¶ Night Shift, Breakfast, and Business Insights
Let's talk about the level of personal business . I mean , I felt like I was literally watching a Jerry Springer episode .
That didn't move me as much , though you can't prove any of that stuff .
I'm not saying you can prove it , but I'm saying that to me is not necessarily what rap beats are all about , Unless you talk about Biggie and Tupac With that one line we all know what it is .
Listen , don't bring the west coast on that .
Most rap beats are not that personal . I mean it used to be everybody was a sucker mc . Whoever says sucker mc the most won , you know folks , your exciting new medical career .
It's just been hit with a serious illness or injury that stops you from earning a paycheck just when you need it most . Check out what Jamie Fleissner of Cephalife Insurance said back on episode 176 about having disability insurance early in your career .
The real reason to get it early on is really twofold . One is to protect your insurability . To get it early on is really twofold . One is to protect your insurability . So if you are healthy and you can obtain the coverage , you also pre-approve yourself to be able to buy more in the future .
So down the road , as your income does increase , you don't have to answer additional medical questions . All you have to do is show that your income is increased and you can buy more benefits at that time . No medical questions asked .
Protect your income , secure your future . Check out setforlifeinsurancecom . Let's get into me doing night shift man . I just finished a week of nights . That is tough , but I love nights because nights there's less politic , and if you know what I mean , I just take care of patients , I operate , and then I sign them out , and then I'm out .
I ain't got to talk to no social workers , I ain't got to talk to no case management managers . I can talk to families , I can talk to the nurses , I can talk to the ED docs , I can write my notes and I am out . I love it .
But yo , it puts a toll on me though , night shifts , cause there's so many different variables that just get twist twisted Right variables that just get twist , twisted right , like like , for example , like when is breakfast is breakfast like ? is breakfast at dinner ? Breakfast is when you hungry , right .
Is breakfast at dinner like right before you go in at 7 pm , or is breakfast when it's actually breakfast at like 7 in the morning ? Like just all these different things that I really don't know what to eat right so hold on .
This says kendrick lamar's latest diss track against pop star aubrey yeah , he called him out though he called aubrey drake graham is the number one song in the country . It says I don't know , I mean just a lesson . It's not a lesson to everybody , don't fake it everyone .
If you are who you are , if you corny like me , just claim your corniness . Don't try to be someone who you're not , because eventually , so you think Aubrey just is like corny . He's a good rapper , but obviously a significant amount . First of all , he's corny and he has a drive , unlike anybody else so let's just put that out there . And he can rap .
But obviously he's pushed up by the industry right , particularly people who are invested in him . They like they have invested in him and helped them , you know , grow and stuff and you have to like someone like him , like normally people like him would fizzle out right , but he's still here , he's still putting music , like what makes him go ?
like he is driven like no other ? But yeah , I mean , but that's the way how it played out , though , right , that's the whole cultural currency thing that Kendrick called him out on so many different ways , like , just , I mean , we can get into it , but no , let's not get into it . You know Texas at 833-230-2860 , just Texas . You know what ?
we talking about ? I know , you know alright so you came back from night shift ? Oh man , yeah , came back from night shift , did mad operations , so when is breakfast ? Breakfast for me is when I get home when you get home in the morning , when you get back to the hotel .
But the problem for me is I sleep . I can't sleep very well when I'm on night shift , like so when I get home , you know I , when I'm in the hotel , like they have these . You know the the was it the curtains that the blackout ?
right the blackout curtains yeah curtains and stuff .
I can only sleep for like five hours why do you think you can't sleep ? I don't know , I don't know , but um , that's part of this conversation actually later on and stuff .
But for me , though , the clinical fulfillment I get is not completely offset , but there are some sacrifices that I have to make , so I get a little bit less sleep during the daytime , but when I'm on , I'm on and I really like that . So it takes me at least a good three days to get back to normal .
But you know , when I'm on , I'm on , and I really , I really like that . So , um , it takes me at least a good three days to get back to normal .
Right and right now you're on what Day two ?
Yeah , day two .
