Advice to Fellows and Residents (with Apologies to Mark Twain[*])

As a section chief in a busy academic center, I am occasionally asked to mentor medical students, residents, and fellows. The best counsel I've ever read was “Advice to Youth, 1882” by Mark Twain. These wise words, over 100 years old, needed only slight modification to be applicable in 2005.

Trainees, always obey your attendings, when they are present. This is the best policy in the long run because if you don't, they will make you. Most attendings think they know better than you do, and you can generally make more by humoring that superstition than you can by acting on your own better judgment.

Be respectful to your superiors, if you have any, also to strangers and sometimes to patients. Some patients will offend you; be prepared. Remember, the needles are in your hands. Do not resort to extreme measures. Two-by-four wooden planks, while effective to punctuate your point, are best left to carpenters, bricks best left to masons. Make liberal use of posies in appropriate instances.

When the ACGME visits your program, be careful of lying; otherwise you are nearly sure to get caught. Once caught, you can never again be in the eyes of the good and pure what you were before. Some authorities hold that you should not lie at all. That, of course, is putting it rather more strongly than necessary. The young ought to be temperate in the use of this great art until practice and experience give them confidence, elegance, and precision, which alone can make the accomplishment graceful and profitable. Patience, diligence, painstaking attention to detail-these are requirements; these, in time, will make the student perfect.

Always take universal precautions. Only 4 days ago, in one of our VIR suites, one of the attendings walked into a percutaneous biliary drainage procedure without his lead glasses. He is one of our best interventionalists and a good friend of mine. During a puncture, the patient screamed, jumped forward, and the needle flew out of the resident's hand toward the attending's face. The resident didn't see anyone behind him. My colleague figured that he was safe behind the action-and he was right. When he saw the needle in midair, he moved his head and the needle fell innocuously to the floor. So there wasn't any harm done. It is the only case of the kind I ever heard of. Therefore, just the same, take precautions. Puncture needles are the most deadly and unerring things ever created by man. Trainees don't have to know anything about proper technique; they don't even need to aim. No, just pick out an attending and throw the needle in the air, and you are sure to get him or her. A fellow who can't hit a 20-cm subcutaneous abscess with CT fluoro can toss a Rosch-Uchida TIPS set into an attending's eye at 30 yards every time.

Remember HIPAA regulations. Never, ever discuss a patient's condition, not even with the patient. The HIPAA police may be hiding around the corner or watching you while behind the portrait of the hospital's founding benefactor. Check to make sure the portrait's eyes aren't moving around, as in the Scooby-Doo cartoons. In fact, never say, write, dictate, or even think of a patient's name-who knows, there may be aliens listening to your thoughts who could share the information with other aliens plotting to learn peripheral vascular interventions, DIPS, or fibroid embolization. Today's research is tomorrow's turf.

Never stand in a fluoro room when unnecessary; never wear your lead when you're not in a fluoro room. Never stand when you can sit, never sit when you can lie down, and never stay awake when you can sleep. If you see a donut, by all means, eat it.

And finally, when conscientiously staying in the hospital after the work is done, to round on your patients and interact with other clinical services in the hospital, remember, the longer you stay, the longer you stay.

1 Adapted from Mark Twain's Advice to Youth, about 1882.

1 Adapted from Mark Twain's Advice to Youth, about 1882.