Is it normal to feel bad after 1st year?

[deleted966164]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

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[deleted1064759]

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Do the best you can but try not to beat yourself up over not getting 6/6 Honors.

I wouldn't even sweat the nurses tbh. You'll be making at least 3x their salary, so let them have their petty battles. I would have just looked the nurse dead in the eye and said "haven't a ****ing clue".

 

[SurfingDoctor]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

Well, what kind of feedback have you gotten all year? I mean, I'm not saying it doesn't happen, but usually people will notify you (and your PD) if you're off the curve as far as clinical performance. If you've heard nothing at all, then usually its a sign that you're on par (the old: no news is good news).

Mottled skin looks like pink lace over pale skin. And the 90 year old could have had a thiamine deficiency or a stroke or just constipation. He's old for christ's sake. You'll learn the work up a old dude presenting with "X" over time, just consider a differential.

Lastly, who gives a crap that nurse thinks?!

 

[deleted966164]

To clarify - I just finished MS1 and am worrying probably "in advance."

The old guy was in their 60s and had COVID - kind of a curve ball as none of the team even suspected that.

 

[SurfingDoctor]

To clarify - I just finished MS1 and am worrying probably "in advance."

The old guy was in their 60s and had COVID - kind of a curve ball as none of the team even suspected that.

Wait, no one suspected COVID in an old dude... during a pandemic?! That can't be serious.

 

[deleted966164]

Wait, no one suspected COVID in an old dude... during a pandemic?! That can't be serious.

lolz . We have like a 0.4 cases per day in the county.

Edit: also - he didn't really present like a Covid patient. No resp. distress, no hacking, no caughing, just altered. Like this thing when they reach and pick stuff from the air.

 

[SurfingDoctor]

lolz . We have like a 0.4 cases per day in the county.

I mean, maybe now, but I doubt attendings haven't seen COVID in a 60 year old at least a good number of times in the ER in the past 18 months... unless, they've been in a coma or under the influence of mescaline... then I would give it a pass.

 

[deleted966164]

I mean, maybe now, but I doubt people haven't seen COVID in a 60 year old at least a good number of times in the ER in the past 18 months... unless, they've been in a coma or under the influence of mescaline... then I would give it a pass.

Oh, there was plenty of Covid here. They've (we've) seen it

 

[Redpancreas]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

I think you're reading way too much into this but brings up an interesting discussion so thanks for asking it.

It is very common for nurses to displace the frustration for how hard they work onto the medical students. As an post-M1, you're basically still a baby. At this point, I was filled with anatomy, biochem, histology, neuroscience, and god knows what else and hadn't really had much practice with diagnosis and differentials.

One useful bit can be gleaned from this is the thiamine deficiency thing. Don't feel ashamed about it, but if you introspect for a second I think you learn a valuable lesson. For the last 9 years of your life, you have been asked mathematical>biological>medical questions with multiple choice answers. You use your knowledge of biology/pathophysiology to piece everything together try to give a perfect answer that "fits" logically, like the end of an episode of Dr. House M.D. That is the knee-jerk tendency our premed curriculum teaches us. Real world medicine doesn't work like this. Things present atypically everytime. Nurses very early in their training learn not think logically (which is why they shouldn't be leading teams) and instead just make sure X, Y, and Z have been done (glucose check, narcan are for their altered mental status protocol). Stroke isn't really something to jump to with altered mental status, but we dont want to miss anything like that so we always scan the head.

As you start to gain clinical, reasoning, you will learn to put aside your world of physiology and start reasoning this way too. The thing is literally no one has thrown you in a clinical setting or expected you to do this but it's coming. You can often distinguish traditional medical students from former PAs/Nurses turned medical students by their approach to medicine and if they've developed these rough clinical guides to medical issues already. While you might say patient comes in with altered mental status, they may say that and then include CT-head NAP, glucose/utox normal limits. You'll need develop this over time.

This is another reason I think there needs to be more clinical integration into the M1/2 years of medical school and not just have M1/2s sitting doing basic science/PhD lecture slides all day.

 

[Redpancreas]

lolz . We have like a 0.4 cases per day in the county.

Edit: also - he didn't really present like a Covid patient. No resp. distress, no hacking, no caughing, just altered. Like this thing when they reach and pick stuff from the air.

This is just another example of the point above. Here are eight chief complaints that ended up being primarily caused by COVID in the last month.

