COMMENTARY

The Most Common Mistakes to Avoid During Residency

Rosalyn E. Plotzker, MD, MPH

Disclosures

November 19, 2018

In some ways, residency is explicit. Every day is set in a hospital. Inside, a network of fluorescent bulb-lit hallways jointed by nursing stations form highways for the foot traffic of sleepless inhabitants dressed in monochromatic uniforms. Each provider has a role and rank. Sign-out is a 6 AM and 6 PM. Daily responsibilities are handed off in lists. There are protocols to follow, algorithms to guide decisions, and checklists to prevent errors. In short, what to wear, what to do, when to do it, and who does what are perfectly outlined. It's foolproof. How could an oversight occur?

Obviously, mistakes happen. In addition to learning how to navigate an increasingly complicated hospital system, new residents are tasked with unearthing the "hidden curriculum" (by definition, not explicit). To make matters worse, each specialty tends to have its own subtle code of etiquette, which becomes even more specific from program to program.

That said, there are certain mistakes that are common to all specialties. Luckily, most are avoidable. Here are a few important ones to keep in mind.

Patient Care Mistakes

Not asking for help or feedback when you need it

This one is practically a rite of passage, and a lesson in humility, for most trainees. Early in training, we often don't know what we don't know. Residents are encouraged to "own" their patients and "take responsibility." In addition, medicine is inherently competitive, dating back to the premed classes that were graded on a curve. It's an understandable concern that admitting our limitations might be perceived as 1) neediness, 2) incompetence, and/or 3) cause for embarrassment. In reality, the opposite is true. If you are unsure about a plan, it's more responsible to recognize when you need to reach out to a senior or an attending physician.

Ignoring a patient's complaint

There are two big reasons to never ignore a patient's complaint. First, a complaint that seems unimportant might be more relevant than you realize. Second, addressing patient concerns—even if you suspect that they're unrelated to the reason for admission—conveys to the patient that you are a trustworthy physician who takes them seriously. Down the road, this might make the difference from a patient disclosing important information they might have withheld had you been dismissive.

Ordering an opioid for a headache medication

Opioids are lousy headache medications. Little explanation needed for this one, but just a friendly reminder.

Viewing a difficult patient or their caregiver as an adversary

This topic could be an article on its own. It's frustrating if a patient or caregiver doesn't agree with your decision, or questions your knowledge. As a young doctor, it can be easy to get defensive. As a patient or family member in a vulnerable position, it can be easy to get defensive. Differing values and opinions might come into play. In these scenarios, remember that you are all on the same team. Communicate that, rather than slip into an argument.

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