Helping out Georgetown University fellows with their oncology consult service for a few days reminded me of how important it was to have at least three good pens with you at all times. By that, I don’t mean grabbing a handful of disposable Bics from a Staples shelf just because you know you will lose a lot—though you should certainly plan for theft and absent-mindedness. There are at least three different use cases you will face daily, and no pen will be ideal for all of them. I’ve tried out enough, and listened to plenty of podcasts on the topic, to be happy with my choices.

Role 1: The task keeper

Intern or fellow, this will be your most-used pen—the one you pull out to quickly jot and check off to-dos, make note of pertinent lab values and vital signs, and write down other important bits of information. If you are anything like me or my colleagues, you will be doing this on the signout, or some other piece of paper packed with information you might need.

This is why your pen should be:

  • as thin as possible, since you’ll likely write on the margins, but
  • not too faint, so it wouldn’t blend in with the rest of the text,
  • quick to use, since you’ll have to pull it out during rounds, patient encounters, and other situations in which fiddling with the cap would lead to losing both time and the cap, and
  • affordable, since you will misplace one every couple of months.

For the first two, the Uni Jetstream wins hands-down. The tip is as smooth as a 0.5 mm can be. It doesn’t skip, spill, sploch, or splat. The price is right—just $2.99 on jetpens.com. It is the best-in-class for every thing save one.

Zebra Sarasa Push Clip is not too thin, but thin enough to be scratchy and slightly annoying. Even with that small flaw, I choose it before the Jetstream. Because of the clip. The wonderful, magical clip.

You see, after four years of rounding, the act of pulling out a pen becomes a reflex. You hear something important, you have a thought, you blink, and you have a pen in one hand and your Very Important Paper in the other. You write something down, you blink, and your hands are free again. You are one with the sign out, and the pen.

To do that, you must at all times know where those two things are. The Very Important Paper is hard to miss, but the pen needs to be not just in the same pocket, but in the same spot in your pocket at all times. For me, the whitecoat-less fellow, that’s the inside of my left front pants pocket. This requirement rules out any clipless pens—goodbye, disposable Bics—but the regular clips don’t fare too well either. Too tight a clip, and you spend too much time fiddling it into the spot you want. Too loose, and it’s easy to put in, and easy to lose.

Which is why the clip is magical. You open it wide on entrance, and clamp it shut once you have the pen where you want it. It won’t budge after hours of walking up and down the hospital stairs. And, unlike one of my Jetstreams, it will be very difficult to break.

Alas, it only comes in one color. This is enough for the mild-to-moderate inpatient workload of a fellow, but during internship I needed the typical gunner pen to stay organized. Zebra Sarasa 3 is the high-end guner pen—one color fewer, but with the Zebra clip. For me today, it is just too bulky, I default to black anyway, and I’d just get annoyed with it running out way before the other two. But for me four year ago, it would have been perfect.

Role 2: The note writer

My choice: Ohto Graphic Liner Needle Point Drawing Pen - 02, 0.5 mm black Runner-up: Pilot Petit1 Mini Fountain Pen - Fine Nib, any colour

As much as I appreciate the ammount of writing I can cram onto a sign out with a thin pen, using one to write in paper charts, or for making notes on an old H&P while seeing a patient, creates an unreadable mess. The faint black lines of your pen blend in with the small type and the gray ruled lines of the progress note. Also, you don’t need as quick an access—a morning note-writing session may seem hectic, but you are the one who initiates the process. A couple of seconds looking for the pen or opening the cap won’t make you lose any information.

The Ohto liner leaves a consistent, dark line, lasts for ages, and is the right size for me. The ink is water-proof and archival safe—which is what you want for a medico-legal document. There’s a cap you need to worry about, but I’ve yet to lose one. And at $2.50 it won’t be the end of the world if I do.

This role can also be filled by a nice fountain pen—and you’ll see some attendings using one. I have had horrible luck finding a fountain pen that I won’t be afraid spilling in my bag or pocket, and most cost too much to carry around the hospital while sleep-deprived. The Pilot Petit1 pens have the right price, nice nib, and are easy enough to use. But I’m still too scared to put it in my pocket.

Role 3: The backup

My choice: Uni-ball Signo DX UM-151 Gel Ink Pen

This is the one you sprinkle around the house to be there just in case. The one you give out to friends and colleagues. And the one you use if you lose any of the others. If you needed to have just one pen, this would be the one, since it’s both thin and dark. Not perfect for either notes or task lists, but good enough.

At slightly less than $2 per pen it is afordable enough, though if you just want something to give out to others—and don’t care about them or their fingers—you can get a box of 60 horrible little stick for the price of three Signos. I guess you can give those out to your enemies and watch them writhe in pain and frustration.

Bonus: A pencil case

My choice: Kokuyo Will Stationery Actic Mini Pencil Case

This is entirely optional, but it saved me a surprising amount of time. It comfortably fits 4-5 pens and refills, and has good build quality. If your bag is small or you don’t mind fishing around for the pen you want, you can certainly do without it.