Lawrence Martin, M.D., FACP, FCCP
Former Chief, Division of Pulmonary and Critical Care Medicine
Mt. Sinai Medical Center
Cleveland, Ohio

Associate Professor of Medicine
Case Western Reserve University School of Medicine
Cleveland, Ohio

(Originally published by Lakeside Press, 1996.)


Medical training can be daunting for you, the house officer. First there are the patients, people whose lives are, for a short time at least, entrusted to your care. If you screw up they could be hurt or, conceivably, die. Some patients will die anyway, no matter what you or anyone else can do. Looking over your shoulder are the attendings, always ready to pounce if you give too much or too little fluids or the wrong antibiotic, or if you don't work up a patient's fever or chest pain in a proper fashion. But let's face it: the attendings are on your side.

Not on your side is the plaintiff's bar, that group of lawyers who can make more money from one medical mishap than you can earn in a decade. How do you avoid giving them the chance?

But that's not all that makes medical training a daunting experience. In the 21st century you face an uncertain world of medical practice. The previous generation of doctors had only patients and lawyers to fret over. You, on the other hand, will be entering a world full of bottom-line HMOs, unforgiving and bureaucratic insurance companies, and unbelievable government regulation. Medicare and HIPPA have now approached the IRS in the complexity of their regulations -- and their power to fine and imprison for violations. As if that wasn't bad enough, some of you will be finishing training in fields that, while intellectually satisfying, require long hours and come with low remuneration. Are you in the right specialty? Will you make a decent living after all your hard training? Are you going to be happy in your work? These are good questions and only you can provide the answers, perhaps the hard way.

So why a survival guide? After all, no book can guarantee you wealth or assure happiness or a litigation- and hassle- free career. Nonetheless this book, promising nothing, might help you survive your training in some subtle ways. Like keeping you sane on long night calls; providing some perspective on what you are training for; and, perhaps, giving a chuckle here and there.

Lawrence Martin, M.D.
Cleveland, Ohio

Preface to Survival Guide -- for the General Public

I wrote The House Officer's Survival Guide for doctors-in-training: students about to graduate from medical school, and graduates who are working in hospitals as interns and residents. The term "house officer," while rather quaint, is widely used in American hospitals to signify young doctors in training. An "intern" is a house officer in the first year of training after medical school, whereas a "resident" is a house officer in training beyond the internship year. Doctors who plan to practice medicine must spend anywhere from three to seven years as house officers, the exact length of time depending on their chosen specialty. For example, general internal medicine requires three years' training, while some surgical specialties require the full seven.

So house officers are my intended audience. But, truth to tell, there's something in this book for everybody. Since the book's publication in July 1996, lay people have frequently told me how much they enjoy the non-medical parts, which constitute about three-fourths of Survival Guide. Sections like "What to do with your money" (Section E), "How Not To Get A Patient To Quit Smoking" (Section B), and "Doctors vs. Lawyers: The Endless Debate" (Section G), interest a lot more folks than just young doctors.

This on-line edition also provides unique opportunity to link to other web sites. Links to other web sites are being added continually. So whether or not you are a doctor in training, you are sure to find something interesting herein. If, in your perusal, you find that some section cries out for a linkage we don't have, or you have any other suggestions about the content, by all means let me know.

Lawrence Martin, M.D.
Cleveland, Ohio

* * * DISCLAIMER * * *

The author cannot be responsible for any action or inaction taken by anyone based on information in this book. While the author believes the factual information to be accurate, much of what is incorporated herein is simply based on experience, opinion and outright biases (albeit predicated on some years of medical practice).

Information in this book which might be used to come to some clinical decision must (obviously) be incorporated into the full context of the patient, and the decision to do or not do something must (obviously) be based on the total clinical picture, known only to the caregiver(s). The author disclaims any and all responsibility.

Information in this book which might be used to come to some personal decision must (obviously) be incorporated into the full context of one's personal situation, and the decision to do or not do something must (obviously) be based on the total picture, known only to the person(s) involved.

In summary, the author offers this book as is, to be used or not used as anyone sees fit. The author disclaims all responsibility for what anyone might do or not do based on something read herein.

Finally, a special disclaimer for lawyers. This book was published in 1996, and went unnoticed by the legal profession until 2002, when a plaintiff's attorney attempted to selectively quote sentences from it. He did this in order to show the jury in a medical malpractice case that I was a biased witness for the defense. (See also Introductory Note, Section G.) His tactic did not work, as the book clearly points out both sides to the malpractice issue. This book is written for physicians in training, not for attorneys trying a malpractice case.


MUSINGS - An Explanation

A Rule: What to do when. The cardinal rule of medicine: First, do no harm. (In Latin, Primum non nocere)

A Law: An observation that is always true. The cardinal law of medicine: Everyone dies of something.

NB: In this book, rules may find their way into lists of laws
and vice versa (so much for definitions).

Lists: Just what it says.

A Medical Musing: Anything other than a rule, law or list, such as essays, quotations, poems, stories, trivia, and general non-sequiturs.

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Copyright © 1996=2002 Lawrence Martin, M.D.
Revised: March 24, 2002