coming to terms with mediocrity

[rachmoninov3]

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I'm on a summer rotation between first and second year. Everyday of this rotation, I wake up the same perfectionist who got into medical school, and every night I go home kicking myself for not remembering some simply physical exam that I should've done, or some question I should've asked.

Of course, this is all in the medical school's master plan. Break 'em in early, when they really don't have a clue. In fact, everyone at the med school I've talked to says I'm having a really good rotation, even tho my preceptor only gave me "average" marks for the midpoint eval. "you're a first year, what do you expect?"---the physician I'm following for this rotation.

So I know that this is just a taste of clerkships and residency, but any advise on how to adjust to this inevitable change (from perfectionist student to completely lost student doing clinical clerkships) would greatly appreciated.

 

[Catalystik]

every night I go home kicking myself for not remembering some simply physical exam that I should've done, or some question I should've asked.

Welcome to the club. With interesting cases, a good doctor always thinks of more questions that could be asked, another exam that could have been performed, or a test that should have been ordered. They continue to think of possiblities, or do further research to refine their differential diagnosis.

Mediocre doctors don't bother thinking about clinical issues after the closing bell rings. Seems to me, you're not going to be in that category.

 

[Tired]

In fact, everyone at the med school I've talked to says I'm having a really good rotation, even tho my preceptor only gave me "average" marks for the midpoint eval. "you're a first year, what do you expect?"---the physician I'm following for this rotation.

So I know that this is just a taste of clerkships and residency, but any advise on how to adjust to this inevitable change (from perfectionist student to completely lost student doing clinical clerkships) would greatly appreciated.

Don't get confused about what's going on.

Your ignorance is being tolerated because of your level of training. It will not be forgiven once you get to your 3rd year.

The day you accept mediocrity is the day you need to hang up your stethoscope. Trust me, both your patients and your colleagues expect far more from you.

 

[Law2Doc]

Your ignorance is being tolerated because of your level of training. It will not be forgiven once you get to your 3rd year.

Gotta agree with this.

 

[Dazeo]

you're not going to feel comfortable in the clinical setting until sometime during your third year. anyone who says they do/did is lying. just keep working at it and eventually, as your knowledge base and experience gets broader, you'll realize that you know exactly what questions you need to ask and what physical exam maneuvers you need to do for each situation. don't be discouraged, everyone feels that way as a first and second year. focus on studying for your exams now and everything else will come with time.

 

[ZagDoc]

Welcome to the club. With interesting cases, a good doctor always thinks of more questions that could be asked, another exam that could have been performed, or a test that should have been ordered. They continue to think of possiblities, or do further research to refine their differential diagnosis.

Mediocre doctors don't bother thinking about clinical issues after the closing bell rings. Seems to me, you're not going to be in that category.

Great post.

 

[PeepshowJohnny]

Agree 100% with how expectations change based on your clinical training.

Typical scenario:
Attending: John, what are Ranson's criteria?
John the second year: Um, I've never heard of them?
Attending: Oh, okay. Well they are...

Now with a third year:
Attending: Bill, what are Ranson's criteria.
Bill the third year: Um, I don't know?
Attending: You are telling me that your patient has acute pancreatitis, a potentially fatal condition, and you have no idea what Ranson's criteria are? How can you expect to care for your patient with such large gaps in your knowledge?

 

[lilnoelle]

I feel like an idiot at the end of every day and I'm doing relatively easy rotations. I've got to admit that I am nervous to start my more difficult rotations. Does anyone have advice on how to pick up speed with the H/P? I know its relatively normal to be slow, but I am quite a bit slower than my peers. I'm trying to pick up speed and it just doesn't seem to be working. Part of it is that I enjoy talking to people. Im also not exactly sure of what a focused H/P is supposed to include for various complaints. I have been working on these aspects and I am still much slower than my classmates.

 

[mikedc813]

I feel like an idiot at the end of every day and I'm doing relatively easy rotations. I've got to admit that I am nervous to start my more difficult rotations. Does anyone have advice on how to pick up speed with the H/P? I know its relatively normal to be slow, but I am quite a bit slower than my peers. I'm trying to pick up speed and it just doesn't seem to be working. Part of it is that I enjoy talking to people. Im also not exactly sure of what a focused H/P is supposed to include for various complaints. I have been working on these aspects and I am still much slower than my classmates.

Practice, practice, practice. Sounds simple, but it's true.

 

[Blade28]

Lots and lots of practice. When I was an MS-I it took me an hour to perform an H&P, then another hour to type it up. I can now do an H&P - plus write it out by hand - in around 15 minutes.

 

[Slide]

Lots and lots of practice. When I was an MS-I it took me an hour to perform an H&P, then another hour to type it up. I can now do an H&P - plus write it out by hand - in around 15 minutes.

