Am I really smart enough to be a doctor?

Some days-okay every day, but some days more than others- I really wonder if I am actually capable of being a physician. Mostly it's when I'm around other students. Or being asked questions. Or in any clinical situation whatsoever. My first two years of school it was easy to blow things off, and tell myself that I'd figure it all out and knowing all these tiny details wouldn't make me a better doctor. I told myself that test grades didn't determine my ability to be a good doctor. It was all about the clinical skills and knowledge that I'd gain over my third and fourth year. But as I reach the end of my third year, I feel like I don't actually know anything, still. My faith in my ability to be a doctor is severely decreasing every day. I can't answer questions that are asked of me, but I feel like all the other medical students are able to. I've heard that I don't really learn anything about medicine until I'm an intern and a resident, but somedays I feel that is just another way of allowing myself to live in denial about my inability to think well enough to be a doctor.
The first day of a new rotation is always the worst, but sometimes it doesn't get any better than that first day. Sometimes I just continue feeling like an idiot. I can't do anything right. I don't know anything. I'm terrified of everyone because I don't think I can make them better. I've already ruled out any profession where on a daily basis I am directly responsible for numerous life and death decisions (ie Emergency Medicine or Surgery) because I know I can't think on my feet the way I would need to in those situations. Maybe that is why I enjoyed outpatient pediatrics. I didn't have to save any lifes. Everyone was relatively healthy, even those who were sick. I didn't feel responsible for life or death decisions. But even in the outpatient world, there was plenty I had no clue about, so many things I didn't understand or know how to deal with, but I feel like I saw them a million times over and still can't figure them out.
So here I sit, three shifts into an emergency medicine rotation, watching physicians run codes and remember what they are supposed to do, and I can't even remember how to do a full neuro exam on a patient, or remember why I might need to. I can't answer a patient's questions about PAD or PID or UTIs or anything. I'm grossed out by half of the patients I see in the ED. I can't stand the noise, the smell, the shear number of people. It is too much for me. I don't like doing procedures. And it all stems from a feeling of inferiority and stupidity.
A doctor once told me that third year isn't really about learning how to be a doctor. It's about figuring out what you want to do and what you like, and learning how to learn. I don't think I've learned how to learn yet. I don't remember things I've already learned. I don't enjoy researching new things. I can't keep all the information in my head.
Another doctor told me the three things you need to be a good doctor are 1. a good personality so people will want to come see you (done), 2. efficiency (gots that) and 3. enough knowledge to function as a docto. That's the one I'm worried about. I liked him, because he said I didn't have to know everything about everything. I didn't have to have all the answers all the time. I didn't have to be a specialist in my field or any sort of genius. I just needed to know enough to deal with things as they came up, and know where to look when I didn't know the answers. That's the worry for me.
I used to want to be a specialist in some field. The fore-most knowledgeable person in whatever it is I choose to do. Now I just want to survive. I don't have enough faith in myself to think I'm going to be anything better than a mediocre doctor. I definitely will be depending more on my personailty than on my actual clinical knowledge. So I'd better work in a place where I don't need to know all that much, or I'm totally screwed.
Will I ever actually be a good doctor? The fact that I don't know much right now isn't an indication of my inability to ever know things right? I'll eventually learn won't I? Experience, practice makes perfect, all that good stuff? Seeing, doing, teaching, eventually knowing? I have to hold on to that hope or I won't be able to function any longer. I can barely function now as it is...

If you are not evaluating me I feel no need to impress you

Lately I have found that I only have so much energy to give. I cannot be "on" all the time. So I have found that if I don't think you are going to directly evaluating me, I won't find any reason to suck up to you. In fact, I may not even be willing to talk to you. You mean nothing to me. Maybe I'll be nice to you at least, but probably not. I can't expend energy on people who aren't going to have some kind of say in my future. I have to do way too much sucking up in my time as a student. I can't care all the time, I'm sorry. So if I find myself in a situation where I am with someone who is not going to evaluate me, I find myself not giving any effort. Not just giving less of an effort. No effort whatsoever. I will walk out of clinic early because I know you aren't going to say anything to anyone because you don't know who to tell that I'm not doing my work. It is awesome. Fairly liberating. I should care a little bit, but I just don't.