Yeah . Actually no , I'm on day one because I finished , you finished , I finished yesterday , I finished yesterday morning , and then I came home Day one . Yeah , well , this is going to be an interesting weekend .
How many people listen to this show on night shift ? How ?
many people .
This is going to be interesting If you're listening right now and you're on night shift . Tell us when breakfast is 833-230-2860 .
I feel like we're on a regular show . And what is for breakfast ? Yeah , man .
The other thing too . Before , before we get into this episode , shout out to Dr Bobby Burches he put me up on this . You guys may or may not use this .
Definitely to people who are self-employed may be using this , but Gusto Gusto is a payroll software where , if you are 1099 or if you're your own business owner , you can pay yourself and it takes care of everything from not only just paying yourself but making sure that , like all your unemployment taxes are paid , making sure all the taxes are filed the correct way
for your state as well as federally . It's , it's amazing . It's really good it's . It's taking me a little bit longer to kind of get used to , mainly because for several years I've had a CPA kind of handle that .
You used somebody else , yeah .
And I think I'm at a point now where I'm just like you know what I actually do want that level of complexity and control , and Gusto makes it a little bit easy . Actually , I think it makes it easier to the point where I feel like I sleep better at night knowing that I can change numbers anytime I need to .
So if we need to bring in a little bit more salary , then we can do that .
I don't have to ask somebody or email someone . Hey , can you ?
you know , just do it and go from there . So shout out to Dr Bobby Burgess , who I think , if he's listening right now , I need to have you back on the show . I'm gonna reach out to him like yo .
You need to come back on the show because the way how he handles his stuff from you know , his taxes to gusto , to a whole bunch of different things , as being an independent contractor is really good and I think that highlights just in general if you are an independent contractor , don't just be like a silo , reach out to other people , talk , you know , don't be
competitive . You know it just only behooves us all if we all work together , right . So , rather than be a race to the bottom , particularly with rates , you know if we all work together right .
So , rather than be a race to the bottom , particularly with rates , you know if we all work together , if we all share rates , if we all discuss , you know some of the tips that or the tricks that we're using yep I think in general it'll make for a better , a better area yeah , no , I agree with you .
I think you know the industry is going to change , or is changing . I should say the industry is changing a lot and I think , with the changes that are going on in our industry right now , with people coming in being more entrepreneurial , it's going to be important to know , like , what is out there .
You know what is out there , what is kind of the what is it that they say ? Take the temperature of the place and figure out , like you figure out where you fit in , how much you can make and when you're getting swindled .
Yeah . So eventually I'm sure not eventually we're going to have to make an episode about this FTC non-compete type thing . Eventually we're going to come out with that . Guys , I've just been tired , but we're going to do it . I got a lot to say about it , but we're going to do it . I got a lot to say about it .
But in essence , like the industry is kind of messed up , right , because it's like you know , I can understand if you're in a tech industry or if you're in some type of industry where that company is actually has all the secrets and they don't want you leaving and taking those secrets and going to another competitor . But what's the secret in medicine ?
Right .
Like you have the secret as a doctor and now you can't go to another hospital or you can't go to another facility . That doesn't make any sense . All this stuff is in the textbook . There's no proprietary thing exactly why is it that I gotta you know ?
my exactly me myself , as a physician , has to be in a right . You don't want me to share the schedule that I have or the antibiotics .
Right what she's on the hush don't tell them about that , zosyn .
Don't tell them . Don't tell them about that , Zosyn ?
It's Piper Sillin . It's Piper Sillin here , Like get out of here man . Anyway we're going to talk about that , yeah , but let's jump into self-care . Self-care while working . This is a big deal . This is huge for A lot of dogs out there , oh yeah , yeah .
So we're not going to talk about it from a sense of burnout , but we're going to talk about what I do and you can chime in or if you have a list , I made some notes as to what I do to kind of make sure that self-care on a daily basis is something that I'm thinking about , because I think that's the way that you have to think about it , and this is
from a resident , even to where I'm
¶ Self-Care Strategies for Physicians
out . I'm 10 years out you know over 10 years out . Self-care is something that you got to think about on a daily basis . You got to make moves , you got to practice this stuff every day .
