I feel like an idiot all the time, what is wrong with my brain?

[cryhavoc]

Intern here. I feel like I never know what I’m doing for my plans unless I use uptodate. I feel slow. I thought it might just be because it is all so new and all my seniors and attendings have so much experience but then this happened.

I have some online hobbies where I play games with people online. I’m losing every game lately. My memory is in shambles. I feel stupid, lose all the time where I used to win the majority of the time.

So now I’m pretty sure my cognitive ability had actually declined and I’m dumber than I have ever felt in my life! What can I do? I feel so stupid all the time and I never used to be so dumb.

My attending questioned me on something any medical student could get right most of the time the other day and I got it wrong! I knew the answer and said the opposite.

I’m seriously concerned. I am sleeping great, eating healthy and making time for fun. There is no reason for me to be acting so dumb.

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[GoSpursGo]

Intern here. I feel like I never know what I’m doing for my plans unless I use uptodate. I feel slow. I thought it might just be because it is all so new and all my seniors and attendings have so much experience but then this happened.

I have some online hobbies where I play games with people online. I’m losing every game lately. My memory is in shambles. I feel stupid, lose all the time where I used to win the majority of the time.

So now I’m pretty sure my cognitive ability had actually declined and I’m dumber than I have ever felt in my life! What can I do? I feel so stupid all the time and I never used to be so dumb.

Literally, you are tired. Go to bed.

 

[cryhavoc]

Literally, you are tired. Go to bed.

I usually get 7-8 hours a night. Sometimes 6 because I wake up a lot. But even on the days I get 8 I feel slow, even with caffeine.

 

[Kissmyabjj]

This was exactly how I felt for the first 3 months of intern year. Using UpToDate is a GOOD thing.

 

[Giovanotto]

You have time to get on uptodate? Also, FWIW, I feel the same way. I have a tremendous sense of fatigue this year, and it has certainly impacted my cognitive abilities. Let us know how it goes throughout the year, hang in there.

 

[wholeheartedly]

I usually get 7-8 hours a night. Sometimes 6 because I wake up a lot. But even on the days I get 8 I feel slow, even with caffeine.

Hours of sleep and quality of sleep are two very different things. I’m not a resident but my job has gotten immensely stressful with covid and even when I log a good amount of hours, i’m still an exhausted idiot because it’s apparently not quality sleep. So that might be your problem.

 

[FrkyBgStok]

You are an intern. In addition to not knowing any medicine and having to learn it quick, you have to learn an EMR, a hospital, the daily routines, the attending personalities, etc. Internship is a super steep curve. And after a few months, you will remember a couple facts from all your UpToDate and use it less. and then even less. and before you know it, you are a second year and you know a little bit of medicine. And remember, you are there to learn. So nobody expects you to know everything.

My little spiel when dealing with med students, interns, or even senior residents is that I don't expect you know all of my questions, I want you to use what you know and try to think through it. this applies to you and those questions. and people don't realize how hard the "guess what I am thinking" game is. I am a second year fellow and had an attending asking me in 5 different ways what the foundational pathophysiology of shock is and I couldn't get there based on his wording. Felt like an absolute fool when he said "decreased oxygen delivery to the tissues." so even the embarrassing mistakes happen to us who have been through it.

 

[Raryn]

I usually get 7-8 hours a night. Sometimes 6 because I wake up a lot. But even on the days I get 8 I feel slow, even with caffeine.

It will get better. You're in a stressful transition.

Do your best to eat right. Get sleep. Take advantage of what days off you have. The days, weeks, month, and whole year will fly by before you know it.

 

[sharkbyte]

Been feeling the same way OP. I've been freezing up a lot on rounds, getting nervous when I just need to relax and think things through.

I think it'll just come with some time. Right now pretty much every patient presentation makes me somewhat nervous (unless the attending is super chill) because I know I know very little.

 

[LucidSplash]

All of the above. Also, responsible caffeine use. Easy to go overboard, use at wrong time of the day, etc. if you drink later in the day, can affect your sleep quality even if it doesn’t keep you awake. Personally when I was using too much caffeine my brain felt like a blender sometimes.