Aparently everyone can tell when I'm bored. Which is always

Something I am slowly learning about myself: I don't actually care about anything anymore. Medical school has sucked the curiosity right out of me. My attention span is about the size of a peanut. Rounds: boring as hell. A "good learning opportunity." Yeah, if I could pay attention all the way through rounds maybe I would in fact learn something. But my ADHD (self-diagnosed) will not allow for that. I can pay attention to maybe two patients that aren't mine. And if your presentation is more than one minute long, you can bet good money that I won't be listening anymore. I don't find "self directed learning" time to be useful, it turns into nap time for me. I'm not willing to spend any more time looking something up than it takes to read an up to date article. By the time I get home I couldn't care less about anything I saw during the day. And if you ask a question at the end of a long clinic day, I'm going to punch you in the face. I honestly don't care about the answers enough to spend another ten minutes hearing the answer.
Does this mean I'm going to be a bad doctor? I sure hope not. I really don't feel any need to add extra work to my schedule. I don't look for extra stuff to do. Either you keep me constantly stimulated or I'm going to be asleep in the corner. I don't give myself assignments, I don't go searching for someone to see, I don't ask questions so attendings notice me.
All of this is bad. Very very bad. Because people are starting to notice. People who write my evaluations. Those people. Apparently I wear my emotions on my sleeve and everyone can tell when I'm bored or annoyed, which tends to be all the time. Sometimes even with patients I'm bored. Depends on the day. Usually I'm not. Usually if I'm with a patient I'm the happiest person in the world. Unless it is getting close to the end of the day, and this one patient blathering on is keeping me from going home (where, in case you are wondering, I am also bored) then I get a smidgen annoyed. And if clinic has gone late, I sure as heck am not going to ask my attending any questions, even if I really want to know.
Why? Because then things like today happen. I asked a simple question (what is the difference in prognosis between two diseases) and got a ten minute answer. Then, the other student felt the need to also ask a question so he wouldn't be shown up, and then the attending ended up on a half hour soap box about God knows what (I literally have no idea what he was talking about). Meanwhile, my eyes are slowly glazing over. I have to start telling myself ot pay attention, but then I'm only paying attention to me telling myself to pay attention. I really did at the time want to know the answer to my question. I have to really really want to know the answer to a question to ask one at the end of the day. But I can tell you, it wasn't worth it. Especially since that guy is not evaluating me in any way shape or form. I could have asked my aunt later, she's a Rheumatologist. That would have been more simple. And I could just tell her straight to her face when I no longer cared about the answer.
Five second answers, that is waht I need. That's about all the time I can spare anymore.
Mostly, I can't win for losing anymore. You can't make me happy. One minute I'm bored out of my mind, sitting and doing nothing, but then the second work appears I'm hoping I don't have to do it.
My poor friends who aren't in medical school but are reading this. You must be terrified of going to the doctor after you read my posts. Don't worry, not everyone is as jaded and cynical as I am. And, when I'm with patients I'm fantastic, they all love me, and I find the answers, so don't worry. But medical school is this annoying game that I am not good at, because I don't have the attention span to follow the rules. If you give me the afternoon off I'm going to take it. I'm not going to try and find myself extra work to do around the hospital. If the choice is between seeing another patient or going home, I'll probably go home. Does this make me a bad student? I sure hope not.
I've found that there are a group of us like me. Students who don't play the game, because we don't have teh energy. Sometimes we worry that we aren't going to be good doctors because we don't play thet game. But friends, I really think we are going to be okay. Because when it comes down to it, I don't need to be the leading expert in any field. I don't need to be a super star. There is nothing at the end of the road I need to compete for. All I want is to be a doctor, and to do that I just need enough knowledge to either know the answers or know where to find the answers. I can do that. And, I've got great people skills, so I know patients will want to come see me. Right? I'm going to keep telling myself that.
Why do I want to be a doctor? Sometimes I don't remember. And people I'm sure often wonder why I want to be a doctor when I seem to lack any interest or enthusiasm in what I do. But the truth of it is, I kinda know what it is I want to do, and that interests me, and I know I can do it without having to be a douchebag about it. I'm not willing to fake interst in things I'm not interested in. But unfortunately, I need to learn how to.
Usually I'm all about the journey, but in this case, I just want to get to the end point. I want to be a doctor. I don't want to answer to a bunch of people. I don't want to have to pretend to be excited about things. I don't want to have to work hard just at maintaining a front. I want to do my work, help my patients, and go about my life. I don't want to be graded and evaluated against my peers. I just want to be a freaking doctor already! Gah.
Anyway, to all of you out there who really are interested in everything, good for you. But could you tone it down a little for those of us who are struggling to stay awake and get through the work they already have to do? And for those of you like me, who really couldn't care less, hang in there. We're all going to be good doctors one day. And to the gunners: bring it down a level, no one likes a douche

