Stressed!!

[monalisa83]

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I just finished my first rotation in peds and I am completely losing my mind. I cant seem to just be myself anymore and am constantly worrying about what everyone around me is thinking of me. I get so hard on myself for making mistakes that I am having a hard time just learning from them and moving on. I tend to be an anxous person naturally, but the added stress of feeling like I am constantly being evaluated is really causing me to feel depressed to the point where I just want to quit- or at least take a break. Is it too early to feel like this? I've pissed off one of my interns already unwittingly, and I feel like such a jerk constantly finding myself saying and doing things I dont normally do that just make me look worse. My confidence has gone down the tube and I find myself on the verge of crying and sumtimes crying flat out in the bathroom and even in front of the interns. I end up spending so much time with my patient that my SOAP notes are later than all the other students. I am book-smart somewhat and did extremely well on my boards and generally do ok during pimping sessions, but Im just so constantly awkward and starting to feel more and more down about myself to the point where I cant even focus in on what the patient is telling me because my mind is so preoccupied by replays of mistakes made during the day or previously- and thoughts of how I just dont feel like I measure up to being average or even comparable to the other students. Any advice? Thanks in advance 🙂

 

[nutcancer]

NEVER EVER EVER make any conclusions based on your pediatrics rotation. If you didn't enjoy your peds rotation or felt akward (sic) in it, you're normal.

 

[ChildNeuro]

I just finished my first rotation in peds and I am completely losing my mind. I cant seem to just be myself anymore and am constantly worrying about what everyone around me is thinking of me. I get so hard on myself for making mistakes that I am having a hard time just learning from them and moving on. I tend to be an anxous person naturally, but the added stress of feeling like I am constantly being evaluated is really causing me to feel depressed to the point where I just want to quit- or at least take a break. Is it too early to feel like this? I've pissed off one of my interns already unwittingly, and I feel like such a jerk constantly finding myself saying and doing things I dont normally do that just make me look worse. My confidence has gone down the tube and I find myself on the verge of crying and sumtimes crying flat out in the bathroom and even in front of the interns. I end up spending so much time with my patient that my SOAP notes are later than all the other students. I am book-smart somewhat and did extremely well on my boards and generally do ok during pimping sessions, but Im just so constantly awkward and starting to feel more and more down about myself to the point where I cant even focus in on what the patient is telling me because my mind is so preoccupied by replays of mistakes made during the day or previously- and thoughts of how I just dont feel like I measure up to being average or even comparable to the other students. Any advice? Thanks in advance 🙂

Attendings and residents like to make you feel like an idiot when presenting, at least some can, regardless of what you do and don't do wrong. Try to forget whatever mistakes you made, after you learned from them, everybody is making mistakes from the attendings down to students. For the SOAP notes, ask basics in subjective i.e. any pain anywhere? N/V? SOB? Tolerating diet? Dysuria? Then ask some specific questions for you patients with a reason in mind, i.e. how is the leg pain today? It will get *alot* faster, I can do it all, and then write it down later, 10-15 mins. (more if there is something I need to talk about indeepth). A full consult takes me only a little bit more as I have to ask the SocialHx, FamilyHx, etc. . . then write up a plan. I would write out the template for the SOAP the day before, or better, come in early in the morning so that it doesn't burn up time later in the day. Relax, if you are worrying about your performance or are self-concious about it, it will impact your functionality, just focus on seeing the patients. Some peds preceptors are downright wicked!

 

[lumbering]

Hey Mona Lisa. I'm about two weeks into my first rotation (internal medicine), and I feel similarly. I'm also naturally book smart and anxious. I told myself that I wouldn't worry about my grade for the first four weeks, and it has taken a lot of the pressure off. Maybe in your next rotation (assuming that it is not your desired specialty), you can just go in with the intention of getting a satisfactory, learning a lot, contributing to the team, and enjoying life. You'll probably end up getting a satisfactory (which probably doesn't live up to your standards), but you'll gain a lot of comfort and confidence.

 

[Sean2tall]

I would not worry, especially not on your first rotation. For one, mostly staff and residents expect you to not be that smooth right off the bat. Taking a longer time to see patients is a normal part of starting rotations. You said you do pretty well with questions, but even then, they frequently don't expect you to know much. Getting the mechanics of talking to and examining the patient I think takes time to get rolling smoothly and more thinking about it is extra stress.

Additionally, if evals are something you are worried about, I would not waste a moment thinking about it. There is literally no way to predict how your evals will be unless you are making lewd comments all the time about patients' breasts or otherwise being offensive (Even then I can't guarantee you will get poor evals 😀).

Sometimes I have thought I looked like such a bonehead in front of a particular attending, only to find out that in the end that attending did not even turn in an evaluation of me. On another rotation a resident wrote in my comments that I was sometimes disinterested, but I got honors anyway. Anyhow, try not to worry! (I know that is like asking someone to not think!)

