Help, I feel like a fraud and I'm scared!

[DocBrown]

As interviews are coming in, I'm starting to feel like a fraud. I'm worried that I don't really know anything and that I'll end up killing a patient.

I'm supposed to be in charge of people's lives next year! How can I do that?

In my spare time, I play guitar in a band, I hang out with my friends (who are NOT in medicine, btw), I hit on girls, and I reminisce about the only girl I ever loved. I'm no hero! I'm not a saint--I got thrown out of a bar for being too drunk! I don't live and breathe medicine!

My goal in life is to get married to a beautiful girl and travel the world! I'd rather live a healthy and happy life than sacrifice my health to work 100 hrs a week saving people's lives!

I got a bigger thrill when I hiked the appalachian trail than when I first successfully cardioverted someone!

This isn't a joke: I'm really scared. I've been having dreams where I'm an EM resident and the attendings are screaming at me, "You idiot! You don't know anything!"

We all know there's a certain amount of bull****ting that goes into completing medical school. Have I become so good at faking it that I've made it all the way through?

Seriously, I need some help!

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[turtle md]

I hear what you are saying. I am not passionate about medicine. My motto is "I have a life, I need a job." I married a pretty girl and we have both now circumnavigated the globe, but still I find myself back in the ED. There is something that keeps pulling me back whenever I feel like quitting. I guess like any good fungus, it grows on you. I still dread coming into work when I am on an off-service month (especially anything related to IM - oh, the rounding ), but find that I look forward to the unexpected in the ED.

As far as not knowing what to do and "screwing up," that is what residency is for! We are here to learn to be Emergency Physicians. If we already knew everything, what would be the point of residency? Sure when you make a mistake it hurts, but hopefully you learn from it. For example, last month, I d/c'd a MVC pt who had no complaints of neck pain without even getting films - cleared him clinically based on Nexus guidelines. Well, the guy began to develop neck pain 48 hours after discharge, so came back in. Ended up having a C2 fx, kinda hangman like. Got admitted to trauma. Luckily, no neuro impairment. So I missed it. But I learned, guidelines only go so far. Luckily the patient did not suffer for my mistake. (BTW: my attending cleared him clinically right after I did, so even the top dogs make mistakes now and then.)

Point is, residency is a learning experience.
Second point is, your job does not have to define who you are. And post residency, I plan on doing a lot more traveling. EM can take you places, both with the schedule allowing for time off, and with the opportunities to do international EM work.

Hope this helps make you feel better.

 

[DocBrown]

thanks a bunch, turtle. actually, that DOES make me feel a lot better.

it's just that there were so many people in my med school who had no sense of humor, and they lived and breathed medicine. They considered themselves martyrs.

I remember one overweight student telling me, "patients don't understand; we sacrifice our own health for their benefit!" that scared me ****less--I won't sacrifice my own well-being for anyone except my loved ones!

 

[keeping-it-real]

might i suggest that both of you re-read the hippocratic oath. please try www.hippocratic-oath.org or google search "oath of hippocrates."

 

[keeping-it-real]

^ i keed, i keed

 

[turtle md]

might i suggest that both of you re-read the hippocratic oath. please try www.hippocratic-oath.org or google search "oath of hippocrates."

Is that the thing they made us say at graduation? I remember something from a drunken haze about striving to protect the sick from themselves and the evil ones that will master them...

Ever wonder if Hippocratic and hippocritic have any connection to eachother?

 

[bartleby]

You are not going to be able to graduate from a US med school and pass the boards without the bare minimum of knowledge which will allow you to function as a successful resident.

As much as we all try to convince ourselves that we have "normal" jobs in medicine in which you'll avoid trouble if you read all the right journal articles and remember all the Wells Criteria, but it isn't true. This is a rough business. Even when you do everything right, there's always that 0.01% that can slip by, and it completely sucks. But that's medicine...

 

[tennik]

You cardioverted someone as a medical student? That's pretty sweet anyway. I don't think you are going to be working 100hours/week in the Emergency room. I think of Emergency Medicine as a haven for people who want to help people but also want to have a life outside of medicine. You can definitely choose a job with fewer hours, especially if you are willing to accept a lower salary.

