How can I overcome anxiety/hatred about this "hands on" crap?

[getunconcsious]

I feel like I may be the only person who's like this. I'll take a good review book over the "opportunity" to learn procedures. I hate procedures. To a lesser extent, I dislike writing H&P's and progress notes too. A lot of people in the thread about evals said that they get the comment "needs to read more". This has never happened to me since I'm typically the most well-read student on the team. I don't get why most students would rather learn procedures. It just makes me want to have a panic attack b/c I know I will get it wrong, and also I don't like hurting people.

While it's nice to have a great fund of knowledge, I feel that my hatred and outright dread of procedures severely narrows the field of potential career choices for me. I hate hands on stuff so much that even though I loved psychiatry I honestly don't know if I could deal with 4 months of medicine and 2 months of neurology as an R1. The thought of doing an LP in neurology makes me break out in a cold sweat!

Hopefully this won't be too much of a problem, since I think I would like to do Pathology. My worry is what if I like something better than path (Psych and radonc are the main contenders), I wouldn't be able to do them b/c I can't handle an intern year. Is there any way to calm the hell down? I've always been an extremely anxious person, and in the past have been diagnosed with both panic disorder and GAD. I don't get "out of the blue" panic attacks anymore, but I often struggled with them on OB/Gyn. GAD is still alive and well. I've been able to almost always escape procedures except for OB/Gyn, but I'm probably doing myself a disservice. I'd really hate to be shut out of psych or radonc because of an internship that would last only six months or a year, but I honestly have huge doubts that I would ever be able to do it. I just don't think I'll ever be able to entubate someone, do an LP, place a central line, etc. I realize that these are all things that can probably be taught, but I just can't get past my anxiety! I'm even worried about pathology because you do have to do bone marrow biopsies!

Is there any hope for me? 😕

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[discontinuebed]

I once met an attending who said "If you're afraid of doing something, it's probably because you're lousy at it. I mean, are you afraid of tying your shoelaces?"

Sounds stupid but I've found it to be true. I trembled when doing my 1st ever ABG. 10+ later, there's still a little anxiety about probing another person with a needle and drawing blood but it's nothing like when I first started.

 

[Top Gun]

I feel like I may be the only person who's like this. I'll take a good review book over the "opportunity" to learn procedures. I hate procedures. To a lesser extent, I dislike writing H&P's and progress notes too. A lot of people in the thread about evals said that they get the comment "needs to read more". This has never happened to me since I'm typically the most well-read student on the team. I don't get why most students would rather learn procedures. It just makes me want to have a panic attack b/c I know I will get it wrong, and also I don't like hurting people.

While it's nice to have a great fund of knowledge, I feel that my hatred and outright dread of procedures severely narrows the field of potential career choices for me. I hate hands on stuff so much that even though I loved psychiatry I honestly don't know if I could deal with 4 months of medicine and 2 months of neurology as an R1. The thought of doing an LP in neurology makes me break out in a cold sweat!

Hopefully this won't be too much of a problem, since I think I would like to do Pathology. My worry is what if I like something better than path (Psych and radonc are the main contenders), I wouldn't be able to do them b/c I can't handle an intern year. Is there any way to calm the hell down? I've always been an extremely anxious person, and in the past have been diagnosed with both panic disorder and GAD. I don't get "out of the blue" panic attacks anymore, but I often struggled with them on OB/Gyn. GAD is still alive and well. I've been able to almost always escape procedures except for OB/Gyn, but I'm probably doing myself a disservice. I'd really hate to be shut out of psych or radonc because of an internship that would last only six months or a year, but I honestly have huge doubts that I would ever be able to do it. I just don't think I'll ever be able to entubate someone, do an LP, place a central line, etc. I realize that these are all things that can probably be taught, but I just can't get past my anxiety! I'm even worried about pathology because you do have to do bone marrow biopsies!

Is there any hope for me? 😕

You can still do path if you really hate procedures that much. I don't think pathologists do bone marrow biopsies. Usually, that would be done by someone in heme/onc. But let me ask you this, how many times have you actually tried to do procedures? If you take the opportunity to do whatever procedures come your way, eventually you can conquer your phobia and it won't seem like a big deal anymore.

 

[Tiki]

You can still do path if you really hate procedures that much. I don't think pathologists do bone marrow biopsies. Usually, that would be done by someone in heme/onc. But let me ask you this, how many times have you actually tried to do procedures? If you take the opportunity to do whatever procedures come your way, eventually you can conquer your phobia and it won't seem like a big deal anymore.

Some pathologists do bone marrow biopsies, it depends on the hospital.

I had a fear of procedures as well, but you just have to force yourself to do it. The only way you'll ever get over it is by just doing it. Take an ER or critical care rotation where you'll get a lot of experience with different procedures. It's better to do as much as you can when you are a student, and aren't expected to know what you are doing.

 

[Anka]

Have you thought about doing an anesthesia rotation where you can learn to do procedures while the patient is under general anesthesia? That way if you take more than a single try to get your IV in, they didn't feel anything.

Anka

 

[smq123]

It just makes me want to have a panic attack b/c I know I will get it wrong, and also I don't like hurting people.

I just don't think I'll ever be able to entubate someone, do an LP, place a central line, etc. I realize that these are all things that can probably be taught, but I just can't get past my anxiety! I'm even worried about pathology because you do have to do bone marrow biopsies!

How do you "know" that you'll do a procedure incorrectly? Even if it is your first try, there's always the chance that you'll do it perfectly the first time. You don't know until you do it.

I understand not wanting to hurt people - but you're rarely in a position where you might damage people permanently.

What helped me during ob/gyn and surgery was reading about procedures that I might have to do before I had to do them - and reading about how to do it over and over and over again. That way, I could visualize myself doing the procedure, which helped. I didn't always get it right but at least I had a good idea of what I should be doing, which greatly lessened the anxiety. There are some good websites and videos online on how to insert a foley, on how to insert an NG tube, on how to suture, etc.

