Lessons From The Locum

I have to preface this blog with a bit of a disclaimer. As I reflected on its content, I realized that I would soon need to read this as much – or more – than anyone out in BlogLand. In a few short months, I will be starting in a new hospital, living in a new house, in a new community, in a new country. While exciting, the days ahead are going to be very frustrating and challenging. I am glad to write these things down now – because I may need a reminder of these lessons in November.

1- Don’t change anything in the first 3 months.

It is very easy for us Type A personality doctor types to come on the scene and immediately assume the role of leader. We are all excited and eager to show others that we have initiative and intelligence. When presented with a problem, we are mostly likely to solve it using methods that have been successful for us in the past. If something doesn’t seem to be working well, we are typically quick to offer an alternative option.

However, when you start as the new man/woman in might better serve you to try to blend in a bit before you try to become the ringleader of the circus. In your first days and weeks at a new employment, you may find yourself asking, “How do you typically do this…?” more often than you say, “ I want to do it this.”

When I first decided to approach the new workplace with this attitude, I was worried that it would make me appear unsure and ignorant. But it actually did the opposite. It’s allowed me to develop a great relationship with the nurses and staff, learn protocol and the reciprocal hospitality has been overwhelming. Once you’ve established a good rapport with your new co-workers; if there are specifics you really need, then ask for it. By establishing relationships first, you’ll seem like much more personable and much less demanding.

2- Don’t answer your phone while standing in the deli section of Wal-Mart.
Just a happy reminder that once you are out of residency and are on call – you have to be extremely careful where and how you answer your telephone.

3- Choose your battles.
This is related to number one, I suppose, but extends beyond just being the "newbie". Whenever starting a new job, you will find that things are handled the same --- yet different enough to sometimes make you uncomfortable. This is when choosing your battles comes in: Am I uncomfortable because this solution is adequate but not my preference OR is this solution not adequate? Oftentimes, the answer will be the former. This happens in hospitals in some many ways, but the repercussions are far-reaching.

For example, one of my fellow Ob/Gyns told me this story from her new job: Her first night on call as an attending, a patient in early labor requested pain medicine. In her residency, the drug was used Stadol for pain control during early labor, so she ordered Stadol for the patient. The nurse replied – “We typically just give Nubain.” But my friend preferred Stadol and decided to go with habit. The nurses at the new hospital hadn’t used Stadol in years and were not accustomed to the changes that it could cause in the baby’s fetal heart tracing. My friend received 2 phone calls because the nurses and in house resident were uncomfortable. My friend went into the hospital and reviewed the tracing – it was overall reassuring and consistent with Stadol.

When I talked with my friend after this, she admitted that there was no reason that she should have given the Stadol over the Nubain, and in fact by doing so, she had cost herself sleep and given her patient and patient’s family unnecessary anxiety because of all the extra room traffic. Now, some devil’s advocates may be thinking – shouldn’t a doctor give the treatment with which they are most comfortable? In some situations maybe, but we must remember that all of our reactions have consequences and there may be times when its better to compromise.

Compromise may also bring opportunity for education. I have been amazed at how much I have learned since I left residency! It has been partly because of the ever-present and terrifying knowledge that I am responsible - but it is also because I’ve learned its okay to ask questions instead of just giving orders.

Fun to watch, but maybe not the best role model.....?