-Failure to thrive
-Slurred speech
-Nose bleed
-Chest pain
-Memory loss
-Diarrhea
-Headache/chills - I guess that one seems a little viral
-Trouble swallowing/ear pain

You'll encounter a similarly diverse presentations with pregnancy (which is something we don't want to miss) which is why we check pregnancy tests all the time.

When ordering, the fundamental rule is to exclude dangerous things or things you don't want to miss. If those causes are ruled out, start your diagnostic investigation with what's most likely and escalate from there.

An additional point is that it's a bit absurd for an ED attending physician to say "they've never ever seen it (Wernicke's) in real life". Either they're inexperienced or they don't know what they are talking about. As an IM resident, I saw it weekly. While the triad for Wernicke's Encephalopathy in textbooks Confusion, Ataxia, and Nystagmus (really any opthalmoplegia), the three symptoms hardly present together and rather than wait for it to fully manifest, we treat confused alcoholics liberally with B-vitamins and fluids since there's no harm in doing that. If we didn't do that, we'd be seeing a ton more of Wernicke's Encephalopathy. What the ED physician may be confused with is Korsakoff Syndrome which is a more advanced state characterized by confabulation due to damage to the mamillary bodies which is less typically seen due to liberal treatment of thiamine deficiency.

 

[Chelsea FC]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

Yes, alot of things u learn 1st year you will find certain fields have no idea about it or care about it, than normal. Also screw that nurse and her power trip. Whenever stuff like that happened to me I smiled and apologized and told myself "to hell with them" im here to collect my future BAG. You will learn and get this right it just wont be a pleasant ride along the way

 

[M&L]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

1. Dont let ppl talk to you like that! They are being ridiculously disrespectful
2. You just finished M1. You aren’t supposed to be good at differentials yet - you haven’t even finished all the systems yet . Integration of knowledge at thst level is more of end of M2-M3 level . You are EXACTLY where you are supposed to be . One step at a time !!! You are doing amazing
3. I was a psych medic before medical school so I know the feeling you are talking about . But please understand , in 2-3 years you will feel in a completely different place. To be honest, they are probably jealous (the one making fun of you). I went out on a date with a nurse (he was anesthesia nurse, very successful too ). We compared knowledge as a fun , snd He told me that in HIS opinion nursing education teaches more of care related stuff vs medical education teaches more of integration/management of cases stuff . And I, as an M2, already knew things he had no idea about . He knew the “what” but didn’t always understand the “why” (I am not saying nurses are better or worse, etc , ppl please don’t jump on me for this one . This is just an opinion of ONE guy I talked to ). So give it time, snd the effort you put in will pay off

4. right now you are learning a bunch of zebras . And that’s ok . That’s exactly what you have to do how . Later on - second year and third - they will teach you how to prioritize differentials .

so to sum up - you are doing great . You are exactly where M1 /rising M2 needs to be . Don’t listen to jerks . They are WRONG to be like that (that question she asked was not your level of education yet ).

 

[ACSurgeon]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

Yea don’t feel bad. As a resident you’ll quickly exceed the nurses clinical knowledge. This is amplified 1000x when as a second year resident you get a bunch of new nurse graduates join a floor you work on, and you’ll realize how little they actually learn in school. Before residency you’ll always have an observing role and no real responsibility. You don’t learn as effectively when there’s nothing on the line. As a resident you make plans and sometimes you’re right and sometimes you’re wrong. The mistakes will teach you more than what you learn when you get it right. But yes. Trust the process!!

re nurses: they’re taught confidence whereas you’re taught to be humble and play nice. Doctors and student doctors are crucified if they are in the least bit aggressive or insensitive. Everyone else in the hospital is encouraged and “empowered” to “advocate” for the patient. In peds the nurses are taught to protect the patient from the residents, so it’s super fun. Welcome to modern medicine. A lot of what you describe comes from a combination or ignorance and arrogance from this nurse. A dangerous combination. Nonetheless, an ER nurse who’s seen dozens to hundreds of strokes/MIs/sepsis will be quick to spout those off as the cause. Common things being, they’ll be right a lot of the time and think they’re super smart. As a newbie, you’ll be intimidated and feel inferior. Trust me, you’re not. You’ll be the resident or attending to pick up the seemingly less likely diagnosis when a nurse comes at you saying someone has alcohol withdrawal when in fact they’re septic or bleeding to death.

finally, we still get to do cool things in medicine. Despite all the politics and other grievances, your job as a doctor will always be cleaner, cooler and better paid than you’re nursing friends. There’s a reason a lot good nurses go back to school and get away from bedside nursing.

try to maintain appropriate expectations for the present and future and you’ll always be happier and more satisfied. Unhappy folks are often unhappy because their reality doesn’t match up with their expectations.

finally, always remember yourself in an earlier phase. As a college freshman you dreamt about being a doctor and now this dream is becoming a reality. Go give a talk at a college or high school pre-med club for some reminders and good feels.

best of luck and congrats on joining the profession!

