Throw in the towel?

[epsilonprodigy]

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1 month into intern year and seriously considering the possibility that I'm not cut out for this. I chose a specialty where malignant personalities and pimping are problems, knowing full well that I don't fare well with either. I chose the field because I loved it- still do. I was ver lucky to have some supportive attendings and residents in school who taught me a ton without being jerks. I can really flourish in that kind of environment, but, I freeze up and can't even tie my shoe when I have a really mean attending. It sounds wimpy, and I know it's ridiculous, but it's affecting my performance and my learning terribly. Also, I'm ridiculously slow at everything and can't keep my patients straight in my head without looking at my paper, leading to crappier presentations than a July MS-3 (no offense guys.) also, when I feel really overwhelmed, I end up just jumping between tasks and not getting anything done. I have a horrible time keeping up with what the plans are, especially if my team isn't the primary. Most services just copy and paste crappy notes from 5 days ago with plans that make no sense, and then dick around with orders in ways that are never even mentioned otherwise.

I'm plenty book smart, but horrible at keeping everything straight in my brain, even with 10-12 floor patients. I think I could do it if I wasn't always terrified of some attending popping out of the woodwork and demanding to know what Mrs. F is on for HTN, etc., but I can't seem to focus on anything but how terrified I am of screwing up. I suck at faking confidence too, so I tend to bleed into the shark tank, as my senior puts it, and really cause the attendings to unleash their wrath.

I went into residency with a lot of doubt about whether I could cut it in this specialty because of the culture, and now I'm sadly facing the reality that I just plain might not be able to do it. I feel like if things continue down the road they're on, I'm either going to get fired or really screw up and hurt someone. I'm so disgusted with myself at this point that I cry and want to quit pretty much daily.

Is this normal or a sign that this just isn't going to work?


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[northernpsy]

It sounds to me like you're a normal person who is just going through a tough adjustment. It's certainly possible that you may end up deciding this residency program or specialty isn't for you after all, but I would give it more time. Definitely do not quit without having another option lined up.

It sounds to me like the best thing you can do for yourself right now is try to come up with a system of organizing your thoughts and jogging your memory on patients so you don't have so much trouble dealing with the grilling and pimping. I think everyone has their own ways of coping. Maybe ask your seniors what worked for them?
It might also help to remind yourself that it isn't necessarily anything personal against you when an attending gets mean. Some of them are like that because it's how they were treated and they feel like it's normal. Some really think they're helping you learn or keeping patients safe by keeping you on your toes. It's not about you being a crappy intern or a bad person. Even if you were crappy, though, that can be remedied with some practice and learning.

 

[RadOncDoc21]

Is this normal or a sign that this just isn't going to work?

Extremely normal... Welcome to intern year!

 

[Crayola227]

Link to my intern megapost:
http://forums.studentdoctor.net/threads/things-to-do-to-shine-in-pgy-1.1188633/#post-17640862

Does your system have Epic?
I was the slowest little intern that couldn't
I didn't learn how to organize as med student, and I had all of the issues you describe
So I describe how I coped with this

Use the SDN search function with my member name, search for "intern" as well as check out my links above.
for working in the hospital, organization, efficiency, politics, setting up self care, getting better feedback/tips from seniors

I've said this before, 90% of the interns at my program endorsed going home and crying almost on a daily basis when we had a round table talk, and this was 2 months in. We all agreed that we had never felt more stupid, annoying, incompetent, overwhelmed, scared, exhausted, and miserable in our lives. We teared up in the workroom together any time we even stopped to reflect on how things were going! Feeling like it's impossible, you can't do it, you'll never get it, and people might actually die -
This is totally normal right now!! And it DOES get better. Hang on!
if you love the field and it's just the environment and learning curve, give it a little more time

Your feelings are not worrisome.
YOU SHOULD NOT unless you are in immediate danger to yourself or a patient, make noises to your program right now
It's fine to ask for feedback and if you are progressing as expected for your level, and if not, what needs to be improved