It is a bit scary to me if you are not willing to sacrafice certain things for your patients, but I don't think this is what you are saying. We are half way to becoming "real" doctors and there is plenty of sacrafice left, but I don't think that your health or band or family are on the chopping block.

Usually people who feel anxious about things are better prepared when they get there!

 

[peksi]

Doc Brown,
You may want to just think "out of the box" for a moment. The key, in my mind to a successful ("define that how you wish") and fulfilling career in medicine is to harnes your skills and blend them with your interestes. For some like my brother, a full fledged ED pit doc in AZ that is clinical care and then cars and street rods. For me it's academics and ultrasound.

Given your travel interests, is wilderness medicine, travel medicine, or better yet, locum tenums where you get to test out new ED's and areas every few months seem more appealing to you?

Not to sound too zen, but many of the steps you have already taken are part of the pathlike journey we are all on. (honestly did someone put honey in my green tea???) Anyway. my point is you can not predict, nor fret about the future to this degree, trust me I have been there! Just go with the flow, work hard, learn what you can and find a way to meld your medical knowledge with your other life interests, many of those I respect and admire have been able to do this and thus have both professional as well as personal satifaction.


Best of luck.

Paul

 

[DocBrown]

thanks for the encouraging words!

 

[Jeff698]

You've described (in great fashion, BTW) what almost every intern in the country feels like around July 1. I was absolutely convinced for the first several months that I was soooo much stupider than all the other interns around me.

Fortunately, with my vast three months of experience as a physician, I only have those thoughts about 2 or 3 times a day now. I call that progress.

Take heart in knowing that the type of residents everyone should fear are the ones who are so confident that they don't feel like what you've described. Cockines is dangerous, especially at our stage of medicine.

Take care and good luck!
Jeff

 

[EctopicFetus]

Certainly as a MS4 I feel similarly to DocBrown. One of my attendings said something to the effect that he would rather have a smart resident who wants to run things by him than a genius who thinks he knows everything. The logic is if you are smart but willing to ask questions those who know more that you can fix little mistakes. Those residents who think they are so smart that they dont need help end up killing people. I think esp in EM there is a gradual process where you gain more and more autonomy. The 1st yr residents have to pass everything by the attending. That being said the seniors were given a lot more autonomy if they earned it.

 

[kungfufishing]

I would say if you werent a little more excited about hiking the AT than about cardioversion, there'd be something wrong. (hmmm georgia-->maine vs. a procedure you'll repeat innumerable times...gonna go with the hiking trip).

 

[docB]

Fortunately, with my vast three months of experience as a physician, I only have those thoughts about 2 or 3 times a day now. I call that progress.

Well said!

 

[sort_timer]

hey brown.

i think your on a great start to your future...you're asking for help. so many people think that medicine is a "john wayne" profession. my view is...better to ask for help now-then have to explain why you didn't later.

good luck.

 

[GeneralVeers]

It sounds like you're pretty well-rounded and well-adjusted to me. Everyone needs to be thrown out of a bar at least once for excessive drunkiness.

In fact, I worry more about the people who live and breathe medicine. In my experience they often are not nearly as good communicating with patients, and they lack some perspective that doing non-medicine things will give you.

 

[beyond all hope]

Glad to hear that you're scared. You should be. It will keep you from killing patients. If you're not a little scared as an intern than you probably have a few screws loose or you're not being adequately challenged by your residency (unlikely).

There will be lots of circumstances where you will be asked to do things during your residency which are out of your scope of practice and ability, and it's important to know when to ask for help. I ran trauma and medical codes as an intern when I probably shouldn't have. In my case, there was no one else more qualified (I once had to take over for a code run by a 3rd year when I was in my first months of training. Not good.)

Interns should ask for help at the drop of a hat. That's what internship is all about. Senior residents and attendings understand that, and are usually more than happy to help. I enjoy it when interns ask for help: it makes me feel more comfortable giving them leeway to work if I know they'll come to me with problems, and it makes me feel like a cool dude when I know the answer.

