A promised Ivy League psychiatric residency never materialized. Rejected, I scrambled for a first-year position as a medical intern.
Q3 2020 hedge fund letters, conferences and more
I found it at the now-shuttered St. Vincent’s Hospital in Manhattan’s Greenwich Village, where I spent a year as a transitional intern: Medicine, ICU, CCU, ER. Neuro.
An Ivy League rejection proved a blessing!
Warren Buffett blesses his Harvard rejection:
At Columbia he met Ben Graham and learned lessons that would launch his success.
10 Great Life Lessons I Learned As A Medical Intern
Here are ten great life lessons I learned as a medical intern:
1) Listen For Horses, Keep An Eye Out For Zebras
An intern maxim:
“If you hear hoof beats outside your window, think horses, not zebras.”
Keep an eye out for zebras, just the same.
At the height of the AIDS epidemic a tragic procession of young, gay men with pneumocystis pneumonia sought care at the St. Vincent’s ER.
Easy diagnosis: snowstorm on the chest X-ray.
Until it wasn’t.
No response to the antibiotic regimen.
Diagnosis Zebra:
Congestive heart failure, rare in a young person.
Wise diagnosis is not brash conclusion but thoughtful differential and careful rule outs.
Two biggest mistakes on Wall Street:
It’s the same this time.
It’s different this time.
2) If You Think of It, Do It!
Intern maxim, back in the day.
If you think of a test, do it. You might make the diagnosis.
Managed care has suppressed testing, inserting prior authorizations laborious to obtain.
Clerks and computers second-guessing doctors.
Care delayed is care denied.
But “think of it/do it” is valuable in everyday life.
If it needs done I try to do it right away.
Lest I forget to do it at all.
Yet remember it as done.
The “waiter’s tip phenomenon.”
A waiter pockets the tip and promptly forgets the party.
3) Stones in Your Pockets Turn to Gold
When you’re a medical student studying books, slides, cadavers, knowledge feels like stones in your pockets, dragging you down.
In internship those stones turn to golden wisdom.
But book knowledge can never replace experience.
Ben Graham’s experience of the 1929 market crash determined his “cigar-butt” investing approach.
That algorithm gave Warren Buffett his start.
But cigar-butt investing cannot scale.
When Warren met Charlie Munger he graduated from cigar-butt investing to buying great companies at fair prices.
And made Berkshire Hathaway what it is today.
Warren never stops learning.
From wise people, great books and his own experience.
The law has an invaluable maxim:
Always remain a student of the law.
Thus…
Always remain a student of medicine.
Always remain a student of life.
Or, as Charlie Munger recommends:
“Be a learning machine!”
4) "See One. Do One. Teach One."
Charlie Munger admires this age-old teaching method of medicine.
See one. Do one. Teach one.
An essential tool of medical education.
Good medical practice compounds as it spreads from attendings to fellows, residents, interns and students.
But bad practices also spread.
5) Sociopathy In Health Care
I expected to find sociopathy in the practice of law.
I did.
I did not expect to find sociopathy in the practice of medicine.
I did.
I will never forget a senior medical student’s teaching:
“Don’t answer the beeper.
Say you didn’t hear it.
What can they say?
‘You heard it!’”
“The true test of a man’s character is what he does when no one is watching.” -- John Wooden
My lesson:
Anticipate sociopathy.
Snakes in suits.
Snakes in scrubs.
Such medical students and interns are known colloquially as “throats.”
Short for “cutthroats.”
6) Promoting From Within
St. Vincent’s always promoted from within.
Suspicious of wise men from afar.
Trusting personal experience over interviews and recommendations.
Promoting who works.
Praise Darwin.
A new intern arrived from hallowed halls.
Wondrous credentials.
Fired in a week.
Never answered the beeper.
7) Charlie Munger's Web of Trust
Trust among good and honest interns builds.
Repeated positive experiences.
Who is honest.
Who never signs out an emergency.
Who never leaves work behind for the next shift.
And like our primate relatives.
Interns don’t forget.
8) The Longer You Stay, The Longer You Stay
A good intern’s work is never done.
After multiple uninterrupted shifts your productivity wanes.
Overwork saps strength.
A good intern never “dumps” work on the next shift.
But…
“He that fights and runs away may live to fight another day.” -- Demosthenes
9) Prolonging Life is Virtuous, Prolonging Death is a Sin
On my first day as a medical intern the wife of an intubated patient welcomed me in a rage.
For a year her husband lay brain-dead on a ventilator.
She visited him daily.
He could never recover.
Nothing had been done.
I found the ethics committee.
A brilliant and kindly surgeon convened a meeting.
I presented the case.
The patient was extubated.
And shortly died.
A grateful widow completed her mourning.
10) It's The Strong Swimmers Who Drown
My strengths are math and language.
I write and calculate quickly and may err.
Never artful in procedures I am always careful.
During the AIDS epidemic we recapped used needles before discarding.
I was not quick but I never stuck myself.
It could prove fatal.
I will always remember a superb medical resident.
Fast and sure.
The sight of his bleeding finger
Impaled upon a used needle, burst through the undersized cap he confidently chose in error.
