Guide for urology residents

Foreword

Colleague.

If you are holding this book, the hardest and most interesting part of your life has already begun. A diploma in your pocket, and a head full of basic science mixed with complete confusion. Welcome to residency.

I do not claim to be a super-specialist in urology, but I still remember when I was just starting my training. I remember the questions I asked myself and my mentors, and the mistakes in my practice simply because there were no more experienced urologists nearby willing to share advice. This guide was created specifically to help you at the very beginning.

We understand that many of you may have entered residency without a complete picture of what urology is and what to expect. It is perfectly normal to begin training without knowing everything — that is why you are here to learn!

This guide is not a strict rulebook. It is more a collection of useful advice and guidance to help you at the very start of your journey.

It is hard to enter the system when we try to sit on two chairs at once. On one, there is training, and it feels as though the student years are already behind us. On the other, everything is only beginning. Medical practice requires constant updating of knowledge. The euphoria of receiving the long-awaited diploma soon fades, and you realise that you are now the person responsible for someone who needs your help. To treat patients successfully, you must continue educating yourself.

Simply copying others is not an option. Mastering new technologies, keeping up with advanced methods and improving established ones — that is the real path to personal and professional growth. No one promises that those around you will always support you. Medicine, like any other profession, is fiercely competitive. Yet no one and nothing can stop you from pursuing development.

This book is more than a collection of advice. It invites you to reflect on your place in urology. Being a good doctor means not only knowing, but also understanding how people feel; not only treating, but also listening—and always being ready to learn and improve.

Chapter 1. General advice for surviving residency

Residency is not an extension of student life. It is two years of concentrated experience, after which you either become a doctor or remain a student in a white coat. Forget trying to sit on two chairs. Your backside is now nailed to one chair, and it is constantly on fire.

Goals and expectations. Everyone will get a diploma, but not everyone will become a doctor

Let us be honest. In all my years of work, I have never seen a resident who was not awarded a diploma. The system is set up so that everyone gets the certificate in the end. But the doctors it produces are very different.

One finishes residency as a capable specialist, unafraid to approach a patient, able to formulate a provisional diagnosis and knowing what to ask senior colleagues. Another leaves with the same diploma, but with a blank stare and only one skill — expertly copying other people's medical records.

So your main goal for these two years is not simply to get a diploma. Your goal is to to decide what kind of doctor you want to become. Will you be a passive observer hiding in the doctors' room, or an active participant? Will you fear responsibility, or seek it out?

Residency is more than studying. It is a chance to immerse yourself in a specialty where every day brings new challenges. Always remember that in medicine, and specifically in urology, knowledge is your reliable companion on the road to success. This road is undoubtedly difficult and sometimes exhausting, but also fascinating and worthwhile.

In surgery, there is a notional formula for a surgeon's capabilities. It accounts for years of practice, number of operations, emotional state and physical fitness. Put simply, the more experience you have and the more stable your psychological and emotional state, the higher your professional level. But experience does not come out of thin air. It accumulates from the dozens and hundreds of small steps you take every day during residency.

Your goal is to gain as much initial experience as possible, ask as many questions as possible and make your first mistakes under supervision, while their cost is still relatively low.

Planning your day. How not to become a paperwork clerk

In the first few months, there is a strong temptation—and an equally strong risk—to become a clerk: someone who only writes case notes and runs around with paperwork. Your job is break out of this cycle and start practising medicine rather than doing clerical work.

Come in earlier. Not to curry favor with the bosses, but for yourself. Half an hour earlier. Drink coffee in silence before the ward starts buzzing like a disturbed hive. Calmly open your patients' records, review fresh tests, scans and overnight changes. By the morning conference or briefing, you won't merely know their names: you'll understand what happened to them. That gives you +100 confidence when talking to the department head and the attending physician. You'll be able to ask meaningful questions, rather than just nod.

Take initiative wisely. After the ward round, do not wait to be given a task. Passive waiting leads nowhere. Approach your patient's treating doctor and say: "Ivan Ivanovich, I examined Ivanov in ward 3. He has these findings. I think we need to do this. Is my reasoning right?" This shows that you think rather than merely carry out orders. Yes, at first you may be brushed off with "Don't interrupt" or "Do as you're told". Do not take offence or take it personally. Senior doctors have plenty to deal with themselves. But by the fifth time your assessment proves correct, they will start listening.

