Confidence

[trudyfae]

HI. I have been an attending for almost 6 years now. I started a new job in August. I am finding that on occasion I still struggle with a lack of confidence and overwhelming self-doubt. When I show one of my experienced colleagues a case and they disagree, I always cave and assume I am wrong. I think I am well-trained, have a good eye, and a natural talent for this whole pathology thing. Do any of you have this problem? Is it more common for women to have these sorts of issues, or just talk about them more?

Some things that I know they are wrong on, I can stand up for myself. I would like some advice on how to handle those situations- How do I talk to a guy with 30 years of experience when I know I am right about something? Terminology has changed, things have changed. I know he is a good pathologist, and so very smart. But a few things I do know, and I don't want to piss him off (or hurt his feelings).

I sure could use some touchy-feely advice from any of you who may have been through this before. Is this something that fades with time? Thanks!

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[KCShaw]

I'm not as far out as you, and a lady I ain't, so keep this in perspective. As a resident, and to a lesser extent as a fellow, it was very very easy to get into the habit of caving to the boss. Frankly, their butt was on the line and for the most part mine wasn't. Nowadays, that's not the case -- my butt goes down first, but it's still difficult to avoid the habit of politely caving to the experience of an elder, no matter how much we get along otherwise.

I remember only a couple of times in residency asking my very assured attending whether I could show the slide to X, Y, or Z other attending because I thought differently than they did -- as long as we asked first this was generally accepted, if uncommon and perhaps met with bemused smirks. Now that I'm out, however, there may not be a lot of other people to ask. Since there is an "odd" number of us, we generally handle disagreements with a quick group pow-wow which either ends in agreement or ends with agreeing to be descriptive/non-definitive, and my recollection is that where I trained did similar. Of course, I'm in a field where it's often perfectly OK, even advisable, to back off from a definitive conclusion -- though we have to be as clear as we can.

Long story shorter, I guess, my advice is to find a way to speak your mind. I still do this by way of a question sometimes.."..could it be X?..Oh? Why do you think that/not think this?" And if you're just uncomfortable about something, you need to feel comfortable enough in the practice to send things out from time to time. It can be uncomfortable, but it can also be liberating and/or confirmatory. I'm aware of a case or two in which junior pathologists were thrown under the bus by their elders, despite showing the case to them, on those rare occasions it comes back to bite.

If you're "sure" you're right about something, why show it around in the first place? And for what it's worth, of the very significant number of female pathologists I've worked with, all but maybe 2 (tiny percentage) were quite strong-willed and voiced in their opinions -- or, about the same number as the dudes. Dunno if that helps or hurts. Heh.

 

[lipomas]

It's been 6 years are you are letting yourself be persuaded that much by colleagues? Are they correct and you are wrong? Having been in practice 6 years you should have some idea about whether you know what you're doing or not. Are these major disagreements or is this like CIN-II vs CIN-III or something?

Do you have a former mentor? They can help. New jobs can be tough and your confidence can take some time to return, but it shouldn't take that long. I think you need to stand up for yourself a bit more or at the very least start talking to your colleagues. Maybe they all have different thresholds or the clinicians want things differently. Or maybe they are out of date or wrong. Of course, maybe you are wrong. But your career is not going to go well if what you describe continues to be what your day is like.

 

[LADoc00]

Do what I do: automatically assume every person you come into contact with is wrong until proven otherwise. Then if the case is reviewed at an academic institution and you are the incorrect (pretty much never the case for me...) then get a 2nd academic consult (!!).

After 2 academic consults get resulted it should be about....2 months? make sure you send 1 to Stanford or Brigham for extra extra long consult turnaround time

By the time you get those results back everyone will have forgotten your ultra rare booboo and you can go back to being Dr. Gregory House.

 

[KCShaw]

Or, if all else fails, start calling things something that doesn't exist, then publish a short series and become infamous for recategorizing something previously quite bland and non-controversial.

 

[trudyfae]

Thanks guys. especially LA doc and KC, your response was well-thought out and I appreciate that.

I have only been at my current job for 5 months. I was military for a while, went back to do a subspcialty fellowship, and am 7 months out from that. I am kind of over the crisis... I have these episodes of self-doubt from time to time, but I (usually) prefer to think that I am just not "over-confident", because I think that can get you into trouble too.
The differences are more on terminology for the most part, although there have been 2 cases that we disagreed on. The older pathologist uses some outdated terminology but I think he is a pretty smart guy. It could be that he is losing his touch.

And thanks, lipomas, but I most certainly know what I am doing. I was just asking if any of you had occasional issues with self-confidence in your practice and how you dealt with them.

 

[lipomas]

And thanks, lipomas, but I most certainly know what I am doing. I was just asking if any of you had occasional issues with self-confidence in your practice and how you dealt with them.

OK, it sounded like it went beyond that initially. Everybody (unless they are a total narcissist) has occasional issues with self confidence. If you don't have any issues, that is more of a red flag to me. All kinds of things can make self-confidence start to wane - a new job in a new practice environment is an important one. So can missing a diagnosis - you get on edge for awhile after that anytime you encounter a similar case.

