M. Andrew Greganti, MD July 1, 2010

A Happy Time Long Awaited This is what you have worked so hard to achieve; so, relish this milestone. You will finally be able to apply what you have learned to the very real world of clinical practice. And you will finally experience the very special fulfillment that comes from helping others deal with illness. The search for this fulfillment probably led most of you into this profession.

Some things that I have learned.

A Privileged Position You will soon assume a very privileged position – one that allows you to gain experience and to learn from the lives of your patients. What you observe will provide a perspective on the human condition that no other profession has. The trust that your patients put in you as they lay out their innermost feelings is truly remarkable and must be regarded as sacred.

Sacred Obligations It is your sacred obligation to learn as much as you possibly can to fulfill the trust that patients put in you. It is also your sacred obligation to teach others what you have learned. To teach is to learn.

Ego and Arrogance Develop appropriate self confidence but … Put aside egocentricity and arrogance – two of the worse enemies of clinical learners, clinical practitioners, and patients. Arrogance is especially dangerous in the clinical setting. An arrogant physician is a dangerous physician.

Acknowledge When You Don’t Know To learn in the most efficient manner possible, you must acknowledge when you don’t know and simply ask those who do – after all, that is why you are here and that is also why your teachers are here. However, …

Read, Read, Read You will never learn enough simply by asking questions or just by doing. Reading must become a daily part of your life. To succeed you will need to set aside a special time for reading. Otherwise, your daily clinical duties will dominate your schedule. First, read in depth about the most common clinical syndromes, then go after the details. Discuss what you have read with your peers and your teachers. Think outloud.

The Importance of Developing Strong Rapport with Patients Always consider what it would be like if you were lying in that bed or sitting on that examination table. How would you want to be cared for? No matter how smart you are or how much you know, patients will primarily judge you on your interpersonal skills, your humanism, and your sensitivity to their needs.

Bedside Decorum, Professionalism, and Rapport Always maintain rounds/bedside decorum Shut the door. Pull the curtain. Don’t discuss patients in public places. Introduce yourself and members of the team - explain your role. Be especially aware of the impact of what you say and how you say it. Patients observe all this and respect you for it – rapport increases.

Other Key Aspects of Rapport Always give the patient time to talk and listen intently to what is said. In general, a “laying on of hands” provides reassurance – examine the patient.

See as Many Patients as You Can The best clinicians I have met have reached the pinnacle in their fields by seeing many, many patients. The same clinical syndrome, as laid out in a textbook, presents slightly differently in every patient. The special nuances of a disease process are only learned by hands- on clinical experience. So, as an early clinical learner, it is especially important for you to see as many patients as possible.

Clinical Learning Never Stops Remember that you will never stop learning or reach a point where you can sigh and say “I know everything there is to know about this disease.” If you do this, you are in for big surprises. After 35 years of clinical practice, I am still amazed with what I haven’t yet learned. Isn’t this what keeps us all going in this profession?? It certainly keeps me challenged and prevents boredom from setting in. You have a great life of clinical learning ahead of you. Take advantage of every opportunity to learn all you can.

The Importance of Your Role as a Student Always remember that your role as a student is very important – in general, you will become closer to the patient than anyone else. Students often find what others on the team miss. So don’t demean your role.

Points to Take Away from Here Enjoy this career milestone The trust patients place in you is sacred. Acknowledge when you don’t know. Read, read, read – and teach others. See as many patients as possible. Take advantage of every learning opportunity you can.

Points to Take Away From Here Arrogance is dangerous, especially in clinical practice. Develop strong rapport with your patients. Listen carefully to what your patients have to say. Maintain rounds decorum and professionalism. Patients will primarily judge you on your interpersonal skills and sensitivity to their needs. Don’t demean your role as a student.

Finally Basically, all that I have said comes down to one thing: Use good common sense.