 

[ACSurgeon]

1. Dont let ppl talk to you like that! They are being ridiculously disrespectful
2. You just finished M1. You aren’t supposed to be good at differentials yet - you haven’t even finished all the systems yet . Integration of knowledge at thst level is more of end of M2-M3 level . You are EXACTLY where you are supposed to be . One step at a time !!! You are doing amazing
3. I was a psych medic before medical school so I know the feeling you are talking about . But please understand , in 2-3 years you will feel in a completely different place. To be honest, they are probably jealous (the one making fun of you). I went out on a date with a nurse (he was anesthesia nurse, very successful too ). We compared knowledge as a fun , snd He told me that in HIS opinion nursing education teaches more of care related stuff vs medical education teaches more of integration/management of cases stuff . And I, as an M2, already knew things he had no idea about . He knew the “what” but didn’t always understand the “why” (I am not saying nurses are better or worse, etc , ppl please don’t jump on me for this one . This is just an opinion of ONE guy I talked to ). So give it time, snd the effort you put in will pay off

4. right now you are learning a bunch of zebras . And that’s ok . That’s exactly what you have to do how . Later on - second year and third - they will teach you how to prioritize differentials .

so to sum up - you are doing great . You are exactly where M1 /rising M2 needs to be . Don’t listen to jerks . They are WRONG to be like that (that question she asked was not your level of education yet ).

Yea their is no comparison in the science or pathology/physiology learning. Despite that, almost every nurse you talk to will mention how they like to “think critically” and how much they enjoy learning physiology and pathology from doctors on rounds…I think

CRNAs actually get a lot of physiology and maybe pathophys taught to them… I’m no expert though.

anyways at some point the book learning becomes a distant memory and lot of your job becomes based on things you’ve seen, patterns you recognize, and maybe some of the ongoing learning you try to do.

 

[deleted966164]

Yea don’t feel bad. As a resident you’ll quickly exceed the nurses clinical knowledge. This is amplified 1000x when as a second year resident you get a bunch of new nurse graduates join a floor you work on, and you’ll realize how little they actually learn in school. Before residency you’ll always have an observing role and no real responsibility. You don’t learn as effectively when there’s nothing on the line. As a resident you make plans and sometimes you’re right and sometimes you’re wrong. The mistakes will teach you more than what you learn when you get it right. But yes. Trust the process!!

re nurses: they’re taught confidence whereas you’re taught to be humble and play nice. Doctors and student doctors are crucified if they are in the least bit aggressive or insensitive. Everyone else in the hospital is encouraged and “empowered” to “advocate” for the patient. In peds the nurses are taught to protect the patient from the residents, so it’s super fun. Welcome to modern medicine. A lot of what you describe comes from a combination or ignorance and arrogance from this nurse. A dangerous combination. Nonetheless, an ER nurse who’s seen dozens to hundreds of strokes/MIs/sepsis will be quick to spout those off as the cause. Common things being, they’ll be right a lot of the time and think they’re super smart. As a newbie, you’ll be intimidated and feel inferior. Trust me, you’re not. You’ll be the resident or attending to pick up the seemingly less likely diagnosis when a nurse comes at you saying someone has alcohol withdrawal when in fact they’re septic or bleeding to death.

finally, we still get to do cool things in medicine. Despite all the politics and other grievances, your job as a doctor will always be cleaner, cooler and better paid than you’re nursing friends. There’s a reason a lot good nurses go back to school and get away from bedside nursing.

try to maintain appropriate expectations for the present and future and you’ll always be happier and more satisfied. Unhappy folks are often unhappy because their reality doesn’t match up with their expectations.

finally, always remember yourself in an earlier phase. As a college freshman you dreamt about being a doctor and now this dream is becoming a reality. Go give a talk at a college or high school pre-med club for some reminders and good feels.

best of luck and congrats on joining the profession!

Thanks. I really needed that!

 

[mrbreakfast]

A lot here, but two points:

1) You will NEVER get to the point where you are not occasionally challenged by a nurse who thinks they're smarter than you. It'll just become less frequent. Part of the job, unfortunately.

