having serious anxiety issues please help

[mcatsucksss]

hey guys
im an m3 and i have never been that much of a talker. but now that im on rotations im expected to present the patients ive seen to attendings and residents at rounds. for the past week or so i just havent been able to do that. my mind goes blank after like the first 1-2 sentences and then i get flustered and shut down. then i have an anxiety attack and im left exhausted for the rest of the day. i can't even present 1 patient without stopping and looking at a resident to help me out. at the very least people are nice about it and trying to help but it is so humiliating for me and i can tell none of the residents want to work with me because of it...
the only way ive been able to present a patient is if i wrote out almost like a script and read off of it but theres just not enough time to do that every day...i really hope this is a phase but no one else i see is like that. ppl just machine gun out perfect presentations like its nothing and i just cant...
its not like i dont know the material, if they ask me specifics about things i can answer fine but when i get asked something so basic like "tell me about the patient" i cant do it...
i need some help/advice please...

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[temporality]

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[officedepot]

instead of writing out a script try jotting notes down in key phrases to help you remember what was said.

Also I suggest making a template for your presentations on a computer and then printing it out each day to just fill out when you go see your patients. Once you get in a good habit things will become easier. Also it takes a long time to get good at presentations. I'm actually amazed at how well some residents can present straight from memory.

I personally write down most of what is said in medical short hand - e.g patient talks for 3 minutes how it's hard to breathe when walking up a hill when he never used to have trouble I will simply write down "+DOE" and present it in that format since that is all the team really cares about (you will know the extra detail if they ask). But doing stuff even like that takes practice. You have to know what basic symptoms to ask and start developing a differential almost immediately to guide the conversation. Once you are decent and depending on the complexity of the problem and knowledge of the patient it shouldn't take longer than 15-20 minutes to talk to the patient and do a focused physical exam (but beware as a new M3 your team will probably want you to be very thorough, you can do more of that M4 year and on the more subspecialty stuff).


when someone asks you to tell them about the patient that's probably asking for a presentation. If they already know the patient and want an update that's a progress note presentation. If it is a consult asking a basic question give them a brief HPI, pertinent pmhx, fmhx, and sochx and hospital/treatment course.

 

[Mattchiavelli]

You need to go into it and keep telling yourself "I am doing ok"- sounds like you're psyching yourself out a lot. It will get a lot easier once you've done it 24092 times. Try re-presenting your patients after you get home to a friend or to like a pillow pretending it's your attending just to get used to the process pf talking out loud and the organization. If you do this you'll get better and will get some good presentations under your belt, which can give you some confidence which in turn will make for even better presentations.

 

[mcatsucksss]

thanks for the advice guys its been a rough couple weeks and my time in this rotation is almost up. i just dont want to give my residents the wrong impression but its probably too late now. im just gonna try my best to practice and do some damage control...

 

[PMPMD]

Like the others have said, it really does get easier. I used to have the same problem. My late uncle was a PR consultant, and helped me change my viewpoint about presenting (his work was in big presentations in front of 100s of people, but same basic idea.) Instead of what I call the "firing squad victim" mentality (thinking that your audience is there to judge/criticize/attack you), I shifted to what I call the "Santa Claus" model. What does Santa do? Give people what they want. What do you (the presenter) have? Information. What does your audience want? Boom. Just give them what they want. Practicing is good, but it's not always practical to spend that much time on each patient (intern year, for example).

 

[Idreamed]

"I must not fear
Fear is the mind killer,
Fear is the little death that brings total obliteration
I will face my fear
I will permit it to pass over and through me
And when it has gone past, I will turn the inner ear to see its path.
When the fear has gone, there will be nothing
Only I will remain"

Hang in there. Do something about it. The other people are not thinking about you as much as you think they are

 

[Kadava Reviva]

It may be hard at first but, several times a day, sit down, close your eyes and visualise yourself giving a relaxed, competent and effective presentation.
Think of everyone in the room as immediate family members or close friends out for a game of golf, dinner or a beer (do not use liquid courage, though). After doing those visualisations, practice giving a presentation by yourself or in front a bunch of toys (study an actual case, so it's genuine), then do it in front of an intimate group. Later, imagine the same while doing the live presentation (they ARE family and friends out for a good time). That way, you will learn the process and techniques, which will become automatic. Don't do those stupid breathing exercises just before your case presentation unless you are a meditation adept and have benifited from these over the years, they are bad in the short term and will only end up making you more nervous and will cause you to hyperventilate, which will make you mentally associate breathing exercises with distress. They only work after several years.
Anyway, try these techniques for a few weeks and best of luck to you.

Love!

 

[Kadava Reviva]

"I must not fear
Fear is the mind killer,
Fear is the little death that brings total obliteration
I will face my fear
I will permit it to pass over and through me
And when it has gone past, I will turn the inner ear to see its path.
When the fear has gone, there will be nothing
Only I will remain"

Hang in there. Do something about it. The other people are not thinking about you as much as you think they are

Very nice philosophy, but it doesn't provide any tools.

 

[Dral]

"Also I suggest making a template for your presentations on a computer and then printing it out each day to just fill out when you go see your patients."

Best advice. This helps/helped me out immensely. Not only does it keep the information organized in a way for your brain to think about it, but it also gives you confidence knowing that the info is there if you need it.

My template is basically this:

Summary statement:

O/N events:

Vitals:

PE:
HEENT
PULM
CARDS
ABD
EXT
OTHER

Labs (I made line skeletons for lab values on my template)

Studies:

Summary:

Plan:


Of course, the actual sheet I print out is more fleshed out, but that's the basic idea. I bring up my sheet in word every AM, then bring up yesterday's note for each patient, copy and paste their summary statement, then copy and paste yesterday's plan. Next, I fill in the vitals and labs/studies. Next, go see the patient. Then fill in the O/N events and PE. Finally, go through yesterday's plan that you copied, cross off things that are done, underline things that will continue, and add new things for that day with check boxes. Done and done.


Also, get into work early. If you have enough time to get all your stuff done and then go for coffee before rounds, it really helps you from just a mental standpoint (brain is saying...yeah, I got this, no problem, I even have time to go get coffee). Plus, coffee rocks.

 

[PMPMD]

Also, be sure of yourself. e.g., "The white count was 15," NOT "The white count was 15? (looks around for confirmation)"