Do not fear routine work, but do not get stuck in it. Yes, you will write mountains of case notes, take patients to ultrasound, chase consultations in other departments and carry out small errands. This is part of the system; there is no escaping it. Treat it as necessary routine. Do it quickly and well. But keep your main goal in mind: learning to treat patients. Once the paperwork is done, go to theatre and ask to assist. Or go to the examination room and watch senior doctors consult. Do not sit in the residents' room scrolling through Instagram. Your time is your most valuable resource.

Self-discipline. How not to become a miserable mess

A doctor's work is a marathon, not a sprint. To avoid dropping dead halfway, you need discipline. Not military drill, but deliberate management of your energy and time.

The power of small steps. Remember this simple arithmetic. If you improve by 1% every day, you grow 38-fold in a year. If you decline by 1% every day, almost nothing will remain. What is 1% a day? Reading one paper. Analysing one difficult case. Learning a new suture. These small things accumulate and eventually produce a huge result. Do not try to become a super-surgeon in a month. Do not set impossible goals such as reading all of Campbell's in six months. That will only lead to disappointment. Just be a little better today than yesterday.

Learn English. Without it, you're a blind kitten in the world of modern medicine. All the guidelines, major studies and breakthroughs are in English. If you don't know the language, you'll treat patients using manuals from thirty years ago. Use apps, read adapted articles and watch lectures with subtitles. This isn't optional; it's necessary.

Find a hobby. Life is not only medicine. If you think about stones and prostates 24/7, you will soon become that same miserable bore. Sport, music, books, hiking — anything. Your brain needs a reset, or it will burn out. Find something that switches off the doctor in you and lets you simply be a person. That is as important as knowing how to suture.

Advice from a senior doctor

• Always greet people first. It costs nothing, but it works.
• Don't play the hero in your first few months: if you don't know, ask.
• The nurse knows your patients — sometimes even better than you do.
• Do not show off. Even if you graduated from a top university, you are a beginner here.
• Never forget: the patient has one chance. You have many.

Chapter 2. Communication skills. A doctor is more than a scalpel

Your knowledge of anatomy and physiology is worth nothing if you cannot talk to people: patients, colleagues and nurses. Communication is as important a tool as the scalpel.

And how does the patient think?

While you worry about forgetting part of the history or making a mess of the notes, the person sitting opposite you is frightened. They are not thinking about your diploma. They are thinking about what will happen to them. Remember that their impression starts with your gaze and your tone. With the way you enter the room: confidently or nervously. Whether you look them in the eye or stare at the paperwork. They read these nonverbal signals instantly and use them to decide whether to trust you. Your humanity in those first minutes may matter more than everything you know.

Empathy. How to talk to the patient, not the diagnosis

Empathy is not about babying people. It is about the ability to see a living, frightened person behind the diagnosis.

A 25-year-old man comes to your clinic. A big, healthy-looking guy. He starts mumbling that he cannot get an erection. You dig deeper: it happens only with one particular woman. With the others, he could compete in the Olympics. You sit there and might even find it funny. But to him it is a tragedy. He has already read about impotence online, worried himself into erectile failure and come to you as his last resort. Here, your job is not to diagnose him — that much is clear — but simply to talk. Say: 'You're fine, man. You aren't ill. She just isn't the right person for you.' And say it so he believes you. That is empathy: seeing the real human fear behind the complaint and not brushing it aside.

Teamwork: How to earn respect and avoid becoming an outsider

Working as a doctor is not just about diagnoses and operations. It also means constantly dealing with other doctors, nurses, department heads and ward support staff. If you cannot communicate, be prepared for constant problems and for nobody to take you seriously.

Respect nursing and support staff. An experienced nurse knows a hundred times more about real hospital life than you. She can help, advise and cover your ass. Don't treat her like a servant. Respect and courtesy are not weakness, but a sign of intelligence. If the nurse is experienced, listen to her intuition. Sometimes she notices a patient's deterioration before you do. A simple thank you for her help won't diminish you; it will make you a decent human being in the team's eyes.

Ask, don't demand. Forget 'Do it!' Get used to saying 'Could you please do...'. It changes everything.

Your theoretical knowledge matters, but your seniors' experience is invaluable. Your diploma is an entry ticket, not a VIP pass. Listen to senior colleagues, even if they seem old-fashioned. Their supposedly outdated methods often hold more practical wisdom than all the fashionable guidelines. If you see something you think is a mistake, do not shout, ‘You're doing it wrong!’ Ask, ‘Why do we do it this way rather than another way?’ That opens a dialogue instead of a conflict.