2) Regarding your thiamine part: you will learn how to form differential diagnoses in time. For now, focus on thinking of differentials in two categories: what is it most likely to be (for AMS in an older person, probably infection, metabolic dysfunction, delirium, acute intoxication, dementia, etc), and what are possible diagnoses you can't miss (massive ischemic stroke, hemorrhagic stroke, subdural, meningitis, etc). Focus on developing and expanding those categories. The third category (zebras, like Wernicke's, which is much less common in 2021 than it was when the textbooks were written) can go after those.

 

[Osteosaur]

You just finished M1 and learned a bunch of physiology and rare diseases. Give yourself a break.

And dear god don't use your vacation to work for peanuts if you can help it!

 

[Ganon]

Always be wary of your sources.

If a brand new nurse is saying something that is likely beyond the scope of what they know, make a mental note and verify.

If physicians in a forum are telling you what nursing education/knowledge is like without having gone to nursing school, make a mental not and verify.

 

[Goro]

This is more of a rant than a question but any input is welcome...

Year 1 is done. I am happy with my performance etc. but I just feel like s@!$. I have learned a ton but I feel like everything evaporated two weeks into the summer.
I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I feel like I know more things than before starting med school but still am not able to "act" appropriately - like we had a 56h baby come in in resp. distress and I still wasn't able to tell if the baby looks fine or dead just by looking. Still can't tell if the baby looks mottled or not. Please tell me this will come one day!

We had an altered older gentleman brought by EMS and one of the nurses decided to play with me and asked me "What do you think is wrong with this guy?" I didn't know that she wanted a whole differential and told her that it could be thiamine deficiency. In fairness, he looked like a long-time alcohol user, had nystagmus etc. She looked at me like I am an idiot and started spewing "Well, it could be a stroke, hypoglycemia, high ammonia..." I could've told her the same if I wasn't put on the spot like that. Still - not proud of myself for saying what I said. When I brought it up to the doc, the doc asked "Is this like the Wernicke's thing?" They said they've never ever seen it in real life. The school tried to make us super sensitive to that like "You will for sure see it a lot of times!" WTF? I don't know what to think anymore...

I know that I still have more time but reading through SDN a few days ago, I started freaking out about clinical rotations (year 3). How am I supposed to do well if the grading is subjective? I can work hard etc. no problem, but I am just freaking out! Do I just trust the process?

Just drowning here... help.

Chill. You know more than you think you know. Have a little faith in yourself

 

[calivianya]

I am working in an ED as a tech. I did that before med school as well. It's daunting to see that people who started with me are done with their 9 month RN program and are doing real stuff and make stupid comments like "Oh, X is on break, Y is on break, Z is not there either so... I am in charge!" (they mean themselves) and when I point out that Dr. P is still there they say that "They don't count..." That's just frustrating.

I just wanted to clear this up so it didn’t frustrate you.

The nursing chain of command has nothing to do with physicians. Doctors are not in nurses’ chain of command and they should not be giving feedback on performing nursing tasks or directing immediate workflow in any way besides putting orders in (obviously unless someone is about to do something stupid that will harm the patient, in which case it’s perfectly acceptable to stop them).

Nurses and docs may be working together, but they have absolutely nothing to do with each other as far as “being in charge” or anything like that. Whoever Dr. P is, unless Dr. P is a DNP in nursing admin instead of a MD/DO, he/she is not in charge of the nurses. That’s not them being arrogant; it’s facts. If everyone else is on a break, the highest ranking nurse at the moment is more or less “in charge” of everything related to nursing on the floor.

 

[Matthew9Thirtyfive]

1) You will NEVER get to the point where you are not occasionally challenged by a nurse who thinks they're smarter than you. It'll just become less frequent. Part of the job, unfortunately.

This literally happened like two days ago to an attending of like 20 years by someone who has been a nurse for like 2. Never ends.

 

[stickgirl390]

If you’re in the hospital working as an ED tech, you’re not in the role of medical student. You can always tell people you’re not interested in answering their “pimp” questions. I have a friend who works as a tech in his spare time and he gets really ticked when attendings try to “pimp” him when he’s there for work, not as a clerkship student. I think it’s perfectly reasonable to say that’s not in your job description, and move along.

It is a learning opportunity, but you also don’t want to burn out or get a sour taste for the profession. When you’re working as a tech, choose whats best for you that day.

