My Advice For Medical Residents

So today I’m rounding at the hospital and the residents and the medical students. I told them, I’m like, okay this is not okay. We’re staring at computers, the system’s totally demoralizing us, we’re all suffering moral injury. Have fun on your path! And they said wait. Is there no hope? What’s your advice? What should we do because here we are just trying to survive residency, medical school, and is there hope?

And I said, okay, here’s how it goes, all right? Right now you feel powerless. And you’re just trying to get through this day, you’re trying to get through your training. The first thing I said is: don’t be one of those punks that gets an MD or a nursing degree or whatever and then’s like, “I’m gonna go in the industry “because I am a doctor, I am a nurse.”

No, you’re not. You haven’t done anything until you’ve actually been out there, fingering butts, actually touching patients. Which means if you’re a doctor, do your residency. If you’re a nurse, go do your clinicals. Go out there, work.

Once you do that, let’s say the system never changed. You can go, go to a startup. Go work to make it better. But you’ve gotta have that clinical experience because I am so sick and tired of people with no, had never touched a patient. Even if they went to medical school, dude, come on. Come on. When I graduated medical school, look, I went to UCSF. It was a pretty hot shot hoity toity place. I didn’t know ish about anything.

And I learned that in my first minute on the CCU at Stanford when I started residency. When my third year told me, “You don’t know anything.” And I might have wet myself a little. Okay, you don’t know what’s up until you do that training. Do the training, then go change the world.

Now let’s say you want to stick on that clinical path. Okay? Well that means that you need to start, first of all, with eyes open. You need to be aware and mindful of what is wrong, and don’t get destroyed by it. And don’t get sucked into the matrix. It’s so easy to go yeah, you know, and then we’re gonna do all these tests, and he’s gonna discharge to street again and I’m gonna spend all this time charting, and this and no. You go, hmm, that was interesting, okay I gotta through this day. Spend a lot of time charting. And these are social issues that are not solvable by medical stuff, so we need to fix that. I’m gonna keep taking notes on medical ideas I have on how that might happen. But then I’m gonna go and do the best I can in a broken system. But never ever capitulate to that system and go, “This is the best there’s ever “gonna be and I’m just gonna…” ‘Cause that’s what got us here, people.

Physicians and nurses and frontline clinical staff said, “Oh, there’s nothing we can do.” You know? So if you do that, you’re complicit in this great crime that is being perpetrated on all of us.

So, no, now here’s my advice. Things are going to tip. They cannot get worse without absolutely destroying the entire fabric of this healthcare system. We’re that close. But we’re at a tipping point. And I think we can go in that Health 3.0, re-personalized, re-humanized, reinvigorated medicine. That means often doing less. But spending more time sitting with patients. Being there witnessing their suffering. Being with patients, right? Doing stuff FOR people instead of TO them.

That can be done right now. Here’s a simple thing you can do. Take your EHR screen instead of staring at it while the patient’s over here creating an obstruction, just flip it around and sit with the patient and build the record together, and watch how that changes the dynamic. Now that’s not for every patient. That’s not for every situation. But man, that’s one thing you can do right now. And if you never lose sight of that, and you never forget the why, you’ll have your bad days and your bad weeks but you’re not gonna get stuck in this horrible spiral of apathy, inertia, midlife crisis, substance abuse, divorce, mental illness, suicide. You think I’m exaggerating? Just look around you. All right?

Now why am I even telling you this? Because I know it can be done. I know you can pull out of this. I’ve seen bright spots everywhere. Heck, we built a clinic, had to close it, because we were too early, right? But we tried. And people see it, and now they go I’m gonna take a piece of this, I’m gonna take a piece of this, and we’re gonna build it in our own way in every little location. So, residents, medical students, people on the path, number one, don’t give up. Number two, get your damn clinical training. Number three, never lose sight of the why. Number four, find that unique path where you’re gonna contribute to making it better and never accept this as it is because they will condition you to believe that you can’t change the system and that you have to adapt. Look, no, no, no, no, no. It’s time to flip that, okay?

So, if you’re down with this, if you’re down with OPP by the way, if another person sends me their idea for an OPP parody. “Oh, you’re down with HSV.” I am going to do something drastic, okay? I might you don’t want to know. So hit share, join the supporter tribe, be a part of the conversation. Please don’t send me OPP parodies. But do send me bright spots where things are working because I can shine a light on them through this platform. We can work together to transform the system. All right, I’m out!