Rules Learnt

Author: Ryan Lucas

Published: 7 November 2026 · Edited: 7 November 2026

Tagged: advice⁠ (link to another page)

Source⁠ (external link) · History⁠ (external link)

Early in my training (though not as early as I would have liked) I realised that I seemed to keep needing to learn the same lessons over and over again. I decided to start writing them down, and have been doing so for nearly 10 years. I’m not sure it helped, but I did end up with an interesting list.

Here they are, roughly in chronological order. Most date from when I was a paediatric registrar. They may be of value to current trainees.

  1. Be kind.⁠
  2. Always be on time.⁠
  3. Don’t touch your face.
  4. When life serves you a big slice of humble pie eat every last crumb and don’t complain.
  5. Never play the victim card.
  6. Always look everywhere for the best vein before trying to cannulate.
  7. Never gossip about a colleague.
  8. You never know when the shit will hit the fan: prioritise and execute, only then take a break.
  9. Always tell the truth (or stay silent).⁠
  10. Anger is usually a waste of energy.
  11. The cleverer you think you’re being, the more likely you’re wrong.⁠
  12. Learn to shut up and listen.
  13. Always carry paper and a pen.
  14. The person holding the kid is more important than the person holding the needle.
  15. When you disagree with someone, start from the assumption that they know something you don’t.
  16. Everything is more complex than you realise (except when it isn’t).
  17. Don’t do procedures in the dark.
  18. Triple check the patient ID.
  19. The only person you should compare yourself to is who you were yesterday.
  20. Accept responsibility for every little mistake; never make excuses.
  21. Most of the compliments that come your way aren’t really yours to claim.
  22. In the pursuit of understanding, curiosity and tenacity matter far more than intelligence.⁠
  23. The greatest risk to your patient’s safety is that they are your patient.
  24. Decompress the stomach.⁠
  25. You haven’t really examined a kid until you’ve seen every inch of skin (mainly for those under 3).
  26. If the blood test really matters, send 2 samples.
  27. If the test really matters, walk it to the lab yourself.
  28. Get it in writing.
  29. We don’t distinguish ourselves in medicine by being smart, we’re all smart. We distinguish ourselves by our character: humility, honesty, kindness, integrity, hard work.
  30. The plane of the back must be at right angles to the plane of the bed.⁠
  31. The worst thing you can be is bitter, it poisons everything else.
  32. If it’s sepsis ⁠— MOVE QUICKLY!
  33. Don’t give the blood bank a reason to chuck your sample.
  34. Short, timely notes trump long, retrospective essays.⁠
  35. Take the obs yourself.⁠
  36. Speak clearly: closed-loop communication.
  37. Bring coffee.
  38. Unexplained tachycardia is a red flag.
  39. Never stab anyone unintentionally.⁠
  40. The sheer tonnage of your ignorance should terrify you.
  41. Neonatal resus = Airway, BREATHING, Circulation.⁠
  42. Tell people where you’re going.
  43. Put a dollar value on your time.
  44. Always doubt “the diagnosis”.⁠
  45. Severe asthma: hit it hard, don’t intubate.
  46. Always have a Plan C.
  47. Nothing slows you down faster than a NETS conference call.⁠
  48. Intra-osseous. Just do it!⁠
  49. If bagging a patient for any length of time, use a T-piece.⁠
  50. Don’t burn bridges.
  51. ROSC is tenuous; keep working hard or you will loose it.⁠
  52. Concision.
  53. Be the dumbest person in the room.
  54. Remember: the world owes you nothing.
  55. Do the blood culture with the fever. Rescinded⁠
  56. Beware people who lack integrity.
  57. It is better to ask for forgiveness than permission.⁠
  58. It helps if people like you.
  59. When you don’t know very much your beliefs decide everything.
  60. There is nothing more dangerous than a true believer.
  61. Physical health depends on what you take into your body and what you do with your body. Mental health depends on what you take into your mind and what you do with your mind.
  62. It never hurts to ask the “Why” question.⁠
  63. Perfect is the enemy of good.⁠
  64. If a job is worth doing well, take your time. Otherwise just do it quickly.⁠
  65. People don’t care how much you know ⁠— but they know how much you care.
  66. Seek out the unassimilated.⁠
  67. Be a human.⁠

