Making the Move Into the Clinical WorldM. Andrew Greganti, MD

July 1, 2010

A Happy Time Long AwaitedThis 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 Thoughts and AdviceSome things that I have learned.

A Privileged PositionYou 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 ObligationsIt 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 ArroganceDevelop 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 KnowTo 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, ReadYou 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 decorumShut 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 RapportAlways 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 CanThe 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 StopsRemember 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 StudentAlways 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 HereEnjoy this career milestoneThe 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 HereArrogance 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.

FinallyBasically, all that I have said comes

down to one thing:

Use good common sense.