 

[j4pac]

Read about sleep hygiene. Your late night gaming may be a problem. Reshuffle your schedule to avoiding gaming one hour before bed

 

[deleted1053216]

Intern here. I feel like I never know what I’m doing for my plans unless I use uptodate. I feel slow. I thought it might just be because it is all so new and all my seniors and attendings have so much experience but then this happened.

I have some online hobbies where I play games with people online. I’m losing every game lately. My memory is in shambles. I feel stupid, lose all the time where I used to win the majority of the time.

So now I’m pretty sure my cognitive ability had actually declined and I’m dumber than I have ever felt in my life! What can I do? I feel so stupid all the time and I never used to be so dumb.

My attending questioned me on something any medical student could get right most of the time the other day and I got it wrong! I knew the answer and said the opposite.

I’m seriously concerned. I am sleeping great, eating healthy and making time for fun. There is no reason for me to be acting so dumb.

So fellow intern here, I completely see your point. To give you an example, I wanted to do a Thyroid lab on a person, I know TSH is the lab to start of with for thyroid issues, I had prepared my presentation to attending planning on saying I would like to do a TSH lab, but, what came out was T4 (for some godforsaken reason).

What I have come to realize is the concept of self-forgiveness is very important here. Mistakes are going to happen and bound to happen, but, what is important is don't let them block you. One of the challenging things as an intern is you never know where you are at and at times it is easier to be silent than asking an attending for feedback.

You will get better, experience is a great teacher. My mother likes to say often to me when I get stressed, Nobody learnt medicine in the womb, if that was the case medical school would not have been necessary. I sometimes think there are seniors that have forgotten what it felt like to be an intern, but even such people teach you, in their case to not be a jerk when you move forward.

Hope this helps!

 

[cryhavoc]

Thanks everyone. Feel less alone now.

 

[Sardonix]

As a fellow intern, this post and its responses was exactly what I needed right now.

 

[mvenus929]

I just want to throw in that sometimes it's your teachers that are making you feel that way.

When I was an intern doing my outpatient rotation, I had a patient who wasn't doing well with his asthma, and mom couldn't tell me what he was supposed to be on or what he was actually getting (the *definition* of a bad historian) despite me asking about 10 different ways. She was also very rude to me in general and not interested in engaging in care. As a relatively new intern, it was a very challenging patient encounter (I mean, challenging for anyone, but especially for someone who is also trying to learn the medicine).

I went to present to my attending and she proceeded to berate me in front of the workroom about my ability to take an asthma history and how I should have asked such and such, etc. I second guessed what I was supposed to know and do for asthma (which is a pretty routine visit in peds) and felt incredibly dumb, despite other evidence to the contrary.

That said, intern year is brutal and sleep deprivation makes you not think straight. Make sure you're getting enough sleep and are eating well.

 

[togaedere]

Completely agree with you that to some gaslighting appears to be a teaching strategy. It sucks and it shouldn’t happen but it does.

even if you *were* terrible at taking an asthma history, I don’t see what this attending felt you were supposed to get out of getting berated.

Our interns already feel SO BAD when they precept and we say “did you ask about X?” And they say “ahh I forgot.” You can tell they really take it to heart. It’s all part of the learning process, a focused history is a very difficult skill that even experienced physicians don’t get right all the time, and mistakes are part of the process.

I just want to throw in that sometimes it's your teachers that are making you feel that way.

When I was an intern doing my outpatient rotation, I had a patient who wasn't doing well with his asthma, and mom couldn't tell me what he was supposed to be on or what he was actually getting (the *definition* of a bad historian) despite me asking about 10 different ways. She was also very rude to me in general and not interested in engaging in care. As a relatively new intern, it was a very challenging patient encounter (I mean, challenging for anyone, but especially for someone who is also trying to learn the medicine).