Did you do surgery yet? Helping suture skin, for some reason, got me comfortable doing other stuff.

 

[LuckyBambooGirl]

Don't think about the fact that you might be hurting them, think about the fact that what you are doing will actually help them get better! I was worried about doing procedures too until I got the chance to actually try a few things. I ended up concentrating so hard on what I was doing that I didn't have time to be nervous about it!

 

[alphaholic06]

Well what about a person who starts to sweat profusely. Sweating shows my nervousness, and it can be seen by everyone especially the patient.

 

[Anka]

Not if they're under general anesthesia, it doesn't. Once you've done ten IVs under general anesthesia, you'll most likely be okay to do it on an awake patient. Same goes with arterial lines, foley catheters, etc. At some point you'll be okay (though you may never be happy) to do procedures in general on awake patients.

Anka

 

[surrender903]

This has never happened to me since I'm typically the most well-read student on the team.

but not the most modest it seems...

 

[smq123]

but not the most modest it seems...

Give the poor guy a break. He's not saying it to boast, just to explain. Besides, when you're a third year, you need to take some comfort in whatever achievements/strengths you may have. There have been days in third year when I've had to make myself feel better by saying to myself "Well, I got into med school...so I'm not a total idiot. 🙁"

 

[getunconcsious]

but not the most modest it seems...

LOL, maybe not the *most* modest. I only said this b/c I have to play up my strengths which in this case is fund of knowledge. Besides, most people hate reading and I like it so it is a fairly accurate statement. Because I suck at the actual procedures and hate doing them, I have to do SOMETHING to impress the attendings/residents. Not only do I lack manual dexterity in general, but being nervous makes it 10 times worse. I don't know why I didn't think this would be such a problem BEFORE I went to med school, I just wasn't thinking that far ahead I suppose.

Someone mentioned doing procedures under anesthesia, which is true that it helps you. I catheterized people under anesthesia and wasn't really that nervous about it. As far as what procedures I've tried, I've delivered 2 babies and countless placentas, stapled and removed staples, done a bit of surgical assisting, and that's about it. After OB/Gyn, my first rotation, I pretty much was never asked to do procedures again. I would probably not take an anesthesia elective b/c it would require me to entubate people, which is something that I simply can't do and I don't think I could ever do it.

I'm very nervous about surgery rotation. I can't sew or do 2 handed knots or anything. I tried practicing for hours and hours on OB/Gyn and never even came close to getting it. I can't do simple interrupted stitches, nothing. I lack the capacity to orient things in three dimensions and also the manual dexterity required. The other thing I'm super worried about is graduating, since our dumb school requires a critical care rotation during MS4. There is no way that I can not suck at that. I'm hoping that I will be able to scrape by with a pass. I've started 1 IV on a classmate, never drawn venipunctures, basically I will try to duck out on any procedure I can. Sometimes I even lie to attendings and residents telling them that "I've never seen one before" so that they will let me watch and not make me do it.

It's a big problem I know, but I'm just not sure how to overcome it. I guess "just cowboy up and stick the tube down their throat" is probably the only answer, but what if I break someone's teeth or something doing this? On a separate but related note, does anyone know how much procedural stuff they expect Psych interns to do while on medicine/neurology? I've heard that at some places they really don't do much b/c they don't want to and also people don't really trust them to do it correctly. As far as path goes, yes it's only 1 procedure but it's about the most unpleasant procedure ever. Personally if I had to have a bone marrow biopsy there's no way I'd do it w/o sedation. I'm hoping that maybe most people are sedated for it? But again I dunno.

Anyways thanks all for the advice.

 

[smq123]

I'm very nervous about surgery rotation. I can't sew or do 2 handed knots or anything. I tried practicing for hours and hours on OB/Gyn and never even came close to getting it. I can't do simple interrupted stitches, nothing. I lack the capacity to orient things in three dimensions and also the manual dexterity required. The other thing I'm super worried about is graduating, since our dumb school requires a critical care rotation during MS4. There is no way that I can not suck at that. I'm hoping that I will be able to scrape by with a pass. I've started 1 IV on a classmate, never drawn venipunctures, basically I will try to duck out on any procedure I can. Sometimes I even lie to attendings and residents telling them that "I've never seen one before" so that they will let me watch and not make me do it.

Oof - poor getunconcsious. You really sound very anxious.

I had a hard time learning "proper" two handed ties on OB/gyn - they didn't teach us very well. I did learn, though, on surgery.

If worse comes to worst, learn the instrument tie. Trust me, an 8 year old could do an instrument tie very well.

Practice as much as possible before surgery. Use chicken breasts (or bananas/oranges if you don't eat meat) and practice suturing.

It's a big problem I know, but I'm just not sure how to overcome it. I guess "just cowboy up and stick the tube down their throat" is probably the only answer, but what if I break someone's teeth or something doing this?

It sounds like you're fixating too much on what COULD go wrong. Don't - I used to do that and the fear would paralyze me. Like I said, focus on reading over the procedure over and over and over again, until you can recite the steps in your sleep. Then, when faced with actually DOING the procedure, you're so focused on the steps that you won't have time to think about what could go wrong.

Good luck. You'll get it!

 

[BATiger]

Well what about a person who starts to sweat profusely. Sweating shows my nervousness, and it can be seen by everyone especially the patient.

Or blushing! I turn bright red when anyone asks me something I am not comfortable with... I cannot fake confidence, it is physically impossible.
So that you know, I have a male classmates who sweats all the time when he's nervous, we are used to it and it just shows he's human. I think it makes him more likeable if that makes sense...