 

[LuckyBambooGirl]

Mona Lisa, I honestly was afraid I would feel like you on my first rotation, but I am starting out on surgery and I am so freakin tired that honestly I just don't care about any of that stuff. The way I see it right now, it is just a waste of energy! 🙂

Seriously, everyone looks like a bone head sometimes. The key is to not be too hard on yourself, and just try again. Remember that your attendings started out just like you. No one expects you to be perfect at this stage. I don't even want to count the bone headed things I have done in the past two weeks since I started my surgery rotation--I just learn from them and then don't bother with them anymore. Chances are no one will even remember most of the mistakes you have made. What is important is trying again.

 

[kat82]

monalisa
i am a 4th year student and while i cant say i experienced what youre feeling so early on, i definitely can relate. i had plenty of times where ive felt the way you feel, on and off during third year. i am also a very anxious person, and having your grades come from evaluations (sooo subjective!) can really add fuel to the "anxiety fire" and really set you off and get out of control.

my advice is, dont be so hard on yourself. especially since you are JUST beginning. remember that you are there to learn right now. you are NOT the intern, and its ok that you spend a little extra time on your notes, so what if you want them to be perfect? 🙂

dont worry that you dont know everything. like i said, you are there to LEARN and focus on that. my mother is an attending, and she tells me that the students who get the best grades/evals are the ones who are the nicest, friendliest and most enthusiastic. as long as youre trying your best and show that youre curious and ambitious (even if you have to fake it) thats really all that counts third year

countless times, i would beat myself up over answering something wrong, writing an imperfect note, or getting a negative vibe from a resident or even attending. but you know what? none of it ever mattered. at teh end of the rotation, i always did pretty well. people commented on my empathy, my enthusiasm, etc. nobody ever said "well, this one time, she got confused between muscarinic and nicotinic receptors" people dont remember that stuff!!

when you start to feel flustered, just take a deep breath and tell yourself "shake it off" and that you just need to do your best. otherwise, being flustered makes it harder to perform during rounds, etc, which will make you even MORE flustered!

so again, just focus on being likeable and do your best!! thats the best you can do!
best of luck
kat

 

[fedUP]

Hi monalisa,

I am an MS-IV and am the same way as you. I’m too hard on myself. I get easily discouraged and depressed. Everyone else might forget about a mistake that I make, but it will continue to haunt me for days and has a negative effect on my mood. I blame myself for everything! I am a very sensitive person and you sound the same way to me. For me, my 'big sib' and my parents are a constant source of support and encouragement for me. Sometimes talking things over with someone and hearing them verbally reassure that “you're okay” or even that your mistake is not a big deal helps so much.

You need to believe in yourself and have faith that things will improve with time. I had a resident who kept reminding me not to be hard on myself or expect myself to be performing at a resident level. We still have so much to learn. For instance, I still stumble and stutter and am sometimes all over the place when I present a case. I know that I am better today than I was when I started, and I know that I will continue to improve. Likewise, you'll be spitting out soap notes so fast before you even realize it. You have to remember that you are not an employee. You are not getting paid to see these patients. You are a medical student and the most important thing is for you to be learning from the work that you are doing. And so what if you spend a longer time with the patient or on the soap note? Isn’t it better to be thorough anyways? One year from now, I promise you that you will be so amazed by how much you've learned and much you've improved.

You need to keep in mind that people are not always judging you. I have been on rotations where I felt like an idiot and no matter how much I studied and read, the attending always managed to stump me (of course). I’ve cried numerous times. Yet, I’m always surprised when I receive a glowing evaluation raving about my performance. It makes me question why I’m so hard on myself. A senior resident once told me that attendings don't necessarily care about how much you know. They care if you are a friendly person who is easy to get along with and is 'teachable'.

You need to realize that you have accomplished a lot in your life and regain your confidence. You are well on your way to becoming a physician and that is something that not everyone can do. Just because this rotation is not going smoothly, it is not a predictor of future rotations. Sometimes you just click better with some people than you do with others and that can really make or break a rotation. If things do not get better, please talk to someone.

-fedUP

 

[fedUP]

Oh and seriously, don’t work too hard on getting people to like you. Just be natural and be yourself, and I am sure you are a likable individual. During third year I was so preoccupied and worried about whether or not this residency director or that residency directory liked me. Now my attitude has completely changed. I think I am a nice person and am easy to get along with. Now I look at the residency director and think do I like this person? Do I feel comfortable working with this person? Is this a program that I want to be a part of for four years? Trust me --- life is so much better this way! And things will fall correctly into place for you. Just take it easy and try not to let people intimidate you or worry too much. Act confident even when you’re unsure about an answer or whatever….. now this advice is coming from someone who still cries every time she reads an EKG wrong during morning report (ugh)!