Otherwise you know the joke's on you , because that stress of being a resident , that stress of you know wanting to take some time off and you feeling like you the only person who can do that , or you know you being in attending and your partners may not be centering this stuff like you , have to have the strength , you have to have be able to just say hey
look , I don't care what anybody says , I'm gonna do me . So I'm gonna start with my number one thing that I do what to make sure that self-care is very important while working and that , for me , is working out . I think that's easy , that's no joke .
Yeah .
For the past two and a half years , y'all I'm telling you , I've been getting my Billy Blanks on , I've been getting my what's that guy , richard Simmons .
I don't know who Billy Blanks and Richard Simmons are anymore .
Royce , it's sweating time and sizzle and sizzle and sizzle . Yo , I'll be getting all that shit on . Who's the other guys ? Sean T . And now I got like virtual private training now with the Future app , which is a great app , but for me , working out is huge . I'll just start , I'll leave it at that .
And it's big for me because I feel like decision fatigue is real , particularly for surgery , decision fatigue is real . I'm not trying to toot surgery's own horn , but we get involved in so many decisions for so many different services and that everybody asks you for a decision or for to make a decision .
What should I do with that ?
it depends and the implications of those decisions are always weighing on you you know , and it's just like who should you operate on , who should you not operate ? On who should you send home ? Who do you need to check on later on ?
how quickly should you check back on right ?
can you send somebody from the ? You know , it's just so many different things .
And .
I think for me , when I finish my 12-hour shift as soon as I get home , or even before I go to work , for an hour to an hour , and like 15 minutes me just working out and there's nothing on my mind except working out and the workout is already made for me .
All I got to do is follow the app , or , prior to that , all I had to do is just pop in the right video and that's it , like there's no decisions that need to be made , it's all ready for me . I love that , and it goes even beyond just saying okay , you're following something , you're making your body better .
For me , it's like this is almost like therapy for me . You know , like this is quiet , nobody can get to me . I love it . So for me , it helps me to focus , it keeps me in the center .
So you think that now you think I mean you're obviously doing it . I guess , like the question is you know , with as much decision fatigue as you have , like , how are you mustering up the energy to then go energize yourself with exercise ?
you know what I mean like , yeah , yeah , yeah , you know like you get so tired , you're just like oh , forget it , I'm just gone the way how I look at it is , by the end of the day , when I'm ready to sleep , I always will think about how crazy the day was , but I always can say , well , can't , it could not have been that crazy , because it didn't beat
me down enough for me to not work out right so .
So that's where I'm at right now . So now it's like well , Although you didn't work out yesterday .
Well , yesterday was a travel day for me and today , which is the next day , was supposed to be a recovery day .
Right .
So for me I was like well , you know , by the time I get home it's going to bed . I really want to spend time with you . Watch that Gerard Carmichael show .
The show is dope yo , the show is dope yo .
I really wanted to do that . So , rather than have the pressure of and we've tried that once where I'm working out in the living room sweating and watching you know a TV show and then you're watching , you know it doesn't work , so that's why I took that day off .
Right .
But today I just switched the days . But yeah , for me that's the way I look at it . It's like no matter how much you can beat me down , you got me for 12 hours , sometimes a little bit more too . It was front not to front , right ? But I just know that it doesn't matter . I'm going to center myself sometime during the day .
Yeah .
And that makes me feel good , that sometime during the day , yeah , and that makes me feel good . That's how . I justify it all yeah yeah , yeah , you're going to cook me for 12 hours , but I'm going to get mine .
Yeah , I mean it has to end at some point .
Yeah .
It's like you're just . It's like starting a race . The gun goes off and you're like I got to get to the finish line sometime . Yeah , I got gotta get to the finish line sometime . It's real man it is for me .
So I'm , I'm , I didn't ask you for your yeah , well , I'm telling you , but , um , I'm line stepping , um , I'm very different from you in that respect , very different from you in that respect . So my , so the way I work is very different than you . Also , right , is that ? So when I work- .
I think the way you work is crazier than the way I work .