 

[justwondering]

some of these issues will by helped by ur psychiatrist (for helping with the biological reasons for your anxiety, etc), the rest hopefully will get better with practice.

i think that med schl and residency are a string of events that pull us out of our comfort zone. ive been so nervous at the beginning of my residency rotations. then as i've learned to deal with the situations those rotations throw at me, ive moved on to something else equally nerve-wracking. its not all bad though! Once you're done with each month, you look back and see how you can now handle problems without a lot of difficulty. i think med schl is similar. you should try to get as much exposure to procedures, etc as possible. not doing procedures and just worrying about them will only makethem much worse than they really are. It's ok if u fail a few times, im sure your attending did!

 

[alphaholic06]

Or blushing! I turn bright red when anyone asks me something I am not comfortable with... I cannot fake confidence, it is physically impossible.
So that you know, I have a male classmates who sweats all the time when he's nervous, we are used to it and it just shows he's human. I think it makes him more likeable if that makes sense...

It's makes sense. It's just terribly uncomfortable for me, and I'm sure it makes the patient nervous as well.

 

[MJB]

LOL, maybe not the *most* modest. I only said this b/c I have to play up my strengths which in this case is fund of knowledge. Besides, most people hate reading and I like it so it is a fairly accurate statement. Because I suck at the actual procedures and hate doing them, I have to do SOMETHING to impress the attendings/residents. Not only do I lack manual dexterity in general, but being nervous makes it 10 times worse. I don't know why I didn't think this would be such a problem BEFORE I went to med school, I just wasn't thinking that far ahead I suppose.

Someone mentioned doing procedures under anesthesia, which is true that it helps you. I catheterized people under anesthesia and wasn't really that nervous about it. As far as what procedures I've tried, I've delivered 2 babies and countless placentas, stapled and removed staples, done a bit of surgical assisting, and that's about it. After OB/Gyn, my first rotation, I pretty much was never asked to do procedures again. I would probably not take an anesthesia elective b/c it would require me to entubate people, which is something that I simply can't do and I don't think I could ever do it.

I'm very nervous about surgery rotation. I can't sew or do 2 handed knots or anything. I tried practicing for hours and hours on OB/Gyn and never even came close to getting it. I can't do simple interrupted stitches, nothing. I lack the capacity to orient things in three dimensions and also the manual dexterity required. The other thing I'm super worried about is graduating, since our dumb school requires a critical care rotation during MS4. There is no way that I can not suck at that. I'm hoping that I will be able to scrape by with a pass. I've started 1 IV on a classmate, never drawn venipunctures, basically I will try to duck out on any procedure I can. Sometimes I even lie to attendings and residents telling them that "I've never seen one before" so that they will let me watch and not make me do it.

It's a big problem I know, but I'm just not sure how to overcome it. I guess "just cowboy up and stick the tube down their throat" is probably the only answer, but what if I break someone's teeth or something doing this? On a separate but related note, does anyone know how much procedural stuff they expect Psych interns to do while on medicine/neurology? I've heard that at some places they really don't do much b/c they don't want to and also people don't really trust them to do it correctly. As far as path goes, yes it's only 1 procedure but it's about the most unpleasant procedure ever. Personally if I had to have a bone marrow biopsy there's no way I'd do it w/o sedation. I'm hoping that maybe most people are sedated for it? But again I dunno.

Anyways thanks all for the advice.

Do you mind me asking what compelled you to be a physician? It sounds like you might have been happier doing something else (PhD?)

 

[PeepshowJohnny]

Okay, this advice is coming from someone who's your exact opposite, so take that into consideration. They ask me to do something, screw not feeling confident, forget patient comfort (he knew he was coming to a teaching hospital), and forget being evaluated. I just want to do SOMETHING instead of standing around rounding forever or reading.

However, even though we're exact opposites, I think this has more to do with anxiety than personal strengths or weaknesses. It's fine not to enjoy procedures, but the picture you're giving me almost fits a social anxiety disorder. You feel incredibly anxious being scrutinized (not only by an attending but by the patient by putting him/her into pain). The fact that it's interfering with your life to the degree that you've shut out possible career paths because of it suggests that this is a big deal and may become bigger. You suggest cowboying up, but I don't think that's sufficient.

I'd worry about you going into Path and being paralyzed by your anxiety there. What if your attending disagrees with your read of a slide? What happens when you tell a doctor who did a biopsy that he sent innadequate sample to make a diagnosis and he blows up at you? Currently, you seem to mention anxiety only relative to procedures, but I'd worry about it generalizing to performance in general.

What kind of therapy are you receiving? Are you taking any anxiolytics? These are more rhetorical questions and I'm not giving medical advice (You really don't want it from someone who barely paid attention in psych). My only advice is of a fellow medical student in that I think this is a big problem that may interfere with your further career more than you think possible if you don't address it in a big way.

 

[Baditude]

I am a bit of a mix of all that have responded so maybe this will help you a bit....I am extremely anxious when doing a procedure for the first time and I am one who sweats and turns bright red when nervous. I have found if I can practice on one of the practice dummies a few times first then I am a bit more confident to do it for real. I am also one who hates to stand around and do nothing so I will take the uncomfortable feeling and the anxiety over the boredom any day. When time allows I enjoy reading up on things I saw or will see on the wards so I am "up to date" but I would rather see the info applied then to just read.
I think you will find the more you do something the less anxious you will become. Like the others have posted try anesthesia so your patients won't feel any mistakes you might make or if your school has the practice dummies work with them until you are comfortable with the procedure.

 

[yaah]

A couple of things. I was somewhat like you during MS3 in that I loathed doing procedures also. At first, some of it was due to anxiety but a large part of it was that I just didn't enjoy it. It just never appealed to me to "get my hands dirty" and all that. I hated surgery for that reason. I actually preferred to spend my days rounding or reading or going to lectures as opposed to being in the OR, because the OR was boring. I wanted to see a bunch of surgeries, but it didn't matter to me whether I helped out. But once I had seen a couple of colon resections or heart bypasses I didn't really need to see anymore.

