Anonymous Doctor

There's an intern, married, who keeps saying she wants to set me up but hasn't found the right person yet. No kidding. I haven't found the right person either. I don't know why married people think that because they met the one person for them, it means they're an expert on relationships. We wouldn't accept that on the professional side of their careers-- if you diagnose one case of pancreatic cancer, it doesn't make you an authority. It just makes you lucky.

So much more luck goes into this job than I expected coming in. Luck as far as who your residents are, who your patients are, what happens to your patients under your watch versus what happens when you're not on call, which patients get assigned to you, which files are on top of the stack in the morning. Already there are interns who have a reputation for being terrible. The program director warns us that our reputations matter. You get one chance to make an impression, and if it's the wrong impression, then you're the lousy intern who's never going to be trusted to make decisions, who's not going to get good evaluations, who's not going to get fellowship interviews, who's going to be stuck in an ultimately unsatisfying medical career. Most of the people who write our evaluations don't spend enough time with us to make judgments of their own. The attendings admit that. They ask around, see what everyone else thinks of us, and that's what they write. But the interns with the bad reputations-- it's not always their fault. You have one complicated case and a patient has a bad outcome-- and suddenly you're known as the one who killed that patient. You accidentally piss off a family and they go complain to the attending about you and you're the "difficult personality" who needs to be monitored. You forget to follow up on one lab result and you're the scatterbrained moron who can't be trusted to do his work. There is no margin for error. It just takes one bad outcome. Other jobs, people can fail. As doctors, we can't. And even though the cost of failure is often absolutely incredibly high, still, it's a standard no one can meet.

I had a full day of clinic today, saw eight patients. Had to refer one of them to gynecology-- she didn't know she was pregnant. Three months along, and she had no idea. No clue. At least I got to give her (arguably) good news. We don't get to give good news very often.