Venting ... just at a cross roads

[Stellamaris]

I am writing from a place of utter desperation , darkness and disappointment . I am a third year resident in a good IM program not the best but far better than most . I suck at everything

Many many days I feel like I know nothing , I can’t come up with a good plan. I have difficulty synthesizing the information quickly enough. I can’t recognize turn subtle turn in events. My organizational skills suck. I am failing miserably in life right now.

My work life has been taking a hit for the longest. The only reason i am still in residency is because people realize I work hard and I am in general a nice person . So I am the sympathy resident , which in and of itself is crushing to my soul . My interns don’t look up to me, they challenge my decisions or question my decisions. Sometimes they say it , sometime it is unspoken but felt. What I say carries no weight .

They gravitate to my 2nd years. My 2nd years never inform me or keep me in the loop like they do with the interns and each other , I guess my ****ed up ness have made me so minuscule in their eyes that I don’t even matter. I don’t think it is intentional but I am often fishing for what goin in , whereas others just casually update each other , and even nurses do the same.So when things happen I feel like I am a step behind . It is a vicious cycle of self doubt

I am the **** show , nurses kind of hang around during rounds to see what beating I will get from attending . I open my mouth to present and I am a rambling , haphazard mess. I usually have to write everything down so I remember what to say and not mix up the patients .It usually does not start that way but somewhere in the process, I have done something that I was not supposed to do or did not do something I should have done .In a calm or less pressure environment or when talking to colleagues I present well and succinctly but something about official rounds or a consultant walking up to me unexpectedly and I am like huh huh huh? I am constantly reminding my self why is the patient here , what are we doing . Without my notes , I am nothing


I am the laughing stock , I feel like my reputation precede me. I feel like when I work with people ... actually I know that when I work with other residents and attending , every info I give is double checked because there is no trust . I am that resident that walks into the room and people go oh God .

This is the second time I have thought about leaving medicine but the truth is I love medicine . When it clicks it feels wonderful, but the problem is it doesn’t very often. My knowledge base is still building up. Eventually it does but...At this point , I am working like an EM physician let’s rule out causes that can kill this patient and go from there . UpToDate is my friend even though I feel like a quack for using it especially infront of people.I can’t deal with the acuity of hospitalist medicine right now because of this knowledge gap ,even if that’s what I love and want to do . I feel like I need 4 years of residency to feel competent and confident . I have given up so much o get here and now I am blowing it.

The truth is I am a slow learner. Its hard for me to retain things. I mean I am not completely brainless but I have tried and still trying tricks to retain info. I was a good student in medical school , passed all my boards but truth is I feel like I am still an advanced intern/PGY2 level. I study and then miss the diagnosis in an actual patient ... wtf. I learn best when people explain why , breaking it down, reason behind actions, but people usually don’t take the time to do that . I NEED a coach / tutor someone to bounce things and thought process with.

All this have made my work life unbearable . I can’t truly connect with my colleagues , I can’t be my true bubbly self at work because I am so conscious of my actions, mistakes and people ‘s perceptions of me. I am tired of confiding in close friends and family . I have burdened them enough. I have no friends at work , I mostly connect with all the other struggling residents. I need a therapist Or just leave medicine all together despite the fact I love medicine ... I guess just accept the fact that just because I love it doesn’t mean I am good at it. Maybe explore other options whatever that may be .i am Just venting . If you have kept reading till the end , Thank you and God bless you. Tomorrow is another day maybe it will be better than today.

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[whoknows2012]

Couple things;

1) I’m really sorry that you are going through this. What you’re describing sounds like a real struggle and I highly suggest you seek professional help in the form of a therapist in addition to whatever I suggest below.

2) to what degree has your program been helpful with your struggles? Did you skate under the radar until it was too late? Usually program leadership has a large investment in trying to make all of their trainees succeed. Often times they’ll continue to try and help until they feel like it’s a lost cause (ie resident unaccepting of help, too confrontational etc). To me it sounds like maybe a small problem became larger and larger as time went on and now you’re stuck

3) as far as being successful in training, a lot of attributes are learnable. Some of course are not. Pattern recognition, presenting, knowledge base, efficiency, and organizational skills are all things that can be improved with the right approach. See number 2. Maybe someone within the leadership or a chief resident could work closely with you to improve your confidence.