Do not set your colleagues up to fail. The staff is a team, not a jar full of spiders. If you spot someone else's mistake, don't run to complain to the bosses. Go and talk to your colleague. If you mess up yourself, have the courage to admit it instead of shifting the blame. Telling patients that another doctor treated them incorrectly is the worst strategy. The patient will distort it all anyway, and you'll get a reputation as a schemer.

Criticism from seniors. How to filter what is said

You will be criticised. Always. It is important to learn to separate constructive criticism from destructive criticism.

Constructive criticism. Someone calmly explains where you went wrong and what you should have done, without attacking you. Listen, understand and thank them. That's gold.

‘You're stupid. Everything is wrong.’ This is shouting for the sake of shouting. The boss is in a bad mood; there could be a million reasons. It has nothing to do with you. Let it go in one ear and out the other.

'I'm in charge here, and you're nothing.' The nastiest kind of criticism. It is not about your mistake, but about their insecurities. Do not get into an argument. Calmly say: "I hear you. I will try to put it right." And draw your own conclusions.

Above all, do not confuse learning with humiliation. If every encounter with a senior colleague brings a stream of abuse, that is not mentoring. It is a toxic environment.

Appearance: people judge the coat first

Let's discuss something many people forget, although it matters enormously: your appearance. First impressions are known to be decisive. Doctors are no exception.

Early in my career, I did not pay much attention to this either. My coat did not fit, and I wore a T-shirt and jeans underneath. I thought knowledge and skills were what mattered. Patients, however, formed their own opinions about my professionalism when they saw my careless clothing. Jokes and dissatisfaction alike became part of my early experience.

The way doctors are perceived has changed greatly over the last ten years. A grey-haired man in glasses used to be seen as the true authority. Today, patients increasingly take young doctors and evidence-based medicine seriously. Appearance still matters. A well-groomed, modernly dressed doctor is perceived as a professional ready to provide high-quality care. People judge doctors by how they look, and this affects their perception of their competence.

The white coat is your armour and your flag. It should be clean and ironed. This is basic respect for yourself and the patient.

Clothes under your coat. Nobody expects a three-piece suit, but a stretched-out Mickey Mouse T-shirt is a poor choice. A neat shirt, polo and medical trousers — that's your standard.

Footwear. It must be clean and closed-toed. No flip-flops or sandals. This is about safety as well as appearance.

Neatness. Combed hair and well-kept hands. Small details, but they build the overall impression. This is not about being fashionable. It is about inspiring trust at first sight.

Forget the bright, colourful Jibbitz on your Crocs, even if they add a little rainbow to your day. Patients prefer their doctor to look professional, not like someone in a fashion show. This is not about being fashionable. It is about inspiring trust at first sight.

Chapter 3. Psychological resilience: how not to burn out completely

Medicine is one of the noblest professions. But it also has a downside that people don't usually discuss. We constantly face moral and legal responsibility, disrupted sleep and rest, and hours standing during surgery. All of it leaves its mark.

Burnout is not an invention for the weak. It is a real occupational illness that can consume you before you notice. An interesting fact: US urologists have the highest rate of burnout. A full 54% of our American colleagues feel completely drained, and this has continued for years. The causes? Endless paperwork, too many working hours and disrespect from management and patients. Sound familiar?

Escape routes. How we cope with stress

We see more pain and grief than an ordinary person sees in a lifetime. Somehow we have to process it. Add overtime, low pay and ungrateful patients — it all builds up. And you start looking for a way to switch your brain off.

Alcohol — a liquid antidepressant.The quickest and most accessible option. A hundred grams of cognac after a shift, a couple of bottles of beer on the sofa at home. The tension fades, problems feel less urgent, and you manage to sleep. But it is a trap. Alcohol is a loan taken from tomorrow at an outrageous interest rate. Today you feel better; tomorrow brings a hangover, more fatigue and even frayed nerves. You enter a vicious circle: stress -> alcohol -> even more stress. It is not a solution, just a postponement of the disaster.

