han14tra

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May 22, 2007
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I am a new attending, and let me just start off by telling everyone still in med school or residency that "It gets better." I have a pretty sweet gig. I work 36 hours/week, and I've been intubating, running codes, and dispositioning patients all on my own. Terrifying? Yes, absolutely...More than you could ever imagine. But it feels amazing to know that your decisions saved the patient's life or made a difference and not your attending's.

But there is something I've been struggling with for years, and I'd love to hear your thoughts. As a doctor, I feel the enormous weight that has been stacked upon my shoulders. I know it is a great responsibility. From Day 1, I have been told things like, "Medicine is your life now," "You're going to be the only thing between your patient and the grave," "Do no harm," etc.

During college, med school and residency, I buried my head in the sand and ignored all of life's distractions -- you know, friends, family, hobbies, etc. I wanted to learn everything I could so that I could be the best for my patient. Like all of you, I was at the top of my class in college and I succeeded in med school and residency. I envisioned that the misery of not having a life would end once I gained the coveted attending status and knew everything. But you don't know everything, and in fact you never will. Toss that unattainable standard by the wayside and forget it. Medicine is constantly changing and even the information that you once learned quickly flees from your memory if you don't use it. It is because I don't know everything that I often fight with a voice in my head that tells me so harshly that "If you miss something, you could kill someone. Medicine is your life. You need to know more."

I want to date, maybe find a husband, start a family, my friends want me to join them in training for a Tough Mudder, I want to spend my hard earned attending $$$$ and travel with my friends and family. And lately, I've been feeling like I should write a book or put out some Spoken Word poetry. Or maybe publish an article in JEMS because EMS is a passion of mine. I also just bought a house, and I want to learn to cook....But it's in those moments when I'm farthest away from medicine that the voice slowly creeps in and says: "You should be reading and studying. You are a doctor. You're going to hurt your patient if you miss something".......Honestly, it makes me envy people working at fast food joints some days. I wish the greatest mistake I could make was screwing up someone's order.

How do you balance work and life, and how good is good enough? At what point are you satisfied with what you know and accepting of what you don't know?
 

winkleweizen

7+ Year Member
Apr 10, 2011
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Attending Physician
You'll never know everything, but you know sick vs not, and if you don't know something you know who to ask.
 

bravotwozero

Chronically ambitious
15+ Year Member
Sep 19, 2004
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You don't need to study as much as you did during medical school or residency, since you're practicing clinical medicine now. Also, that's what cmes, board recerts and conferences are for anyway ...


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gman33

Moderator Emeritus
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Aug 18, 2007
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Initially study and pass boards.

After that, come up with some plan for ongoing learning. I read a couple of journals. Not every article, but the ones that might change my practice. I'll do some research on weird stuff i see. Listen to a few podcasts.

Most of my time away from work is for myself and my family.
 

Hercules

Son of Zeus
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Jul 25, 2000
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Unfortunately your question is a very important one that each person has to answer for themselves. As you have stated, the study of medicine is not a discreet task with a defined end point. You will never check the box and scratch "learn medicine" off your to-do list. However, this was true at every point in your career before now-- you just hadn't realized it yet.

So ultimately you have to figure out how much studying is enough. I will say that many of us feel that after sacrificing much of our 20s, our 30s are officially ours. Trust in your training and do some CMEs as an attending and you should be in good shape. I would spend much more effort focusing on wellness and outside interests as an early attending. You have had information pounded into you for a decade. Now you need to develop yourself and your relationships so that you can achieve that balance that will enable you to have a long and enjoyable career. No one burns out from not studying enough. Lots of careers are cut short by not being able to achieve a good life balance.


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emergentmd

10+ Year Member
Jul 6, 2008
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Fo real? You need to relax. You are an EM doc. If you are so Type A about this, you are going to kill yourself working in the ED.

In the 15yrs since I finished residency, I only read when I have something I am not sure of during work. I spend 1 min reading up to date. Maybe do this once every 3 shifts.

I have otherwise not opened up any text books. My CME involved clicking repeatedly and answering the questions which I usually always pass.

My experience working the ED and learning community standard of care is much more practical than some article expounding why I am not practicing correct medicine.

I have learned that even the best studies takes years to change community standard of care.

TPA for CVA, Abx choices, etc..... Reading these most up to date rags are a waste of time. Even when I read these studies, the specialists ALL do things differently. I can't even keep track of all the different cardiac STEMI meds permutations that they use. Some want angiomax, some heprin, some lovenox, some nothing. I just give up and ask what they want.

Anyhow, relax, enjoy your shift. Enjoy your money. In a yr, you will see what I am saying.

Now fire away.....
 
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BJJVP

7+ Year Member
Feb 5, 2011
188
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Attending Physician
OP, you sound like a slacker. I'd bet my latest copy of Annals that you still give abx to diverticulitis.

I am being sarcastic, of course. I totally agree with emergentmd above...especially the 6th paragraph. Most of these little "advances" we hear about as residents lose their support or never take off at all in community medicine. I only US for lines and rarely do a FAST. I probably haven't calculated any kind of a score for any condition in 5 yrs...I just decide if I need to scan or not or I decide that someone needs to be admitted or not...Heck, at this point, I even get annoyed when someone makes me calculate a GCS.
 

dchristismi

Gin and Tonic
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Dec 4, 2003
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As the others have said, you'll figure out a system eventually - the learning you do now will be mostly in the trenches.

I read here, and surf at SERMO (there are cool cases posted there between all the ranting). I take Annals and JEM on flights and the beach. And no, I don't read cover to cover. Read abstract. If interested, read discussion. Very rarely do I read the methods and detailed statistics. (Ok, never.) I look up stuff all the time on PEPID - meaning maybe once or twice a shift, depending on how weird my day is going. I enjoy the weird-ass case reports in JEM.

I haven't cracked a textbook since residency... and I was never the greatest at reading textbooks anyway, so mostly they're decoration.

When I add some weird esoteric diagnosis to my differential, I look it up. And I mean things like cold-induced urticaria, which I have diagnosed exactly once, and post-gastric-bypass dumping syndrome mediated hypoglycemia aka alimentary hypoglycemia, which I have also diagnosed exactly once.

You have to live your life. Medicine may be a calling, but it's not everything. Most of us have a lot of identity tied up in our careers, but it isn't the end-all-be-all.
And at the end of the day, it's really nice to say "you know, I saved that guy."
But it's also nice to eat tacos, drink beer and go hiking.
 
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shookwell

10+ Year Member
Apr 9, 2008
205
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Attending Physician
I read a little bit more than most of the posters in this thread, however, one of my jobs is at a major academic center that is very cutting edge, so I stay on top of the resident listserv and read pretty much everything that's sent out to the residents so I can know whether they know what they are talking about when they want to do stuff like discharging PEs and not give antibiotics for diverticulitis.

I do like EB medicine and try to read those although I've fallen quite far behind due to a lack of motivation and an abundance of beer and tacos.
 

The White Coat Investor

Practicing Doc and Blogger
Partner Organization
15+ Year Member
Nov 18, 2002
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Attending Physician
In med school there were some people for whom medicine was a calling and others for whom it was a career/job. The second group still wanted to be excellent doctors, they just had outside interests they also want to pursue. Most people who go into EM fall in that second group. It sounds like you're one from the first group. There's a few more of those in academics than in the community, but it's a definite disconnect with most in the specialty.

Realize that your dedication level or whatever you want to call it is already higher than most of ours so if you slack a little you shouldn't feel guilty about it. No more typing. I'm going canyoneering. For the next week.
 
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