4) how have your evaluations been? Some of what you say is probably true, ie someone has told you this before. Some however sounds like you’re super self conscious and maybe internalizing everything even if things aren’t necessarily directed at you.

5) in addition to what I recommended in 2 and 3 find a clinical mentor (whether within the program leadership or otherwise) who has the time to sit with you, go through cases plans decision making etc. I know “practicing” isn’t the real thing but this is what builds the knowledge base, sets up the scaffolding for your decision making and improves your confidence. To me it doesn’t sound like you are beyond being helped. I’d suggest you get on this ASAP and seek help from your program tomorrow if you haven’t already. As chief resident I often worked closely with interns and residents who were struggling, without judgement, and worked together to improve some deficiency or struggle they were dealing with. Good luck and feel free to PM if you have some specific questions

 

[gorbage]

I agree with whoknows2012 that it would be helpful to know how your evaluations have been, OP.

Reading this post, I can see that you are struggling and I am so sorry to hear that you've been feeling helpless and low at work. It's just hard to know if your issue is predominantly a work-related one (i.e., if you would be most helped by organisational strategies and memory tricks) or an issue of anxiety or depression clouding your perception of yourself and impacting your efficiency and success.

 

[Stellamaris]

Couple things;

1) I’m really sorry that you are going through this. What you’re describing sounds like a real struggle and I highly suggest you seek professional help in the form of a therapist in addition to whatever I suggest below.

2) to what degree has your program been helpful with your struggles? Did you skate under the radar until it was too late? Usually program leadership has a large investment in trying to make all of their trainees succeed. Often times they’ll continue to try and help until they feel like it’s a lost cause (ie resident unaccepting of help, too confrontational etc). To me it sounds like maybe a small problem became larger and larger as time went on and now you’re stuck

3) as far as being successful in training, a lot of attributes are learnable. Some of course are not. Pattern recognition, presenting, knowledge base, efficiency, and organizational skills are all things that can be improved with the right approach. See number 2. Maybe someone within the leadership or a chief resident could work closely with you to improve your confidence.

4) how have your evaluations been? Some of what you say is probably true, ie someone has told you this before. Some however sounds like you’re super self conscious and maybe internalizing everything even if things aren’t necessarily directed at you.

5) in addition to what I recommended in 2 and 3 find a clinical mentor (whether within the program leadership or otherwise) who has the time to sit with you, go through cases plans decision making etc. I know “practicing” isn’t the real thing but this is what builds the knowledge base, sets up the scaffolding for your decision making and improves your confidence. To me it doesn’t sound like you are beyond being helped. I’d suggest you get on this ASAP and seek help from your program tomorrow if you haven’t already. As chief resident I often worked closely with interns and residents who were struggling, without judgement, and worked together to improve some deficiency or struggle they were dealing with. Good luck and feel free to PM if you have some specific questions

Thank you for the advice and supportive words. I am in the process of finding a therapist. Number 5 is what i feel will be helpful . Going through cases and helpfully critiquing my plan so I know where my thinking went wrong.unfortunately, that has not happened for other reasons. The program is supportive but that sort of help has not being provided. Organizational help and memory tricks will be helpful. I am currently working on that myself right now. Also looking for case based learning resources. evals have been neutral .
I dont have depression or anxiety..only when i am at work... sigh .. outside of the hospital i am well adjusted , and yes likey i am internalizing all of this and been self conscious . My goal right now is to find a clinical mentor... and thats proving harder than i thought. I dont know if there are any online resources . Everyone is busy busy busy , but i will keep trying . Thanks so much

 

[Stellamaris]

I agree with whoknows2012 that it would be helpful to know how your evaluations have been, OP.

Reading this post, I can see that you are struggling and I am so sorry to hear that you've been feeling helpless and low at work. It's just hard to know if your issue is predominantly a work-related one (i.e., if you would be most helped by organisational strategies and memory tricks) or an issue of anxiety or depression clouding your perception of yourself and impacting your efficiency and success.

Thank you for the reply .Yes to both , organization and memory trick will be good for me i feel. I learn based on concepts and reasoning. I am not typically an anxious or depressed person, actually quite the opposite outside of work and around other people that are not work colleagues. I just have low work self esteem i guess because of all my deficiencies at the moment