The struggle is real

[ExcaliburPrime1]

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I thought it would be easier by now, but every day is a struggle as a psych resident. I constantly feel overwhelmed and I occasionally feel like no one (least of all me) has got a clue about a patient's symptoms and their plans.

The funny thing is, I go through the motions and get a lot of praise over being a good intern, but deep inside I feel incredibly inept and that it's a short matter of time before the crumbling edifice collapses.

Should I bother bringing these thoughts to the Chief Resident or someone higher up? Should I continue going through the motions in the hopes of a brighter future a few years down the line? Should I resign and perhaps apply again next year or even reconsider this career path and do something new? I haven't got a clue. 🙂

 

[birchswing]

My disclaimers aside,
<——————————
sounds like impostor syndrome,
unless you can point to real tangible evidence that others really know or can do something that you can't to a degree that they are providing medical care and you aren't.

Or, you could be running up against limitations of the field that were misrepresented to you and others are less conscientious about those compared to you. I wish I could think of an example that didn't sound so crass, but when you look at factory farming, there are people who will get a job and see what others are doing and quickly internalize certain actions as normal. There are the rarer few who see things that don't feel right and who can't let those feelings pass. I've never worked in farming, but I worked at a restaurant once where we all used the same disposable glove for collecting tortilla chips from a warming drawer—day after day after day. It had holes in it so that some of my fingers weren't covered. It didn't even make sense to use it as it was probably more dirty than my hand. I looked around at people to get an acknowledgement that this was insane, but it was what they had always done and they were just working to get through the day. Their concern was not the safety of the customers but about not being hassled. It's easier to just get along.

I'm sure the same thing happens in medicine. If you raise doubts, if you ask too many questions, if you point out that it's impossible to know something with certainty, you're creating waves. So instead you doubt yourself and assume everyone knows something you don't.

Just spitballing. Take anything that seems true and leave the rest.

 

[Fan_of_Meehl]

I thought it would be easier by now, but every day is a struggle as a psych resident. I constantly feel overwhelmed and I occasionally feel like no one (least of all me) has got a clue about a patient's symptoms and their plans.

The funny thing is, I go through the motions and get a lot of praise over being a good intern, but deep inside I feel incredibly inept and that it's a short matter of time before the crumbling edifice collapses.

Should I bother bringing these thoughts to the Chief Resident or someone higher up? Should I continue going through the motions in the hopes of a brighter future a few years down the line? Should I resign and perhaps apply again next year or even reconsider this career path and do something new? I haven't got a clue. 🙂

As long as your struggling doesn't involve your work dipping seriously beneath standard of care/practice or putting patients at risk and you're receiving genuine praise...

You may just be on your way to becoming an actual competent mental health clinician (which the world needs more of).

Nothing more dangerous in a mental health clinician than being overconfident and oblivious to one's limitations or being blithe or disconnected from the responsibilities of delivering adequate care.

Growing pains?

I always say that clinical psychiatry/psychology can either be done very well (in case it is incredibly emotionally and intellectually demanding) or very poorly (which, alas, pays the same as doing it well). Often your own conscience is the only thing driving you to continue to put real effort into your differential diagnostics, chart reviews, and treatment plans. I wouldn't seek to extinguish that fire, just dim it down to a pilot light so you don't overheat.

 

[Doctor Bagel]

I'd be much more worried if you thought you knew what you were doing. 🙂 I still feel like I don't have a clue most days.

 

[wolfvgang22]

It sounds like you are suffering from some burn out. When I feel as you do I try to take a step back, remind myself I can't do everything and ask for help. As a resident doing inpatient, nurses and fellow residents were good sources of support when I needed a little. Don't be afraid to ask their opinions about patient care. Make sure you have some time off scheduled and be sure to do something you enjoy. Try to forget work for a little while when you are at home each day.

 

[OldPsychDoc]

Do talk to a Chief Resident or other trusted senior. Chances are they've felt the same stuff--and still do many times.

 

[Dharma]

I thought it would be easier by now, but every day is a struggle as a psych resident. I constantly feel overwhelmed and I occasionally feel like no one (least of all me) has got a clue about a patient's symptoms and their plans.

The funny thing is, I go through the motions and get a lot of praise over being a good intern, but deep inside I feel incredibly inept and that it's a short matter of time before the crumbling edifice collapses.

Should I bother bringing these thoughts to the Chief Resident or someone higher up? Should I continue going through the motions in the hopes of a brighter future a few years down the line? Should I resign and perhaps apply again next year or even reconsider this career path and do something new? I haven't got a clue. 🙂

I wouldn't be surprised if the vast majority of your classmates feel like this at least some of the time. That feeling you describe... helps drive you forward to keep improving. At least that's what I tell myself.

 

[Ceke2002]

I thought it would be easier by now, but every day is a struggle as a psych resident. I constantly feel overwhelmed and I occasionally feel like no one (least of all me) has got a clue about a patient's symptoms and their plans.

The funny thing is, I go through the motions and get a lot of praise over being a good intern, but deep inside I feel incredibly inept and that it's a short matter of time before the crumbling edifice collapses.

Should I bother bringing these thoughts to the Chief Resident or someone higher up? Should I continue going through the motions in the hopes of a brighter future a few years down the line? Should I resign and perhaps apply again next year or even reconsider this career path and do something new? I haven't got a clue. 🙂

Do talk to a Chief Resident or other trusted senior. Chances are they've felt the same stuff--and still do many times.

Agree with OPD, you should talk to your Chief Resident or a senior adviser type that you trust. You might be surprised to find out how much self doubt they experience themselves. My Psychiatrist is a senior consultant/head of department, and he still questions and doubts his own abilities - difference is he has the experience, and the support network, to deal with those doubts before they take over too much and start affecting patient care. Maybe your Chief Resident et al may have some similar advice for you as well, ways to manage the doubts, and so on.

All the best. 🙂

 

[milesed]

You are only 2 months in right? You're not supposed to know much at this point. What service are you on?

 

[Monocles]

I think everybody is in the same boat! We have a professional development course with one of our instructors and she says that almost every psych resident goes through a disillusionment/depression phase during intern year. I thought I was the only person experiencing those things and then I opened up and talked to my co-residents about it and it turns out that everyone had the same feelings. Even my friends who went to other programs are going through the exact same. It helps to be able to talk about it, are you close to any co-interns in your program? Do you have access to resident therapy?

 

[SeniorWrangler]

Sometimes people feel like this initially when working with the severely mentally ill - they feel like it's an impossible job because there's no way to "fix these people". After a while you realize that that there are no fixes, and that good work and compassion are all you can offer.