Essential Advice for First-Year Family Medicine Residents

Because We’re Not Wrong.

Let Me Explain. 

When I think of the life cycle of a medical professional, I very much believe it is like that of a frog. ????

1. Undergrad = eggs.
2. Medical student = embryo.
3. Intern = tadpole. 2nd-year resident = tadpole with hind legs.
4. 3rd-year resident: looks like adult frogs but still has a small tail
5. Attending = frog????

Has the fear set in? Good. And now, let me reassure you. Despite the fact that you are thrown into this situation completely unprepared, there is a robust safety net in place to catch you if you stumble. Although you are making every medical decision, you have guidance if you don’t know what to do.

The key is to recognize when you are unsure about your actions.

From day 1,

It can be difficult to discuss every one of these items in one visit, and it’s not because of the time constraints. It’s because they should all occur in different age ranges, different demographics, earlier for special reasons, or not at all because of age. Additionally, you must access all of these elements simultaneously to ensure your clinic operates smoothly. It takes PRACTICE! You will eventually become adept at it.

One tip I have learned from my attendings is, “Don’t wait for tomorrow; what can be done today?”

This means that even if the patients are there for a sick visit, you should mention these screening tests and offer referrals so they can stay up to date and schedule return to the clinic (RTC) visits for procedures. Think ahead. Keep your patient’s health up to date. ✓ It is not their job to know what they should be getting done, although it would help if they did. It is YOUR job to know and to offer it at every visit, even if it is declined every time. And don’t forget to DOCUMENT the offer and the fact that they declined it every single time.

Code

Furthermore, learn your coding. Huh? Each clinic visit needs a code. It is how patients are charged, so your clinic can bring in the money. New patients and established patients get different codes. Well-child visits get different codes. Procedures have different codes. Modifier codes show you did something not covered in the first code. It can be daunting. But you will get it, I promise. Ask your upper levels for guidance or if you’re attending. The last thing about the clinic is this: At times it feels as though you are out there on your own. It is scary to be responsible for a patient.

• What if you forget to mention something is important?
• What if you forget to ask a question that is pertinent?
• What if you forget to talk about a screening test? Etc.

Your mind will race. Fortunately, it’s mandatory to discuss every patient encounter with an attending.

So here are some tips on what to do before discussing the case with your attendees.

Hospital rotations are scary. My first rotation was ICU, and I will admit I was terrified.

I have written another blog post on How to Survive ICU, which some of you might want to read. But in general, hospital medicine has its own finesse, too. In my opinion, the ICU and adult medicine are quite similar. ICU is an adult med with ventilators, pressors, and higher acuity.

Regardless of which hospital rotation you have, befriend the nurses and get them on your side. They were there before you and will be there after you leave. We are passing through. The staff takes pride in their work, and you will need to trust them. They spend more time with your patients than you do, so trust them if they say something’s wrong! Please check with the patient and assess the situation rather than giving orders over the phone. Be the doctor.

Important Tip:

If you did not perform the task, do not claim that you did. If they ask you about bowel sounds, but you didn’t listen, don’t say “normal.” ✓  Admit that you didn’t do it. Honesty is the best policy. This is not only because it makes you honest and trustworthy, but more importantly, it ensures safety in medical practice. It protects the patient. in case the chart indicates a “heart murmur,” but you do not detect one, please acknowledge that you did not hear it. unless you do hear one, but you’re not confident, say that.

If you’re unsure, don’t hesitate to ask. Never assume anything about anything. Be as transparent with your attendance as possible. Recognizing your shortcomings as a physician will be the best tool you have to protect your patients. It also allows your attendants to trust you and your clinical judgment. They will be able to trust that if you’re not sure of what you’re doing, you will ask for help and guidance. This ensures patient safety.

Imagine if you had a family member who always tried to fix your TV, never asked for help, always said they knew how, and every time they ruined it more. Would you feel comfortable having this person work on your TV again? Would you trust them around other electronics? NOPE

Be honest about the things you don’t know, ask for help, and read about it! This is what residency is about. 

Back to the clinic:

In my program, at around six months, our clinic responsibilities change. Initially, we had to discuss every single patient encounter with attendings, but now we only need to consider higher codes or patients that require more extensive medical decision-making. Anything below that, we CAN manage on our own. BUT… if I have a question about something, I still ask.

Overall, the first year of family medicine is full of many emotions and thoughts. I am sure the second year will be the same. The purpose of residency is to manage patients independently, ensuring that nothing is overlooked and that care is provided using evidence-based medicine. That way, when you are working at an attending level, you thrive, and so do your patients. So let residency do its job.