I'm actually a little sad that our interns know what they are doing already. They rarely need me for advice anymore. The 2nd years are now pretty arrogant and should be asking for advice more often (I was the same way, I'm sure)

 

[NinerNiner999]

You will meet many more people in medicine who are boring, have no sense of humor, and live and breath by the Osler way. The fact is that you realize that you're not like that, and you have a pulse. Don't worry - you are far from a fraud and, despite the fact you will probably make many mistakes during residency, you will unconsciously improve into a great physician. Relax, keep your humility, and always try to learn more - I'm pretty sure that's your nature anyway. Keep on rockin too.

 

[DocBrown]

thanks, everybody. I'm feeling much better about all this now that I've heard other people's experiences; it's good to know that I can keep on doing the things I love and actually be a competent physician.

I don't want to do any job unless I can do it properly. I started medical school with the notion that I don't need to live and breathe medicine to do it properly. during med school, however, I was exposed to so many students who looked at me like I was the scum of the earth when I went to play a few shows with my band instead of flying to Dominica to do a medical mission.

now I'm getting back to my original idea.

 

[peksi]

PLAY A FEW SHOWS?? What instrument DocBrown? I play drums....Mapex. Maybe someday DW but not willing to spend the $$$.

Realize that there is a recognized moto for many in EM
"Work Hard....Play Hard!"

Seems to me some of those you have had earlier experiences with may not understand that, or have different views. That's ok.

Part of our responsibility in EM as Faculty is to help residents find their "fit" within their career to optamize their medical and life success....I think you'll do just fine. You seem to have a very healthy developed 'self awareness', which honestly is invaluable. I hope you consider Christiana Care for EM Residency.


Paul

 

[colforbinMD]

I was exposed to so many students who looked at me like I was the scum of the earth when I went to play a few shows with my band instead of flying to Dominica to do a medical mission.
.

You should have flown to Dominica to play a few shows. When I was there we desperatly could have used you!!!!!

By the way. Though the fear of not getting an EM spot is dominating my life right now. I know all to well how you feel. If it makes you feel better when I was a tech pre med school one of my attendings played every week at least twice a week in a jazz band.
Out of curiosity what type of music does your band play?

 

[DocBrown]

PLAY A FEW SHOWS?? What instrument DocBrown? I play drums....Mapex. Maybe someday DW but not willing to spend the $$$.

Realize that there is a recognized moto for many in EM
"Work Hard....Play Hard!"

Seems to me some of those you have had earlier experiences with may not understand that, or have different views. That's ok.

Part of our responsibility in EM as Faculty is to help residents find their "fit" within their career to optamize their medical and life success....I think you'll do just fine. You seem to have a very healthy developed 'self awareness', which honestly is invaluable. I hope you consider Christiana Care for EM Residency.


Paul

Drummer, eh? Why do you guys always insist on missing practices?
I play guitar. My band is winding down--I can sense it's on its last legs. But I do hope to start up another band during residency!

 

[GeneralVeers]

thanks, everybody. I'm feeling much better about all this now that I've heard other people's experiences; it's good to know that I can keep on doing the things I love and actually be a competent physician.

I don't want to do any job unless I can do it properly. I started medical school with the notion that I don't need to live and breathe medicine to do it properly. during med school, however, I was exposed to so many students who looked at me like I was the scum of the earth when I went to play a few shows with my band instead of flying to Dominica to do a medical mission.

now I'm getting back to my original idea.

My colleagues looked at me the same way. I wouldn't study for 18 hours a day, 7 days a week like they would, rather I'd go golfing and trapshooting on weekends. They were convinced that I was lazy, or not as committed as them. That's probably true, however like you, I don't want medicine to be my whole life. I think of it as a career that I hopefully will enjoy and do well, but when I'm not in the hospital I don't want to think about it.

I also had no interest in doing overseas mission work. Everyone else was flying to Kenya, Belize, Honduras, etc. for missionary work. In my view, working in a county facility is missionary work in its own right, and at least we're helping people in our own country.