"it was a really good learning experience" is code for "my life sucked"

We medical students cannot just say that things are bad. So we've found new code words for expressing our distaste in things. WE'll talk about the hellishness of a rotation and instead of just being able to end it with that, we always have to add "well, I mean it was a good learning experience. I learned a lot." If one more person says that to me I'm going to kick their ass. Because I know! I know that means they hated every second of it, but for some reason we have to put a happy face on everything and pretend we love stuff that we dont! WHY?! It makes no sense! Is it just that we don't want to show any kind of weakness? Or that we are worried by saying we didnt like something we are going to get a bad evaluation, someone is going to think we are uninterested? Are we just trying to be more PC? I do not know. All I know is that I do it too. No one finishes a crappy rotation or class story without saying "well at least it was a good learning experience."
What does that even mean? I learned the self control not to kill myself or others? That's what it means to me. I learned how hellish life can continue to be. I learned that I hate certain parts of medicine. I learned that everyone is more interested in medicine than I am. GAH!
Why can't I just say "hey, this place sucked, and the experience sucked, and I hated it all, and I don't care if there was a good learning experience portion of it, I'm just going to talk about how much it sucked?" I mean, I know people should look on the bright side of things, glass half full and whatnot. But sometimes it just gets ridiculous.
I really have nothing more to say on this, except that I feel like a bad person if I don't end everything with "at least it was a good learning experience." But when you hear someone say that, run the other way from whatever they were doing. It's like when a guy asks someone if a girl is pretty and they say she "has a great personality." Code blue code blue! Run the other way.