Taking pills in secret. When insomnia and anxiety become normal, many people start taking antidepressants and tranquillisers without a doctor's prescription. They take a few pills from patients, buy them through acquaintances or ask for a prescription "for Mum". This leads downhill. Without specialist supervision, the wrong medicine or dose may bring not relief, but worse anxiety, apathy or a stupor that prevents quick decisions in the operating theatre. Your brain really starts thinking more slowly. There is no shame in seeing a psychiatrist. The shame is in secretly swallowing pills like an addict and pretending everything is fine.

Prevention strategies. Learn to say no

Burnout is almost always the result of blurred boundaries between work and personal life. You can't save the world 24/7. Learn to set those boundaries, or the world will eat you alive.

• Admit that you are not coping. . This is the first and hardest step. Say to yourself: I'm exhausted. I'm at the edge. I need help. This is not weakness; it's courage.
• Talk. With a colleague you trust. With a friend outside medicine. With your wife, if she's ready to listen. Just talking it out, getting it off your chest, is already half the job.
• Do not be afraid to see specialists. Psychotherapists and psychiatrists are doctors, just like us. Seeing one is like a urologist seeing a cardiologist when their heart causes trouble. It is normal. It is the right thing to do.
• Find your own non-destructive escape. A hobby unrelated to medicine. Fishing, hiking in the mountains, building model tanks, reading books — not medical ones! — or a sauna. Anything that lets your brain REALLY switch gears.
• "But you're a doctor." How to handle relatives and friends. Learn to refuse politely but firmly. ‘Uncle Kolya, we can't sort this out on the fly. Come for an appointment on Monday.’ But if it is an emergency, you are a DOCTOR. You give it 100%.
• How to take a proper holiday. A good holiday starts with respect for your colleagues. Wrap up your work a week beforehand; do not leave unresolved loose ends. Prepare a clear written patient handover plan. On holiday, turn off your work phone. Trust your colleagues: they will manage. And when you return, be sure to thank whoever covered for you.

Your personal philosophy: Be honest with yourself

Despite all the challenges, I believe that a doctor who chose medicine as a calling and loves it should not succumb to burnout. Burnout stems from an inaccurate self-assessment. This leads to unrealistic expectations from doctors themselves, management and patients alike.

Do not assess yourself unrealistically, take on tasks that cannot be completed or assume responsibility that cannot be borne. Keep your self-assessment realistic. Don't let high expectations turn you into an idealized version of yourself, and you will stay in harmony with yourself and the world around you. Stay true to yourself: your patients, colleagues and you will all benefit.

Work in harmony with yourself, and do not miss the chance to find your place in medicine and in life. Changing jobs is not a tragedy, but a new chance to show what you can do. Stay true to yourself; your patients, colleagues and you yourself will all benefit.

Chapter 4. Professional growth and research

Residency is not only about practical work. It is the time when you must lay the foundations for your future professional growth. A time when you must learn how to learn.

Mentoring: How to find your teacher

You need a mentor. Not the one listed on paper, but a real one. Someone who will teach rather than boost their own ego at your expense. Don't choose by titles. A world-famous professor may not spare even five minutes for you, while an ordinary doctor in the next room may be a brilliant clinician willing to share experience. How do you find one? Watch who actually works, who isn't afraid of difficult cases and whom other doctors turn to for advice. Then ask to join them. Ivan Petrovich, may I watch how you perform this operation? May I manage this patient under your supervision? And be a good student. Don't be afraid of asking stupid questions. But before asking, try to find the answer yourself — in books, papers or online. That shows you're not just after a ready-made solution, but want to understand.

Scientific literature and continuing medical education. How to really learn

"A doctor must learn throughout life!" Sounds beautiful. In practice, we got a continuing medical education system where, like a Pokémon, you run around collecting credits. Points, not knowledge. It is a grand sham.

Dull webinars. 90% of continuing medical education webinars are an hour of monotonous mumbling and covert advertising for dubious drugs. You leave one running in the background and wait for the pop-up asking you to 'Confirm you have not yet died of boredom'.

Paid courses and tests that treat you like an idiot. You pay money to spend your own time listening to low-quality content and answering elementary tests.

So how do you really learn?

• Read PubMed and other databases. Yes, often at your own expense or through Sci-Hub, because the hospital has no subscription.
• Watch excellent surgeons operate on YouTube. It is free and often more useful than any webinar.
• Discuss with colleagues. In private chats and the doctors' room. Real cases, without censorship.
• Attend decent conferences. Go where there are live discussions and workshops, not only a buffet.
• Read articles critically. Not everything in print is true. Look at the level of evidence and the study design. The stronger the study, the more useful it will be to you.
• Organise your knowledge. Take notes and bookmark things. This helps you absorb information better.

