Lacking insight

[greenleaves]

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I'm hoping to gain some perspective on my situation. I'm an IMG with average scores and an attempt on CS. I am book smart but not people smart. I've been taken advantage of incessantly, which has made me paranoid and always on the lookout for the worst scenario. The CS failure has further strengthened my belief that I have professionalism issues that may come to a head if I were to start residency. I also have what I can best describe as anxiety and extreme sensitivity to rejection. I replay perceived slights over and over, trying to discern some meaning or malicious intent behind the interaction. I start out any new relationship by being cheerful and always smiling even though my usual demeanor can be described as having "masklike facies." This usually disintegrates as over time I believe people think of me as "subversive" (their words not mine) and creepy. I labor under the feeling that I'm not normal and I can't do anything to fix it. Another descriptor someone used was "he's smart but not someone I'd hang out with after work."

I feel I have a schizoid personality and am happy to spend time by myself. Unfortunately residency isn't a place for fostering such behaviors and I keep worrying about it. I know I will pass any exam but the professionalism milestones are what I believe will sink my career. I can try smile and do genuinely care for patients but getting that across in a non sinister manner seems very hard. To add to my problems, my hands are always ice cold, which leaves a bad first impression when shaking hands and makes performing physical exams a discomforting process for the patient.

Is there hope for me to complete IM residency successfully in face of these concerns? I know it's important to have insight and self introspection but overdoing it can be really taxing and maladaptive. Is there something short of therapy that might help me cope? I would have chosen another area to work in but with loans and obligations, I feel my only way is to push forward.

TL,DR: I care and want to be liked but always come off as unlikable. Scared that I will fail the core competencies. Is there hope I will be able to adapt and survive 3 years?

 

[rokshana]

I'm hoping to gain some perspective on my situation. I'm an IMG with average scores and an attempt on CS. I am book smart but not people smart. I've been taken advantage of incessantly, which has made me paranoid and always on the lookout for the worst scenario. The CS failure has further strengthened my belief that I have professionalism issues that may come to a head if I were to start residency. I also have what I can best describe as anxiety and extreme sensitivity to rejection. I replay perceived slights over and over, trying to discern some meaning or malicious intent behind the interaction. I start out any new relationship by being cheerful and always smiling even though my usual demeanor can be described as having "masklike facies." This usually disintegrates as over time I believe people think of me as "subversive" (their words not mine) and creepy. I labor under the feeling that I'm not normal and I can't do anything to fix it. Another descriptor someone used was "he's smart but not someone I'd hang out with after work."

I feel I have a schizoid personality and am happy to spend time by myself. Unfortunately residency isn't a place for fostering such behaviors and I keep worrying about it. I know I will pass any exam but the professionalism milestones are what I believe will sink my career. I can try smile and do genuinely care for patients but getting that across in a non sinister manner seems very hard. To add to my problems, my hands are always ice cold, which leaves a bad first impression when shaking hands and makes performing physical exams a discomforting process for the patient.

Is there hope for me to complete IM residency successfully in face of these concerns? I know it's important to have insight and self introspection but overdoing it can be really taxing and maladaptive. Is there something short of therapy that might help me cope? I would have chosen another area to work in but with loans and obligations, I feel my only way is to push forward.

TL,DR: I care and want to be liked but always come off as unlikable. Scared that I will fail the core competencies. Is there hope I will be able to adapt and survive 3 years?

have you though about 1. getting some counseling to help with your issues and to get a proper dx (and not self dx) and 2. do a specially other than IM that has less patient/people contact (ie path or rads)? Realize that its a lifetime of dealing with people not just the 3 years of residency.

 

[greenleaves]

have you though about 1. getting some counseling to help with your issues and to get a proper dx (and not self dx) and 2. do a specially other than IM that has less patient/people contact (ie path or rads)? Realize that its a lifetime of dealing with people not just the 3 years of residency.

Unfortunately, I haven't gotten any IVs for path despite applying. I have the greatest chance at IM and I'm not going to look a gift horse in the mouth if I match. Under ideal circumstances I would aim for path.