Boards Post Traumatic Stress Disorder. It is real

Many people probably think I'm just making excuses for the way I feel about test taking these days, and no one wants to hear me talk about failing the boards one more time. But the fact of the matter is, it has permanently and horribly affected my life. I can't just get over it, like people seem to think I can. And in talking to other students who have also failed the boards, it seems to be a pretty common theme.
We have been through a traumatic event. We may not have been in 'Nam, or in Iraq. We may not have been brutality beaten or held hostage (at least, not literally). We may not have been in a natural disaster and almost lost our lives. We may not have been in a plane crash or been witness to a murder. But in our own way, we have suffered a trauma that isn't likely to leave our minds any time soon.
The boards are built up to be the end all be all of tests. Nothing in life matters quite as much as your board scores. They determine your entire future, your ability to get a good residency, fellowship, attending position. You will forever be judged on your board scores. And maybe none of htat is really true, but by the beginning of second year that is for sure what you think. You spend all of your time studying, worrying, stressing, crying, and then studying some more. the atmosphere during boards prep time is the worst time you'll ever have in your life (at least, I have to hope that is the worst experience I will ever have). And then the dreaded day comes when your scores come in, and you find out you failed.
The world really does feel like it is ending. You see all your hopes and dreams for the future fade off into the distance. All of a sudden all you can see is this failure, it defines you, it has ruined you, it means everything to you. And no one who hasn't failed the boards can truly understand what that means. They think they can, and they can be supportive of you, but when you've failed teh boards, you have lost a piece of your life. It is a dark, dark day. It shouldn't matter as much as it does, but sadly it does.
A friend of mine who also failed the boards said she went through the five stages of grief, and it is totally true. It is just like any other tragic moemnt in a person's life, except that it shouldn't matter so much. So when I tell people that I have PTSD from it, they laugh and tell me to cut it out. But they don't understand that I do wake up in the middle of the night freaking out about having failed. I do dwell on it and what it means for my future. I dread being denied residencies beause of this failure. I feel like it completely defines me. And the worst part is, it has taken all of my limited test taking confidence and killed it.
So now, when it is test time, I fall into a horrible depression. I can't get out of bed. I snap at everyone. I worry about failing. I can't focus long enough to study. I dont want to study. I'd rather stare off into space than get out my book. I start to cry, my stomach ties up in knots, and all I can think about is how I failed the boards and will never again be able to take a test. I try to tell myself that I will pass the rest of these tests, that if I study hard enough I'll be fine, that this time around I'll be prepared for whatever test is coming, but the week before the test the same thing happens: I realize I haven't spent enough time studying. I start to stress about how I shold be studying more. I try to study but become distracted by anything and everything. I feel a deep sense of dispair, and worst off, I don't care about anything. I'm so busy being stressed and anxious and depressed about the test that I have no energy left to study. So I stay in bed all day. I watch television. I stare at the ceiling. I take naps. I write blogs. I do not study. I do nto do anything productive. Because I tell myself I don't have time to go to the gym because I have to study, or I don't have time to clean or cook because I have to study, but then when I go to study, I just can't do it. And for some reason I never say I can't lie in bed all day because I have to study.
Then test time comes around and it is basically a self fulfilling prophecy. I don't do well on the tests, because I can't get myself to study. I have lucked out thus far and not failed another test, but maybe it is just a matter of time. Will I ever be able to get over this? Is it something that can even be fixed? I have to hope that eventually I will get over this and be able to study again, because the test taking is not anywhere near over. That all being said, I should probably go back to studying for my test next week...