The current continuing medical education system is a cynical, ineffective sham. It imitates training but delivers no real knowledge. A thinking doctor learns independently every day, because they understand that a patient's life depends on their knowledge. For the rest, even 1000 CME credits will not help.

What should you do? Grit your teeth and follow these rules, because without the required tick in the box, we lose the right to work. But do not deceive yourself. Make a clear distinction: this is for the report, and this is for your brain.

Chapter 5. Hard Talk: what textbooks leave out

At university you were taught to treat diseases. But you weren't taught what to do when things don't go to plan. And that happens. You need to be ready for it.

The first death of a patient

Sooner or later it will happen. You will do everything correctly, according to protocol, yet the patient will die. Your first feeling will be overwhelming guilt. Your mind will frantically search for a mistake: 'What did I do wrong? What did I miss? What if I had ordered another test...' That feeling will eat away at you. And that is normal. But you need to understand one simple thing: you are not God. You cannot control everything. Medicine works with probabilities, not guarantees. Your job is to do everything within your control, professionally, honestly and to the best of your ability. Beyond that is not your responsibility. The most important thing afterwards is not to face this alone. Talk to your department head or a more experienced colleague, not to find someone to blame, but to analyse the situation with a clear head and get support. This is not weakness. It is professionalism.

Complications and medical error

Everyone makes mistakes. Grey-haired professors do, and so do you. The question is not how never to make a mistake. It is what you do once you have made one.

The main rule: do not lie. Everyone makes mistakes: grey-haired professors and you. The question is not how never to make a mistake, but what you do once you have messed up. The main rule is not to lie — to yourself, your colleagues or your patient. Yes, it is frightening. Yes, it is embarrassing. But lying, hiding or keeping quiet about the problem will only make things worse. It is a snowball that will eventually crush you first. As soon as you realise something is going wrong, call for help. Do not play the lone hero and try to sort everything out yourself. One person's heroics in the operating room often end in tragedy for another on the operating table. Knowing when to call a senior colleague is maturity, not weakness. Always review your mistakes with colleagues, your mentor or your department head. Not so that you can be publicly humiliated, but so that you can understand why it happened and avoid making the same mistake again. A doctor who does not learn from mistakes is dangerous.

The difficult conversation: delivering bad news

Telling a patient or their relatives about a serious diagnosis, poor prognosis or death is one of the hardest tasks a doctor faces. They do not teach it at university.

• Prepare yourself. Think through what you will say and how. Find a quiet place where you will not be interrupted.
• Speak directly and honestly. Do not use complicated terminology or evasive wording. People need to understand what you mean.
• Allow emotions to be expressed. Their emotions, not yours. People may cry, shout or blame you. Do not argue or make excuses. Simply stay with them and let them express the first wave of shock and grief.
• Do not give false hope. But do not take away the last hope either. Talk about what can be done to relieve suffering and about palliative care.
• Do not rush. This is not a conversation you can squeeze into five minutes between operations.

It is hard. It is draining. But it is part of our work. And a great deal depends on how you conduct this conversation.

Chapter 6. Patients and their quirks

Patients vary. Grateful, frightened, meticulous. And some are difficult.

Rudeness as a diagnosis

Sometimes what walks into your office is not a patient but a bundle of negativity. Someone who starts shouting at you from the doorway, accusing you of every imaginable wrong and making demands. It used to infuriate me. Now I understand that rudeness is often a symptom — of fear, helplessness or pain. How should you respond? Above all, do not become emotionally involved. Do not stoop to their level. Stay calm and maintain professional distance. I understand your emotions, but let us focus on your medical problem. Shouting will not help you. If the person does not calm down and becomes personally abusive, you have every right to say: I cannot continue the consultation in this tone. You are a doctor, not a punching bag.

