Anyone else feeling stupid yet?

[Mad Jack]

The only science course I took as an undergrad was Bio101. I found this forum looking for information on the way the intern/resident situation was set up 50 years ago, my thread was closed.
Yet this thread has numerous future doctors using the word "******ed" to refer to their feelings of incompetence and remains open.
First, that word is a medical term, referring to people with subpar I.Q., usually under 80. I would imagine that was taught in some undergrad class. It is socially unacceptable to use it towards a mentally competent person who feels incompetent or makes a mistake. This group should know that more so than any other.
Second, what did you think it was going to be like to be a "real" doctor? Did you think people were going to be coming in with textbook symptoms?: "I have a fever of 102 and severe pain by my right hip", " I'm a 60 year old man, I was shoveling my walkway and now I have a shooting pain up my left arm"
Of course you have to learn by doing, luckily most of the mistakes you make will be minor.
This is an old thread, but so many of you feel the same and repeat the word. This contribution will probably be taken down, I hope a few people get to see it. Don't use the word ******ed as a derogatory reference, even if it's towards yourself, learn as much as you can now, and don't for one minute think there will ever be a day when you have ALL the answers, because ask any doctor who is about to retire, that day will never come, the human body and brain are too complicated for any one person to master in their lifetime.

This post is developmentally delayed to the point of significant detriment to intellectual capacity.

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[Aqua_Vitae]

Well, perhaps if one feels so overwhelmed, and inferior to their peer group, then they have an insight to their limitations. If they were the proverbial "big fish in the little pond" then the case may be that they should pursue a career in a less challenging profession.

Really reread your first post on this forum again and decide if it belongs here on this forum.

I've used the word ******ed my entire life. Now as a doc I use it in the context of an idea or thought of someone with an IQ of less than 70. Your cutoff is 80, so you would be calling people ******ed who actually are not.

 

[rokshana]

Argue all you want about PC or free speech
My point was I asked a legitimate question, that was locked, but the moderator here sees fit to leave up a slur that everyone on this forum should know not to use. It's not as if this were a forum for Attorneys or Golf Pros.

A term that an eight year old knows is wrong, is okay on this forum, but me asking "Hey how did the resident/intern system work 50 years ago?" is taboo?

you weren't asking about "how" residency worked 50 years ago...you were asking how you could go about finding your sperm donating daddy...that is more like seeking medical advice, not seeking info on how the system worked back in the day.

 

[jadedphysiotherapist]

This post is developmentally delayed to the point of significant detriment to intellectual capacity.

L.O.L.

That is all. Please continue the maturity savagery.

 

[FrankieK]

Yes, it is quite scary that this is the supposed generation that would be giving me medical care in my old age.

I think Darwin's theory will clear out most of the hacks here. Hey the world needs baristas too ;-)

All that college, and afraid to do the job, such a shame...

 

[FrankieK]

This post is developmentally delayed to the point of significant detriment to intellectual capacity.

you weren't asking about "how" residency worked 50 years ago...you were asking how you could go about finding your sperm donating daddy...that is more like seeking medical advice, not seeking info on how the system worked back in the day.

If I had the information of how the system worked "back in the day" ( that's an old fashioned colloquial expression, are you old? Were you a resident in the 60's?)I would have the information I needed. I don't need or want a daddy

 

[Mad Jack]

If I had the information of how the system worked "back in the day" ( that's an old fashioned colloquial expression, are you old? Were you a resident in the 60's?)I would have the information I needed. I don't need or want a daddy

Back in the day is a pretty common expression used by people 30+ years of age. Surprise, we're not children.

 

[FrankieK]

Back in the day is a pretty common expression used by people 30+ years of age. Surprise, we're not children.

No, it's not even used by my generation, which, obviously is old enough to be your parents, that expression was used by my sperm donor's generation!

 

[Mad Jack]

No, it's not even used by my generation, which, obviously is old enough to be your parents, that expression was used by my sperm donor's generation!

It was brought back in rap culture during the 80s and 90s, and many of us use it to this day. I still use the word "awesome" way more than is healthy as well.

But anyways /tangent

 

[dadaddadaBATMAN]

All that college, and afraid to do the job, such a shame...

If you get through medical school and aren't afraid to start working as an intern, you either don't give a damn about your patients or you're a fool.

The same could be said for starting as an attending. Being afraid is a sign of self-awareness. Something which you seem to completely lack.

 

[rokshana]

If I had the information of how the system worked "back in the day" ( that's an old fashioned colloquial expression, are you old? Were you a resident in the 60's?)I would have the information I needed. I don't need or want a daddy

what is younger than a millennial? Evidently that would be your generation?

and i'm southern...and if you have read any of my posts you would know that my Daddy was a surgical resident in the 60s (and i don't need to ask how to find him via an online forum).

 

[Mad Jack]

If you get through medical school and aren't afraid to start working as an intern, you either don't give a damn about your patients or you're a fool.

The same could be said for starting as an attending. Being afraid is a sign of self-awareness. Something which you seem to completely lack.