Another example of how I am not a good medical student

I haven't blogged in awhile because I've been so busy with third year, which for all of you struggling first and second years out there, third year is awesome. I'm finally starting to feel a purpose towards this crazy life I chose, and am reminded of why I wanted to do this in the first place. Third year has given me hope that I did not make a mistake and that I do, in fact, want to be a doctor, and that I am, in fact, fully capable of being a good physician. Not to toot my own horn or anything but I am an excellent communicator, patients and other staff love me, and I'm a hard worker, so eventually I am going to be a good doctor, as soon as I figure out all this medical stuff. And I'm starting to see that that will come in it's own time. It was great when a doctor told me that the purpose of third year is not to learn everything about medicine, but to learn how to learn and how to practice as a doctor. The learning everything comes slowly over time. That is nice to know.
So, that's the good news about third year. I've figured out a couple of secrets to help me get through the rest of the year. Unfortunately, all of these secrets make me feel like a horrible slacker, and makes me worried about my future in medicine if already I'm finding all these shortcuts for life. However, I have also decided that when I want something, I'm willing to work hard for it, and I don't see the point in busting my ass for something that isn't going to make a huge impact in my life.
For example: I have pretty much decided that I'm either going to do internal medicine or pediatrics. Unless my neurology rotation is just the greatest thing since sliced bread, I don't really think any of the other stuff holds any interest for me. That has lead to me checking out completely in my rotations, which is bad. I am currently in my OB rotation, and I've realized that OB is just not for me. So I'm not going to go into it. However, if I were a good medical student like all the others, I'd still work my ass off for an amazing grade or whatnot. I am not like the other students. I have realized that I am not going to honor or high pass this rotation, and if I just do well enough, I am going to pass. So, instead of working my ass off to just pass, I've decided to just pass. That means showing up on time, being nice to my patients, doing my work, leaving, and studying for the test. It does not involve getting to work early, trying to overly impress people, and going above and beyond. Is that bad?
I think it is a little bad, because now my attendings can tell I have no interest in OB, and they probably think I'm a horrible medical student, and that really isn't good. But on the other hand, it is helping me stay sane in this crazy world. Saving up my energy for my rotations that are going to count for my future. Right? I sure hope so. Otherwise I'm just a bad student, and does that translate into being a bad doctor? I sure hope not.
The things I've done, that I'm pretty sure no other medical student has done in the history of medical school. Okay probably not that big a deal, but still:
1) I take naps. Why not? You know the saying "eat when you have a chance to eat, sit when you have a chance to sit, pee when you have a chance to pee?" I take that a step further and nap when I get a chance to nap. There is a call room for students on this rotation, and sometimes I have absolutely nothing to do, and I can't stand the thought of studying anymore, so I take a little nap. Apparently that is horrifying to some of my classmates. I think it is just good thinking.
2) I leave when I have a chance to leave. I am not one of those "are you sure?Maybe I should stick around," types of students. If the attending says there is nothing going on and I have the option of just sitting around waiting for something to maybe happen or leaving now, I'm going to leave. And if there has been nothing going on for hours, I'm going to ask if I can leave. It's just one of those things. So yes, I've left the hospital on a weekday at noon before, because someone said I could. And at 430 I've asked if I can go home to study or whatever if I haven't done anything since noon. And I don't think that is going to affect my evaluation enough for me to really worry about it.
3) Rotations where high pass is determined by a test grade automatically means I'm just going to pass. Therefore, I am not going to put too much effort into it. I cannot do well on tests. I have anxiety, I don't study enough, I have no self esteem. It's just a thing I've gotten used to. So while I believe if I study hard I can pass the test, I know that for most of these rotations I am not going to do that well. So what does it matter if I pass with a 70.1 or a 89.9? It doesn't, especially since all they see is pass. So I'm not going to kill myself to turn in stellar work for our busy work that we are given. I'm not going to try and be the best student ever. I'm going to do what it takes to get through, learn what I can in the meantime, and try to hold on to my sanity.
4) I plan things during rotation time so I can get out of rotations. Especially in the ones I'm not passionate about. Sure, I'll come have a meeting on campus at 3pm! That works just perfectly, that gets me out of clinic for awhile. It's for school right? Oh I have a doctor's appointment...oh yeah...hmmm...dont' feel bad about it. Granted, I don't do this every day, but I probably do it more often than I should.
5) I am devious. Recently I have started playing attendings against each other. Not really in the horrible way that sounds. More in the "oh Dr. so and so said I should work with them today..." and then turning around and being like "oh I need to get back to work with the other doctor" and then leaving. Or hiding out to study. They don't seem to notice. It's pretty awesome. Or going to preceptor in the morning, coming home and napping before going back to my rotation. Yep, that is me.
Hopefully none of my attendings will ever read this blog, or I will be busted big time. But honestly, I don't think any of this is going to have a negative effect on my ability to treat patients, because when I'm with a patient I give my best, I give them everything. I'm passionate to work with people, I want to help them as best as I can, I like to be there for them and be the one to take care of them. I just don't put up with a lot of bullshit, and I can't pretend to be something I'm not. Which is a gunner. So, yeah, maybe that makes me a bad student, but I don't hear my patients complaining. Maybe it's because I leave before I can hear them. hmmmm....

