Doctor World canstockphoto11903338Although there is much advice on helping new interns adjust to residency life (part 1, part 2), not much is shared about helping recent residency graduates survive the real world of EM practice. Dr. Amal Mattu, Professor and Vice Chair at the University of Maryland’s Department of Emergency Medicine, solicited for advice from his department’s faculty and recent residency graduates. Below are the top 15 themes which arose from the discussion and are frankly great reminders for all practitioners in the ED.

Top 15

  1. Be honest and be a life-long learner: It is ok to simply to say “I don’t know” when asked a question by a student, resident, or patient, but then go look up the answer. Or set your ego aside, and ask for help. Don’t feel pressured by the fact that you are no longer a resident. It is ten times more embarrassing if your impromptu answer/guess is wrong. On the flip side, you do not want to be known as the emergency physician who knows NOTHING. So “bust your butt day in and day out” to always be learning. Be a lifelong learner.
  2. Do thoughtful charting: Go back and re-read your notes (especially the HPI) before signing them. Try to read them as an outsider and look for 2 things.
    1. Would this be a note I would feel comfortable having being read out loud in front of a group, such as a medical review panel or jury?
    2. Does my note (especially the HPI and Medical Decision Making sections) justify my final disposition, whether that be admission or discharge?
  3. Listen to your patients. In the midst of a busy shift, it is easy to forget that the history is usually your best source of information. Resist the temptation to start ordering a bunch of tests before you have taken the time to listen to your patients or their family/friends who may be providing the history. It is worth the few minutes it takes to sit down and really hear what the patient is saying. You will learn so much AND your patients will appreciate it more than you can imagine.
  4. Update patients: When things get busy, time can really fly by for us as providers in the ED, but remember that while an hour or two may go quickly for you, that hour two seems like forever for a worried patient or family. We may not make decisions until all our lab results or imaging studies are back, but people feel abandoned if they don’t hear updates from you in that time period. Although we can all do better on this, try to at least pop your head in when walking by a room to let them know what you know thus far, what your are waiting for, and if possible, a general idea of how long it might take.
  5. Get to know your colleagues! Get use to using fellow attendings first names. Look it up if you have too. We meet so many people that we often forget who we have met or talked to before. If you use their first name instead of Dr. Jones they will often wonder how they know you, and it tends to make them friendlier. Only people that want something from them call them Dr. Jones. Be their friends.
  6. Talk to your patients before they go home. It is not OK to give the discharge papers to the nurse and have it be the end of the patient visit. You will be able to complete the loop of communication much better. Furthermore, it helps to prevent the “on the way out” question to the nurse that then has to pass to you. Your patients will feel better about going home if you talk to them and explain that you are happy they came in. Because they do not need to be admitted, you should emphasize the importance of continuing their evaluation/treatment by their primary care physician, especially if it is a diagnosis that can not be completely diagnosed/treated in the ED. Patients tend to respond to this communicated plan much better than being ushered out by nursing staff with the same instructions in written form only.
  7. Treat your patients like your family members. Never forget to treat your patients and their families as if they were your own. Patients are unique individuals who are more than diagnoses and “interesting cases”. When a patient is having a hard time deciding about something, I will say, “If you were my father/sister/etc. here is what I would suggest you do.” This, hopefully, let’s the patient know you see them as a whole person, not just someone with a problem. Remember what an honor and privilege it is to practice medicine.
  8. Create positive memorable moments: People don’t always remember what you say, but they will remember how you made them feel. This goes for the patients and the entire ED team: consultants, technicians, nurses, students, housekeeping… Lead by example. Bring candy, smile, and thank people for the work they are doing. It costs very little and will pay dividends.
  9. Say YES to projects. As you are beginning your careers, you want to say “yes” to projects more often than not. Just be sure that these generally align with your career goals. As a corollary, say YES to family first. Say yes to your family at least as much as you say yes to your career. Years down the road, you will not regret declining the opportunity to be on another committee, but you will regret missing your child’s school play.
  10. Be a Tigger: “Your attitude, not your aptitude, will determine your altitude.” This quote by American author Zig Ziglar emphasizes the importance of working hard and bringing a positive attitude to what you do. It will pay off at work and in life. Be the Tigger. Nobody likes working with Eeyore. This is often easier when you leave your pride at the door.
  11. Take care of yourself: The better you treat yourself, the better you will treat your patients. It is always okay to take bathroom breaks, take a few minutes to eat and drink, or check in with your loved ones during a shift. Your mind, body, and patients will thank you for it.
  12. Don’t be a complainer. There is a lot happening behind the scenes of any department that residents are not privy to. You will learn a lot and will be in a much better position to implement change by just observing, listening, and understanding the department’s political environment and issues. Do this instead of complaining or trying to “fix things” on Day 1. Of note, you might want to remove this phrase from your vocabulary: “Well, where I trained…”
  13. Pay yourself first. Live like a resident for 2-5 years after graduation. Aggressively pay off loans. Maximize your 401k and other retirement options. Recommended website: White Coat Investor.
  14. Aim for work-life integration. There is no such thing as work-life balance. You will never feel that you have the perfect balance between work and life. But know that you can achieve work-life integration. Maybe some days you end up devoting more time to work than life, but other days the opposite may be true. Just remember that there is always a give-and-take. So don’t forget to stop and reflect on whether you are on track for your goals in both work and life.
  15. Have fun. Don’t take yourself too seriously. It will make you a better physician and will improve your interactions with patients, nurses, ancillary staff, consultants, etc. Try to find humor in the midst of the craziness. If there is no humor to be found, create it (within reason). It will make for a better shift in the short term and a more rewarding career in the long term.


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Michelle Lin, MD
ALiEM Founder and CEO
Professor and Digital Innovation Lab Director
Department of Emergency Medicine
University of California, San Francisco
Michelle Lin, MD


Professor of Emerg Med at UCSF-Zuckerberg SF General. ALiEM Founder @aliemteam #PostitPearls at Bio:
Michelle Lin, MD