I was recently put in charge of a service.  There are 3 surgeons on this service but one was gone this month, but still, one of these surgeons works like a mean working machine and probably puts in more hours than I do.  I had 3 interns reporting to me.  All of them are residents in our various programs, none of them surgery.  It was very interesting to me because it has been a long time since I have been in a leadership position and in any case that was in the Marine Corps as an enlisted Non-Commissioned Officer (NCO).  Leading enlisted Marines is different than leading doctors.

In trying to understand how to be a good leader, good physician to our list of patients and serve as resident to the attendings, I gave a lot of thought to the things I would like to say to the next batch of interns that will have the opportunity to rotate on my service this coming month.

1. You have graduated from medical school, this means you are a doctor.  This doesn't mean that you have the right to practice medicine, only that you know are qualified to learn how to be a physician.  This will be your privilege to do over the next few years.  Honestly, you don't even have full licenses to practice.  Your current license to practice medicine is provisional and quite limited to the teaching facility.  
2. If you want the respect of your peers and of your fellow workers (nurses, unit secretaries, circulators, scrub techs, custodial staff (yes, everyone)) then you must earn it.  None of these people see the paper on your glory wall, they only remember how you treat them and how you make them feel when you interact with them.  If you treat them with respect, dignity and good humor, they will help you on your way.  If not, you have no one to blame but yourself.  YOU are the doctor and they demand your professionalism at every level.  Arrogance and assumptive superiority does not equal professionalism.
3. You will learn surgical disease and how it relates to you by doing surgical admissions and consults.  The learning does not take place when you are interacting with the patient because your current level of skills and experience is exactly what you rely on when performing those interactions.  The learning comes when you interact with your senior in presenting the case to him or her, and if so asked, when you present to the attending.  Participate in that learning process by noting what I tell you is important in your presentation and what is not.  Even so, there are things that aren't important but you still need to know.  Learn everything about the patient then be as brief and focused on the surgical problem as possible.  Learn what goes into the differential diagnosis.  Prepare to discuss possible treatment.
4. Learning also take place in how well you maintain our list.  No other residency in this hospital will keep such a detailed list.  Surgical decision making ability and judgement can be increased as you take time to understand and execute what needs to happen on the list.  Indeed, as a patient's stay in the hospital progresses, their entry on our list is a microcosm of surgical thinking and decision making.  To you it may just be a list.  To me, it is a record of our responsibilities to the patient and to the attending.  Its upkeep is a direct reflection on how much attention you pay to the evolution of each patient's hospital course.

The other day I was talking with a 2nd year in one of the other programs.  She agreed with me about the above points and expressed some of the same thoughts about her experiences regarding her new role in leading interns as they rotated through their stint in her program.  As we talked, this occurred to me: we are here for the patients, not because we are doctors.  In other words, having graduated from medical school merely grants us the opportunity to learn how to be physicians.  We are still on a journey and only arrogance or laziness stands in our way of becoming the physicians our patients need us to be.