 

[longhaul3]

The nurse pimping you can kick rocks. Next time she draws labs you should pimp her on the coagulation cascade.

Also if that was actually the nurse's differential for altered mental status in an alcoholic, she should hit the books. Strokes cause focal deficits, not altered mental status—I would think Wernicke's over a stroke. Just because she's confident and condescending doesn't mean she's right.

If you ever work at a major public, safety-net hospital you will see Wernicke's more often than you think.

 

[Captain_Falcon]

The nurse pimping you can kick rocks. Next time she draws labs you should pimp her on the coagulation cascade.

Idk why but this had me laugh out loud

 

[Tenk]

If you learned everything in one year why would there be another 6+ to go? You’ve only gotten your feet into the pool, you haven’t even started swimming yet.

 

[Eyeronic]

Is it normal to feel bad after 1st year?​

I'd be a lot more concerned about you if you weren't feeling bad.
Your peers who insist all is still perfect in their world are faking it.

 

[Matthew9Thirtyfive]

I'd be a lot more concerned about you if you weren't feeling bad.
Your peers who insist all is still perfect in their world are faking it.

Lol okay. I mean yes, some people feel bad. That’s normal. It is not necessarily “faking it” when people say they are doing great after MS1, and shaming people for being happy or insisting they must be lying is ridiculous.

 

[Eyeronic]

Lol okay. I mean yes, some people feel bad. That’s normal. It is not necessarily “faking it” when people say they are doing great after MS1, and shaming people for being happy or insisting they must be lying is ridiculous.

Perspective helps. Being over 10 years removed from it, I can state it with confidence. Everything comes out of the dark eventually.
Are you still a medical student? If so, you'll figure this out eventually.

 

[Matthew9Thirtyfive]

Perspective helps. Being over 10 years removed from it, I can state it with confidence. Everything comes out of the dark eventually.
Are you still a medical student? If so, you'll figure this out eventually.

You’re falling into @Goro ‘s favorite trap. Solipsism. Try being a little less condescending.

 

[Lem0nz]

A lot here, but two points:

1) You will NEVER get to the point where you are not occasionally challenged by a nurse who thinks they're smarter than you. It'll just become less frequent. Part of the job, unfortunately.

2) Regarding your thiamine part: you will learn how to form differential diagnoses in time. For now, focus on thinking of differentials in two categories: what is it most likely to be (for AMS in an older person, probably infection, metabolic dysfunction, delirium, acute intoxication, dementia, etc), and what are possible diagnoses you can't miss (massive ischemic stroke, hemorrhagic stroke, subdural, meningitis, etc). Focus on developing and expanding those categories. The third category (zebras, like Wernicke's, which is much less common in 2021 than it was when the textbooks were written) can go after those.

Had a nurse try to stop me from doing an emergent bedside procedure on night float as a PGY5. Told me I was not credentialed to touch her patient and that she would be calling security.

I calmly but firmly informed her that when security arrived I would be asking them to restrain her and we would see who's instruction they listened to. I did not stay and wait for her rebuttal. As I was walking away and she was standing there fuming I overheard one of the other nurses telling her in a hushed voice "that was the chief surgery resident and he is absolutely credentialed to do whatever he needs to in this hospital, he's the one we call for help".

/flex.

You generally have the high ground when you can plainly state to someone "which one of us is capable of cutting open someone's chest and massaging their heart back to life with their bare hands?"

granted there's a 99% mortality but that isn't the point now, is it?

 

[Eyeronic]

Try being a little less condescending.

You first.

 

[Lawpy]

I'd be a lot more concerned about you if you weren't feeling bad.
Your peers who insist all is still perfect in their world are faking it.

Wait so you think everyone should feel bad at some point in training? Geez, no wonder medicine is messed up

 

[Osminog]

Wait so you think everyone should feel bad at some point in training? Geez, no wonder medicine is messed up

Any difficult journey will include some periods of feeling bad. Nobody gets to the finish line without some disappointments, setbacks, or regrets along the way. On its on, this aspect of medical education/training isn't something that "messes up" medicine.

 

[Matthew9Thirtyfive]

Any difficult journey will include some periods of feeling bad. Nobody gets to the finish line without some disappointments, setbacks, or regrets along the way. On its on, this aspect of medical education/training isn't something that "messes up" medicine.

Dude. The idea that anyone who says they are doing well after MS1 must be lying is ridiculous. It is absolutely possible to go through all of med school without feeling terrible. Plenty of people do it.