Part of this was that I already knew I wanted to do pathology, so I was really only interested in the surgeries from a pathologist's point of view (i.e. how is the procedure done, where are the true margins of resection, what things are important to the surgeon). During my surgery rotation, the only suturing I did was sewing up tiny laparoscopic wounds or small incisions. I learned how to tie basic knots, and how to manipulate the needles, but never really had to get beyond that. The surgeon once tried to get me to close a 10 cm leg incision, but I screwed up the knot tying so much (he was trying to get me to do some complicated knot I had never seen before) that he just gave up. Didn't necessarily try to avoid other procedures, but didn't seek them out either. I helped out with central lines and chest tubes but never did them myself. I got honors - in part because I had all this random pathology knowledge that impressed them, and I think in part because I was on time, helped out where necessary, and all that. You don't have to be a procedure ***** to get honors or do well.

It sounds to me though that the major part of your problem is simple fear. As loathsome as it sounds, you have to confront those fears. You aren't going to kill anyone. When you do procedures, you will have help. If you shake or sweat or whatever, realize that 95% of everyone who ever did procedures got nervous the first time they did them. (The 5% who didn't are probably narcissists or just don't have much of a soul). You have to develop your own strategies, of course, but avoidance is not a good strategy. The time to learn these things and confront these fears is during med school, not later on. Do you really want to get to residency and have to put in an IV and not have the experience?

As far as pathology, yes, there are few procedures in pathology. But if you're choosing pathology because it has the fewest procedures, you may not be successful. You have to like what you do, not choose it as the lesser of the evils. If it is necessary, talk to a doctor. Talk to a therapist. There are all kinds of anxieties and all kinds of strategies to deal with them. But keeping to your self and adopting an avoidance strategy in the hopes that you will just get through it for the rest of your life doesn't serve anyone's interests, especially yours.

You just have to do it. Once you are successful, you will start to worry less and less about all the little things that can go wrong and also realize that things aren't as bad as your mind is making them out to be.

 

[QofQuimica]

What helped me during ob/gyn and surgery was reading about procedures that I might have to do before I had to do them - and reading about how to do it over and over and over again. That way, I could visualize myself doing the procedure, which helped. I didn't always get it right but at least I had a good idea of what I should be doing, which greatly lessened the anxiety. There are some good websites and videos online on how to insert a foley, on how to insert an NG tube, on how to suture, etc.

I think this is really good advice. Understanding the purpose of what I'm trying to do and visualizing the steps over and over in my mind is really helpful for me when I'm trying to learn a new skill, too.

This is not a medical example, but it's the same idea. When we were seniors in college, my ex tried to teach me to drive a stick. It was disastrous, and it didn't help that he was clearly impatient with me for not getting it right away. I had this book that explained all about the clutch and the gears, and then I went and sat in the car in the parking lot by myself and just practiced changing gears with it in the parking space. The next day, I drove that car ten miles to work. I stalled out at every single red light, and it took me twice as long as it should have to get there. But I did get there, and now I even prefer driving a stick. 🙂

 

[BSN2DOC]

Or blushing! I turn bright red when anyone asks me something I am not comfortable with... I cannot fake confidence, it is physically impossible.
So that you know, I have a male classmates who sweats all the time when he's nervous, we are used to it and it just shows he's human. I think it makes him more likeable if that makes sense...

Same here!! I am naturally a very pale person (northern european descent) and when I blush, I turn BRIGHT fire-engine red. And I am not in medical school yet, but in nursing school when I had to do my first catheter or IV, I was so incredibly nervous and turned bright red.

The "trick" I use now is that I forget that is a human I am workin on -- especially if the procedure I am doing is inflicting pain. I just see it as a "task" that needs to be done.

When I observed in the OR, I asked a colorectal surgeon how she was able to do what she does with so much confidence and so much ease -- her response was very similar. She said "it is a task that needs to be done... I forget I am working on an actual person..." or something along those lines.

 

[Feli]

...reading about procedures that I might have to do before I had to do them...

This is the common sense answer^ that I assumed the OP had done since he was bragging about his book knowledge, but nonetheless, reading ahead is the way to go in my limited experience. Videos of office/bedside procedures or surgeries are also even more invaluable if you can find them. Most attendings I've encountered will make me name list the procedure step by step (to make sure I've read on it) and/or watch them or their resident do it once before they'll let me try it solo.

Reading only goes so far, though. Eventually, you're gonna have to jump in there. I liked what "How to be a truly excellent JMS" had to say about procedures regarding that they will run the smoothest if you are prepared and act swiftly. Stuff like sutures and ties certainly have to be practiced at home; there's no way around it.

My best advice is just patient selection. If it's a squirmy kid or a hysterical 30yo woman, try to privately ask the resident if you can assist or just observe since you're not real confident with the technique yet. If it's a 50yo war vet who could care less or a gomer circling the drain, then you certainly should jump in there and go for it. I remember setting up the sterile packs and supplies for one office procedure in front of a patient. He asked me if I was gonna perform it, and I said, "no, I've never done one of these before, so I'll just assist the doctor." The attending walks in and tells me to, "go ahead." It was kinda funny, but the patient told me he didn't mind as long as the doctor was observing. I did it all myself, it went flawless, and he thanked me at follow up a couple days later.

I'm sure the psych hopefuls will jump all over me, but I think 98% of the GAD stuff is just a crutch and all in your head. Everyone experiences that stuff from time to time - especially the eager to please personalities which are very prevalent in health care. You just have to trust in your preparation and do the best you can; as was mentioned, you're not gonna kill someone by botching simple stuff like an IV, intubation, suturing a simple lac, fracture reduction, or LP. I use a square breath (inhale for 2sec, hold 2sec, exhale 2sec, hold 2sec... repeat) to calm down before a big procedure, public speaking, etc.

