Imposter Syndrome

I wrote this my first year out of medical school and at the time shared it on a site I was writing for. I’m re-sharing all these years later, because it’s still very applicable (both to me and others) – particularly since many of you are at the beginning of your med school or residency journey.

Doctor Amelia
Imposter – My daughter as a lady bug, doctor, Doc McStuffins, kid.

IMPOSTER SYNDROME

Occasionally I find myself in the OR standing over a patient (on a step stool, thanks to my losing battle with a vertical challenge), scalpel in hand, with a “holy-geez-someone-call-a-doctor” feeling. It’s that surreal feeling you get as you transition into a new role, just intensified I think now that my new role involves…I don’t know…cutting people open and pulling out their babies or looking at someone’s insides with a laparoscopic camera?

Honestly, each day is a weird transition of sorts. I get up every morning and do normal things – shower, nurse a couple of babies, lock the front door with a piece of toast hanging out of my mouth and a coffee cup balancing in the crook of my arm, and I transition. The transition is usually seamless – get to the hospital, round, deliver babies, scrub for surgeries, or see patients in clinic, lather, rinse repeat. But every once in while when there’s a moment to step back and survey a situation I will suddenly notice this flood of weird feelings, like I’m a kid playing dress-up and at any minute I’ll have to come back to the real world.

It happens the first time you do a full physical in medical school, or as you sit counseling a family during a tragic diagnosis or bad outcome, maybe when you hand off a tiny, slippery, screaming human to it’s exhausted mother – this overwhelming feeling of “I should NOT be allowed to do this” delicately balanced with “how did I actually become capable of doing this?”

Everyone in medicine feels it at some point and I don’t know that it’s easily explained to those outside the medical field. The only non-medical thing I can personally relate it to is the feeling of overwhelming responsibility paired with shear terror you get as you cradle your first born (or first bornS, if you’re in the multiples club with me) in a quiet house and realize the hospital failed to send you home with a nurse or monitor or instruction manual of any sort. You know, when your brain is wavering between “I got this.” and “Nope, totally don’t got this” but hasn’t quite established where “comfortable” is just yet.  It’s this air of not belonging, almost of doing something you shouldn’t be doing, even though you’re doing exactly what you should be doing.

It’s weird. It is so weird.

I’ve heard it called Imposter Syndrome somewhere, I’m honestly not sure if that’s an actual title of something or if I pulled it out of thin air, but it seems appropriate. I assume the frequency of this feeling will continue to fade as we settle into these new roles, but I wonder if it ever completely disappears? After years of practicing medicine do you ever still get that feeling or does it become so routine that you lose sight of the uniqueness of it all? Either way, I can only assume that with a country full of interns braving their PGY-1 year that I’m not alone in the Imposter Syndrome struggle.

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I’ve had a few distinct times I felt this – my first cadaver lab as a med student, probably my entire first year as a doctor, my first midnight and only-Ob-in-the-hospital delivery as a new attending, my first solo surgery. It’s important to note that these things never feel unsafe – it’s not so much a feeling of unqualified as it is a sense of finally realizing this dream you’ve had so long. I can only describe it as a sense that you are finally granted both permission and skill to do these amazing things.

Ob/Gyn Residency – An Update (At the End)

IMG_6626Well hey there, can’t believe anyone is still making it over this way. Residency is kind of time-consuming, who’da thunk it?

I started this post 1.5 years ago and never finished. Awesome.

Considering we’re coming up on the half-way point end of my residency experience, I figured now would be a good time for an update. Last I checked in was a year ago basically forever ago and I was learning to do LEEPs on summer sausages and perineal laceration repairs on cow tongue. Since then I’ve graduated on to being allowed to work with actual patients who are much easier to talk to and far more enjoyable to be around.

Current Going Ons

So, what am I doing these days? Well, this month I’m on Elective. As a chief electives are really awesome, because I basically get to do whatever I want. For me at this point that means I am doing book-keeping things (getting my Texas medical license, which is about 2,000 steps, updating my certifications for BLS and ACLS, etc.) and stalking all the clinic books to see more vulvar pathology and infertility things. I’m also helping out in L&D some, taking q4 traditional call (from home, because my program is awesome to the chiefs), and operating a bit with the group I’ll be joining next year.