Internet-fuelled anxiety and psychological phimosis

‘Doctor, I read on the internet…’ That phrase makes you want a drink. The internet has turned millions into hypochondriacs. They arrive with ready-made diagnoses, often fatal ones, and demand that you confirm their fears. Your task is not just treatment; it also involves psychological support. Explain patiently and calmly why a headache is not always a brain tumour and discomfort in the side is not necessarily kidney cancer. It takes enormous patience, but it is necessary. Otherwise, the person will go on living in constant fear. Another group has what I call psychological phimosis: they will endure terrible pain, blood in the urine or a fist-sized stone, but will not go near a urologist. Why? Fear of what might be found, or embarrassment about a finger examination. The main barrier is in their mind, not their prostate. How do you coax someone out of that trench? Often a wife or other loved ones provide the main push. But if the patient reaches you, your job is to create as much trust as possible. Explain that preventive examination is nothing to fear and early diagnosis is an opportunity. Normalise the concern: ‘Many people come with similar symptoms. There is nothing to be ashamed of.’ Sometimes breaking through fear is harder than breaking a stone.

Professional boundaries

This is particularly relevant to male doctors treating female patients. Flirting, unmistakable hints and attempts to make the relationship personal do happen. There is only one acceptable position: firm and unambiguous. You are the doctor. She is the patient. There can be no other relationship between you. Any attempt to cross that boundary must be stopped gently but confidently. This concerns both your reputation and professional ethics. Exploiting a patient's vulnerable position for personal purposes is the lowest of the low.

Chapter 7. The system: money, bureaucracy and common sense

You are part of a large and not always logical system. You will have to learn to live within it. Rather than fighting windmills, understand the rules of the game.

Free healthcare: who pays the bills?

Treatment is free. A magic phrase many patients believe in. But you and I know it's a myth — an expensive one. The state pays for every free operation and every hospital bed-day. In other words, ultimately all of us pay through our taxes. Why does this matter? Because resources are not endless. CT queues, shortages of modern equipment and exhausted doctors are direct consequences of chronic underfunding and the illusion of free care. What does this mean for you? Be realistic. Don't expect the newest equipment in your department. Learn to work with what you have. And learn to explain to patients why some things happen less quickly than they would like. Not because doctors are bad, but because the system has its limits.

Public vs private clinics: Two different worlds

Sooner or later you will face a choice. Or perhaps you have already made it.

Public clinic. It offers stability and a huge variety of patients — the best training — but also bureaucracy, low salaries and shortages of everything. Here you are first and foremost a doctor.

Private clinic. It means comfort, good equipment and higher pay. But here you are also a seller of medical services. Your job is to bring the clinic profit. Here the patient is a customer, and customers often believe they are always right. It is a world of service, reviews and constant oversight.

Neither option is unambiguously good or bad. Both have advantages and disadvantages. Many find a compromise by combining jobs. The key is to understand that these are two different worlds with different rules.

Money: A sin or a necessity?

You did not go into medicine for the money! You will hear that more than once. It is a particularly vile form of manipulation. Yes, you came to help people. That does not mean you must be a penniless enthusiast. Your work is difficult, carries responsibility and requires constant learning. It deserves decent pay. Do not be embarrassed to talk about money. Do not apologise for wanting a normal life. Fair pay for doctors is not a whim but a condition for the development of the entire healthcare system. An exhausted, poor, humiliated doctor cannot be a good doctor.

Chapter 8. Foundations: Asepsis and Documentation

Two boring but absolutely critical things trip up both young and experienced doctors: asepsis and documentation. Neglect them and even the most brilliant operation can come to nothing, while you are left legally exposed.

Asepsis and antisepsis. A war against an invisible enemy

At university, this topic is covered almost in passing: washed your hands — well done. In practice, however, if you do not follow the basic principles, all your knowledge and skills may become useless.

• Gloves do not last forever. After just 45 minutes of surgery, a quarter of surgeons have microperforations in their gloves. After an hour and a half, half do. The lesson? Change gloves during long operations, and wear double gloves. This is safety, not paranoia.
• The sterile table is sacred. Do not put your phone, pen or notebook on it. If someone does this in front of you, it is better to sterilise everything again. You do not know what infection is lurking on that iPhone.
• The antiseptic must do its job. . Iodine and alcohol-based solutions need time to work. Wiping the skin and cutting immediately is a sham. Let the antiseptic dry and do its job.
• Catheters are open gates for infection. Insert it badly, fail to change it on time or leave the port uncleaned, and a hospital-acquired infection follows. In 10% of catheterised patients, bacteriuria develops within a day. Follow protocols.

Documentation. How to write without ending up in prison

Progress notes and the discharge summary are not essays on a free topic. They are legal documents. A great deal depends on how you write them. These are legal documents.