 

[getunconcsious]

Do you mind me asking what compelled you to be a physician? It sounds like you might have been happier doing something else (PhD?)

Well...I never really wanted to be a surgeon or anything like that. So I didn't consider procedures very much. I was thinking about IM subspecialty, peds, or psych when I went to med school. But then I took IM and it was too procedural. And peds is too procedural as well. Psych I enjoyed a lot. And also loved Pathology in MS2. So now that I'm actually here it's probably psych vs. path. I'm just wondering how comfortable I would have to be with procedures to 1) graduate medical school and 2) to practice in these fields. It makes a difference to me if Psych interns don't have to do as much procedural stuff on their medicine rotations as categorical medical interns. Also how much do path people really have to do bone marrow biopsies? I'm trying to get a feel for these things.

 

[haveaniceday]

Well...I never really wanted to be a surgeon or anything like that. So I didn't consider procedures very much. I was thinking about IM subspecialty, peds, or psych when I went to med school. But then I took IM and it was too procedural. And peds is too procedural as well. Psych I enjoyed a lot. And also loved Pathology in MS2. So now that I'm actually here it's probably psych vs. path. I'm just wondering how comfortable I would have to be with procedures to 1) graduate medical school and 2) to practice in these fields. It makes a difference to me if Psych interns don't have to do as much procedural stuff on their medicine rotations as categorical medical interns. Also how much do path people really have to do bone marrow biopsies? I'm trying to get a feel for these things.

I think it is important (as mentioned by others) that you find a way to actually confront your apprehension instead of avoiding it. If you are a psych intern on a medicine service, you likely need to function as a medicine intern, including doing all necessary procedures. If there is a choice to do one and one of your fellow medicine interns would rather do it, then let them...but this won't be the case all the time. I really think you cannot just assume that avoidance is going to work, that is not fair to your teammates.

I understand that you have a real anxiety and I think you need to try to deal with it. I have a lot of sympathy for you, but I also think it is imperative that you overcome them to the point that you *can* do them if needed if you want to graduate from medical school. Even on psych, if there is an emergency that requires a procedure and you are the only M.D. around, you have no choice. You cannot say: "I can't do that, I am a psychiatrist." That is the reason one must go to medical school and do a partial medicine internship to become a psychiatrist.

 

[MJB]

Well...I never really wanted to be a surgeon or anything like that. So I didn't consider procedures very much. I was thinking about IM subspecialty, peds, or psych when I went to med school. But then I took IM and it was too procedural. And peds is too procedural as well. Psych I enjoyed a lot. And also loved Pathology in MS2. So now that I'm actually here it's probably psych vs. path. I'm just wondering how comfortable I would have to be with procedures to 1) graduate medical school and 2) to practice in these fields. It makes a difference to me if Psych interns don't have to do as much procedural stuff on their medicine rotations as categorical medical interns. Also how much do path people really have to do bone marrow biopsies? I'm trying to get a feel for these things.

That makes sense. I wish you luck.

 

[hippiedoc13]

There are some good websites and videos online on how to insert a foley, on how to insert an NG tube, on how to suture, etc.

The NEJM website has a number of these videos, which are of great quality. You should be able to access them through your school's institutional subscription to NEJM.

And I would just echo what others have said on here, which is that it is important to confront this anxiety and learn to do these skills. Once you get a few minor procedures under your belt, it will do wonders for your self-confidence...there are few things that feel better than looking back and realizing that you have been successful at something you thought you'd never be able to do!

Some of the best advice I ever got came from a mentor early in med school: "Welcome to medicine. Time to get comfortable being uncomfortable." No truer words were ever spoken.

 

[getunconcsious]

Well thanks for the advice all. I guess I *can* do stuff if I have no choice. I did deliver 2 babies and countless placentas without any mishaps of any consequence. I think I'm honestly more worried about procedures now than I was then. OB/Gyn was my first rotation and since then, I've never even been offered the chance to do procedures. It's just all notes and rounds and stuff. I guess maybe it's good that I have surgery last since I'm sure that one will force me to become a little more acclimated to procedures again. I'm not sure what all procedures psych interns do on their medicine months. I'm guessing on their neuro months they have the one procedure that neuro has...the LP.

 

[Brian Griffin]

There's nothing worse than when you realize you have anxiety about something in medicine that you didn't think you would... this is a little off topic, but I've always been a pretty social person and I never thought I had trouble communicating with patients before, but I just started Family Medicine (my first outpatient experience)...and I'm realizing, I'm totally anxious/uncomfortable about taking a sexual history and talking about other personal topics such as that with patients. It's not that I have a problem talking about sexual issues or any judgments about it or anything (at least I don't think I do), I think I just get so caught up with how exactly to say certain things "appropriately" and how to find the right words... I definitely get anxious about it and then I feel kind of flustered... and I'm sure it shows in front of the patient.

I think the key to beating anxiety about things like this is to (as people said above) just kind of fake it til you make it. I've found that, with doing procedures, I know that I have to appear confident in front of the patient or else they'll get really nervous, so even if I'm feeling anxious about it, I always try to act confident, even when I'm about to do something I've never done before. And it kind of works, even though I think I'm "acting", I definitely feel more confident about it if I just approach it in a confident way. I guess the same principle should apply to having uncomfortable conversations as well. I liked what someone quoted above... "...time to get comfortable being uncomfortable." It's so true... but regardless, anyone have any tips or tricks that helped them overcome a bit of social anxiety when it comes to addressing personal issues with patients?