The worst residents are the ones that lack fear. As you said, they're either miswired and don't give a damn, or arrogant and think they know everything. The latter can be particularly deadly as it means they are both going to have difficulty learning and growing as a physician since they have nothing to learn, and they are confident even when incorrect, leading them to challenge anyone that tries to steer them in the right direction.

Perhaps the scariest thing of all is one of those physicians all grown up and two decades into practice, who is unwilling to hear any research or have anyone change their mind about anything because they know how things are and anything that challenges those beliefs is either biased or wrong. Bad medical practice thrives in that, and when one of those types ends up in academics they literally breed their own brand of ignorance into their residents, perpetuating their cycle of misguided intellectual arrogance and practice.

 

[gutonc]

A reminder that this is a professional forum and respect for each other, patients and diverse opinions and points of view is expected.

That said, the thread title has been changed because it can be considered offensive and distracted from the point of the thread and discussion.

Carry on...like adults.

 

[cellsaver]

The most recent edition (July 4, 2017) of Annals of Internal Medicine might be helpful to OP and others. It is available only through subscription. You can access it online if your teaching hospital has a subscription to it and access it from their servers. Otherwise, I am copying the article on this post with proper attribution. If this is against the rules, please advise or delete.

----------------------------------------

A Letter to New Interns
Taichman DB, Moyer DV, Laine C. A Letter to New Interns. Ann Intern Med. 2017;167:66-67. doi: 10.7326/M17-1293

EDITORIAL Annals of Internal Medicine

A Letter to New Interns​

It is the time of year when 2 new letters follow the names of former medical students who don fresh white coats as they begin internships. Annals of Internal Medicine and the American College of Physicians wel- come those joining the practice of medicine. This is a thrilling time as you embark on your residencies. And it's thrilling for those of us years past residency to be reminded of the excitement and rewards of a life in medicine.

In this issue, we publish 2 Annals Graphic Medicine pieces about the beginning of internship (1, 2) that evoke some of the emotions you are likely feeling. You are bursting with excitement because you are finally a “real doctor.” You are also terrified because you are suddenly a “real doctor.” Here are some guesses of the other emotions you might be feeling in varying and complex waves: Proud (of what you've accomplished). Relieved (by the hard work that is finally behind you). Dread (of the hard work that is before you). Inflated (your ego, that is, because of all you know). Ashamed (of knowing so little). Jealous (of fellow interns who you are sure know more than you do). Intimidated (by “real doctors”). Scared (that becoming a “real doctor” is hard). Scared (Will I harm a patient?). Scared (Will I get sued?). Scared (Will I deserve it?). Scared (Will I ever forgive myself if I make a mistake?). Scared (that you'll be discovered for the impostor you believe yourself to be).

We know these emotions well. Decades after be- ginning our own internships, we still experience each of them regularly. These mixed emotions are understand- able and appropriate, and they can even help navigate the ups and downs of our profession. The ups are awe- some. The downs are awful. But they're manageable if we pay attention, are honest with ourselves, and reach for support when we need it.

The challenges of residency training are formida- ble: juggling a dizzying array of pathophysiology; un- derstanding an ever-growing spectrum of pharmaco- logic effects and interactions; struggling to orchestrate a cacophony of diagnostic, therapeutic, and social ser- vices for complex patients, many with significant social determinants of health in play; and achieving good out- comes for your patients and meeting measures for your hospital that help to keep the doors open. All of this while worrying that your lack of experience will allow a missed symptom, sign, or clue to harm a patient when a more experienced physician would have recognized it and responded at once. It is more than enough to make smart, dedicated people feel inadequate. Add to that a professional culture that extolls not only intellec- tual brilliance but imperturbability in the face of adver- sity. This can be the perfect formula to turn feelings of inadequacy and exhaustion into self-loathing and de- spair (3, 4). The long hours may make it difficult to find time to draw on the support of friends and family, add- ing to a sense of isolation. Although you might think so, you won't be alone. Others will be quietly suffering as well. We all experience these emotions to varying degrees not only during training but throughout our careers. Challenges come not only from within ourselves but from external forces as well. Ever-increasing administrative burdens, productivity expectations, and a highly dysfunctional health care system will at times seem insurmountable (5–7).

An alarming number of physicians experience de- pression and some attempt or complete suicide (8, 9). It is time to change the culture in medicine because suffering in silence is dangerous. Ask for help. The help is in the community surrounding us. Don't pretend to yourselves or others that you're not anxious about what you don't know or that you don't need the support of colleagues. It is dangerous to our patients and feeds a vicious cycle that magnifies feelings of inadequacy and despair. Ask for help. Lean on colleagues and their strengths, and pay it back by being there in their times of need. Also, draw inspiration from patients and their strengths as they do from us and ours. We must accept that we cannot know it all, that we need breaks and support throughout our careers, and that we are not invincible. These mindsets and practices will nurture the resiliency we need throughout our professional lives to help focus on the rewards of a challenging pro- fession, rather than on the challenges themselves.

