1. The first two years of practice would be a steeper learning curve than medical school or residency
I remember the final three months of residency: I was ready to take on the world. I didn’t need my preceptors anymore—heck, after studying for my exams, I was more up-to-date on the guidelines than they were. And then suddenly I had graduated, my preceptors were gone and I realized the decisions truly stopped with me. While I wasn’t paralyzed with indecision, I was significantly slowed by self-doubt.
Once I started on my own, there was no longer someone sitting in the office with whom I could double-check the dose of common drugs and/or who could remind me to check for x, y and z. I quickly lost my cockiness and started spending significant portions of my evenings reading UpToDate.
2. Paperwork is daunting
While I had done a portion of the paperwork for some of my preceptors, I was never left to experience the true brunt of it. The paperwork generated in working up even a minor problem can be truly overwhelming. Every test I order either comes back to me three times or I spend a lunch hour trying to find a result that never came. Insurance forms, letters from lawyers, flu watch, policy changes that need to be reviewed . . . it never stops!
I wish I had appreciated what my preceptors were doing over their lunch hours and between patients. I was never taught how to deal with paperwork, but my locuming lifestyle meant I never fell behind in it. Whatever it takes, do not become one of those people who jeopardize patient care by failing to do their paperwork in a timely manner.
3. Certain patients will be ridiculously demanding of your time
I was shielded from certain types of patients during my training. I remember having been a bit offended when a patient refused to see me, or my preceptor said, “Mr. X is a bit difficult, I’ll see him.” I didn’t realize the truly demanding/actively psychotic patients rarely see the resident. And I didn’t realize how many minutes could be sucked up just having them walk through the door!
4. I would do things I had sworn I’d never do
After years of watching preceptors cut the odd corner or occasionally give in to unrelenting pressure to prescribe an antibiotic for viral upper respiratory tract infections, I swore on my newly minted certification that I was going to be the best doctor. I was going to follow guidelines. I would swab every throat and wait for the lab results before giving antibiotics.
And I was wrong. I quickly came to realize that it is impossible to be the perfect doctor and that certain situations require that common sense and/or self-preservation trump guidelines. I also realized that some guidelines are largely pharma-ceutical industry-driven attempts to get us to treat more and more conditions that were once a part of everyday life rather than a disease. I imagine medicine to be a lot like parenting–—eventually we all find ourselves doing things we swore we’d never do.
5. There will be days when I don’t want to be a doctor anymore
Sometimes the responsibility of being a doctor is crushing. On a daily and sometimes even hourly basis we make decisions that can have a tremendous impact on our patients’ lives.
It is not easy to constantly make those high-stakes decisions: Do I spend $10,000 of the tax payers’ money to medevac this patient? Do I need to place this patient on a Form 1 or do I send him home with followup in the morning? But for every day when I no longer want to be a doctor, there are many where I realize I have the best job in the world.
I have the privilege of seeing people at both their best and worst. I help to shepherd people both into and out of the world. So, to the new graduates who just started independent practice—it’s not all going to be flowers, pay cheques and accolades, but it will be deeply fulfilling. Welcome to the work force!
Sarah Giles is a locum family physician in Ontario and the Northwest Territories and an aid worker with Médecins Sans Frontières.