 

[SocialistMD]

getunconscious-

Does your medical school offer skills labs? At my medical school, we had to practice procedures on each other; where I am doing my residency, we have rubber arms, sides of ribs, etc... on which to practice procedures. It sounds like your anxiety could be overcome with more exposure, and you should know how to do basic stuff in case you find yourself on call at HCPC and someone codes. I would ask Dr. McNeese or the program directors of anesthesia/surgery if they have any simulator stuff you could do (particularly anesthesia; I don't think the surgery department has anything like that. At least, they didn't when I was there). Either that, or find out which fourth year is doing an anatomy rotation currently and practice on cadavers.

P.S. There are many residents in pretty much all fields who are still terrible when it comes to procedures. I still give the nurses a, "What do you want me to do about it?" when they come to me saying they can't place a peripheral IV because if they couldn't get it, the odds of my getting a peripheral are about zero. While you'll have to learn to do procedures, you don't have to be good at them to be a good physician and you shouldn't let this dissuade you from choosing a career that you would otherwise enjoy.

 

[chagall]

Yes, I had a similar issue. Getting some handle on the anxiety through medication has really opened up a new world for me in terms of future specialties...I was thinking definitely path, but I got to the point where I actually enjoyed patient interactions (a lot) and procedures (with some definite nervousness still at first!). So now I'm going into a clinical field that I love. PM me if you like. (Note: I'm not giving medical advice, just telling my story).

 

[Top Gun]

You know, when I started clinical rotations, I had anxiety about doing procedures as well. But whenever I had success with a procedure (i.e. thoracentesis), I experienced a real sense of accomplishment. Eventually, I even came to enjoy doing procedures as well. And whenever I was unsuccessful with a particular procedure (I had trouble with intubation during my anesthesia rotation), I would think, well, I was unsuccessful, but at least I tried. And for those procedures I still have trouble with, I will take every opportunity to practice them, including during residency. Don't let anxiety stop you. Conquer your fears, and think of every procedural opportunity as a learning experience.

 

[diosa428]

I just want to second the NEJM videos. They're great, and short, so you can watch them multiple times until you really feel comfortable with the procedure.

 

[medicinesux]

don't forget about autopsies in path- I know the patient is dead and all but that is still quite a procedure if you ask me

but pick your poison....medicine is all about paperwork and procedures! I absolutely abhor paperwork and I initially stunk at procedures in my med student days. However, my fear of procedures wasn't enough to outdo my disdain for paperwork eventually leading me into a more procedure oriented specialty. Therefore, I now find myself doing procedures I never imagined myself doing five years ago. The only way to overcoming fear is meeting it head on and confronting it.

 

[marie337]

I can completely relate with your post. I posted a very similar question a few months ago. Any time there is a possibility of me actually having to do something procedural my anxiety takes over. The only thing that works for me is to focus on one patient at a time. If I get up in the morning and thing of all the things I have to do that day, then my day is shot. I really try to just get through one thing at a time. Just keep in mind that all of this is only temporary. Eventually you are going to settle into a field that you like, and do that for the rest of your career. You will be good at what you enjoy. Also, if we were expected to know how to do everything, we wouldn't still be paying tuition to learn. Always keep in mind that you are paying for these people to teach you how to be a doctor. Take what you can from every experience and move on to the next one. Things haven't necessarily gotten easier for me either, but it really seems more tolerable if I keep these things in mind.

 

[Hard24Get]

I agree with most everyone - therapy/+/- anxiolytics + prepared, repeated exposure is the way to go. I will also offer you the mantra I use, "feel the fear, and do it anyway". There is a great book by the same name.

 

[LadyJubilee8_18]

LOL, maybe not the *most* modest. I only said this b/c I have to play up my strengths which in this case is fund of knowledge. Besides, most people hate reading and I like it so it is a fairly accurate statement. Because I suck at the actual procedures and hate doing them, I have to do SOMETHING to impress the attendings/residents. Not only do I lack manual dexterity in general, but being nervous makes it 10 times worse. I don't know why I didn't think this would be such a problem BEFORE I went to med school, I just wasn't thinking that far ahead I suppose.

Someone mentioned doing procedures under anesthesia, which is true that it helps you. I catheterized people under anesthesia and wasn't really that nervous about it. As far as what procedures I've tried, I've delivered 2 babies and countless placentas, stapled and removed staples, done a bit of surgical assisting, and that's about it. After OB/Gyn, my first rotation, I pretty much was never asked to do procedures again. I would probably not take an anesthesia elective b/c it would require me to entubate people, which is something that I simply can't do and I don't think I could ever do it.

I'm very nervous about surgery rotation. I can't sew or do 2 handed knots or anything. I tried practicing for hours and hours on OB/Gyn and never even came close to getting it. I can't do simple interrupted stitches, nothing. I lack the capacity to orient things in three dimensions and also the manual dexterity required. The other thing I'm super worried about is graduating, since our dumb school requires a critical care rotation during MS4. There is no way that I can not suck at that. I'm hoping that I will be able to scrape by with a pass. I've started 1 IV on a classmate, never drawn venipunctures, basically I will try to duck out on any procedure I can. Sometimes I even lie to attendings and residents telling them that "I've never seen one before" so that they will let me watch and not make me do it.

It's a big problem I know, but I'm just not sure how to overcome it. I guess "just cowboy up and stick the tube down their throat" is probably the only answer, but what if I break someone's teeth or something doing this? On a separate but related note, does anyone know how much procedural stuff they expect Psych interns to do while on medicine/neurology? I've heard that at some places they really don't do much b/c they don't want to and also people don't really trust them to do it correctly. As far as path goes, yes it's only 1 procedure but it's about the most unpleasant procedure ever. Personally if I had to have a bone marrow biopsy there's no way I'd do it w/o sedation. I'm hoping that maybe most people are sedated for it? But again I dunno.

Anyways thanks all for the advice.

I'll help you hun! I'm going to use pigs feet and suture to practice before rotations. We can do it together. When is your surgery rotation? Mine is in the summer

 

[VentdependenT]

lexapro. Go see a doctor.