I wouldn't worry too much unless seniors, attendings, chiefs, or PDs tell you that you are not doing as well as expected
- so pimping you, criticism, and general meanness, don't let that freak you out at this point
The moment the program starts making any official noises to you,
read on SDN about how people deal with remediation,
transferring programs or negotiating favorable resignations

things that will help IMMENSELY right now for job security -
*always* be honest - if you didn't do something or don't know it, DON'T LIE!
protect your reputation for honesty
also, be the first one to show up, and the last to leave
if you have another single order or note or any ounce of work left in you to do,
or it's the difference between volunteering to help someone or going home, WORK

programs will hold out hope for dumb, slow, disorganized interns to be trained to be better
if they possess good character and good work ethic - these they don't think can be taught
show them you have these qualities

I try to advocate for suffering interns. You can PM me and it will stay safe

 

[Law2Doc]

Sounds like you are having more issues with confidence than anything else. If you've convinced yourself you can't do it you are guaranteed to falter. If instead you can put on a smile and tell yourself, "I've got this" or "no problem, I can figure it out" that goes a long way. As Yoda would say, "There is no try".

 

[epsilonprodigy]

Thanks all. Good to know this is at least somewhat normal. Regarding when to worry: i didn't ask for formal feedback, because I was just too embarrassed, felt like I was doing crappy, and was told on a rolling basis if I did something the wrong way. I felt that I already had a pretty good idea of what I needed to fix, which was everything. Nonetheless, no one ever sat me down to tell me what an awful job I was doing, and my attending actually told me that he knew I was working hard and that he appreciated how much I cared. That was amazing to hear from someone who's such a hard ass. So no, there haven't been any formal indications that I'm a lost cause, but would they even start to go down that road this early in the game?


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[TooMuchResearch]

It's normal.

You're potentially ahead of the curve as you've already identified multiple deficiencies to correct.

 

[girlofgrace7]

The fact that you care enough to recognize when you fall short (or think you fall short) is actually a good sign. I try to tell all the incoming interns that the only things most upper levels and attendings really care about are that you work hard and know when to ask for help/admit you don't know. The most terrifying interns are those that come in with too much confidence and confidently wind up harming patients. My first month on as an upper level, I had three brand-new, July interns. One asked questions all day along, even to ask permission for social work or child life consults to entertain patients. One would ask if she couldn't figure something out, but she caught on fairly quick. The last one avoided asking questions or put off handling a situation/asking someone until later. Guess which one made me most nervous to leave alone on their call days.... The nurses on the service would purposely shoot me a page whenever they told him something worrisome or important to ensure serious issues got taken care of, but there were several "hey, I got this text a while ago. I don't know what to do with it. 'Patient febrile, rigors, dusky, desatting'" (I kid you not).

I struggle a lot with confidence level, but I've learned over the last few years that confidence isn't necessarily related to competence (though it definitely helps with talking to families and doing procedures). I've found that, especially with many introverts, many people who say "I think..." are often more knowledgeable that people who say "I know this is true" because the more things that you actually know, the more things you realize that you don't know.

Intern year is tough. Make friends with co-interns, cry to your family or friends back home, find ways to destress after work (and don't just wallow in your house), take care of yourself, and find ways that work for you to organize your thoughts. I'm a third year resident, and I'm still very reliant on my notes to present patients and such. Just keep them well-organized (whether that's a notecard per patient, a printed off copy of your progress note, a SOAP note list printed offline, or a patient list with notes written in. Above all else, keep a running list of what you need to do for the day (on particularly stressful days, I'll even start drawing in boxes for each progress note, checkout, etc. so things don't slip through). I don't know if it applies to your program, but I know at my program that it is incredibly beneficial to do checkouts first (as opposed to H&Ps or random small things to follow up on) if you get a bunch of admissions in the afternoon bc it's much easier to check out to the night person and then lock yourself away somewhere with your pager off while finishing H&Ps, etc. (as opposed to doing an H&P and getting incessant interruptions and staying 4-5 hours late to wrap up check outs).