 

[docjolly]

Hey Mona Lisa. I'm about two weeks into my first rotation (internal medicine), and I feel similarly. I'm also naturally book smart and anxious. I told myself that I wouldn't worry about my grade for the first four weeks, and it has taken a lot of the pressure off. Maybe in your next rotation (assuming that it is not your desired specialty), you can just go in with the intention of getting a satisfactory, learning a lot, contributing to the team, and enjoying life. You'll probably end up getting a satisfactory (which probably doesn't live up to your standards), but you'll gain a lot of comfort and confidence.

here, here! I agree with you lumbering. I, too, am in Internal Medicine (my 3rd week) and I feel a bit lost and overwhelmed. And it doesn't help that, at times, the attending with whom I am working makes me feel very inadequate. It's so frustrating and discouraging. But I'm going to keep positive, and try not to take things so personally. I'm learning how important it is to develop a thick skin, and how to turn every situation into a learning opportunity 🙂

 

[jdh71]

I just finished my first rotation in peds and I am completely losing my mind. I cant seem to just be myself anymore and am constantly worrying about what everyone around me is thinking of me. I get so hard on myself for making mistakes that I am having a hard time just learning from them and moving on. I tend to be an anxous person naturally, but the added stress of feeling like I am constantly being evaluated is really causing me to feel depressed to the point where I just want to quit- or at least take a break. Is it too early to feel like this? I've pissed off one of my interns already unwittingly, and I feel like such a jerk constantly finding myself saying and doing things I dont normally do that just make me look worse. My confidence has gone down the tube and I find myself on the verge of crying and sumtimes crying flat out in the bathroom and even in front of the interns. I end up spending so much time with my patient that my SOAP notes are later than all the other students. I am book-smart somewhat and did extremely well on my boards and generally do ok during pimping sessions, but Im just so constantly awkward and starting to feel more and more down about myself to the point where I cant even focus in on what the patient is telling me because my mind is so preoccupied by replays of mistakes made during the day or previously- and thoughts of how I just dont feel like I measure up to being average or even comparable to the other students. Any advice? Thanks in advance 🙂

This is a simple diagnosis: you are a big time people pleaser (all of us are to some extent, but this sounds like it is really interfering with your work, and I would suspect with your personal/social life as well). That level of codependcy is going to drive you crazy if you dont recognize it and deal with it. You have no control over people, places, instituions, and MOST situations. You CANNOT make people like you, and in fact, if your a good little codependent, your attempts to please will only be met with contempt. The solution is to STOP trying to make anyone like you or think your are smart or apologize when resident's get angry. Please pay attention! What others think of you is NONE of your business (think about it). It is not your responsibility to make sure they like you. You KNOW your responsibilties and those are to be a 3rd year student, and if you would concentrate on those areas: H&P's, prog notes, presentations, etc. and less on what everyone thinks of you, you live a much healthier, happier, and less stressful life, while at the same time being more real and learning all those skills that you need to sucede in third year - you will also gain something much BETTER than people "liking you" and this is RESEPCT. Who cares if they do not "like" you, if they respect you . . . Let everyone else worry about that nonsense.

 

[uL007]

This is a simple diagnosis: you are a big time people pleaser (all of us are to some extent, but this sounds like it is really interfering with your work, and I would suspect with your personal/social life as well).

you offer great, solid advice. however, i do not think monalisa's problem is that she is a "people-pleaser" per se. in my opinion, people-pleasers do not have public breakdowns. they are people who know how to brownnose and smooth talk.

monalisa sounds more like a sensitive person. she is too self-conscious and too aware of herself and her mistakes. there are a lot of people in this world who are like her. in fact, i think certain events can occur in ANY person's life that cause them to become overly critical and hard on themselves during a particular period. monalisa is just going through a rough time. she needs to hang in there and with time she will learn to lighten up on herself and not take things so personally.

 

[ChildNeuro]

you offer great, solid advice. however, i do not think monalisa's problem is that she is a "people-pleaser" per se. in my opinion, people-pleasers do not have public breakdowns. they are people who know how to brownnose and smooth talk.

monalisa sounds more like a sensitive person. she is too self-conscious and too aware of herself and her mistakes. there are a lot of people in this world who are like her. in fact, i think certain events can occur in ANY person's life that cause them to become overly critical and hard on themselves during a particular period. monalisa is just going through a rough time. she needs to hang in there and with time she will learn to lighten up on herself and not take things so personally.

I think peoplepleaser's worry alot about everyone is thinking of them, especially on rotations, when you get more experience, i.e. less brain power needed to be devoted to clinical work, the peoplepleaser part because easier to do because you can please everybody and do outstanding clinical work, IMHO. It is hard when you start because you are trying to figure everything out, and if you have an abusive attending then you spend too much brain-power and energy trying to figure out how not to be a target. No one could live like a third year does indefinitely, even though people may yell at you as a surgical resident, at least you will understand surgery much better than a third, and understand how to handle nasty attendings.

