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A Weird Thing Happened This Week

Discussion in 'Clinical Rotations' started by Hawaiian Bruin, Mar 13, 2007.

  1. Hawaiian Bruin

    Hawaiian Bruin Breaking Good
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    And it had nothing to do with the match.

    So I signed up for a couple weeks of EM recently, because if I do enough shifts I can get a month of credit in 2 weeks. And since I want to get school done with ASAP, I figured why not. I'll have to actually work for the first time in months, but maybe it'll be good to have think for a change to practice for July 1st or June 24th or whenever the hell it is that intern year starts. Especially since I haven't "seen" a single patient on my own in a meaningful way since my sub-i ended in September.

    A weird feeling came over me sometime within the first couple shifts. I realized that I was... competent. I could see a patient, take a quick, detailed, pertinent history, do an appropriately focused physical, generate a reasonable DDx, and order the right tests. I wasn't scared $hitless. I welcomed the challenge of whatever walked/limped/rolled/got dragged into the ED. I felt good. I felt, in truth, like a doctor.

    Now this is not a brag post. I am not writing this to say "ZOMG I'M THE BEST MED STUDENT EVAR." Far from it. This is for you third years and even preclinical students out there who do not feel this way, at least not yet.

    I'm writing this because I remember a time when I was truly, absolutely terrified. Of everything. I remember very clearly walking into Day One of third year, onto an L&D floor on OB/GYN of all things, and felt sick from fear. From not knowing. From not wanting to break something or someone. From not wanting to look or act like a moron. From not wanting to be relentlessly yelled at or put down or both.

    Of course, there were plenty of times that I didn't know. I most certainly did get yelled at, pimped, demeaned, made to feel stoopid, etc. And while I did manage to break a copy machine, I didn't break anybody thankfully, although I came pretty close to snapping a preemie in half in the NICU once I think. Those little bastards are fragile.

    But somehow without really even realizing it, I learned. I assimilated knowledge and ability. And for every moment that I thought "I've never done this before, what if I screw it up, what if I hurt the patient?" there was another in the future when I thought "Shoot, I've done this before, no problem. Lemme grab some local and a knife." Even on the rotations where I'd go home and bitch to friends over beers, "Dude this month sucks, I'll never use this crap ever again," there would be times in the future when I'd be proven wrong. Plenty of times, actually.

    I learned the most, of course, from the patients. All of them, from the complex to the simple. You learn something useful in the majority of patient interactions as a med student, and the lessons don't have to be about disease. You can learn about yourself, about how other people live, about how different people think, all that good touchy-feely stuff. But even if you take away one tiny little miniature nugget of new knowledge from a random patient encounter, when you stack all those nuggets together at the end of the med school day, you just learned one hell of a lot.

    Don't get me wrong, med school sucks. It sucks so bad. It sucks your life dry. I've read the blogs of Panda et al. and I agree with pretty much everything they have to say. But if you went into this business for the right reasons, you'll be just fine. You'll find your niche, the way Panda found EM, the way I found anesthesia, and the way you'll find whatever it is that floats your personal boat. And for all the merciless abuse and violent assaults on the very fibers of your sanity that medical school will relentlessly hurl at you, you'll wake up on the other side of it at the end of your fourth year feeling the way I do today. You'll feel like a doctor. You won't feel like a pretender anymore, you won't be scared, and while you'll know that you have plenty, plenty more to learn, you won't feel stupid. It's one hell of a nice feeling. Do your best to enjoy the ride.
     
  2. superoxide

    superoxide Member
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    Excellent post man:thumbup:

    I'm finishing up my second rotation (Ob/gyn) and yes, I feel like I'm a complete Moron...still:scared: Can't wait to get to the point where you are right now. Hope the match went your way and all the best with your internship.
     
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  3. Uncle Izzy

    Uncle Izzy Member
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    I had the same epiphany during fourth year and it happened in the ED as well. It's a maginificently empowering feeling to feel like you actually know something. What then became difficult was realizing that I still had alot left to learn... Each patient presented something new and cool.

    What made the ED such a great place to find that out about myself was that it was one of the very few places in the hospital where patients come in without a diagnosis and you really have to work them up. Additionally, many times you actually find out what's wrong during the shift. All labs are stat and rads studies come back in an hour. This many times confirmed what I was thinking and other times expanded the DDx.

    Congrats to all of us... We may actually become the competent docs we always hoped we would be.
     
  4. pillowhead

    pillowhead Senior Member
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    I, too, have had similar experiences in the ED during spring of my fourth year. It's a good place to finally bring to together all of your clinical training in all the specialties as well as testing diagnostic, medical management, and procedural skills. It feels good to finally feel like you can sort of work up and treat a patient, at least the straightforward ones.
     
  5. CatsandCradles

    CatsandCradles SDN Donor
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    Thank you Hawaiian Bruin .:luck: :luck:
     
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  6. JulianCrane

    JulianCrane The Power of Intention
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    I hope this happens, cuz right now I just don't see it happening. Especially when I'm utterly bored on a daily basis.
     
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  7. chintu

    chintu Senior Member
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    I am currently on my ob/gyn rotation and this pt who had been vomiting a lot and was on reglan developed some sort of acute dystonic reaction. The intern mistakenly wrote in her note the diagnosis of psychosis and prescribed benadryl for it. The attending thought something was fishy and she consulted an R3 for a second opinion regarding tx of acute dystonia and both of them seemed clueless until finally I butted in and provided my fancy explanation of the dopaminergic versus cholinergic pathway imbalance leading to dystonia and told them that when I was on psych cogentin was the DOC for tx of acute dystonia and that Benadryl would probably work as well but its for dystonia not to treat the psychosis. The attending was thoroughly impressed by my knowledge and asked me if I was going into psych...I simply told her that I recently finished my psych clerkship and I remembered a thing or two about it. Haven't felt like that all year long.
     
  8. DeLaughterDO

    DeLaughterDO Ghost in the Machine
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    Congratulations on your newfound feelings of competence.

    A note of caution, however:

    I remember that feeling all too well during 4th year - the feeling that I knew more than the residents that I could do their jobs "no problem."

    However, after graduation and actually starting internship, I learned that I didn't know sh!t. Being a medical student is one thing, an intern another. The responsibility is VASTLY different... However, by the end of internship....

    just kidding. I STILL feel like an idiot sometimes. There really is no end to learning. Just enter medical school and residency with that attitude and you'll be fine.

    Thanks for the great post, Hawaiian Bruin!
     
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