That doesn’t mean that if you feel that way, there’s something wrong with you. But can we please stop perpetuating this self martyrdom that medical students will all inevitably hate their lives?

 

[Lawpy]

Any difficult journey will include some periods of feeling bad. Nobody gets to the finish line without some disappointments, setbacks, or regrets along the way. On its on, this aspect of medical education/training isn't something that "messes up" medicine.

I think being humbled and facing difficulty is different from feeling bad (the word choice of "should feel bad" was offputting). The other guy was making an absurd point that those who felt good after 1st year was faking it, which is ridiculous.

 

[Osminog]

Dude. The idea that anyone who says they are doing well after MS1 must be lying is ridiculous. It is absolutely possible to go through all of med school without feeling terrible. Plenty of people do it.

That doesn’t mean that if you feel that way, there’s something wrong with you. But can we please stop perpetuating this self martyrdom that medical students will all inevitably hate their lives?

Far more dangerous is the myth is that feeling upset or stressed out or dejected during medical school is atypical. Over a quarter of medical students and residents have signs of depression, and 10% of medical students have suicidal ideations. Many more don't meet the criteria of psychiatric illness but are constantly haunted by stress, imposter syndrome, and distress over academic setbacks. Yet there is a pressure on medical students to create a façade—to put on a brave face so that your peers don't think you're weak or dimwitted, and to gossip about those whose façades aren't as convincing as your own. Medical school culture sometimes turns into a competition to determine who's the most masochistic. If you shed a tear when the welts from the self-flagellation get too sore, you're looked down upon by other participants who take a sick pride in their ability to hide the pain.

And yes, I'm sure there are some people with exceptional memories and resilient attitudes who aren't fazed by any aspect of medical education or training. If they are indeed "doing well" in every dimension of their academic lives, then I'm not all that concerned about them. I don't care if people believe them or not, and they shouldn't care either; if they're doing well, they're doing well. I'm more concerned about the toxic culture that tells the many student who are experiencing negative emotions that there's something wrong with them and that they should bury those emotions as deeply as possible.

 

[Lawpy]

Far more dangerous is the myth is that feeling upset or stressed out or dejected during medical school is atypical. Over a quarter of medical students and residents have signs of depression, and 10% of medical students have suicidal ideations. Many more don't meet the criteria of psychiatric illness but are constantly haunted by stress, imposter syndrome, and distress over academic setbacks. Yet there is a pressure on medical students to create a façade—to put on a brave face so that your peers don't think you're weak or dimwitted, and to gossip about those whose façades aren't as convincing as your own. Medical school culture sometimes turns into a competition to determine who's the most masochistic. If you shed a tear when the welts from the self-flagellation get too sore, you're looked down upon by other participants who take a sick pride in their ability to hide the pain.

And yes, I'm sure there are some people with exceptional memories and resilient attitudes who aren't fazed by any aspect of medical education or training. If they are indeed "doing well" in every dimension of their academic lives, then I'm not all that concerned about them. I don't care if people believe them or not, and they shouldn't care either; if they're doing well, they're doing well. I'm more concerned about the toxic culture that tells the many student who are experiencing negative emotions that there's something wrong with them and that they should bury those emotions as deeply as possible.

I mean, i agree, but that's very different from claiming that people who didn't feel bad are faking it. Yes there are challenges and difficulties but to accuse someone who managed well and didn't feel bad like the other user did is flat out absurd.

I just think we should let people feel how they want to feel with little to no judgment

 

[Matthew9Thirtyfive]

Far more dangerous is the myth is that feeling upset or stressed out or dejected during medical school is atypical. Over a quarter of medical students and residents have signs of depression, and 10% of medical students have suicidal ideations. Many more don't meet the criteria of psychiatric illness but are constantly haunted by stress, imposter syndrome, and distress over academic setbacks. Yet there is a pressure on medical students to create a façade—to put on a brave face so that your peers don't think you're weak or dimwitted, and to gossip about those whose façades aren't as convincing as your own. Medical school culture sometimes turns into a competition to determine who's the most masochistic. If you shed a tear when the welts from the self-flagellation get too sore, you're looked down upon by other participants who take a sick pride in their ability to hide the pain.

And yes, I'm sure there are some people with exceptional memories and resilient attitudes who aren't fazed by any aspect of medical education or training. If they are indeed "doing well" in every dimension of their academic lives, then I'm not all that concerned about them. I don't care if people believe them or not, and they shouldn't care either; if they're doing well, they're doing well. I'm more concerned about the toxic culture that tells the many student who are experiencing negative emotions that there's something wrong with them and that they should bury those emotions as deeply as possible.