 

[kingcer0x]

Im good at simple procedures but for some reason i cant do foleys. I have only done 3, I have screwed up or failed more. Good thing nurses can do them HAHA.

 

[Ypo.]

Our school seems to be anti-procedure. I get told "no" at every turn. The other day I found out we were allowed to start IVs. Now I just have to find a nurse who is willing to let me try it on their patient (not likely on the OB floor lol).

 

[Arctic Char]

lexapro. Go see a doctor.

dude, vent got bigger! i must say that you have one of SDN's top 10 avatars . . .

getunconscious - i know what you're talking about. i thought i was going to love doing procedures in med school and i've learned that, quite frankly, i'm not a huge fan. its part of the game though, so i managed to learn the necessary things thusfar (blood draws, IV's, at this point), but man the first FNA i saw on an infant i was pretty surprised and i don't know if i would enjoy doing that. not so much finesse involved . . . and LP's . . . they just seem annoying. i mean, they're difficult enough as it is, but add to it a squirming kid and nervous parents and lots of staff etc etc . . . and thats when i say "you get the tissue yourself, i'll analyze it."

anyway, good luck in coming to terms. i'm sure we'll all find out niches . . .

 

[vtucci]

Well...I never really wanted to be a surgeon or anything like that. So I didn't consider procedures very much. I was thinking about IM subspecialty, peds, or psych when I went to med school. But then I took IM and it was too procedural. And peds is too procedural as well. Psych I enjoyed a lot. And also loved Pathology in MS2. So now that I'm actually here it's probably psych vs. path. I'm just wondering how comfortable I would have to be with procedures to 1) graduate medical school and 2) to practice in these fields. It makes a difference to me if Psych interns don't have to do as much procedural stuff on their medicine rotations as categorical medical interns. Also how much do path people really have to do bone marrow biopsies? I'm trying to get a feel for these things.

Your IM rotation was procedural? Damn-- we barely got to do any procedures during our IM rotation. I saw a paracentesis once but that was it.

I understand your anxiety. I feel it too sometimes. I am sure that even the most confident student feels that anxiety and fear of screwing up and hurting the patient (and if we don't, there is really something wrong with us).

I am planning to go into EM and I wish I had a ton of practice doing lines, chest tubes, intubations. The more I get, the better I tend to feel even when the unexpected happens (like the LOL with no veins and the need to do a peripheral line on her foot as opposed to the antecubital fossa).

 

[Doowai]

I like procedures, have done some but not alot - never done a paracentesis or thoracentesis. I picked my residency primarily on how many procedures I could learn.

I get scared, but somehow I can just do it. I am trying to think where it comes from. I guess I like adrenaline a bit. I liked when I worked security in a bar when I was in my twenties - approaching the problem patron, the heart rate pumping, wondering when it would really jump off, would someone try to stab me in the eyes with keys from behind, my individual tissue/cells were playing Guns and Roses WELCOME TO THE JUNGLE on a microscopic level.

I graduated 2 years ago, have been teaching in the meantime. I am certified to teach in 3 districts. One is really wealthy. I asked to teach at the most inner city school with the worst reputation. I love it. Heavy gang affiliation. One shooting at school this year and one other gun incident (but it was only one kid waving a gun to intimidate another kid). I have broken up several large brawls, one of them the kids filmed on their cell phones and posted on youtube. It was a large scale brawl. I hate teaching at the wealthy well behaved school.

I did not match last time - made a major mistake in an interview, and did not know how to present myself. never had to interview for a job before, for 16 years I owned my own businesses - I hired people, not get hired. Got some outside help on my personal statement and interviewing skills. This year presented myself much better and had a fair number of interviews and think I presented myself well.

This year got a prematch offer from a place with great pay, great vacation time, easy slow pace, near family,very safe small little town, great savings plan, but teaches almost no procedures. Turned it down. Can you believe it? After missing the match one year because of failing step 2 CK the first time, and then failing to match the next year - turning down a prematch 2 years out as a FMG. I did not feel good about it. I must be crazy - but I kind of like the pressure.

Late last night, with only a few minutes to go that anyone could offer me a prematch I get a prematch offer from the program that offers the most procedures : EGD, vasectomy, colonoscopy, stress treadmill, etc. I prematched, probably the last prematch offered in the nation. Its high crime, far from family, high volume very busy hospital, less vacation time,... but I feel good about it. Its ghetto and perfect for me. I am basically a loser, but someone up on high always seems to help me out - I have dodged so many bullets in life; literally and figuratively.

I dunno - I grew up in an environment in which I got beat up at home and there was alot of fighting at home. I got beat up in school alot until I was about 12 - got a weight set, took Karate and wrestling and soon was someone few people would mess with. Had a guy bring a gun to school to kill me in 9th grade. Adrenaline and stress was just a daily thing.

Just a thought and I could be way off base - maybe people who love procedures come from highly dysfunctional backgrounds and don't feel normal if there is not alot of adrenaline. If you came from a nice normal upbringing maybe you just are not used to adrenaline pouring through your arteries like gasoline through a NASCAR engine. Maybe calm feels normal to you???

I dunno just a thought on why some people like stress and some don't. I loved turning down a great prematch offer, with mediocre board scores, FMG, out 2 years . I just knew that once again I would be blessed and things would turn out okay.

Maybe thats another factor - some people have a feeling like things will work out, and others don't.

So maybe its just a need for stress and an innate feeling like it will all work out. I dunno

Sorry you are struggling with this. I know that if you decide to you can overcome this and weak things can become strong to you.

 

[tkim]

Uh, were you addressing the OP's question, or using it as an opportunity to talk about yourself? I'm confused.

 

[MeowMix]

OP: don't worry, in many places the interns, residents and med students are competing to do procedures. If you don't want to do it, just hide while the task is being assigned, or generously give your med student the opportunity. There is no need to freak out.