 

[2121115]

Thanks guys. especially LA doc and KC, your response was well-thought out and I appreciate that.

I have only been at my current job for 5 months. I was military for a while, went back to do a subspcialty fellowship, and am 7 months out from that. I am kind of over the crisis... I have these episodes of self-doubt from time to time, but I (usually) prefer to think that I am just not "over-confident", because I think that can get you into trouble too.
The differences are more on terminology for the most part, although there have been 2 cases that we disagreed on. The older pathologist uses some outdated terminology but I think he is a pretty smart guy. It could be that he is losing his touch.

And thanks, lipomas, but I most certainly know what I am doing. I was just asking if any of you had occasional issues with self-confidence in your practice and how you dealt with them.

Typical "medicine" personalities here. You admit even the slightest of honest self-criticism and people jump all over you for being "weak".

 

[lipomas]

Typical "medicine" personalities here. You admit even the slightest of honest self-criticism and people jump all over you for being "weak".

Did you read the original post? It said that she frequently changed her diagnosis when confronted with a different opinion, always caves, and has a lot of self doubt. That's not a slight amount of honest self criticism. That's what sounds like a crisis of confidence and possibly of one's own skills. It may have not turned out to seem that extreme after later posts, but that's not the original post. The first thing I thought of when I read it was that that must be a dangerous group, if you happen to be the patient whose biopsy is getting sent there.

 

[2121115]

Did you read the original post? It said that she frequently changed her diagnosis when confronted with a different opinion, always caves, and has a lot of self doubt. That's not a slight amount of honest self criticism. That's what sounds like a crisis of confidence and possibly of one's own skills. It may have not turned out to seem that extreme after later posts, but that's not the original post. The first thing I thought of when I read it was that that must be a dangerous group, if you happen to be the patient whose biopsy is getting sent there.

I did read the original post and I guess I didn't take it the way you did. Just goes to show you how lack of context in an internet forum can result in things being taken the wrong way.

 

[trudyfae]

i appreciate both of your input very much. i re-read the original post too, and i could see how it could seem worse than it was. it seemed worse than it was to me while experiencing it too. since i am self-exploring here in this anonymous forum, i do tend to overreact a bit and take things a little too seriously. and as was mentioned, these episodes (i have had 2 since i started) are precipitated by a difficult case that we disagree on. anyway, thanks again and it is nice to know that all of you aren't as infallibly confident as some people i know and know of.

 

[caffeinegirl]

As somebody also relatively fresh out of training...whenever I disagree with another colleague, we send it out for academic consultation. We have an unwritten rule, that if there's any disagreement, or inkling that it's a tough case, then why go out of your comfort zone..just send it out! We also cosign all malignant and tough cases (ie, show it around to other colleagues).

Even though I'm relatively new, there have been few cases where I disagreed with my colleagues, and even if I'm right or wrong, I'll send it for a consult. It's part of the learning process (which doesn't end after training). At the end of the day, it's not about pride, it's about patient care.

 

[LADoc00]

The masculine and feminine approach to work and work conflicts is so radically different, it's very fascinating especially since its been less than 100 years since women were in the medical field. Wasnt Elizabeth Blackwell the first female physician in the US?

The masculine seeks confrontation and when confronted seeks domination.
The feminine avoids confrontation and attempts compromise.

Very interesting...

 

[caffeinegirl]

I don't know if that's always entirely true. In my practice there isn't a male vs. female difference in approaching confrontation....we all get along really well and would rather compromise than confront.

I'll throw in the other changes in culture...East coast vs. West coast...things are waay more laid back and less confrontational on the West coast IMHO.

 

[LADoc00]

I don't know if that's always entirely true. In my practice there isn't a male vs. female difference in approaching confrontation....we all get along really well and would rather compromise than confront.

I'll throw in the other changes in culture...East coast vs. West coast...things are waay more laid back and less confrontational on the West coast IMHO.

Yah, doesnt have to be a male/female thing. Men can definitely have a feminine approach to the workplace and vice versa. And people can flip flop on occasion, be comprising 90% of the time, then revert to confrontation in rare moments of stress (lucidity?).

Having SO'd on West Coast, in the Midwest and in New England, the West Coast can be very confrontational so Im not sure I would agree completely with that. Ive always felt people tend to exaggerate how laid back California is because they see people rollerblading down Santa Monica or some crap.

There is a lot fake politeness and backstabbery here, which in my opinion is an order of magnitude worse...

Im getting much more cynical in my old age though, I really feel most Pathology groups suck. They lack foreward thinking, they react rather than out think their competition, they wallow in self-pity and inaction, they turn on each other very quickly (ie- lack loyalty), etc.

Maybe 5-10% of the groups out there are any good, heck maybe less. Dont get me started on gubberment pathologists or academics..

 

[trudyfae]

The masculine seeks confrontation and when confronted seeks domination.
The feminine avoids confrontation and attempts compromise.

I like this, LADoc, and while it is not always true I am sure, I think it is in many situations. Certainly with me- I prefer to avoid controntation and attempt compromise. Find and emphasize commonalities rather than differences.

 

[yaah]

I know several people who seek confrontation for the purpose of advocating a compromise.