 

[Crayola227]

Thanks all. Good to know this is at least somewhat normal. Regarding when to worry: i didn't ask for formal feedback, because I was just too embarrassed, felt like I was doing crappy, and was told on a rolling basis if I did something the wrong way. I felt that I already had a pretty good idea of what I needed to fix, which was everything. Nonetheless, no one ever sat me down to tell me what an awful job I was doing, and my attending actually told me that he knew I was working hard and that he appreciated how much I cared. That was amazing to hear from someone who's such a hard ass. So no, there haven't been any formal indications that I'm a lost cause, but would they even start to go down that road this early in the game?


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Not so much, just that you mentioned "bleeding into the shark tank" and mentioned the word fired in your post

Typical doc fashion, I just went on to list, "if you experience the following signs, present to your nearest ED" sort of disclaimer
so you would know the "real" danger signs

 

[swoopyswoop]

Hey, we are all feeling the exact same way right now.

I print out each patient's progress note for the day (print 4 pages --> 1 page so you don't have a huge packet, and then photocopy them 1-->2 sided) and carry it around in my pocket. The progress notes automatically populates vitals ranges, currently ordered inpatient scheduled + PRN meds, rough I's and O's (you still need to look for yourself how much the NGT is putting out). Makes it more manageable when the attending asks if someone is on X med or some other random detail from the plan that's easy to forget when you have 30 patients on your service!

 

[MediCane2006]

As others have mentioned, finding a system of organization that works for you is key. You will also get better at filtering out the important info for every patient rather than feeling like you need to know everything about each one.

Personally, I think printing out progress notes gives you way too much information and paperwork to lug around for each patient, especially with how bloated the EMR-populated notes tend to be. A system that worked well for me was index cards for each patient - front of the card had the patient sticker, then their PMH, meds,etc with space to update them. Back of the card listed test results, key events, etc. Then on your
patient census, you can jot down daily lab results and check boxes for all the daily tasks.

You sound like you're doing fine. The year gets better, I promise.

 

[Arcan57]

You've never had to deal with the influx of data that you are having to deal with now. As mentioned above, you'll need to develop a system of storing critical information where it can be recalled in seconds with 100% accuracy. This is made challenging by the fact that you are still learning what exactly constitutes critical information (and each attending/senior has their own ideas about what is "critical"). Identifying what is new or different about the patient from your last presentation and what interventions may be playing a role in that difference isn't a bad place to start. Also, remember that it's a venal sin to not know a critical piece of info but a mortal sin to lie about knowing. "Let me check" followed by an answer in the proximate future is a reasonable expectation for an early year intern's answers.

 

[QofQuimica]

Thanks all. Good to know this is at least somewhat normal. Regarding when to worry: i didn't ask for formal feedback, because I was just too embarrassed, felt like I was doing crappy, and was told on a rolling basis if I did something the wrong way. I felt that I already had a pretty good idea of what I needed to fix, which was everything. Nonetheless, no one ever sat me down to tell me what an awful job I was doing, and my attending actually told me that he knew I was working hard and that he appreciated how much I cared. That was amazing to hear from someone who's such a hard ass. So no, there haven't been any formal indications that I'm a lost cause, but would they even start to go down that road this early in the game?

Of course you're "doing crappy" at this point; so is every other intern across the country. No one comes out of medical school prepared to be an attending. If you did, there would be no need for doing a residency at all. So fine, you don't know much yet. That's why you're about to undergo the next 3+ years of eighty-hour training weeks: to learn how to take care of patients. I guarantee you two things: everyone else in your class feels exactly like you do (though they may not all admit it); and if you had colossally screwed up beyond the pale for where you're at in your training, someone definitely would have told you.

As others have said, work on identifying weak areas and improving them. It sounds like you've already determined that organization of patient info is a weak area for you. Ok, fine, that's a good thing to start with then. Ask other interns or upper levels what they do, and experiment until you find a system that works well for you. Regarding the stress of attendings yelling at you: that gets easier to let roll off your shoulders with time too. The next time that happens, try to focus more on the message (what that person wants you to have done differently) and less on how it's delivered. You don't have to like all of your attendings, and you won't like them all. But they do all have something to teach you, even if it's just how NOT to behave toward an intern in July. So try to focus your attention on what you can learn from each one, and maybe that will help you focus less on them being "upset" with you.