Coping With First Years as a Doctor

Nothing beats the feeling of getting into medical school. It’s an amazing achievement, especially if you’ve dreamed of it for a long time and have always wanted to be a doctor. You tell all your friends and family and you remember that moment for the rest of your life. Everyone gets excited and people start seeing you in a new light. You’re no longer a high school or college kid; you’re now going to be a physician responsible for people’s lives in a few years.

That ecstasy doesn’t last for too long, though, because the pressure starts piling up from that moment on. You get into med school and you start worrying about how good you are and the amount of tasks and tests you need to do well on. You go from being the smartest kid in class your whole life to sitting in a room where everyone was the smartest kid in their respective classes; it’s now a test of who is the best of the best. The competition is tougher. Then you start worrying about your USMLE scores and getting into residency. You take the most important tests of your life and you apply for the MATCH and spend a couple of months interviewing. After you’re done, you wait a few more months for your results, wondering if you’re going to get a chance to become a doctor this year or not.

Once you do get a residency position, there’s a period of happiness followed by a period of dread; you’re now entering a more difficult period of life. It’s time for you to actually be responsible for people’s lives. Doubts start to fill your head as you wonder if you’re good enough, if you’ll make it. You made it past numerous tests, but this is completely different. First-year residents face a variety of challenges.

When you consider the difficulties of residency, you need to think about work hours. A standard work week (generally speaking) is forty hours per week. This is based on working eight hours per day for five days a week. A lot of people reach the end of their forty-hour work week exhausted and looking forward to the weekend. An old law stated that residents shouldn’t work more than eighty hours a week. This is twice as much as a regular work week. Imagine how exhausting that can be!

Rules are changing in the medical field, but not for the better. Starting last July, first-year residents will be allowed to work for up to twenty-four-hour shifts. This is increased by a potential four-hour period for the transition between shifts, which is when doctors at the end of their shifts are handing over patients to doctors just arriving for the start of theirs. The reasoning behind this is that short shifts affect patient care, as arriving doctors may not know everything about the patients who were already at the hospital. This allows doctors to stay with their patients for a long time.

A lot of residents have questioned whether their mental and physical well-being were put into consideration when this new rule was decided. Residents were already overworked and stressed. Some residents say they may not eat for the duration of their shift due to being so busy. Under the old eighty-hour rule, some doctors ended up staying for longer because there wasn’t enough time to complete all their work. Perhaps, under the new rule, they’ll have time for it, but it would be worrisome if they received more tasks and had to stay even longer. It also doesn’t make sense to try and improve patient care by elongating work hours since exhaustion and burnout of residents will result in a decrease in that quality.

Another issue that keeps doctors awake before their first day of residency is if they’re good enough. You spend years of medical school learning loads of information and being tested on it. First, assuming you did a good job acquiring that information, you wonder if you can still recall everything; it’s not easy to recall something you learned four years ago. Recalling information is made even more difficult due to the stress of the job and how sensitive it is. You need to remember things on the spot and you have to remember them correctly. A wrong dose can kill a patient, either by under-treating them or due to the drug’s side effects.

Medical school doesn’t teach students how to draw blood or insert catheters, for instance. These are things all physicians know how to do and are considered basic maneuvers. You’re faced with a lot of techniques that you’re supposed to learn on actual people. You’re poking someone with a needle as they watch you do it. The fact that they know you’re still learning and are anticipating a mistake from you doesn’t help either. Practicing on mannequins and models may help, but doing something for real is significantly different.

Going to supervisors to seek help managing stress isn’t really an option either. Being a resident can be extremely competitive, and residents are always trying to stay ahead of the curve. Complaining to your supervisor could result in putting you at a disadvantage. It’s not that the supervisor will think less of you, but you won’t like it if they try to help. How can they help? There’s not much they can do since they can’t change the rules. What they can do is assign you less work. This will result in you learning less and ending up behind your colleagues. If anything, this will increase the amount of stress a resident feels rather than decreasing it.

There are a few things residents, and doctors in general, can do to cope with the stresses of the job. One of these is not getting involved too much with the patient’s suffering. This might sound cold, but it’s necessary. I’m not saying to forget the person you’re dealing with is in pain and needs help, but don’t mistake that suffering for your own. Basically, it’s important to be sympathetic without being empathetic. Understand your patient’s suffering and do your best to help them, but don’t suffer for them. This isn’t just for you as a physician, but also for the patient. Seeing things from an objective point of view will allow a doctor to make better decisions, as being too subjective can cloud a person’s judgment. A patient needs someone who sees things clearly and can help them, not someone who is distressed.

It’s also important to release these negative emotions and feelings. Repressing them and not dealing with them can be disastrous and lead to depression. It’s important to find hobbies to release that negative energy and to talk about it. Some hospitals have meetings where bad cases are discussed.

Finally, it’s important to learn to forgive yourself. For a lot of cases, there’s nothing you can do, and for others, there will be unforeseen complications you couldn’t have predicted. It’s important not to take the matter lightly. Work toward being a better doctor and being able to provide the best possible care for your patients. Remember what happened for future reference when facing a similar case, but don’t let it eat you up inside. You’re only human after all; you can’t save everyone.

Residents, and everyone in the medical field, are under a lot of stress. Steps need to be taken in order to minimize that stress to ensure their well-being and that the quality of care they provide isn’t compromised. It’s really out of a physician’s hands when that happens. Most doctors truly care about their patients and would sacrifice everything for them, but there’s not much you can do after working shifts for so long. Share with us your methods of coping with stress so others can learn from them.