Is this a H&P by Surgery standards or by Internal Medicine standards? 🙂

 

[Tired]

Lots and lots of practice. When I was an MS-I it took me an hour to perform an H&P, then another hour to type it up. I can now do an H&P - plus write it out by hand - in around 15 minutes.

Of course now your H&Ps totally suck ***.

 

[bcat85]

I feel like an idiot at the end of every day and I'm doing relatively easy rotations. I've got to admit that I am nervous to start my more difficult rotations. Does anyone have advice on how to pick up speed with the H/P? I know its relatively normal to be slow, but I am quite a bit slower than my peers. I'm trying to pick up speed and it just doesn't seem to be working. Part of it is that I enjoy talking to people. Im also not exactly sure of what a focused H/P is supposed to include for various complaints. I have been working on these aspects and I am still much slower than my classmates.

I feel like an idiot and I just started gross anatomy. I don't have any advice (as I'm an M1) but I thought I'd provide some company.

 

[8744]

Agree 100% with how expectations change based on your clinical training.

Typical scenario:
Attending: John, what are Ranson's criteria?
John the second year: Um, I've never heard of them?
Attending: Oh, okay. Well they are...

Now with a third year:
Attending: Bill, what are Ranson's criteria.
Bill the third year: Um, I don't know?
Attending: You are telling me that your patient has acute pancreatitis, a potentially fatal condition, and you have no idea what Ranson's criteria are? How can you expect to care for your patient with such large gaps in your knowledge?

Bill the Third Year if He Had Any Testicles: Hey, go **** yourself. Why don't you just tell me the answer instead of being a dickweed. You are supposed to be teaching you know, not just strutting around like God's gift to medicine.

 

[8744]

Is this a H&P by Surgery standards or by Internal Medicine standards? 🙂

Dude, I dictate my H&Ps, it takes me about five minutes once I have all of the information, and nobody has ever complained because nobody has ever read them. In fact, most people just skip to the "Assessment and Plan" which is the real meat of the thing and all most people want to know.

The only thing anybody cares about when you do an H&P is whether you document enough to bill for the encounter for the maximum amount. Thus, most medical documentation in the real world is driven by the need to bill and most of the rest is for lawyer protection. The important things about most patients most of the time could be written in thick black marker on one side of a small index card.

And you cannot take an hour to examine a patient except as a medical student. This includes taking their history which is and should be the most time-consuming part of the exam. If you're asking about their travel history, for example, and carefully documenting every camping trip they have been on since Carter was president you are wasting time.

 

[bcat85]

Bill the Third Year if He Had Any Testicles: Hey, go **** yourself. Why don't you just tell me the answer instead of being a dickweed. You are supposed to be teaching you know, not just strutting around like God's gift to medicine.

👍

 

[njbmd]

I'm on a summer rotation between first and second year. Everyday of this rotation, I wake up the same perfectionist who got into medical school, and every night I go home kicking myself for not remembering some simply physical exam that I should've done, or some question I should've asked.

Of course, this is all in the medical school's master plan. Break 'em in early, when they really don't have a clue. In fact, everyone at the med school I've talked to says I'm having a really good rotation, even tho my preceptor only gave me "average" marks for the midpoint eval. "you're a first year, what do you expect?"---the physician I'm following for this rotation.

So I know that this is just a taste of clerkships and residency, but any advise on how to adjust to this inevitable change (from perfectionist student to completely lost student doing clinical clerkships) would greatly appreciated.

Medical school is like Marine "boot camp". You all have to go over the wall. Some people clear by six feet; some scrape when they go over but you all go over that wall. By going over the wall, you are successful. Professional school is about getting over the wall; by six feet or by a scrape, but once you clear that wall, you have the skills that you need to become a physician.

In undergraduate school, you are evaluated by grades- A, B, C, D and F- which tend to place people in various little groups. Professional school places you in one large group- physician or if you fail- non-physician.

Your average means that you are the "average medical student" at your level. Sure, it's great to be "exceptional" but in medical school, exceptional doesn't come around very often. Be happy with average because in the scheme of things, average is very OK. It means that you are clearing the wall.

 

[45408]

Bill the Third Year if He Had Any Testicles: Hey, go **** yourself. Why don't you just tell me the answer instead of being a dickweed. You are supposed to be teaching you know, not just strutting around like God's gift to medicine.

Word. The attending could have at least suggested that Bill go look it up and then ask Bill about it the next day, but the default dick move - which is par for the course here on SDN - is to imply that Bill is going to be a BAD DOCTOR.

 

[Blade28]

Of course now your H&Ps totally suck ***.

They're still better than yours though. 🙂

Is this a H&P by Surgery standards or by Internal Medicine standards? 🙂

It's as complete as it needs to be, if that's what you're implying! So it's like an IM H&P...except I don't ask about family support at home, job, education, etc. And I don't delve too much into family history unless it's relevant. And I tend to skip looking in the eyes and checking reflexes (unless I'm doing a neuro exam or something else of the sort).

And no "problem list." 🙂