Write specifically, without padding. Patient stable, no complaints is a poor entry. Condition satisfactory, no active complaints. Haemodynamics stable, BP 120/80. Urine output adequate. Abdomen soft and non-tender is a good entry.

Do not document something that did not happen. Didn't measure oxygen saturation? Don't write 98%. That's falsification.

Document refusals. If a patient refuses an examination or procedure, this must be documented in the medical record, preferably with their signature. "The need for the procedure and the possible risks of refusal have been explained to the patient. The patient declined the procedure, and this has been documented accordingly."

AI as an aid. A tool, not a cure-all. AI-based tools are emerging that can make life much easier. Ambient AI assistants can listen to your conversation with a patient and automatically generate a structured SOAP note. This saves a lot of time and reduces the risk of errors. Explore these technologies. They are the future. But remember the main rule for working with any AI: Garbage In, Garbage Out. In plain language: feed it a shovel of crap and that is the kind of intelligent answer you will get back. If your initial request or dictated text is unclear, AI will not perform a miracle. It will simply structure your chaos. So always, absolutely always, check what the machine has generated. AI can hallucinate: invent facts, mix up doses or misinterpret context. AI is your assistant, your clever secretary, but not a replacement for your brain. The final responsibility for the record is always yours.

Friday discharge. A checklist that will save your weekend

Friday. Your mind is already on the weekend, but you must discharge five patients, write five discharge summaries, admit a new patient and attend three operations. In that rush comes the most common and dangerous slip: a poor discharge summary written in haste.

Why is this your personal headache?

• Endless phone calls. They will call your personal phone and the ward. ‘Doctor, you didn't give me a prescription!’ ‘You told me to take tablets, but I've forgotten which ones and how often!’
• Monday readmissions. Your discharged patient is standing at the department door. With a fever, bleeding or a blocked catheter. Because you forgot to tell them something important.
• Complaints and legal risks. If a patient develops a complication because your instructions were incomplete, YOU will be at fault. And the favourite phrase in the complaint will be: My doctor never told me that!

So before handing the patient that precious piece of paper, spend two minutes on the final instructions.

Chapter 9. Life outside the clinic. Conferences, presentations and staff parties

Sooner or later you'll have to leave the doctors' room for more than a coffee run. Professional life isn't just operations and ward rounds; it also includes taking part in the medical community. That's work too, and it deserves a thoughtful approach.

Conferences: a theatre of absurdity and usefulness

What is a medical conference? For most doctors, it's a legitimate way to escape routine, meet colleagues, drink at pharmaceutical companies' expense and pretend you've joined the world of great science. And that's partly true. Don't expect every talk to transform your thinking. Things often follow the same script. For the first hour, everyone sits looking intelligent and pretending to be interested. After the first coffee break, the hall empties. Only the most persistent and the most naive remain. Real scientific discussion and useful networking often move to the corridors and bars.

Why go? Networking, a change of scenery and understanding trends. — You meet people from other cities and clinics. You learn what drives them and which technologies they are introducing. These contacts may be invaluable in the future. Simply leaving your department and seeing another city is already powerful burnout prevention. Even a stream of boring talks can yield something important and show you where the specialty is heading. The advice is simple. Do not be a naive idealist, but do not be a cynic who stays in the bar either. Attend interesting sessions, ask questions and meet people. But do not expect revelations from every speaker.

Presentations. Why take on this headache?

One day you will be invited to speak. Your first reaction will be panic. Prepare. You need to give presentations.

What does it give you? Above all, it forces you to organize your knowledge. Secondly, it is makes you visible.

How do you give a good presentation? Know your audience. Don't burden students with complex molecular mechanisms, or professors with elementary truths. Structure is everything. Every presentation needs a framework: problem, methods, results and conclusions. Clear and to the point. Slides are for pictures, not walls of text. No one will read a wall of text on your slide. Use charts, diagrams, key figures and short points. Say everything else aloud. And rehearse! Run through your talk at home in front of a mirror. Time yourself. Stay within the allotted time. Nothing is worse than a speaker being cut off halfway through a sentence.

Work parties: an obligation or an opportunity?

A medical staff party is a genre of its own. Approach it carefully.

