What Medicine Has Done To Me
I guess this post has been a long time coming, and probably why I haven’t written for awhile. It’s a culmination of a year of clinical training, and what effects it has had on me, from the good, to the bad, to the ugly. I think I’ll start with the bad and the ugly, because that’s what’s really been bothering me for awhile now.
Medicine has made me into a shitty person. Or, maybe more appropriately, the shitty-person side of me was always there, but the stress of medicine brought him out. Many of the problems, I believe, stem from behaviors in medicine that I can’t shake from my person when I’m not in my medical role. Shitty Graham takes several forms:
- Impatience. Often you’re sitting around waiting for a lab result, or a patient to go to x-ray, or waiting for a patient to get his new medication. Or you have a patient that talks on and on about unrelated things, when you know you have many more patients to see and you don’t want to get behind. But this attitude comes home with me. I want this now, I need to hurry to finish that, why are these other people besides me taking so damn long? I’ve lost the ability to live in the moment.
- No tolerance for incompetence. (It dawned on me yesterday why this one has happened.) The transformation from preclinical student to clinical student is a miraculous one, and the amount of knowledge learned is mind-boggling. But with this comes another step: beginning to feel like one understands medicine–and even if you don’t, patients ask you questions as if you do. When strangers ask you questions about medical stuff and you know the answer, it feels great. It feels like you went through all this training for a reason. But at least for me, it’s been a terrible boon for my ego. I really think it’s made me feel like a total know-it-all, even in the non-medical world. It’s weird. I’m incredibly guilty of “always having to be right” in the non-medical world, and honestly trying to fight this and tell myself I’m not always right and that I don’t always have to be. But at the same time, I’ve probably become much more confident and sure of myself (read: cocky), so that I don’t even question whether I’m right or not. Now granted, this never applies to medicine and rarely applies to anything of importance in my life, but it does impact my interactions with others, and how I probably make others feel.
I don’t want to make this sound like I’ve become some sort of terrible monster, but it’s just the little occasioal interactions and thoughts that run through my head that didn’t used to be there.
I haven’t really talked about this at all with any classmates, probably mostly out of shame and the fear that no one will feel the same way, and it’s just me that’s a terrible person. But somehow the pseudo-anonymity of the web and the written word makes it easier to type the words than to say them. I’m just trying to be honest with myself and figure out what I’d really like to focus on in the coming year–mainly why I went into medicine and how I can rediscover some of my humanity and virtue, because the path I’m taking right now won’t lead me anywhere I want to be.
The Good I referred to above will, I guess, be left for another post. Believe me, there’s plenty of it, but I’m just not feeling it right now.
As for this blog–what will I write about since I’ll be doing a year of research and not seeing patients? Several people have asked. I think I’ll spend more time reflecting on the year as a whole (I love reflecting, if you can’t tell), and then who knows, probably some thoughts on research, being a teaching assistant, and then of course my 2 month jaunt to Guatemala next year.
(And welcome back to MedPundit, who thought she was giving up blogging but it’s reeled her back in.)
(Editted, I total was unclear by what I meant by incompetence.)
Here’s the good news: there are a lot of good doctors out there, and many of them are also good humans. They all went through what you’re going through, and the good ones struggled with the feelings that you are dealing with. And the fact that you are aware and struggling means you’re going to be fine. Trust me. I’m a doctor.
As a doc who’s been sued twice, I would strongly caution you against admitting in print that you believe yourself to be incompetent. Even though any rational person understands what you mean, you must never NEVER give a lawyer material to slide in front of you at a deposition.
If I were you, I would edit the post and re-publish.
best,
Flea
I agree with what Sid Schwab said in his comment. I think that you are expecting too much of yourself. Why would you think of yourself as being “incompetent” after just one year’s experience in clinical medicine. The amount of knowledge that a med student is expected to learn is phenomenal. It can’t be learned in one year. If you feel the same way after you finish all of your training, i.e. med school and residency, then I would say you real cause for concern.
I think that Flea is overreacting to the situation. I would again remind you that a junior in medical school is not expected to know “everything.” I am not as concerned about the subject of you blog as Flea is. I agree with him that a practicing physician or a resident in the last year or two of training should not make such a statement, but I don’t think that such a statement by a medical student means a lot.
As to the “bad” side that you say has come to the for during the past year, I would have to say that you are probably very normal. As we progress through our medical training and become more proficient in medicine, I think that most of us become impatient when we face the situations that you have enumerated. I think that you are a fairly “normal” junior medical student.
I’ve found myself in the same situation as you on many occasions although I haven’t gone into medicine (yet). It seems that there’s always a negative side to things, in many learning experiences in addition to medicine. Take my experience with research as an example. I’ve felt myself becoming overly confident when I know I shouldn’t.