Obstetrics

In the past 3.5 years I have delivered more babies than I can count. Some of them stand out as memorable, others fade into a pool of joyous but not unusual. I’ve delivered extraordinarily tiny babies who were very premature, very sick babies, stillborn babies, babies who died soon after delivery, babies who belong to my personal patients and friends and co-workers, babies who made their way via stat c-sections, “birthday babies” (in what other field is it AWESOME to work on your birthday?), surprise babies, twins, and everything in between. Most of the birthdays have been incredibly happy, many heart-wrenchingly sad, a handful were awkward, many were scary, some were downright strange, but most were just lovely experiences that didn’t leave long-lasting impressions due to pure volume. Despite the variety, I can confidently say every single delivery has been absolutely an honor for me. I am still truly in awe every time I attend a delivery that I get to this as my job. It’s unreal.

Gynecology

A mix of clinic patients, procedures, and surgeries – I’ve come to enjoy this sector of my field so much more than I anticipated. It turns out that surgery as a doctor is about a billion times more enjoyable than surgery as a medical student. I’ve done countless “minor procedures” like D&Cs, LEEPs, hysteroscopies, tubal ligations, and diagnostic laparoscopies. In my second year I got more experience with open and laparoscopic abdominal procedures – myomectomies, giant ovarian cystectomies, salpingectomies, ruptured ectopic pregnancies, bleeding ovarian cysts, etc. Open myomectomies are a “second year case” but still one of my favorite surgeries, I have no idea why – I just find them very fun. Third year I operated with the oncologists a lot. The past two years I’ve done more hysterectomies than I ever anticipated. I’ve gotten to do a good amount of Urogyn (pelvic organ prolapse and incontinence) surgeries. I have seen a huge range of very interesting cancer cases and I absolutely loved my Oncology rotations. I loved them so much that I very strongly considered a fellowship in Onc (which was absolutely never on my radar until last year). More on that non-decision later. Outside of Oncology I’ve operated on a handful of very sick patients, but for the most part non-oncology patients tend to be relatively young and healthy. This was actually one of the reasons I was drawn to this field in the first place.

Life

Oh, life. The twins are 4 years old now and absolutely the coolest kids I’ve ever met. We added a new addition to the family in June, he’s a cute little ball of chubbiness and is learning to crawl and pull-up now. We unexpectedly and tragically lost two of our sweet dogs earlier this year. As most of you know they were an integral part of our family dynamic and we will always have a void where they belong. I’ve accepted a job in College Station starting in August – so if you’re in need of an Ob/Gyn in the Texas A&M area, come see me! 🙂 We never planned on going back, but a great opportunity presented itself and we are absolutely ecstatic to make it back to Aggieland!

 

Residency Work Hour Restrictions

The Grass Is Always Greener?
Growing Up in the Era of Work-Hour Restrictions

Tired DoctorIn 2008, the IOM study on resident work hours came out and in the years that followed the Accreditation Council for Graduate Medical Education (ACGME) subsequently implemented a gamut of “recommendations.” As a medical student, I remember thinking it was a much needed change – why wouldn’t it be a good idea to improve patient safety and decrease resident fatigue?

Alas, as a newly minted intern growing up in the era of work-hour regulations, it’s become apparent that many of these changes may actually make life harder without achieving their main goal of improving patient care.

The 80-hour work week cap is fine; it’s been in effect on its own since 2003 and overall it seems to have made residency more humane. Most programs have found reasonable ways to limit work hours to this full-time-times-two amount, at least when hours are averaged over four-week periods.

However, the additional bullet point “recommendations” from 2010 seem to play out very differently in real life than they do on paper. Many of them seem to be arbitrary lines drawn in political sands hiding behind a facade of patient safety, but that’s another blog for another time.

So, what do the bullet point regulations look like in the hospital?

They look like: Interns can’t work 24-hour shifts. 

So, what used to be a two-and-a-half shift weekend turns into a four shift weekend. At a four intern/year program like mine, that means instead of two people splitting the weekends and having a post-call day after 24 hours on, one intern is committed to night-float six nights/week for a month while the remaining three interns take the three leftover weekend shifts. The result: Fewer hours at a time in the hospital, but more working days in a row and more days/month away from your family.

Is that worse than working a 24-hour shift? I’m not sure it is. It’s certainly not better, though, and I’ve yet to see convincing data that it’s made drastic improvements in patient care; I have seen a few mildly convincing reports that it’s potentially done the opposite. What it has definitely done is make scheduling and coverage more stressful and taxing.

