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I stink at doctoring....

Discussion in 'Medical Students - MD' started by m1, Mar 7, 2002.

  1. m1

    m1

    I'm an M2, (I know, I signed up last year and didn't post much) and our class just learned all of our clinical skills. We now have to perform all these hx and physcials at our clinic and hospital. Anyway, after about a month of this I came to the realization that I totally stink at it. I'm fairly awkward at doing the skills and there are all these uncomfortable silences while I try to figure out what I am going to say. Does anyone else feel like this? Am I ever going to get good at this stuff?
     
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  3. quit worrying. when was the last time anybody perfected all their skills the first time through?
     
  4. ckent

    ckent Membership Revoked
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">Originally posted by wernicke:
    <strong>quit worrying. when was the last time anybody perfected all their skills the first time through?</strong></font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">I agree. When we all first interviewed patients last year, everyone had a laundry list of questions they basically just read from, often read in order while ignoring whatever the patient might have been saying :rolleyes: . I'm only a second year too, but I get the feeling that we will learn more about what we need to ask about when we learn more medicine. Part of working with your diagnostic tools, in my opinion, is just looking confident about what you are doing and making deliberate movements. You can put your stethescope on the patient's forehead to listen to their headache if you want to, they are not going to know that you don't know what you are doing unless you tell them (or one of your colleagues tells them) that you don't know what you are doing.
     
  5. Chill, take a deep breath, roll-play with friends, go over a few scenarios in your mind and when the time comes to do something, just do it. You're not going to be perfect. If you are concerned about it now than you will make a great doc!! <img border="0" alt="[Clappy]" title="" src="graemlins/clappy.gif" />
     
  6. tjmemtp

    tjmemtp Junior Member
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    Hey M1 your trying to hard. Its just like talking to someone, how hard is that. you'll be fine, just try not to think of yourself as a doctor and more of a person trying to figure them out. The pressure will fall and you r mind will begin to take less time and those awkward silences will be eliminated. I am not a physician yet, but I am a Paramedic and we have to ask the same questions a Doc does, so just have fun and pretend they are your friend. And any good skill comes with practice nobody and I mean nobody gets it right the first time. My first IV and intubation were both missed, but I kept on trying.
     
  7. hosskp1

    hosskp1 Senior Member
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    It takes years of practice-- all of medical school, residency, fellowship and years of clinical work to get really good at everything. At my rotation now- Medicine-- the Chief of the department is the best I have personally seen at H&P, dx, and other aspects of clinical medicine. He is older and has more experience than anyone else in the hopsital-- AND IT SHOWS. If I get sick, I want him as my primary care doctor. Many of the attendings are almost as good or at the same level, but I have personally worked with this guy. He keeps on saying that only practice will get you better-- I believe him.

    I got frustrated when I started too when I learned that I was not that good at H&P's -- So I try and do as many as I can and I feel like I do a better job than when I first started. I even dx a Pneumonia, a DVT, a viral meningitis. I have yet to hear a murmur though (although the attending and resident keep telling me it is there). I keep on trying because I am not up to the level I would like yet (I am better than some residents, but that is not saying much).

    BOTTOM LINE--- if I keep practicing, I will get better (I hope) and maybe that might work for you as well. No patient is going to ask how long it took you to get good at something if you do a good job for them. Rectal exams, Lumbar puntures, IV line, blood draws, ABG, catheter placement, sutures, percussion, ausculatation, reflexes-- I have a long way to go.
     
  8. Ludy

    Ludy Senior Member
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    I'm also an M2 and I completely agree, m1. We started practicing on real patients in October, just doing the history at first, and I'm now fairly comfortable with that (although I still "forget" to ask about sexual history because I'm usually at the VA and am too embarrassed to ask 70-year-old men how their sex life is). But we just started doing the complete physical a few weeks ago, and I feel the same way you do: I stink at it. I can't percuss, I have yet to see the optic disc, and I'm convinced that the patients are perfectly aware that I have no idea what I'm doing. The worst part is that in a few months, this is what I'll be doing all day and I'll be expected to not only look reasonably competent, but also to make diagnoses!
     
  9. vixen

    vixen I like members
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    </font><blockquote><font size="1" face="Verdana, Helvetica, sans-serif">quote:</font><hr /><font size="2" face="Verdana, Helvetica, sans-serif">You can put your stethescope on the patient's forehead to listen to their headache if you want to, they are not going to know that you don't know what you are doing unless you tell them (or one of your colleagues tells them) that you don't know what you are doing. </font><hr /></blockquote><font size="2" face="Verdana, Helvetica, sans-serif">CKent, you are too funny!! <img border="0" alt="[Laughy]" title="" src="graemlins/laughy.gif" />
     
  10. WSU02

    WSU02 Member
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    M1,
    Don't worry...every single doctor was an incompetent klutz in the beginning. I swear, you do get better...heck, by 4th year, you can do an adequate (not the complete, but an adequate) H&P in 20 minutes flat.

    The trick is developing your own style and algorhythm of questions...while allowing what the patient says to guide you. Takes practice.

    Trust me, in 1 year, you will be amazed at the difference in your skills.
    Kristi
    14 days until the match!!!!
     
  11. squeek

    squeek Senior Member
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    M1, I feel your pain. We've been seeing patients since last fall, starting with psych interviews and neuro exams, and then we moved into physicals (including rectal and pelvic). We have a test of our skills in two weeks, and most of the time I can't even remember to take the pulse! My last physical diagnosis instructor has been really encouraging, though. He says that it takes EVERYONE years and years to be competent, and even as an attending you never stop learning little tidbits of info about the physical. The best thing to do is try and keep trying, and one day we'll get better...we hope! :)
     
  12. m1

    m1

    Thanks for the replies.
    I figured it would take a long time to really become competent. One good thing is that I see the M3's at the hospital and clinic and they are really good at this stuff. Hopefully by this time next year I'll feel as confident as they appear.
     
  13. Voxel

    Moderator Emeritus 7+ Year Member

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    I'm a MS4 and the difference between my History/PE skills as a 2nd year and a fourth year are like day and night. My advice is to PRACTICE, PRACTICE, PRACTICE. You will learn what is normal vs abnormal and how to tailor your history and then PE to the patient's story.

    You will only know what different heart murmurs sound like if you listen to lots of normals, and then when any sounds that are out of the ordinary appear, you will say "hey that's not normal and haven't heard that in my last 20 heart exams". You will then use the various tricks you have learned (or will learn) about listening with the pulse, asking the patient to lie in certain positions, vasalva, PMI, etc.

    Everything comes with time. Use every opportunity to practice. You are there to learn.
     

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