 

[smq123]

I'd really hate to be shut out of psych or radonc because of an internship that would last only six months or a year, but I honestly have huge doubts that I would ever be able to do it. I just don't think I'll ever be able to entubate someone, do an LP, place a central line, etc. I realize that these are all things that can probably be taught, but I just can't get past my anxiety! I'm even worried about pathology because you do have to do bone marrow biopsies!

I don't think that pathologists everywhere do bone marrow biopsies. At my hospital, the heme/onc fellows do the biopsies - the pathologist just reads them.

Also, don't feel like you're "locked out" of psych just because you're not comfortable with procedures. Someone else with a similar issue posted this:

http://forums.studentdoctor.net/showpost.php?p=6175481&postcount=11

The person who posted that is a PGY-4 in psych. If that person could do it, then I'm sure that you can too.

 

[getunconcsious]

Just a thought and I could be way off base - maybe people who love procedures come from highly dysfunctional backgrounds and don't feel normal if there is not alot of adrenaline. If you came from a nice normal upbringing maybe you just are not used to adrenaline pouring through your arteries like gasoline through a NASCAR engine. Maybe calm feels normal to you???

I dunno just a thought on why some people like stress and some don't. I loved turning down a great prematch offer, with mediocre board scores, FMG, out 2 years . I just knew that once again I would be blessed and things would turn out okay.

Maybe thats another factor - some people have a feeling like things will work out, and others don't.

So maybe its just a need for stress and an innate feeling like it will all work out. I dunno

Sorry you are struggling with this. I know that if you decide to you can overcome this and weak things can become strong to you.

Thanks for the advice. But, your thing about adrenaline isn't true for everyone. I actually grew up in a pretty bad situation with a lot of DV-type issues for about half my childhood. It is for this reason that I believe my fear response is actually OVER-conditioned. I'm afraid of situations in which normal people would not be, because I was always scared at home before. That said I'm of a distinctly different temperament (somewhat effeminate) and thus tend to react with fear/avoidance rather than rage/confrontation. Probably much more than anyone needed to know, but I think your theory is interesting. It sort of makes sense but it fails to account for inherited differences in temperament. Environment matters of course, but kid A exposed to the same situation for the same duration as kid B will react differently, and each will learn the conditioned responses that work best to ease his pain. It's my belief that cognitive patterns are at least half inborn. Thus some kids from "normal" backgrounds, while they may have fewer deviant responses one way or the other (such as us being on opposite extremes), would still exhibit a range of interests.

Well that was off-topic but oh well. I guess now everyone can tell that I'm interested in psych. 😎

 

[Mayhem]

I wouldn't worry. I used to sweat like mad and tremble whenever I had to do something, even just site an IV. I would have caved except that we have graded procedure cards for each rotation so I had to sack up or fail. After a little practice you stop over-thinking things and it just becomes routine. Granted, I still sweat like mad when I'm being observed but in general it's not a big deal and most people accept that we're students so when we miss the intubations, they just take over (I'm on anaesthesia).

Btw, I have a theory that most people rush to procedures because it allows them to feel like they're doing something on the ward instead of just observing for 8-10 hours a day. Same reason we proudly declare for the the whole world to hear that "We're on duty" as though the hospital would grind to a halt if we weren't there. It helps us feel like we serve a purpose plus there's that small chance that it will get us some good press with the Doctors. It all feeds into my theory that med school is a cult and we're slowly being brainwashed.

 

[McDoctor]

I feel like I may be the only person who's like this. I'll take a good review book over the "opportunity" to learn procedures. I hate procedures. To a lesser extent, I dislike writing H&P's and progress notes too. A lot of people in the thread about evals said that they get the comment "needs to read more". This has never happened to me since I'm typically the most well-read student on the team. I don't get why most students would rather learn procedures. It just makes me want to have a panic attack b/c I know I will get it wrong, and also I don't like hurting people.
While it's nice to have a great fund of knowledge, I feel that my hatred and outright dread of procedures severely narrows the field of potential career choices for me. I hate hands on stuff so much that even though I loved psychiatry I honestly don't know if I could deal with 4 months of medicine and 2 months of neurology as an R1. The thought of doing an LP in neurology makes me break out in a cold sweat!

Hopefully this won't be too much of a problem, since I think I would like to do Pathology. My worry is what if I like something better than path (Psych and radonc are the main contenders), I wouldn't be able to do them b/c I can't handle an intern year. Is there any way to calm the hell down? I've always been an extremely anxious person, and in the past have been diagnosed with both panic disorder and GAD. I don't get "out of the blue" panic attacks anymore, but I often struggled with them on OB/Gyn. GAD is still alive and well. I've been able to almost always escape procedures except for OB/Gyn, but I'm probably doing myself a disservice. I'd really hate to be shut out of psych or radonc because of an internship that would last only six months or a year, but I honestly have huge doubts that I would ever be able to do it. I just don't think I'll ever be able to entubate someone, do an LP, place a central line, etc. I realize that these are all things that can probably be taught, but I just can't get past my anxiety! I'm even worried about pathology because you do have to do bone marrow biopsies!

Is there any hope for me? 😕

The more empathetic you are, the harder it is to do a procedure. Most any procedure involves harming a person in some way, whether by making an incision, or probing with a needle, or inserting a speculum, etc...this isn't necessarily a glaring weakness. You are just more suited for some specialties over others.

Personally, I hate procedures, primarly because they are redundant and boring. Nothing bores me like a punch biopsy or removing a mole. I am in family medicine, and I turf as much of this crap as possible onto my partners. (I don't make alot of money).

My days of getting barked at by some scrub tech about where to stand and what I can and can't touch are over, and yours will be too, sooner than you realize it.

 

[Anka]

.