I went to present to my attending and she proceeded to berate me in front of the workroom about my ability to take an asthma history and how I should have asked such and such, etc. I second guessed what I was supposed to know and do for asthma (which is a pretty routine visit in peds) and felt incredibly dumb, despite other evidence to the contrary.

That said, intern year is brutal and sleep deprivation makes you not think straight. Make sure you're getting enough sleep and are eating well.

 

[samac]

The other day I was reading some info on one of my patients while another intern was presenting a patient. Attending caught me off guard and asked me a stupid easy question about DVTs and how they’d cause a stroke. I just panicked and quickly said aorta. Sometimes we say dumb things. Sometimes we feel stupid. I think it’s ok.

 

[rokshana]

The other day I was reading some info on one of my patients while another intern was presenting a patient. Attending caught me off guard and asked me a stupid easy question about DVTs and how they’d cause a stroke. I just panicked and quickly said aorta. Sometimes we say dumb things. Sometimes we feel stupid. I think it’s ok.

And maybe pay attention in rounds...

 

[samac]

And maybe pay attention in rounds...

We’re allowed to work on our patients while other residents are going through their patient presentation and imaging. I knew what discussion was going on, but I was putting in orders for the patient we just talked about.
This was first day with a new attending and they had asked at least 6 questions of my co resident and I think she realized she didn’t pimp me through my patients so wanted to throw one my way. Thanks though.

 

[Candidate2017]

I am a second year fellow and had an attending asking me in 5 different ways what the foundational pathophysiology of shock is and I couldn't get there based on his wording. Felt like an absolute fool when he said "decreased oxygen delivery to the tissues." so even the embarrassing mistakes happen to us who have been through it.

The bigger question is why is an attending pimping a fellow.

OP, it will get better. To all the interns who are getting pimped: I had an IM attending who pimped the F out of me in intern year. Earlier this week, as a consultant on her patient, I asked her if she noticed his BP was getting out of control because no one bothered to restart his home HTN meds

 

[Apollyon]

The bigger question is why is an attending pimping a fellow.

20 years ago, when I was a med student, there was this Pulm/CC attending that I called "the Dragon Lady". One morning, she accused the fellow of trying to intentionally emotionally hurt her - because the fellow didn't order a manual diff.

As I've said many a time - "some animals have to live in the zoo, because they can't survive in the wild". And, in the zoo, they get neurotic and histrionic, because there isn't some predator to call them on their ****.

 

[Raryn]

The bigger question is why is an attending pimping a fellow.

Probably even more important to make sure the fellows know the basic pathophysiology of their specialty

 

[FrkyBgStok]

The bigger question is why is an attending pimping a fellow.

because I ask them to. I really want them to stretch to the limits of my knowledge. It is one of the best ways that I learn.

 

[Candidate2017]

because I ask them to. I really want them to stretch to the limits of my knowledge. It is one of the best ways that I learn.

Hmm, ok, some people like taking it rough. I find "pimping" whether it means "put in my place" or referring to making people prostitute themselves is distasteful, though wholly descriptive of medical training.

Personally, I feel "pimping" is only necessary to keep med students and interns on their toes and impart the need for keeping up with learning. Beyond that, I find seeing patients, reading, and having a discussion with colleagues more helpful than being asked random questions.

 

[samac]

Can I give another idiot story? Today I got paged on a patient at the VA that wasn’t mine that I knew nothing about. We cover the hospital on weekends after the residents there leave. It was before noon, I hadn’t been emailed a check out so I assumed the VA residents were still over there and told the nurse that. She said “oh there’s a Jimmy on here I can ask them” and I said that sounds great, assuming it was the resident at the VA. (I’m off service so I don’t know the residents other than the ones I’ve been working with.)
Nope, Jimmy wasn’t the resident. It was the god damn attending at the VA.
I feel like an incompetent dumb dumb.

