Gasping,
You meet diagnostic criteria for Physiatric Low Esteem And Suffering Experience (PLEASE). I believe that you are in the earliest stages and there may be help for you.
The first thing that you need to know is that the disease is endemic to most university PM&R training programs where most attending physiatrists are colonized with PLEASE. In fact, the PLEASE vector has been cultured from the nares and rectal mucosa of most tenured academic physiatrists who finished their residency prior to 1991.
The causes of PLEASE are well known and have been previously elucidated in other threads:
http://forums.studentdoctor.net/showthread.php?t=561597
PLEASE is a chronic relapsing condition that waxes and wanes over time. Your journey towards putting PLEASE into long-term remission starts with an accurate diagnosis.
PLEASE usually strikes physiatrists during their second year of post-graduate training. Symptoms may come on insidiously or begin precipitously. In the early stages, victims generally report feelings of malaise, confusion, hopelessness, impending sense of doom, restlessness, fear of the unknown, and an aching sense of regret.
As PLEASE progressses, physiatrists may lose their sense of orientation, medical judgement, historical context, and time. Recent scientific evidence suggests that once infected, the PLEASE vector resides in the ventromedial thalamus and frontal lobes of the brain. Thus, fulminant PLEASE often manifests with delusions of grandeur, an exaggerated sense of entitlement, anti-social behavior, self-preoccupation, and complete disregard for the feelings of others.
In recent years, we begun to understand more about PLEASE's mechanism of transmission. Epidemiological studies clearly demonstrate a higher incidence of PLEASE in large academic and multi-specialty group practices. Thus, epidemiologists believe that cannibalism may play a role: It's long been known that physiatrists eat their young.
My own experience with PLEASE started during my second year of residency. I was making my rounds as a dutiful, busy, eager beaver on the consult service racking up RVU's for my attending. At the time, I knew little about PLEASE. I had only heard stories and urban legends about the scourge and its effects on others.
Then, one day just before lunch, I was dispatched by my attending to the bowels of some surgical ward with a PM&R consult that read, "Please eval for compression stockings." Then, just like that, it took hold of me. I stared at the consult form for 15 minutes trying to make out the words and attach meaning to them.
My medical career flashed before my eyes...just mere months prior I was pushing amiodarone, running codes, putting in chest tubes, titrating drips in the ICU, suturing up crackheads and prostitutes in the ED...now, I was ordering up stockings for patients....Oh, PLEASE...
It hit me hard. Some who have conquered PLEASE (and it can be conquered) say that their affliction was like a blessing of sorts. It's as if someone peals back the veil and reveals the soft ugly underbelly of our modern health care system. Others compare it to seeing the face of God.
I was viscerally affected. I stumbled in the hall. I felt nauseated and confused, but I saw the consult as directed. I ordered the Jobst stockings (20mm Hg). Our institution billed the patient's insurance $320.00; my attending met his RVU productivity target for the day...
There is no known cure for PLEASE. The best treatment may be prevention. You can live and thrive with PLEASE by putting the following 7 habits into daily practice:
1) Question everything anyone tries to teach you.
2) Challenge authority.
3) Talk the talk; and walk the walk. That is, believe and practice the principles of rehabilitation.
4) Don't be a doormat.
5) Don't be a doorknob.
6) Don't be a tool.
7) Don't let others define what you do, lest you become their little b*tch.
PLEASE is a silent killer of physicians. Left unchecked it will rob you of your sense of self-worth, medical professionalism, and humanity. You will become consumed with antiquated ideas and nostolgic thinking. You will perseverate over trivial medical decision-making. You will begin talking in strange, almost incoherent vocabulary substituting bonafide medical terminology with politically correct Rehabby language...
Don't let this happen to you. Remember, you are a doctor. You know more and are smarter than the therapists you direct. You are actually smarter than most of the other doctors in the hospital when it comes to functional neuroanatomy, musculoskeletal medicine, and disability. Start practicing the 7 habits immediately. Find support among your classmates, SDN, and those who have escaped the scourge of PLEASE.
Please...