That’s great but literally no one said that. The argument was that some people will feel bad and some people will be fine. Feeling almost any sort of way is valid and should be accepted. Shaming students for feeling great or loving med school or accusing them of lying is ridiculous and just as bad.

 

[Redpancreas]

Had a nurse try to stop me from doing an emergent bedside procedure on night float as a PGY5. Told me I was not credentialed to touch her patient and that she would be calling security.

I calmly but firmly informed her that when security arrived I would be asking them to restrain her and we would see who's instruction they listened to. I did not stay and wait for her rebuttal. As I was walking away and she was standing there fuming I overheard one of the other nurses telling her in a hushed voice "that was the chief surgery resident and he is absolutely credentialed to do whatever he needs to in this hospital, he's the one we call for help".

/flex.

You generally have the high ground when you can plainly state to someone "which one of us is capable of cutting open someone's chest and massaging their heart back to life with their bare hands?"

granted there's a 99% mortality but that isn't the point now, is it?

Yeah if I tried that I'd be called into my PDs office the next day, but I'm a couple years JR to this stud. Medicine is hierarchical.

 

[Osminog]

That’s great but literally no one said that. The argument was that some people will feel bad and some people will be fine. Feeling almost any sort of way is valid and should be accepted. Shaming students for feeling great or loving med school or accusing them of lying is ridiculous and just as bad.

It's really not "just as bad." It's far better to be doing great and to face skepticism when you boast to others about how well you're doing, than it is to struggle and be miserable while having to pretend that everything is fine. As far as I know, no medical student or resident has committed suicide because they were perfectly happy with their lives and some of their peers questioned their sincerity.

I agree that sunglasses avatar person was somewhat overstating his point. There are some medical students who are wholly content and have no major stressors that damage their mental health—but at the same time, there are plenty of students who are "faking it," as described in sunglass avatar person's post, due to the toxic culture that I described earlier. In true SDN fashion, people clung on to trivial clarifications ("no, some people are actually doing awesome!") rather than discussing the issue of actual substance and practical relevance: how so many unhappy, stressed-out medical students feel the need to pretend that they aren't struggling.

 

[Lem0nz]

Perspective helps. Being over 10 years removed from it, I can state it with confidence. Everything comes out of the dark eventually.
Are you still a medical student? If so, you'll figure this out eventually.

That’s great but literally no one said that. The argument was that some people will feel bad and some people will be fine. Feeling almost any sort of way is valid and should be accepted. Shaming students for feeling great or loving med school or accusing them of lying is ridiculous and just as bad.

I don't think anyone is shaming students from feeling a specific type of way. Rather, I think that given the lens of completing residency, none of us had a point where they didn't feel depressed nor did they know any student or resident who at some point didn't have serious depression. Personally I did not know a single resident out of a cohort of 30 each year (so like... 80 by the time of graduation?) that did not have serious depression for at least some span of a couple months if not much longer. Not a single one.

That's all. I don't think they're shaming people for being happy or sad or anything of the sort. The original comment that started this off of people faking it was also universally true in my experience. Its quite sad, but something we deal with. It was much worse in residency than medical school but also very prevalent in medical school. And I did not go to a malignant program or school, the farthest thing from it. Its just hard. I will agree that not everyone was faking it in medical school, but by the end of training everyone faked it at one point or another for sure.

That's how I would translate his old people speak. Not sure any of you really need to argue about it.

 

[Lem0nz]

Yeah if I tried that I'd be called into my PDs office the next day, but I'm a couple years JR to this stud. Medicine is hierarchical.

I had some other really classy moments. I threw our trauma spectra phone across the trauma bay once after telling my attending to eff off when I was on the receiving end of a 20 minute rant about something the resident who signed out to me messed up before I even showed up to work. I then self reported myself to my PD about ten minutes later when I calmed down and was like "sssooooooooo listen you're probably going to get a report from the ED tonight and I just want to get out ahead of it and say I'm really really sorry..."

The attending going off on me apologized to me and the PD, PD and Chairman sat me down and told me with like a really stern face "you can NOT do that", and then like thirty seconds later everyone was laughing so. Idk. Work is weird.

 

[Matthew9Thirtyfive]

I don't think anyone is shaming students from feeling a specific type of way. Rather, I think that given the lens of completing residency, none of us had a point where they didn't feel depressed nor did they know any student or resident who at some point didn't have serious depression. Personally I did not know a single resident out of a cohort of 30 each year (so like... 80 by the time of graduation?) that did not have serious depression for at least some span of a couple months if not much longer. Not a single one.