• To go or not to go? Go. You must. At least for an hour. Ignoring it completely may be seen as disrespect towards the team and management.
• How should you behave? Remember: this isn't a party with friends. You're still at work, just in an informal setting. Your colleagues — and, more importantly, your bosses — are all here.
• Do not get wasted. One glass of wine is your limit. A drunk doctor talking nonsense or dancing on a table is a sight people will discuss for months.
• Don't talk about work. Do not complain about pay or discuss patients or colleagues' mistakes. Talk about neutral topics.
• Use this time for informal conversations. Approach your department head and colleagues from other departments. It is an excellent chance to build contacts in a relaxed setting.

Be polite, be pleasant and, above all, know when it is time to leave. It is better to leave a little early with a good impression than to stay to the end and become the subject of tomorrow's gossip.

Chapter 10. Clinical reasoning. How not to become a mechanic

Diploma, qualification category, years of service: none of these is the substance. You can work as a urologist for 20 years and still remain a tradesperson. Not a doctor, but a mechanic.

What is the difference? A mechanic knows like turn a nut. He follows instructions. A doctor must know why. Why did this stone form? Why did this antibiotic fail? The doctor must see the whole system, not merely a set of symptoms.

How do you develop clinical reasoning?

• Ask yourself why. Do not merely state a fact; try to understand its cause. Why does this patient have pyelonephritis while another with the same stone does not? Why did this treatment regimen help one person but not another?
• Question things. Even authorities. Even guidelines. Guidelines describe an average approach. The person on your operating table is specific and unique. Think, analyse and seek unconventional solutions when standard ones do not work.
• Discuss with colleagues. Discussing difficult cases is one of the best ways to learn to think. One mind is good; several are better. You will hear other views and see the problem from another angle.
• Learn from mistakes. Your own and other people's. Every mistake and every complication is an invaluable lesson — provided you do not bury your head in the sand, but analyse the situation honestly.

A doctor who stops thinking and starts working from templates is professionally dead. Don't let routine kill the researcher in you.

Chapter 11. Inspiration and despair

After a hard shift, you'll stand in front of the mirror in the doctors' room, look at your tired face and wonder: why did I come here? Why do I need all this? That question will return again and again. When nothing works out, when people shout at you, when you feel utterly worthless.

That same morning, as you walk down the corridor without having slept, the elderly woman whose renal colic you relieved the night before catches up with you. She takes your hand in her dry, warm palms, looks into your eyes and says: "Thank you, son. You are such a good doctor."

And at that moment, you will understand why.

Your journey will be made of these two poles. Despair and a quiet, simple human thank you. A sense of helplessness and incredible pride when you make a difficult diagnosis for the first time on your own, without a hint. The desire to quit it all and the stubbornness that makes you come to work the next day.

That is the essence of our profession. Your path is built from these contrasts, from these small victories over despair. Do not forget that in your darkest moments.

Conclusion. Learn your lessons

"A thesis is written from its conclusions." My supervisor's words. He was right. All of life is written from conclusions. Learn a lesson and move on. Fail to learn it and you will make the same mistakes again and again.

This book is not a dogma. It is my experience and my conclusions. Your path will be different. But I hope my notes help you avoid some mistakes, find your own answers and not to lose the most important thing in this meat grinder — yourself.

Being a doctor is not heroism. It is service: quiet, everyday and often thankless. What matters most is not awards or recognition, but honesty — with yourself and your patient — and the ability to remain human.

You do not have to be perfect. You have to be honest. With the patient, with your colleague and with yourself. The rest will follow.

What to read, watch and who to follow

• Adam Kay — This Is Going to Hurt: the story of a doctor who left medicine at the peak of his career. Honest, funny and very sad. Essential reading to understand that you're not the only one.
• Irvin Yalom: When Nietzsche Wept; Lying on the Couch. It is about psychology and the doctor–patient relationship. It helps you understand not only patients, but yourself as well.
• The TV series Scrubs. Yes, it is a comedy. But it may be the most honest series about the lives of interns and residents. It has everything: humour, tragedy, real friendship and burnout.
• Professional communities and Telegram channels. Find a few channels in your specialty that discuss interesting cases and translate articles. It is a good way to keep up to date. I would particularly like to recommend Uroclub under the leadership of N. K. Gadzhiev, Doctor of Medical Sciences — it is a genuinely high-quality, active community with plenty of useful resources.

So, if you've read this far, draw a conclusion. One that matters to you. And keep going. Live. Make mistakes. Correct them. But always learn from them.