Well , but I prefer to work that way . But I work Friday from Friday 5 o'clock to Monday 7.30 in the morning . So Friday 5 pm to Monday at 7.30 in the morning . So Friday 5 pm to Monday at 7.30 pm , excuse me , 7.30 am .
There is no day shift , there is no night shift . No , there's just me .
That's the shift . That is the shift .
So , for me , I have to always be very mindful of the fact that my day can it can look any which way at any point in time , and I'm going to be the one to be called and the one to be responsible for making all of those decisions , doing all of the procedures , you know , coming in , writing the orders , doing all that stuff Right Like , and there isn't
like another person , right Like , I don't have PAs .
Yeah , that's the thing .
Right , Like so you have PAs . I don't work with a PA . Yeah Right , Someone who can write the notes . See the patient .
Discharge .
Right , discharge , do all of those things . So I don't . I don't have those things , so I have to be very mindful , and so I don't know if you would call this self-care for me . I really don't , but for me , what I like to do is , when there is downtime , I take my downtime , and that could mean take my downtime any which way I want .
John Wick .
Yeah , john Wick , that's one . Yes , rush hours Y'all , y'all , y'all .
One , two three , the TNT channel be on lock .
Sometimes my downtime honestly is . I just need human interaction .
That isn't necessarily going to be clinical , so I might call somebody on the phone or a lot of times actually , I'll just go shoot the breeze with the nurses , you know , and we won't be talking about patients , we'll be talking about just about anything that's going on and just laughing it up talking about the dog , talking about who went on vacation , and you x ,
y and z . So I take that's kind of how I like get my mind ready to be able to say all right , you know , I've vegged out enough , now I'm ready to make another decision there isn't like this intellectual constant revving of the you know of the intellectual machine . So I kind of just chill out that way .
Is there a certain type of food that you eat , or do you always try to get a nap ?
No , actually I indulge myself .
Do you go for walks or anything like that ?
Nah , I don't do none of that , she's like none of that fill my cup shit ? No , none of that . Fill my cup . Listen what I do . People would not consider my cup . No , none of that . Fill my cup . Listen what I do . People would not consider self-care . But it's not up to them , right , it's not ? It's not .
It's not for them to decide what my self-care trading places 48 hours , you know trading places . 48 hours , not so much . Okay , trading places . Yes , you know , that's my favorite movie I can see .
I have legs . Damn , I just gave away a password . The stuff that they say in Trading Places they could not say nowadays . Oh man , yeah , that's a All right , so Renee likes to yuck it up .
So you like to have personal conversation that's just like , or I just like to watch .
Who won ? Kendrick Lamar . Did you see which housewife ?
whoops , which housewife that type of stuff ? No , I don't watch housewives , so I don't know .
I'm making a point because you made such a big deal about it , like three episodes . I know , but speaking of someone said they got beef . One of them said they had beef with you on social media good , bring it .
Nobody said . Somebody said they got beef with me on social media .
Please . No matter where you are in your career , you've seen patients your age or younger get seriously injured , have a long term illness or even have a mental health issue that affects their ability to work . Now , what if that was you ? No , for real . What if that was you without disability insurance ? How are you going to replace your paycheck ?
Disability insurance how are you going to replace your paycheck ? In episode 176 , jamie Fleissner of Cephalife Insurance explains why the best time to buy disability insurance is during your residency .
Most people , most physicians , acquire their disability policies during residency , and there's several reasons . First of all , when you're younger , you're able to obtain the insurance because they ask you a whole host of medical history and so you usually don't get healthier over time .
Usually you get less healthy over time , so when you're healthy , it's easier to acquire the coverage . Number two it's also less expensive because it's based on your age and your health . You're not getting younger or healthier over time , so you're at the ideal time . The earlier you get it and the younger you are , the less expensive it's going to be .
So , whether you're a resident or you're an attending , it's never too late to protect your income . Renee and I , we use Set for Life Insurance to find a disability policy that fit our needs and budget . So what are you waiting for ? Check out setforlifeinsurancecom Once again . That's setforlifeinsurancecom . That's setforlifeinsurancecom .