On another note, I’m a sophomore at Rice University, so medical school is still a little ways off. I came across your blog in USNews and I look forward to keeping up with your takes on med school.
I think the saying about “you know youre not crazy if you worry about being crazy – crazy people (unfortunately its a crude term) dont question their sanity” applies to this case. If you aware of it and acknowledge it you can work on it.
I’m only a second year med student (as of July 31, gah), but I sympathize. I’ve dealt with enough doctors who were terrible people to be terrified of becoming one. I probably drive my husband crazy with “Has medicine made me an asshole yet?” checks periodically.
I’m going through this too, man. I’m actually only at the beginning of my clerkships, but I’ve noticed a change in my attitude just from being immersed in this sort of arrogant, judgemental culture of medicine. I do have some great mentors though, and I’m hoping some of it will rub off and I can be a good person again!
Ya gotta keep the paranoia alive–i the way I do it.
Have I missed something? What questions didn’t I ask? Did I address the problem he came in with?
When I was finishing my third year, I was cruising, on the coast to the finish line–but you will find out how little you know come 4th year. Actually managing patients and ferreting out their diagnoses is a big leap from reading PP slides you cribbed from UpToDate. The simplest, commonest problems are really complicated. Sick of hearing about asthma? Wait till its you in the driver’s seat, not just watching. Then do it 40 times a day. It’s no picnic.
It does get better.
You wrote;
“. . .it does impact my interactions with others, and how I probably make others feel.”
EXACTLY. My now ex husband acquired “attitude” when he became an attorney. I had to remind him during arguments that I was not on the witness stand. He became condescending to me in conversation, and worse, would not admit it or consider that it was happening.
It is good that you are aware of this change in yourself but you have to practice leaving the “attitude” for work or your relationship might possibly suffer for it.
Lily
My husband is an architect and owner of a firm … and that has certainly brought out the worst in him. He confuses me with his employees. He’s highly impatient and critical.
Just remember that folks can sense who really cares about them (can’t you?) – and their favorite doctors are those who care. Don’t care if you’re their favorite doc? Well, you should have seen one of my docs’ eyes light up last week when I told him cheerily that it was good to see “my favorite doctor”.
If that doesn’t help your attitude, keep an open Bible on your desk as my spine surgeon does. That can do wonders for an attitude-adjustment :-)
Someone with a reason to worry … would not be worrying about it.
You’re tired, you’ve been through a lot, you’ve seen too much … cut yourself some slack.
I’m with Dr. Schwab … you’re going to be fine.
I too agree with Dr. Schwab. I’m entering med school this fall and am very worried about the potential for a personality shift during the training. I think being aware of it is critical to being on top of it. Plus, a little meditation for the impatience and some close friends or family that will knock you upside the head from time to time for being silly/cocky can help too. At least that’s what I’m planning on using. Good luck & keep reflecting.
Does medicine make you change? My experience in med school was that many general surgeons were jerks. I often wondered if jerks pick general surgery or if general surgery makes good people jerks. Having then gone through the a not-exactly touchy-feely general surgery internship at Duke (back in the day of the 130-hr workweeks) I found that nice guys are still nice guys with occasional bad days and jerks are jerks. And I guarantee you that the jerks don’t sit around (or blog) wondering if they are bad people. That’s only for those who really aren’t.
OK, so I ramble a little, but don’t worry about it. The hours and stress will et worse before it gets better, but things will improve and so will you.
(Oh yeah, and pretty much every doctor out there should answer “yes” to any attorney who asks if they were “incompetent” during their first clinical year.)
i think you have earned the right to have no tolerance for incompetence. You are in a profession that has zero tolerance for incompetence,at least officially. You have worked long and hard to gain that competence.
The fact that this bothers you one whit and that you blogged about it speaks legions.
Don’t worry, you are still human and kind. And if you don’t think I am a dithering moron, I would be happy to be your patient.
Uh, about that former smoker with the nasty subcutaneous lesions… how long had he quit? couldn’t figure out how to comment on that post…
Not to worry Graham…
When I started my first clinical year I wondered if general surgery made jerks or jerks were just attracted to general surgery. Then, in my general surgery internship at a program notorious for its stress/workload (130 hr workweeks, 110% divorce rate, etc.), I found that while the stress can make anyone cranky/bitter/short with others, when you start doing “real” medicine, esp what you enjoy (for me, Ortho) life gets a whole lot better. And I found some general surgeon residents who love their jobs and were actually tolerable.
Now, in the real world, there are stressors that will test your patience (ie single payor fanatics, etc. j/k), but if you are a nice, even-tempered person baseline, you will very likely remain that way.