Throughout my medical career, every new position carried with it that familiar duality of transitions: the promise of growth coupled with the unease inherent in being the new kid on the block. As someone obsessed with understanding and optimizing the experience of doctoring, I’ve spent a lot of time reflecting on which things made my life easier while navigating all these transitions, and which ones I wish I had known to implement.

Below, in no particular order, are five things I would like to tell my younger, less experienced (if highly motivated) self.

As with so many things, most of these are simple and obvious in hindsight. And as with so many things, the crux lies in remembering to do them.

Write down everything that strikes you as inefficient, suboptimal, or downright strange

Have you ever been away from home for a while and when you returned you saw those familiar four walls through an entirely new lens? That bare lightbulb swinging freely in the kitchen because you haven’t gotten around to hanging the fancy Scandinavian lamps you bought online? Those purple stains where your kid threw ketchup at the wall that you read online could be removed with toothpaste- but turns out they probably meant white toothpaste? That weird smell in the hallway that you thought you were imagining but is sadly, definitely real?

When you start a new position, you have the advantage of beginner’s mind. You can observe things that have become so routine to the rest of the team that they no longer see them at all. This is a huge asset; a way to move the ball forward when it’s gotten stuck in the cracks of a flawed system. It may be hard to imagine when you start out, but within a few months you will develop the same blinders.

Sure, we still fax all of our orders to the pharmacy, nothing to see here, folks, moving right along.

Well, yes, the faculty meetings are scheduled to take place at the same time as teaching rounds so half of the staff are missing but that’s when we’ve always held them.

Yeah, there aren’t enough computers for everyone in the physicians’ work room so we just take turns.

Trust me, you don’t want to open that drawer. We’re not sure whose used tupperware that is but it’s been in there for at least a year.

We are not built to stay in novelty, we are built to normalize. Not only that, but the surge of energy you get from starting something new will inevitably wear off. And with less energy comes less passion to improve, to optimize, to innovate.

When you bring a fresh set of eyes to the inner workings of your organization, the whole team benefits.

So, write it down. Then be the change.

Introduce yourself to everyone and remember their names

And I mean everyone. The radiologist in the reading room. The nurses chatting in the nurses’ hub. The case manager. The social worker. The dietician. The physical therapist in training. The IT guy. The ED doctors.

It can feel awkward to go up to someone and introduce yourself when you’re the NKOTB (little 80’s throwback there- those of you too young to know them, I feel sad for you) and especially so when others don’t make any moves to introduce themselves or maybe even to acknowledge you. It’s particularly challenging when there is a palpable power dynamic (as there so often is) and you are- or at the very least feel- less senior. But there is nothing more awkward than not knowing someone’s name months after working with them regularly.

The longer I live, the more I realize that people hold the keys to all the doors and establishing relationships with them is the quickest way to walk from room to room.

Now, I have a terrible memory for names. My brain simply refuses to hold on to them. Someone will introduce themselves and while I will remember how old their kids are, what their spouse does professionally and that they love the orange chicken at the catered lunch today, I will immediately forget their name. If you find you also suffer from this affliction, I highly recommend writing down people’s names and roles immediately after you’ve spoken with them. (Include the note about the orange chicken, you never know when that might come in handy).

And yes, I do realize we wear ID’s in the hospital, but in my experience whenever you need to remember someone’s name it’s during a phone call, or in a dark reading room or while their lab coat with their ID is hanging over the back of a chair.

Bring coffee

Okay, this may be my inherent pro-coffee bias speaking, but in my experience, there are few things in a hospital that create more goodwill than bringing your team coffee. Patients and families may bring sweets or baked goods to say thank you. Maybe even the occasional pizza if you’re lucky. No one brings lattes.

I remember the first time my senior resident brought me a latte while I was busy frantically pre-rounding on a slew of new admissions. It felt like one of the most thoughtful, random acts of kindness I had been on the receiving end of. Not only did it vastly improve my morning, it also left a lasting positive impression of that resident. By all means, find out if people drink the stuff before you bring them one, I’ve been told not everyone is a coffee drinker (I know, so strange). Then bring them a matcha latte or I don’t know, a chai tea instead. At the very worst it will go to waste, but the impression of caring will linger.

To be clear, I am in no way advocating for you to let yourself be sent to get coffee. There is a world of difference between being the coffee bringer and being the coffee getter. What I am referring to is a proactive, unexpected, thoughtful gesture. We could all use a few more of those in the hospital environment.

Get to know the equipment

Again, this sounds so obvious, doesn’t it? And again, there is nothing worse than months into your new position having to ask how to run a blood gas or how to work the ultrasound machine or how to view an event on the monitor. (I mean, yes, there are worse things, obviously- it’s a hospital. But you get the gist.)

When you’re new, it will seem proactive and reasonable for you to ask for a brief primer on how to find and operate routine or emergency equipment. When you’ve been there for a year it will seem irresponsible and unprofessional that you don’t know how. Take time during your first week or two to have the nurses show you how to program the monitors, how to view a tracing or disconnect the patient so the monitor doesn’t alarm. Have the respiratory therapists show you the high-flow nasal cannula setup. Go over the T-piece resuscitator in the delivery room. Know where to find G-tubes and line kits. Etc.

Trust me, this will pay off in spades down the line.

Ask for feedback

Uggh, I know, right?

This one is hard, at least for me. The hard part being genuinely receiving it and not resorting to rationalizing or getting defensive. But I have found that proactively asking for feedback actually makes it easier not to fall into reactive behaviors for the simple reason that I feel empowered. I’m the one that has sought out the feedback, and I am doing so for my own benefit. There is no power over. Yes, it can still feel awkward and it’s good to have a few phrases prepared when asking for feedback. I generally go with something like: Could we meet for a few minutes this week to discuss what’s going well and where I can be more efficient?

Listen, you don’t have to agree with all the feedback you receive. But being open to hearing it gives you room to grow and seeking it out will show your colleagues and team that you are invested in your work, you value their input, and you are confident enough to hear what you could be doing better.

By the way, don’t just go up the ladder for feedback. Remember that great leaders seek out feedback from the people they lead. Ask the nurses, the interns, the medical students. Often enough, they are the ones watching you the most closely.

You’re not alone

Starting a new position can be daunting. It helps to remember you’re not alone. Every single person you interact with had to face those same awkward beginnings at some point. (Except that super stern NICU nurse, she definitely marched in there day one and told everybody what’s what. Everyone else though.)

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I’d love to hear which strategies helped you navigate that daunting initiation phase. What would you tell your younger, less experienced and highly motivated self?