sitting to study brings me to tears

Hopefully I will be able to get over this soon. The past seven weeks I've been in adult ambulatory medicine and I will let you know, I am not studying. Occasionally I have busted out my book and tried to read a few chapters, but that usually results in me staring off blankly into space or falling asleep. It always ends in me putting away the book not sure I've actually learned anything.
But, Friday is test time, and I'm starting to get a little anxious. However, my anxiety is not of the type that will help me study. Instead it is that crippling "I don't want to study I don't give a shit about this" type of anxiety. This is bad news. I know I'm not smart enough to just do well on a test without studying. But I also can't seem to get into my head that studying is going to have any impact whatsoever on my grade. For someone with such low self esteem I sure do have a lot of faith in my ability to kick ass on tests, even though I have repeatedly shown myself that I am not good at tests. You'd think this would lead me to study, but instead I get trapped in this half-panicked half-defeated frame of mind that is not conducive to studying. "I should study so I can do well on this test," I'll say to myself. Followed quickly with "why? I can't honor the block anyway, why bother? I'll just pass this one." Which is closely followed by "but what if I don't pass the test? I suck at tests! I should study." That usually results in me at least picking up the book and opening it. But that then leads to me staring blankly at the pages, arguing with myself about how important this is even if it is super boring and no I don't know everything in the book as much as I try to convince myself I do and just reviewing right before the test has never worked out to my advantage before so why should it now?
But the worst of it, worse than the pure disinterest and dislike of studying is the depression that comes along with studying. I've been in a bad mood all day and finally figured out it's not because I'm lonely here in Montrose (I only have two days left here, I can get over it), and it's not because so and so didn't call me today or return my texts, and it's not because I am tired of my host mom, or no one emailed me today, or any of those other things I can usually attribute my bad mood to. It's not PMS because it's not that time of the month. It really is just a severe depression that comes with studying. I forgot that I get it, because the past seven weeks I've been convincing myself that I'm learning enough in clinic without studying, and that my time is better spent riding my bike and enjoying the beautiful weather. So last Thursday was the first day I actually sat down with my book in a coffee shop and studied. And it sucked and brought back horrible memories of the past two years. So I stopped, mostly because I didn't care but I blamed it on the fact that my mom was in town and we had an adventure planned.
Yesterday I was so proud of msyelf, I went for a bike ride AND managed to get to the coffee shop to study. And I studied for like three hours. Okay, I sat in the coffee shop for three hours. I'm not sure how long I actually studied. Because within minutes of oepning my book I wanted to close it back up again. But yesterday I just felt bored. Probably because the stress of the fact that the test is days away hadn't quite caught up with me yet.
That stress caught up with my today, and I've been on the verge of tears all day, and I couldn't figure it out for the life of me. What was wrong with me? Why am I in such a bad mood? I should be in a good mood, I'm almost done with this rotation, I get to go home soon, I only have one more day of work. But I guess that slowly the realization that on Friday I have a test that I am not prepared for but cannot seem to make myself become prepared for. I know I need to study, I'm stressed out about the test, I'm worried that I'm going to fail it, I don't feel confident, I know a panic attack is in the makings, but I cannot sit down with my book. Instead I just sit around thinking about how stressed out I am and should study, but when I try to study I want to cry, so I stop studying just to get stressed about studying again.
This is why I failed the boards. More than any of the other crap, it was this, this feeling of knowing I need to study but not having the ability to do it. I simultaneously care and don't care about this test and my need to study for it. I'm defeated, I know I can't honor, I know I'm barely going to pass, but for some reason I can't convince myself that I need to study because I might not barely pass. I might not pass at all. And I don't want to remediate anything. I don't want to fail another test. I just want to move on with my life. But I can't. I cannot study, and I don't know how to fix this problem. I can hope it gets better with other blocks, and with the cold since I won't want to play outside. But what if I'm like this forever?
It worries me that I have no desire to study or learn. All I want to do is treat patients, but I don't have the knowledge to do so, and I can't seem to drum up the enthusiasm to learn things. I don't know what medication I should use for diabetes management. I don't know what labs I want to run on a patient. I don't know what to do if a patient goes into cardiac arrest. All this information is at my finger tips, but I don't give a damn enough to look up the answer. I keep thinking that I'll learn it, but when will I learn it if I won't study? It doesn't make any sense.
I need some kind of motivation pill or something. Something that gets me focused and excited to learn. Something to help me succeed. But until I find this magical pill that doesn't exist, I am going to have to figure something else out. Maybe just sitting with my book long enough, reading one word at a time, one sentence at a time, not trying to get too ahead of myself, and eventually I'll learn something. Right? Let's hope so.
I'd like to say I'm going to go back to studying now, but really I'm going to get ready for bed. I'll then probably lie in bed for an hour worrying about how I didn't study enough today and won't have time to study tomorrow, I'll get no sleep, but I won't get out of bed to study, I'll just lie there freaking out. At least I know myself well enough to know this is how my night is going to go...That's progress right?