¶ The Importance of Therapy in Self-Care
Point number two with me and as you guys can all tell therapy . I need therapy , but I do therapy , yo . Therapy is key for me and therapy can look a lot of different ways for a lot of different people . For a while . Therapy was this podcast right ?
You can tell just by listening to the show from the first time , all the way up to like several years into the show . Like I literally was getting some shit out , you know . But what were you getting out like that , I don't know . You have to go back and listen to it . Go , listen to it . We need to download .
We need to download no recap no .
Right but in the past . Using a therapist for me has been great . Right , it's helped me to understand , like , my blind spots . It's helped me to understand things that like , I just need an explanation or I'm looking for an explanation as to why , but I think that's dope , you know , and it's , you know , like we've had who we had .
We had better help on this or we had a better help as a sponsor . I didn't go with them , but you know , therapy is great . It's a good thing . You know you learn new vocab like trauma and you know this is my trauma surgeon . I didn't know that you know gaslighting and all this other BS and stuff . I'm like , yeah , you can get that from social media .
I know I'm literally gaslighting you right now .
I know , but you know several years ago me Woosa Woosa . You see , I'm in a brighter place , alfred right , I'm in a better place . You know A higher level . I'm in a higher level , right Road . I don't explode anymore like I used to right . So yeah , therapy is great .
So using a therapist to kind of talk things out works for me , and I don't mind telling people about it anymore . It's just like .
That's what it is . That's what I do . You mind telling people about ? Yes , in the past I did .
I was like I ain't trying to talk to anybody about it , but now it's like look , I need therapist every now and then it's all good to chat , you know , and make your moves and go from there . Don't judge me .
Let me know at 833-230-2860 or judge you , and you don't care yeah , I don't care I don't care .
Number three something from residency . Check this out .
What . This is something . Hold on what from residency could possibly be self-care .
Well , this is not self-care from residency , but this is a vestige from residency that I had to learn to stop , and this is where therapy comes in .
Berating myself .
Right , You're a berater . Oh yeah , Berating yourself . You know that's part of the survival mechanism , right ?
You kind of berate yourself in anticipation for what your attendings are going to say about you or what someone else is going to say about you , and that kind of motivates you to make sure that you don't make those mistakes , or motivates you to stay up a little bit longer , or motivates you to come in earlier so that you can , you know , make sure that you
jump ahead like you're playing chess , isn't like ? Oh yeah , you can't say that I'm late because I'm getting here like nine hours before you know my so wait , so no , this is a very interesting concept to me .
Um , berating yourself like what does , what does that look like ? And the reason that I'm asking what it looks like .
Anything that goes wrong is your fault , right ? So you just kind of blame yourself yeah right , and it doesn't even have to be anything tragic . It just could be something as simple as even someone pointing out something to you . That is not that big of a deal . But the fact that they pointed it out to you , you go back and attack yourself .
Why did I leave myself open ? They pointed it out to you . You go back and , like , attack yourself . Why did I leave myself open ? You know , like the potassium , like everybody knows not everybody , but a lot of people who don't know like in the intensive care unit we try to keep potassium at four . We keep magnesium at two .
We get the orthopedic docs taking notes right now .
Ortho , actually just tell them to chill , they take notes Ortho just put your notebook away .
They take notes . Put they're just taking notes . Ortho , just put your notebook away . They're taking notes . Put your notebook away and they're like okay , when are you going to get ?
to the hammer . There's no hammer .
Look at them , ball it up .
The hammer and blood . You're going to get the orthos mad at us , but what y'all going to do anyway , please ?
I'm going to get the orthos mad . You talk about them all the time . No , I don't , anyway . No , I don't . So . No , the reason that I was asking is because , you know , I think that so berating yourself might look normal to people , right ? They may not even realize that they're doing that .
They might just think well , I'm being self-reflective , I'm not actually berating myself . So what's the like , what's the difference , like , how did you ?
know like in your mind , dumbass , why did you do this ? Or you know someone could die off of this and it's like okay , today their potassium is 3.8 or so is that bad ? you know , I'm saying like it's certain things that are just like they're not that big of a deal .
That is just like , hey , you know you , okay , yo you having like nine different conversations . I'm just laughing at ortho . So it's like it's a , it's a , it's just a .