I want to get counselling but I have been advised not to because of the stigma it might carry when applying for my license. I am deathly afraid but at the same time I've been advised that it's possible to adjust and make changes. The people telling me to suck it up and that everything will be fine are close family and other well wishers, which is the reason I felt the need for some unbiased advice. I'm willing to put in the effort needed to succeed at clinical practice but if I'm perceived as a malcontent, it's almost impossible to change that impression.

I identify myself in all the threads posted about resident firings and non renewals. I read their stories and see something like it happening to myself. I want to stave off getting under the microscope because once that happens, it's only a formality from that point on.

Is it wise to enter a residency contract in such a state, taking into consideration that this is my only chance to practice in the US?

 

[AdmiralChz]

You’ve unfortunately gotten horrible advice. If you are so affected to the point where patient care is compromised (possibly considering your description), it won’t matter what state boards think of counseling as you likely won’t complete training.

Get help first, then enter the clinical realm. You owe your patients the best doctor you can be.

 

[AdmiralChz]

I want to stave off getting under the microscope because once that happens, it's only a formality from that point on.

What does this mean, exactly? Your going to be under the microscope while in training and in practice.

 

[rokshana]

Unfortunately, I haven't gotten any IVs for path despite applying. I have the greatest chance at IM and I'm not going to look a gift horse in the mouth if I match. Under ideal circumstances I would aim for path.

I want to get counselling but I have been advised not to because of the stigma it might carry when applying for my license. I am deathly afraid but at the same time I've been advised that it's possible to adjust and make changes. The people telling me to suck it up and that everything will be fine are close family and other well wishers, which is the reason I felt the need for some unbiased advice. I'm willing to put in the effort needed to succeed at clinical practice but if I'm perceived as a malcontent, it's almost impossible to change that impression.

I identify myself in all the threads posted about resident firings and non renewals. I read their stories and see something like it happening to myself. I want to stave off getting under the microscope because once that happens, it's only a formality from that point on.

Is it wise to enter a residency contract in such a state, taking into consideration that this is my only chance to practice in the US?

don't listen to them, it is bad advice...you get in trouble during residency, then you may kill any career before you even have to discuss issues with a medical board.

get help, work out your issues which will ultimately let you be a better resident and physician... don't then you ultimately may be a danger to your self and your patients.

am surprised that you have gotten nothing from path since it tends to be less competitive than IM.

you may want to consider emailing programs you have not heard from to see what is the status of your application.

 

[greenleaves]

What does this mean, exactly? Your going to be under the microscope while in training and in practice.

I was referring to the various postings where residents are told they need improvement and from which point on, their actions are scrutinized more so than their peers. This has apparently caused many to get caught in a cycle where the end result is usually non renewal of contract.

And I guess patient care is compromised as it's possible patients didn't like me due to my nervous demeanor. I'm trying hard to overcome my anxiety by being more social at my current workplace but it's hard and I'm completely useless in after work gatherings. I feel the need to have alone time after working with people all day.

I will try to find a therapist and address these issues. But it's a very anxiety provoking proposition, never get a chance to practice by not taking a position vs. getting a chance to practice and blow it.

don't listen to them, it is bad advice...you get in trouble during residency, then you may kill any career before you even have to discuss issues with a medical board.

get help, work out your issues which will ultimately let you be a better resident and physician... don't then you ultimately may be a danger to your self and your patients.

am surprised that you have gotten nothing from path since it tends to be less competitive than IM.

you may want to consider emailing programs you have not heard from to see what is the status of your application.

I have been in touch but mostly I have received rejections. Judging on how this cycle has gone so far, my best bet is a program that offers pre match and I have such an interview scheduled for next week. I aim to find a therapist and try to overcome my issues. Is a psychologist more appropriate than a psychiatrist at such an early stage?

 

[mvenus929]

I was referring to the various postings where residents are told they need improvement and from which point on, their actions are scrutinized more so than their peers. This has apparently caused many to get caught in a cycle where the end result is usually non renewal of contract.

To be fair, you aren't hearing about all those people who get put on probation and then successfully pass residency. We've had a couple in years past. Granted, if the reason you are getting put on probation has to do with your lack of insight into the matter, then you're not going to be helped.