Asides

  • Or as Fred Rogers put it: “There are three ways to ultimate success: The first way is to be kind. The second way is to be kind. The third way is to be kind.” ↩
  • Still aspirational for me. ↩
  • Sometimes the truth ought to be slant.⁠ ↩
  • “Pride goeth before destruction…” (Proverbs 16:18) ↩
  • Intelligence without curiosity devolves into stupidity. ↩
  • This is for paediatric resuscitation, and it’s a good one for trainees to keep in mind. A child being bag ventilated via a mask can quickly develop a significantly inflated stomach, which causes problems with both ventilation and venous return. Dropping an NG tube is an easy thing to do but an easy thing to forget to do. ↩
  • This is talking about lumbar punctures: positioning really matters. It is very easy for the child to get rotated along their long axis, which will put the needle off trajectory. You have to be really insistent that the back be at right angles to bed. ↩
  • I never mastered this one. ↩
  • “Obs”: heart rate, blood pressure, respiratory rate, capillary refill time. They can convey critical information about a sick kid. My advice to young players: If there’s a sick kid under your care, and especially if someone is really worried, go and do the obs yourself. Put your hands on the kid, feel their skin, look them in the eyes. You will get a huge amount of data; over time you’ll be able to read it intuitively. Just relying on the raw numbers on a chart is a bad idea: you’re reading the result of a lossy compression algorithm. Go and get the raw data! ↩
  • This is about needlestick injuries (mostly). ↩
  • The point being that, for a newborn, the breathing part (and keeping bub warm) is usually the whole thing. ↩
  • I live by this one. More true for me now than ever. ↩
  • NETS = Neonatal (and paediatric) Emergency Transport Service. It’s often the trainee’s job to escalate a sick kid to NETS for either expert input or retrieval to a tertiary centre. Sometimes (at night) there might only be one trainee. Do the urgent things first before you get bogged down on a conference call. ↩
  • If a properly sick kid needs IV access and it’s hard, don’t be scared of putting in an IO line. It’s only scary the first time you do it, but once you’ve done it (on a human) it’s a no-brainer. ↩
  • This one may be archaic now: modern bag-valve masks can provide PEEP. ↩
  • ROSC = Return of Spontaneous Circulation. If you’re doing a resuscitation and you get a pulse back, great! But now the work really starts! That person is still sicker and weaker than they’ve ever been; things can so easily fall apart. ↩
  • Turns out: no evidence base for this.⁠ Blood volume is what matters for sensitivity, not timing.⁠ ↩
  • Words to live by. ↩
  • “What’s the purpose?” ↩
  • I originally learnt this as “Don’t let perfect be the enemy of good.” I had a mentor when I worked in Dubbo who taught me this version, which is much wiser. Perfect is like the speed of light (c): the energy required to accelerate to c grows without bound as you approach it. Perfection isn’t just unattainable: the effort of approaching it (i.e., the cost) grows without bound ⁠— everything else suffers. ↩
  • My Dad’s favourite line was “If a job’s worth doing it’s worth doing well.” I’ve modified it: things are asked of us that must be done, but need not be done well. ↩
  • Bureaucracies are a bit like the Borg: they want to assimilate individuals into The Collective, rendering their individuality irrelevant. These institutionalised drones loose their ability to think independently from the hive mind. They see organisational rules and structures as permanent and inviolable (even comforting). I find it very difficult to work with drones, so I’m always looking out for the unassimilated. ↩
  • This is related to the preceding point. Sometimes you find yourself talking to someone and you realise that while the sounds are coming from human vocal cords, you’re not actually talking with a human. You’re talking with an avatar for a system ⁠— the human is incidental and fungible. The best example is when you’re on the phone to customer service (pre-AI): you can tell that the person has some flowchart in front of them and if your problem isn’t on the flowchart then they can’t help you; using their brain wasn’t in their job description. Doctors can sometimes do this too. When they come to a consultation with a prefab set of pathways and an objective to assign the patient to a path. When they come to an interaction only to convey a message or obtain a signature. When they only show the patient a mask. In that moment those doctors are not being humans, they are being avatars for a system. Don’t do that. Be a human. ↩

References

  1. Emily Dickinson, “Tell All the Truth but Tell It Slant— (1263),” in Emily Dickinson: The Complete Poems, 5. print, ed. Thomas Herbert Johnson (Little, Brown Comp, 1960). ⁠ (link to another page) ↩
  2. Penny Pei Lee Kee et al., “Diagnostic Yield of Timing Blood Culture Collection Relative to Fever,” Pediatric Infectious Disease Journal 35, no. 8 (2016): 846–50, https://doi.org/10.1097/INF.0000000000001189.⁠ (external link) ⁠ (link to another page) ↩
  3. Seán Olann Whelan et al., “Pediatric Blood Cultures—Turning up the Volume: A Before and After Intervention Study,” European Journal of Pediatrics 183, no. 7 (2024): 3063–71, https://doi.org/10.1007/s00431-024-05544-0.⁠ (external link) ⁠ (link to another page) ↩

Bibliography