¶ Navigating Imposter Syndrome in Medicine
I think it's a thing that a lot of people go through , whether it's berating themselves or some people want to call it imposter syndrome okay you know , or it's a form of imposter syndrome , okay , but basically it's . It's a way where you're you're thinking that you have to be perfect in order to get good outcomes .
But , as we all know , like medicine will like very much humble you , like you can do the same procedure a hundred times and that 101st time will just be something completely different , where you're just like Yep , as they say , if you don't have any complications , you're not doing enough cases , right , right .
So that's , that's kind of where I've learned to just chill out with the beratement of myself and realize that you know what , for the most part , you know I'm a part . First of all , I think the key thing is just understand that we all are part of a system . Right , we're part of this large system .
There's like , let's be real , like we are cogs in his wheel and , in essence , like the , the system of how we practice health care in the United States catches a lot of people , takes care of a lot of people and , yes , you know you can make a mistake that you know causes someone possibly to pass away and die and so forth .
But in essence , you got to remember that . Look like we all are trained very well . You know , if we make a mistake , it's usually not on purpose and for the most part it's not a major mistake . And I think for me , that's when I've just been like , ok , listen , like the the insulting is not necessary , like the perfection is not necessary .
But yeah , like I check on things and I check on things and I check on things and I make sure that I don't miss anything , because I always treat that person like it's a family member and so forth . But yeah , I mean this internal discussion that nobody else knows is going on . That's what would go on for a significant time after residency .
So how did you get over that ?
I just stopped giving a fuck and I just started realizing that I was trying to like . The driving force for me several years ago was not the patient , it was my colleagues right and once I'm pleasing and once I realized that that was stupid . You're never gonna . You're never gonna please them anyway , so why are you trying to please them in the first place ?
it was just like whatever it is what it is like it like it and you , you start realizing because then , when you once you get over that and you start realizing like oh wait , I see what happened .
You've been covering , for you've been covering your mistakes by doing a , b , c and d all the time , it's just that you're just highlighting mine or you're just highlighting somebody else's deflect , you're deflecting .
Ah , now I get it right and now I've just been like yeah , like you know yeah I , I didn't check on x , y and z , but that's not that big of a deal , but that's what your job is too . Can we move on ?
Guys like that's kind of how it is , like I like for particularly in surgery , sign out , like it sometimes can be very like malignant and just I've just been like hey , guys like I don't know that answer and I don't , I don't think it's that big of a deal . Now that you're on , you should check on it , right ?
Since you got that question , why don't you research it and get back to me ? You look it up and move on ?
With a smile . See you later .
And you can tell it burns out . You don't think that that's its own level of toxicity ?
Yes , Sometimes you have Hence number two the therapy . You remember that episode of Atlanta ? Hey yo with my dude right here when he got burned at the airport and he created that entire facade for that TSA lady Ruined that woman's life , ruined that woman's life .
Yeah , I think , yeah , I think that that's really interesting because I think , especially if you are a , resident , if you're listening to this or you're a very new attending and you do have that uncertainty about yourself right , because you're either training or you're just out of training that self-reflection is one thing but self-beratement is another , and I think
there's a fine line that you won't even necessarily know when you've crossed over that line . You know because I , I can , because as you're talking , I'm thinking about myself as a resident . I'm like did I have that ? I'm like I don't even know , like I don't . I actually don't even know . I remember .
I remember one time I was on the MFM rotation and um , people know , some people don't people , some people don't know what that is .
Um maternal fetal medicine or a high risk obstetrics .
Um why did they call it that ? Why don't they just say high risk obstetrics ? Why did they say maternal fetal medicine ?
Because you're taking care of the mother and the fetus . But isn't that just , general OB ? Listen , that's what I didn't vote for them to call it .
that that's what I said . Why don't you just call it that ? I don't know .
So anyway , so I was on that rotation and my attending cool , attending Wendy Kinsler . She was cool , I really liked her , learned a lot from her , and I remember I was on the floor one day and I was looking at something in the computer and I must have looked intense . I must have looked intense , was it potassium ?