That's all. I don't think they're shaming people for being happy or sad or anything of the sort. The original comment that started this off of people faking it was also universally true in my experience. Its quite sad, but something we deal with. It was much worse in residency than medical school but also very prevalent in medical school. And I did not go to a malignant program or school, the farthest thing from it. Its just hard. I will agree that not everyone was faking it in medical school, but by the end of training everyone faked it at one point or another for sure.

That's how I would translate his old people speak. Not sure any of you really need to argue about it.

I’m probably older than him (or close anyway). And he literally said anyone who says they’re fine after first year is lying. So yeah.

 

[JP2740]

Is it normal to feel bad everyday of my life? I’m pretty much an attending and still have some weird underlying anxiety constantly rolling around.

 

[Chads2]

Is it normal to feel bad everyday of my life? I’m pretty much an attending and still have some weird underlying anxiety constantly rolling around.

The anxiety comes from knowing what you don’t know.

 

[Chads2]

The nurse pimping you can kick rocks. Next time she draws labs you should pimp her on the coagulation cascade.

It doesn’t even need to be that esoteric. Real-life examples:

Nurse: “The doctors have ordered some plasma to support your blood volume.”
Me: “Well, more to correct the elevated INR and bleeding”

Nurse: “Why are they saying he has a borderline personality disorder? It’s definitely a personality disorder.”
Me: “No it’s actually called Borderline Personality Disorder.”

Nurse: “If the patient has encephalopathy, why not just give lactulose?”
Me: “Because it’s not hepatic encephalopathy.”

Of course, I try to not be condescending in doing so. I’ve actually had very interested nurses ask me to explain the cosyntropin stim test after I try to hammer home the importance of the timing of the blood draws. These are the nurses who are also not typically condescending to my students or residents.

 

[Chads2]

Not sure any of you really need to argue about it.

But it’s the Internet!

 

[longhaul3]

Nurse: “If the patient has encephalopathy, why not just give lactulose?”
Me: “Because it’s not hepatic encephalopathy.”

This one is a great example—there are a lot of savvy nurses who can manage things in their wheelhouse really well because they see it all the time. But it's very algorithmic and all if/then scenarios. Same with the nurse who tries to shame you for not thinking a patient with altered mental status is having a stroke...for the ED nurses, neuro problem -> stroke alert

 

[Redpancreas]

This one is a great example—there are a lot of savvy nurses who can manage things in their wheelhouse really well because they see it all the time. But it's very algorithmic and all if/then scenarios. Same with the nurse who tries to shame you for not thinking a patient with altered mental status is having a stroke...for the ED nurses, neuro problem -> stroke alert

Exactly. They may even get brownie points from their nursing supervisor for escalating the level of care by being pushy with the resident. Meanwhile, this resident who caved to nursing hears it from his/her attending the next day when trying to find out why this patient was admitted and neuro was consulted and the patient gets billed for a day in the hospital with consultant fees, ends up with COVID, gets readmitted when in the symptomatic phase, and gets brought to the ICU. Never take advice from those who don't have to live with their consequences.

There was an ICU nurse who thought I was being insensitive when I was talking to a patient. They were there for an Occult GIB. They were in the ICU for close monitoring after IR angiogram and the patient asked what all the procedures (including the past) were for and I proceeded to explain it was a pretty unusual case (i.e. malformation)....and the nurse jumps in and interrupts and says, actually we see cases like this ALL the time....without reading past yesterday's progress note to know that this patient had a congenital disorder and needed a record breaking number of IR interventions already. When I explained the situation, she exclaimed that wasn't what she heard on signout...like I guess if things didn't happen during their shift or the preceding one, they don't exist?

 

[Chads2]

When I explained the situation, she exclaimed that wasn't what she heard on signout...like I guess if things didn't happen during their shift or the preceding one, they don't exist?

I have noted that “signout” rarely involves what a patient is treated for / how a patient is being treated. As a young attending, I asked a nurse how she knew what was going on with a patient. She said she got it from the night nurse in signout. I asked who that nurse got it from...and she said, the day nurse who signed out to her. So I asked...did anyone in that chain ever speak to a doctor or read a doctor’s progress note.

It was the first time she’d ever read a doctor’s progress note.

But, in the process of doing that, she learned where to look and how to know more about her patients.