I recently had the honor and privilege of keynoting to several hundred medical students at a wellness conference. In the talk, I shared my thoughts on choosing a medical specialty (which you can find in my last post), as well as my top 10 pieces of advice for budding clinicians, which I have included here:

“As I leave you tonight, I wish to share with you some parting advice and challenges regarding clinical practice, because it is going to be upon you sooner than you realize. And it will be awesome. Not always easy, that’s for sure, but that’s not why we get into medicine.

  1. I want you to think about the type of leader, teacher and physician you want to be. What reputation do you want to have, and what example do you want to set? When you leave your rotation, institution or even profession, what legacy do you want to leave? And how are you going to start practicing that today? Set the standard for professionalism that you want to see. If you want a tightly run team, be the punctual one, the one who has the lists printed out in the mornings and a plan for the day.
  2. Look for examples of who you want to be. I once heard a quote from General Stanley McChrystal’s former aide-de-camp and Navy SEAL Chris Fussell about career development, and I really liked it. He essentially said: “In your career, when trying to gauge your progress, development and competitiveness, find someone at your level who you admire, find someone slightly senior to you whom you admire, find someone very senior to you whom you admire, and use them as a blueprint for your own career path.”
  3. The third challenge that I issue to you is this: Don’t be the kind of doctor who trash-talks other specialists. Generalists do it to specialists, specialists do it to generalists, and doctors in the same field do it to each other. I urge you to keep an eye out for this, and to not engage in this type of behavior. There are ways to be hard on others in a way that is productive and a way that is destructive, and at the end of the day, though we may specialize in fighting different disease states, we are on the same side in the quest to heal and do no harm.
  4. You will see a lot in medicine. Sometimes you will even ask “that can happen?” (Rest assured, it can). You will see trauma, tragedy and even horror. Some of it may have been preventable, some of it may have been inflicted by one human upon another and some of it may seem senseless and without reason. I urge you to not get disheartened by this, but rather to internalize this as a positive. Be grateful for your health and your own mobility, and that of your loved ones. After my time in neurosurgery, having seen much paralysis and spine surgery, some days I marvel at the beauty of simply being able to wiggle my toes. After my time in internal medicine spending time with the sick elderly, I am more grateful than ever for the health of my aging parents.
  5. Learn to hone that spidey-sense. As you gain more clinical acumen, you will get a sense of when something just isn’t right. And I encourage you to listen to that voice. You may not think you know anything when you start, but you have the chance to sharpen your sixth sense at each patient encounter. It will start with thinking “I should have asked about [x]” when you walk out of a patient room – and if you don’t, I guarantee that your preceptor will ask you if you asked about [x] if you neglect to. As you become more senior, this niggling feeling will become more reliable, and will provide the key to an incomplete picture – or could even save a life.
  6. Learn to look at the gestalt. It is challenging at first, as you learn the basics, the art of the history and the physical, but as you progress, you will learn the art of pattern recognition. And I don’t just mean patterns of symptoms – if it were that simple, the robots would already have our jobs – but I mean the entire patient picture, including social context and genetic factors. Sometimes you have to zoom out before you can really bring your patient’s problems into perspective.
  7. As part of honing your spidey-sense and looking at the gestalt, I also encourage you to hone your ‘bs’ meter. It won’t be very long into residency before you pick up on keywords that can call the certainty of the information you are being given into question. Examples of this are “not as far as I know” (translation: “I haven’t checked”), “not since I last checked” (translation: “I haven’t checked in awhile”), “I think so” (translation: “I have no idea”), and “I’m pretty sure” (translation: “I still have no idea”). In fact, I encourage you to check yourselves and catch yourselves when you say these things – because you will say these things when you first start out, either for fear of looking unstudied or unprepared. Don’t worry about it. You will be judged more for faking competence and being caught, and it could cost a patient their health someday.
  8. Which leads me to my next point. Practice humility. Check your ego at the door. If you knew everything already, we wouldn’t need residencies. We know you are here to learn, and so accept corrections with grace and as an excuse to make yourself better, rather than making excuses or taking it as a personal criticism.
  9. Be a closed-loop communicator. In high-acuity situations, help eliminate room for error – close the loop. If someone asks for 1mg of Epinephrine to be administered during a code, leave no room for error –  respond with “1mg of Epinephrine in.” Close. The. Loop.
  10.  Plan your life, but be flexible. Residency can be like navigating a jungle, swinging from vine to vine. It’s okay to change your course, but don’t let go of your current vine until you have the next one in hand. Always have a plan B, and keep an eye out for opportunity. You may not end up where you thought you would – and that’s okay. Lives are long and full of surprises.”