Huh , was it someone's potassium ? No , but I must have looked really intense .
Magnesium Somebody's magnesium ? Is there magnesium four ?
It was seven . Okay , it was seven .
So I must have looked really intense because when she walked onto the floor I could hear her and she goes , look at her , Look at her . She said something to the effect of like I look so intense , Like I'm in this thing , and I never forgot that moment .
It was just a small moment , but I never forgot that moment because I was like , how does she know that I was so like ? You know , that I was just so like intense into this thing ? I must have been thinking , I must have been thinking something that made me so tense and it like basically made me behave in such a way where she actually noticed it .
You know what I mean and it was amusing to her . But it just made me think , Like was I at the point where I felt like , no , I got to get this right , I got to get this right , I got to get this right ?
And I was in my head thinking that while I was doing whatever it was on the computer , such that she even noticed , like , dude , like you look intense .
So I think , as a resident . There's certain when I'm mentioning these things , guys like there's certain , you got to have a certain amount of leeway , right , because as a resident , there's so much that you're not in control of and you look for control in the things that you can control , which is taking care of patients , getting there on time .
You know replacement , you know rounding . These are the things that I got to be very like .
They become very anal about that stuff you know . So you know , particularly when it's so uncertain . Some in some residencies you don't even know if you're going to be moving on to the next year or not . So you're like always on stress Right , like you are on one all the time .
So I definitely agree with what you're saying , like you could be very intent for whatever it may be reasons . As a resident , though , like I tend to kind of just like I hate , like I don't like when people say , just chill , you're going to be all right .
Yes , you are , but when you're in attending and you're talking to a resident residents ain't trying to hear that shit . They're like listen , man , I'm just trying to get to the end of the day . I need a good recommendation or I need a good grade and stuff I need to finish I don't need you to tell me in 20 years , shut up , man .
But yeah , I see what you're saying .
I think as an attending , though , when you are dealing with a lot of stress or you're dealing with a lot of situations where you know you just don't know Right , because you know that decision fatigue is real is you know , particularly where you're at like if you don't have a lot of help , you can feel like you're all alone , right , right , and I think the key
thing is is that you can't clone yourself , right . You can't be in multiple places .
Right .
You can only prioritize what's the most important thing and you can't take care of everything . So if they're calling you for so many different things , it's like yo , like everybody , take a chill pill . I'm just going to prioritize this .
That's . That's tough , though , as a resident Well listen .
But that's why I said , as there's certain things from this that you got to take away I'm talking to the attendings at this point , right now . Right , because as a resident , yeah , it's tough , but even as a resident , you still got to triage , right , you still ?
got to prioritize right because what's going to happen the next morning or what's going to happen , you know , when it's . When you're talking to the attending and you're telling them about all these different things , they're going to be like yo , yo , yo , don't give me everything , triage the most important things that I gotta know .
And you're going to be kicking yourself in the butt like wait , you only want to know , like the pertinent positives , right , but I mean herein problem , right , is that if you're like , if you're like me , and you encounter an attending who essentially is like out to get you , yeah .
And now the little thing that you thought , yeah , that's not a big deal , that's the thing that they want to know . Forget about all the other big things . They pick the smallest thing and they're like no , I wanted to know that , why didn't you know that ? How do you like ? You see what I mean .
So that's why I'm saying is there a fine line , which I think there is , between self-reflection and self-beratement ? So what's the fine line ? I mean ? I I think that it's hard to tell . I don't think that you actually know or not . Everybody knows . Like I said , I don't know if , as a resident , at some point , that I wasn't self-berating .
I think my first year of residency .
So if you had a resident right now calling you and saying , hey , dr Darko , I need your assistance with this , calling you and saying , hey , dr Darko , I need your assistance with this . I'm in a program that's X , y and Z and . I'm getting to residency , I'm starting my days at 4 in the morning and I'm leaving by 9 o'clock at night and I'm on my stuff .
But my cholesterol is high , my stress is high , I'm estranged from my family , all these different things .
What are you going to say to them ? Just chill , no , it's gonna be all right .
