Nerdoscience

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So, I'm an intern now, and I'm pretty comfortable with my H+P taking skills, and love talking with (most) patients. But I really clam up in front of my attendings and even my residents and fellows. I had this problem big time in med school, and am kind of forcing my way through it, but I really thought I would "Figure it out" eventually.

The result is that I have patients telling my attendings that I am the best (medical student/intern) they have ever had, but also getting evaluations that say my communication or personal skills are lacking.

Anyone else in that boat, and any advice?
 

jeff2005

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Nerdoscience said:
So, I'm an intern now, and I'm pretty comfortable with my H+P taking skills, and love talking with (most) patients. But I really clam up in front of my attendings and even my residents and fellows. I had this problem big time in med school, and am kind of forcing my way through it, but I really thought I would "Figure it out" eventually.

The result is that I have patients telling my attendings that I am the best (medical student/intern) they have ever had, but also getting evaluations that say my communication or personal skills are lacking.

Anyone else in that boat, and any advice?

I had that problem in med school. I was comfortable one on one with patients but hated being put on the spot on rounds. With more experience will come confidence and then this won't be an issue anymore. In any case, you have good people schools with the people that really matter - the patients.
 

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I have not had that problem, although admittedly my mind goes blank when I am pimped, or put on the spot.

Being at ease in many different situations requires practice and occasionally a bit of Propranolol. ;)

It might do you some good for the future, just in case, to have one of your more eloquent patients write you a letter of recommendation. This can be sent to your program director, even better if you can get it unsolicited, but perhaps can bolster your support when faculty goes over your evals. Doesn't hurt to have it in your file.
 
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Nerdoscience

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I guess I should be a little more specific; the thing that really gets me is seeing the patients with the attendings, especially doing physical exams. Man, I feel like a bumbling idiot, even though I am now pretty confident when it's just me and the patient. Total performance anxiety kicks in.
 

OldPsychDoc

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Nerdoscience said:
I guess I should be a little more specific; the thing that really gets me is seeing the patients with the attendings, especially doing physical exams. Man, I feel like a bumbling idiot, even though I am now pretty confident when it's just me and the patient. Total performance anxiety kicks in.
I was like this, even as a senior resident. It was the presence of a more senior, experienced person that really inhibited me. I always wanted to defer leadership during rounds to that person, maybe fearing that I might make a mistake, or something. There are also a few of us (one or two, maybe? :oops: ) in medicine who aren't comfortable "showing off", although we're perfectly comfortable and competent about doing our jobs.

You will probably turn out fine...maybe you can find an attending along the way who seems to have a similar personal style and ask them for feedback.
 

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Nerdoscience said:
I guess I should be a little more specific; the thing that really gets me is seeing the patients with the attendings, especially doing physical exams. Man, I feel like a bumbling idiot, even though I am now pretty confident when it's just me and the patient. Total performance anxiety kicks in.
Well, that's totally different. We all act like bumbling idiots in front of the attendings. It will get better or you will graduate and be the attending, embarassing the poor resident.
 

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I just started my anesthesiology residency and in July, we are 1 on 1 with one of two attendings for the whole month. With one attending, everything is really smooth and I usually come off as organized, effective, and efficient. With the other (who is more senior, somewhat more demanding, and who doesn't mind needling me when things don't go well), I often come off as a bumbling fool. I can't start lines, I can't get things in the correct order, somehow my drugs are all out of place, and things I thought I had prepared just aren't working. I never thought I was one of those guys who cracked under pressure, but I do with this guy. Still, I can already see that this frustration, this uncomfortable feeling flailing in front of this guy, has forced me to be better.

Maybe you can find a way to turn your inner feelings of awkwardness and bumbling into a motivating force to "hold it together" to stick it to him?
 
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Nerdoscience

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That would be the thing to do, but then I'd need a good attitude, huh?
 

beyond all hope

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Recently having become an attending, I am in the strange situation of seeing it from the other end. I personally think I'm a friendly, nonthreatening guy but some of my residents get nervous around me. I don't know why. Maybe it's the dripping knife that I carry around with me...:)

As a result I steer away from these residents during their H&P, and then I'm sure to be extra-gentle during presentations.

Don't take evaluations too seriously. Once you're a resident, you're not going to get fired unless you do something really bad or are a complete idiot (even then, most graduate). Different people are going to have different opinions about you, but what matters most is what the patients think, not what the attendings think.

Like one of my former attendings said. "Get your lovin' at home, 'cause you ain't gonna get it here."