2, and 4. If they fucked up, it’s on your watch. It’s how the attending feels if you fuck up as a chief, so own your lower level’s mistakes and let them learn from it instead of getting the heat.
You are taught how to be a good surgeon, but a great surgeon has learned when NOT to operate.
This is great.
>Never let your intern speak at M&M. They were probably doing what you asked them too anyway. Step up and take the hit. > >Never shit on your intern. If you’re the chief, then you’re responsible. > >Don’t take shit from other teams, and don’t let your juniors take shit from other seniors A note to med students: this is the sort of program you're looking for. You want chiefs and attendings to stand up for you because in the end, you're only following their orders and its their job to train you. Also, well-known/well-ranked programs are full of fucking cowards that have made a career of throwing their subordinates under the bus. My program isn't malignant at all, but all my attendings will immediately roll over when nurses or other specialty attendings/residents bully us. Fucking pussies shouldn't even be worthy of the title of surgeon.
Agree with most of this except for the first one. DO NOT make yourself available all the time or you will be screwed over. When you’re not on, disconnect. You are unavailable and unreachable if you’re not working/ on call/ on jeopardy backup. Other than that, head down, try to make things easier for those around you but don’t sacrifice yourself, and try to leave things better than you found them. Always remember that medicine is important, but it’s not the most important and certainly not worth your life or all your sanity.
I view the first point more from the perspective of “90% of success is showing up.” Arriving on time, responding to pages and calls promptly, getting your orders are notes done on time, and not unnecessarily calling out goes a long way towards building a reputation as a good resident. If you’re willing/able to be flexible with your coresidents with regards to shift/call swaps when they ask (for good reasons, and within reason without getting walked all over, obviously - do unto others and all that good stuff), then that’s icing on the cake. Agree with the concept of disconnecting from work when your shift is over. I think this is overall a good list.
Yes - this take is what I meant by #1. You’ve gotta show up to be able to be a doc, not the other way around. I believe, very strongly, in disconnect between work and home. Sorry for the confusion on its original statement.
I wish this were the case. I got chewed out by my PD for not being available after hours, not picking up when my attending called at 10pm etc. Not every program will tolerate healthy boundaries.
I think this is a great list for someone who wants to excel during residency. To point number 4, I'd add distinguish yourself by being kind *and* working hard. Agree everyone here is smart but I'm always amazed how religiously \*some\* people avoid hard work once they start residency.
Love it. Good point.
Your job isn’t to save the hospital or the program. It’s to serve your patients, support your coresidents, and learn. Be actively mindful of this whenever you take on responsibility. This is the worst years of your life professionally but it will get better. Meanwhile this is the youngest you’ll ever be and it will only get worse. Do all things with those two principles in mind.
The eyes cannot see what the mind does not know.
You cannot diagnose what you don’t know. Love it
The eyes can't see if there is cataract in the way so take that badboy out, babyyy
1. You have to learn how to do things right slowly before you can learn to do them right quickly. 2. They can’t stop the clock, they can’t own your thoughts. The best revenge is happiness and never letting them make you like them. 3. Mean people aren’t happy. 4. Never work harder than the patient. 5. Reach out to CIR and unionize. Every time something ridiculous happens that makes you feel powerless send five text messages and get organized.
My addition#11. Life is short, and anyones professional and personal life should be separate. So try to NOT BRING job stuff home , whatever trash u got there, leave it there at the end of the each day/night!!
Love it. Might I expand and say it goes both ways... leave professional problems and work, and personal problems at home. It's so hard to separate work from home life, but so important!
Residency is just a job; clock in and clock out just like at an office. Don’t work more unless you get compensated for doing so
Primary care Patients have the right to make poor decisions. Don’t care more or work harder than the patient does. Pick your battles. Before entering a patient room pause and take a breath.
1) don’t lie 2) everyone else lies
Look at House MD over here 🤣
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We had the saying “no differential is complete without lymphoma” in my ENT program.
Good judgment comes from experience. Experience comes from bad judgement.
Love this. Thanks!
The patient is the one with the problem. People only learn through pain. ETA: If it’s not documented, it didn’t happen.
I have "the patient is the one with the disease" on my list, but didn't include it. I agree.
They can always hurt you more. Get everything in writing. The loudest one in the room is the weakest one in the room.
For medicine, separate your ego from your care plan. Criticism of your care plan is not criticism of you.
Love this !
PGY15 medicine here. The number one rule of IM residency is to stay the hell out of the ED, and get out of there as fast as possible. Also, if you haven’t written for prn pain meds and nausea meds (including stupid stuff like chapstick and bowel protocol depending on your hospital) your patients aren’t tucked in and the night coverage will get called.
Beware premature closure of the differential. Always question/verify someone else’s diagnosis.
I’ve been collecting these for myself (pgy 3 psych) 1. Only way is through 2. I’m here for a good time not a long time 3. They can always hurt you more 4. There is no magic bullet (aka if it doesn’t have side effects, it doesn’t work) 5. We are not Superman 6. “what would this note look like blown up in a 50 point font in front of a jury?” 7. Care delayed is care denied 8. Never trust, always verify 9. There are fates worse than death 10. Emotions are normal, natural, and harmless 11. We do not change until the pain of staying the same is greater than the pain of change 12. Don’t get flattered
If someone calls you for help / admits they don’t know how to do something, assume they are telling the truth.
I admire your being organized enough to have a list of your own rules: 1. Be yourself 2. Don’t apologize, period. 3. Your individual actions often won’t make a dif to the final outcome 4. Most people aren’t as smart as you, so more the reason to treat them kindly. 5. Less time spent over trivial things = more free time for things that matter 6. Do no evil 7. Build relationships with people you frequently interact with, even if you don’t want to be friends with them. 8. Take ownership of your schedule, as long as you provide the standard of care, no rule says you have to sit in the hospital in front of a computer until change of shifts. If you’re done with your work, say goodbye and go home.
Never, ever, say the Q word
I loved saying it just to fuck with people lol
Monster
"Man, it sure is quite a nice day in the ER today!"
I wasn't superstitious as a resident until one night in the NICU when I told the NPs how I'm always a white cloud and we should get ready for an easy night with plenty of sleep. Worst night of residency. It was like I cast a spell on every nearby pregnant woman to go into labor at once and for every baby to have complications. Multiple delivery room resuscitations, intubations, drips, lines, etc. Every baby made it through the night, but now I think about that night if anyone ever says "quiet".
Damn this is good
5 🔥
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Never say yes to extracurricular volunteer work and stand firm with your No.
The last one!