No , I mean , I think at that point you see what I'm saying though no , I know , but but that's because you gotta there has to be something that you could tell people to say , hey , listen , like first of all , like I see what you're going through , this shit ain't right and I get it .
20 years from now you're gonna be like yo , but for me , like there's got to be something where you got to give them some type of tips , and that's why I'm saying , like at this point , like you got to prioritize what's the most important thing , right ?
obviously , but I'm gonna tell you , sometimes the most important thing is in such competition with the thing that is also extremely important , the thing that is most important versus the thing that is extremely important , which aren't always the same things . The thing that's most important is your health .
The thing that is extremely important is you finishing this residency , and those two things are competing Like that's a problem because , wait , the thing that's important is whose health ?
The patient's health ?
No , no , no . The resident's health . Okay , Right , like , my health as a resident is going to be important , because if I drop dead ain't no residency . Right , if I have a mental break ? Oh , well .
Ain't no residency , but the thing that's very important Maybe if you're a third or fourth year , yeah , but the thing that is very important to me is finishing this residency , and so that also piles on to . You know , if I don't finish this residency or if I do something to piss somebody off , then how is that going to affect me ?
Because I really want this thing , I want to finish , so that you know , for I think like and it's not that I disagree with you that you know you shouldn't berate yourself and things . Of course you shouldn't berate yourself Like that's just not , that's not healthy and that , honestly , is just not humanly normal .
Right Like self-preservation is actually the first law of nature . So if you start berating yourself , you're actually your own enemy .
That's what I'm talking about yeah Right , that's what I'm talking about .
Yeah , no , I agree with that , but I just think it's such a tough dynamic .
¶ Clear Communication in Healthcare Decisions
Well , I've been in situations as an attending where , like I felt like there's just so much decisions that need to be made on so many different people that there's times where I'm just like I tap out , like you're gonna have to transfer this patient to another facility , you're gonna have to go here , you're gonna have to go there , because me as one person can't
deal with all of this stuff . There's come to a point where I was like , look , this is too much . I know people right now who are probably listening to this show , who do , who don't even know that , or they know that and refuse to do that . I'm like , at certain points , like your ego is hurting a patient .
You know what I'm saying ? Well , yeah , it's not just hurting a patient , but it's hurting you , and it's hurting your entire program , your entire service .
Well , residents don't really , most residents don't really they don't make the decision to transfer . I'm talking to the attendings right now .
Yeah that's what I'm saying . But that's what I'm saying when I say program , I'm not just talking about residency program , but I'm talking about , like your surgical program or whatever Right , like to take on patients that you know . You know that other people in yours , on your service , cannot handle .
So for you guys , right , that might be bariatrics , right , for example . Right . So bariatric patient comes in says I have abdominal pain . I got this issue . You find out , you know this person needs surgery . I got this issue . Blah , blah , blah . You find out you know this person needs surgery and you're like can't handle that here .
That's not what we do Not at this particular facility . You got to go . Other people might be like nope , bring them on , put them on the OR schedule . And , by the way , my partner is going to operate on you tomorrow , when you know that that partner doesn't do bariatrics . You know this , but you're going to do it anyway .
Right , like that's the equivalent of me starting an induction .
This is why I will tell you shit .
Right , no , but that's the equivalent . So we we see this in OB with VBACs Right , or TOLACs Right , trial of labor after C-section . There are people who are like listen , I don't do VBACs , I just don't do that . I personally do VBACs . I was a VBAC baby . I do VBACs . I don't have people don't do VBACs , but technically the facility can handle VBACs .
Then technically I can make the decision for myself whether or not I want to labor somebody who's had a C-section previously . But do I do that knowing that my partner who is coming on doesn't do VBACs ? And so when this lady doesn't deliver on my shift , I'm like she's your problem . Now , campbell , do I do that Right ?
So you know , these are the things that sometimes people will do , that sometimes I think you gotta wonder why .
Be very clear to nursing staff . Be very clear to your colleagues . Be very clear to nursing staff . Be very clear to your colleagues . Be very clear to consulting physicians what you can , can't do or what the concerns are , and that's it .
Clear communication is definitely self-care .