I tend to agree with this recent JAMA article suggesting limiting hours without changing workload is completely counterproductive. I do, however, consider myself incredibly lucky to be a resident at a humane program that takes care of its residents.

The regulations seem to be put into place without regard to specialty or program size, which could be the fundamental flaw. What works for primarily clinical specialties like Family Practice and Pediatrics may never work for primarily surgical specialties like General Surgery or for mixed surgical specialties like Ob/Gyn and Orthopedics. In politics and in medicine, blanket regulations, while easier to create, track and implement, rarely achieve proposed goals on a global level.

I guess it won’t matter for me too long – come July 1, 2014 I move up in the ranks to “2nd year” and am suddenly capable of working a 24-hour shift…yet another arbitrary line those bullet points draw in the proverbial sand.

What do work hour restrictions look like in your hospital?

 
I originally wrote this post for my monthly column over at The American Resident Project, a collaborative blog with some of the best resident and medical student bloggers that I some how got invited to participate in. Check it out here.
 
 

Image Credit: imagerymajestic | freedigitalphotos.net

Ob/Gyn Residency – Month 1

Danielle Jones, MDSorry I’ve been away so long! Between graduating medical school, moving across the state with 6mo old twins, traveling, welcoming our new Au Pair, Odelia, and starting residency, life has been hectic, to say the least. I can only imagine life will continue to be hectic(-er), but now that I’m back to some what of a predictable routine my goal is to blog more frequently. Not for y’all – I’m sure you didn’t miss me a bit (*tear*) – but for me, as I truly enjoy writing here and I fully intend to keep doing it.

July 1 marked the first day of residency, with a week of orientation preceding, and so far it’s been a nicely terrifying adventure. I started on Ambulatory Gynecology, so I feel like I’ve been eased into everything very slowly. My hours have been fine and I’ve been able to keep up fairly well with things, but again – I’m on basically the easiest rotation of intern year.

The biggest thing I’ve found? I have so much to learn. I often feel like a lost puppy – I do a lot of wandering around in clinic asking upper-levels where consents are kept, how to access lab values in the 25 EMR programs we use, and if we’re really sure I can give that person a refill on their Fluconazole, because holycrapmynameMDisonthatscript. I’m sure the 2nd years see me coming and battle each other for hiding spots in the equipment closet lest I ask them for 6,000th time which forms I should fill out on a pre-op hysterectomy patient. God bless their patient souls (see what I did there? heh).

Labor & Delivery call days have been fun, delivering babies and having my name go on the birth certificate is an exciting step forward from being the (extremely awesome, but typically nameless) professional placenta catcher I was in my third year of medical school. Being in charge of triaging patients has taught me a lot, but I still feel like I know close to nothing. Every upper-level and attending I’ve worked with has been extremely patient and almost all of them are eager to teach. If nothing else, after the past several weeks I am 100% convinced I chose not only the right specialty, but the perfect program for me.

Pagers still annoy me. I can’t figure out why we can write prescriptions on an iPad and it magically shows up at the pharmacy, but I still have to carry around a ridiculous piece of technology (and sometimes two or three of them) from 1970 everywhere I go. You’d think we could just get an app on our phone called “PAGER APP” and divert pages to it. I mean, really, it cannot be that hard to do. Oh well, I finally figured out how to use it and I’m slowly becoming less senile towards the little guy. At least nobody has asked me to fax anything yet.

 

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Sim labs have been great teaching tools. We’ve done some simulated complicated deliveries with Noelle (and her weird, tiny baby) which are nothing like real-life complicated deliveries, but do give you a chance to slowly and calmly think through management techniques without the nervousness. We used beef tongue for an unusually great model of perineal lacerations and hysterotomies and a couple attendings and residents worked with us learning closure techniques. We learned LEEP on some unfortunate HPV-infected summer sausages (that smelled…awesome…yah I’ll go with awesome) and the Pap Smear reps came around and gave us a nice overview of the correct technique for gathering those. All in all, I feel like these have been an awesome chance for us to practice things we are suddenly expected to know how to do.

IMG_66262013-07-01 14.45.01

 

 

 

 

 

 

 

 

 

 

So, life is busy, but good. I expect in the coming months things will only continue to get crazier and busier, but the work is fun and the people are great. My co-interns are better than I could have asked for and the upper-levels and attendings here are fabulous, as expected.

Screen shot 2013-07-15 at 5.11.53 PMInterns celebrating Jenna’s birthday!