 

[MLNS]

Can I give another idiot story? Today I got paged on a patient at the VA that wasn’t mine that I knew nothing about. We cover the hospital on weekends after the residents there leave. It was before noon, I hadn’t been emailed a check out so I assumed the VA residents were still over there and told the nurse that. She said “oh there’s a Jimmy on here I can ask them” and I said that sounds great, assuming it was the resident at the VA. (I’m off service so I don’t know the residents other than the ones I’ve been working with.)
Nope, Jimmy wasn’t the resident. It was the god damn attending at the VA.
I feel like an incompetent dumb dumb.

Cross covering is one of the biggest *****ic ideas to whoever came up with *****ic residency scheduling ideas

My favorite are the dickhead attendings who, when you tell them you’re the cross covering resident, berate you for not knowing some random detail they mentioned in note 72 from 8 weeks ago. Ya, man, totally got that info in my 30 second sign out 44 minutes ago.

 

[Sardonix]

Cross covering is one of the biggest *****ic ideas to whoever came up with *****ic residency scheduling ideas

My favorite are the dickhead attendings who, when you tell them you’re the cross covering resident, berate you for not knowing some random detail they mentioned in note 72 from 8 weeks ago. Ya, man, totally got that info in my 30 second sign out 44 minutes ago.

Meanwhile, you later consult them regarding a patient on their service later that night: "I don't know, I have a lot of patients."

 

[QuizzicalApe]

Everyone's giving a lot of good advice. At the end of the day, buckle down, get rest, don't sweat that you're relying on UpToDate because it's a good resource and you're not expected to know anything right now, and it gets better.

I knew second year was better than intern year when one of my co-residents stopped saying that he wanted to burn down the hospital during our downtime in the resident lounge.

 

[Food]

Yup, normal intern things. I'm a crit care fellow now and work with ophtho, anesthesia, ENT interns who are all extremely qualified but it's hilarious to see them struggle with the cognitive load of being in a completely new environment, working a real job in the real world and learning to communicate with a multidisciplinary team. What you're feeling is totally normal because when it comes to being a doctor - you're supposed to be dumb, you've only been doing it a few months. You'll be amazed by your progress come next July

 

[obgyny]

You’ll continue to feel dumb until you’re a 2nd year resident guiding the new interns and suddenly you’ll realize that you’ve actually learned quite a lot your intern year.

It’s the interns that think they know it all that worry me...

 

[mistafab]

I just wanted to chime in that I feel like a total idiot. Im doing pretty well most the time, and am pretty efficient... but over little things I just make these dumb mistakes that it seems like only one attending that I never have directly worked with sees. It's like every once in a blue moon I have 4 hours with this attending, and it is in this 4 hours I make a stupid mistake I never otherwise make. I just feel like i'll never be able to succeed working with this attending. They're always going to think I am a complete ******* and probably spread the word. How the hell am I going to survive this for four years with this person thinking I am completely incompetent. I just feel like a big dope. I do not want to get labeled the "problem" resident. Anytime i've made a mistake I have owned up to it and had a good attitude about it, with like a "learning" disposition and what have you. Just feel like my general incompetence is going to bite me in the a**.

 

[Sardonix]

I just wanted to chime in that I feel like a total idiot. Im doing pretty well most the time, and am pretty efficient... but over little things I just make these dumb mistakes that it seems like only one attending that I never have directly worked with sees. It's like every once in a blue moon I have 4 hours with this attending, and it is in this 4 hours I make a stupid mistake I never otherwise make. I just feel like i'll never be able to succeed working with this attending. They're always going to think I am a complete ******* and probably spread the word. How the hell am I going to survive this for four years with this person thinking I am completely incompetent. I just feel like a big dope. I do not want to get labeled the "problem" resident. Anytime i've made a mistake I have owned up to it and had a good attitude about it, with like a "learning" disposition and what have you. Just feel like my general incompetence is going to bite me in the a**.

Ah yes. The Achilles Attending. I got one of those too. They never do anything outright mean to me, but I feel like I will never meet their expectations.

I also realize these feelings are BS. You should too. It won't solve the issue, but it will help you frame it. We WILL get better. Everyone does.