So, now you're asking yourself, “I've worked all these hours, gone into this much debt, lost this much sleep—for what? To lose more sleep, work more long hours in an often dysfunctional system, doubt myself and my abilities? And to make how much?”

Well, here is how much you'll make: You'll make your patients feel better. You'll make them live longer. You'll help to improve their quality of life. And when you cannot, you'll help them to make decisions that will give them and their loved ones peace of mind. You'll help them to see that they can have control in the face of diseases that cannot be controlled. You'll make your medical students see their potential. You'll make your interns proud of how much they know while teaching them what they don't. You'll make your colleagues feel good when they help you think through a difficult clin- ical problem. You'll make them feel valuable when they help you through your tough times, just as you have felt when helping them. And you'll constantly be in wonder as science advances and enables health outcomes bet- ter than yet imagined.

Welcome to medicine! It's a wonderful place to be. You are beginning a career that demands and rewards you with continuous learning and the pursuit of excel- lence. These very demands are our strengths and bring joy to medicine—if we are able to admit to ourselves that they are challenges to which we may not rise flaw- lessly and without help. Your arrival as our new col- league reminds us, as it does every year, of the rewards of being a doctor. It motivates us to do the best we can for our patients, our colleagues, and ourselves. Wear
your white coat proudly, and please reach for help when it gets heavy.

Darren B. Taichman, MD, PhD
Executive Deputy Editor, Annals of Internal Medicine

Darilyn V. Moyer, MD
Executive Vice President and Chief Executive Officer,

American College of Physicians
Christine Laine, MD, MPH
Editor in Chief, Annals of Internal Medicine

Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1293.


References
1. Natter M. Annals Graphic Medicine - July Plunge. Ann Intern Med.
2017;167:W1-2. doi:10.7326/G16-0029
2. Bitterman J. Annals Graphic Medicine - Internship. Ann Intern
Med. 2017;167:W3-6. doi:10.7326/G17-0001
3. Sinha P. Why do doctors commit suicide?. The New York Times. 4
September 2014. Accessed at https://mobile.nytimes.com/2014/09
/05/opinion/why-do-doctors-commit-suicide.html on 22 May 2017.
4. LaCombe MA. Forbidden topics. Ann Intern Med. 2017;166:754.
[PMID: 28505653] doi:10.7326/M16-2137
5. Yaghmour NA, Brigham TP, Richter T, Miller RS, Philibert I, Baldwin
DC Jr, et al. Causes of death of residents in ACGME-accredited
programs 2000 through 2014: implications for the learning environment.
Acad Med. 2017. [PMID: 28514230] doi:10.1097/ACM
.0000000000001736.
6. Lindeman S, Laara E, Hakko H, Lonnqvist J. A systematic review on
gender-specific suicide mortality in medical doctors. Br J Psychiatry.
1996;168:274-9. [PMID: 8833679]
7. Erickson SM, Rockwern B, Koltov M, McLean RM; Medical Practice
and Quality Committee of the American College of Physicians. Putting
patients first by reducing administrative tasks in health care: a
position paper of the American College of Physicians. Ann Intern
Med. 2017;166:659-61. [PMID: 28346948] doi:10.7326/M16-2697
8. Sinsky CA. Designing and regulating wisely: removing barriers to
joy in practice. Ann Intern Med. 2017;166:677-8. [PMID: 28346949]
doi:10.7326/M17-0524
9. Farris GE. Annals Graphic Medicine - Anatomy of a donut hole.
Ann Intern Med. 2017;166:W53-7. [PMID: 28346952] doi:10.7326
/G16-0024

Ann Intern Med. 2017;167:66-67. doi:10.7326/M17-1293
© 2017 American College of Physicians

 

[Relentlessrook18]

I totally feel like an idiot as a new family med intern. I thought I knew how to give a decent presentation of a patient, but I get so nervous. And some patients have so many problems it's hard for me to even figure out where to begin. Especially on inpatient service. Guess I need to keep practicing and reading on the patient's as much as possible.

 

[hallowmann]

I totally feel like an idiot as a new family med intern. I thought I knew how to give a decent presentation of a patient, but I get so nervous. And some patients have so many problems it's hard for me to even figure out where to begin. Especially on inpatient service. Guess I need to keep practicing and reading on the patient's as much as possible.

You're not alone. I am constantly reminded of how little I know, or worse yet, how much I have forgotten or am not accustomed to through 4th year that now I too feel like I stumble on patient presentations (even non-complex ones). It is the same for my fellow interns and I'm sure yours. Keep it up. Work hard, we'll get there.

 

[Relentlessrook18]

You're not alone. I am constantly reminded of how little I know, or worse yet, how much I have forgotten or am not accustomed to through 4th year that now I too feel like I stumble on patient presentations (even non-complex ones). It is the same for my fellow interns and I'm sure yours. Keep it up. Work hard, we'll get there.

Thanks buddy. Best of luck and hard work to you and your intern group as well. I hope that in a year from now we can both say... dang... we are so much better physicians now than we were one year ago!