 

[persia]

I felt the same way on my peds rotation, I kept thinking 'how come everyone says peds people are so damn nice?!' I thought my resident and attending were some of the meanest people I ever met and they would roll their eyes at me and sigh and tell me how pathetic my attempts at soap notes were. 😡 I had just come from a rotation where I was often pronouced to be 'excellent' so that was hard to understand. And besides, no offense to anyone here, how hard is peds really? I mean, it's not heme/onc or anything. These are kids with frickin' colds and such.

I had really wanted to like peds but I was really turned off by that and I was miserable.

But I agree with everyone else here, and I wish I had learned this earlier in the year. Keep a wall between these comments and yourself. Be detached. Smile, and learn to say 'thank you!' for the comments. Looking back, I actually took the mean comments from the peds res seriously, but there wasn't much to learn really. Other rotations, I could discern more easily what they were trying to teach me, and I could appreciate that. Then, I really saw that they were trying to HELP me, and I was grateful for the feedback. SOme people are great teachers! and others sort of lose track of what their job is. Most students like the nuts and bolts like, no write your notes like this; use this book, read it like this; here's what this lab value means, etc.

One awesome intern told me that while you might feel like everyone is watching you all the time, mostly they are too busy with their own stuff, so just relax and be yourself. She also said that if ever any weirdness comes up with anyone, realize it is all about power and control. And right now you have neither so just submit and let them 'win' the battle. 😉 Try all these suggestions people have here and you will find what works for you. 👍

 

[oldbearprofessor]

And besides, no offense to anyone here, how hard is peds really? I mean, it's not heme/onc or anything. These are kids with frickin' colds and such.

No offense taken! Peds is easy. Just last night I was wondering whether the ventilated "peds patient" I had with pulmonary hypertension needed a decongestant or just some saline nose drops?? And what about my pedi patients on cardiopulmonary bypass (ECMO)? I just ordered them up some Pedialyte and their diarrhea was gone.

To the OP: Sorry you had a tough rotation. If peds interests you, try doing an elective later on after you've gotten a bit more clinical experience.

 

[VALSALVA]

No offense taken! Peds is easy. Just last night I was wondering whether the ventilated "peds patient" I had with pulmonary hypertension needed a decongestant or just some saline nose drops?? And what about my pedi patients on cardiopulmonary bypass (ECMO)? I just ordered them up some Pedialyte and their diarrhea was gone.

To the OP: Sorry you had a tough rotation. If peds interests you, try doing an elective later on after you've gotten a bit more clinical experience.

There's a huge difference between general peds. and peds. subspecialties. You understated these differences and the other poster failed to even mention them. Fact is, gen. peds is somewhere in between pedialyte and cardio-pulmonary bypass, but probably a hair closer to pedialyte.

 

[persia]

Alright, alright, I knew I shouldn't have said that. You got me OBP.

But what I meant was that on my rotation we only saw RSV kids and sepsis rule outs. We really never saw anything other than that. I wish I had been on a different service since some of my friends got to see some really interesting and difficult cases with the kids. And they learned alot! So maybe for me it was the patient load was really just that, kids with sniffles and colds. I also did a little peds onc and that was really interesting but Valsalva has a good point. General peds is really different from neonatology.

No offense intended, OBP.

 

[jdh71]

you offer great, solid advice. however, i do not think monalisa's problem is that she is a "people-pleaser" per se. in my opinion, people-pleasers do not have public breakdowns. they are people who know how to brownnose and smooth talk.

monalisa sounds more like a sensitive person. she is too self-conscious and too aware of herself and her mistakes. there are a lot of people in this world who are like her. in fact, i think certain events can occur in ANY person's life that cause them to become overly critical and hard on themselves during a particular period. monalisa is just going through a rough time. she needs to hang in there and with time she will learn to lighten up on herself and not take things so personally.

I do not disagree with you that this may be a transient phenomenon brought on by the stress of the rotation, and I don't know a single medical student at the beginning of third year who is not very hard on themselves. We are all obessive-compulsive personalities of different amounts of patholgy along a spectrum (with only the very rare reaching the level of "disorder" per DMSIV) and generally very self-critical. Thinking back . . . everyone was a genius, while I was a bumbling idiot . . . according to the committee in my head 😀

But, the OP is people pleasing - if you've had to sit through all the group therapy I have . . . you smell it coming off of people like a stink. It spirals out of control. Think about it like a "relapse" and the OP's "off" of the "people pleasing wagon". It's time to regroup, and come at the problem from a different angle, namely the solution. You cannot live in the problem and solve the problem, you MUST live in the solution. In the end, I only offer suggestions, but suggestions, from experience, I've found to work. The OP may take it or leave it.