August 18, 2008

• Optho-I’m doing it wrong

  I just cant seem to do anything right.

  The last few workdays, I have slowly been giving myself a complex. A brief history: prior to entering medical school, I worked as an ophthalmic technician for my ophthalmologist. An amazing doctor, he has definetly been a huge influence in my decision to apply for ophto myself. However, while he made a great doctor and influence, he could occasionally be a difficult person to work for. Mostly due to the minimal positive feedback he gave out

  He assigned me various tasks in addition to my tech duties in order to beef up my med school application. Which is great…but he always just assumed I knew without any prior experience how to write a case report, or do some complicated technical procedure, and then when I didnt, there would usually be once chance to fix any mistakes and then he would just go and take care of whatever the task was himself.

  It got to be very stressful going to work for a time because even though i KNEW there was no reason I should have a given piece of knowledge, whenever i didnt, I would beat myself up over it.

  Now at no point was I ever insulted, or put down. Comments usually were along the lines of, “wait, you NEVER learned this?” or “This is inappropriate format for a medical journal, you need to rewrite it..” Which seems great until you realize that at no point was the “how” or where do i learn that answered, even when i explicitly asked.

  Well, the solution to that problem was to stop asking questions and basically teach myself how to do something in one chance or not at all, since if I failed the one attempt, the opportunity would be retracted. Which is not the most terrible of solutions. However it made me on the whole much less inclined to ask questions, and much more self conscious about anything i couldnt do right on my first try.

  Along came medical school, and with my habits rather firmly set from this experience (along with several others) I tended to be one of those people who sits toward the back of the class and is rarely heard from. At least academically anyway. Not because I was a bad student, but because my habits simpyl made me less inclined to ask for help, since i was usually not expecting to receive any. Which actually got me through my first two years pretty well.

  Well as I have mentioned in other posts about third year, one of the well known trial by fire rituals med students have to eventually go through is known as “pimping” wherein an attending or someone else in a position of authority higher than yours tests your medical knowledge on the spot. I did not do well with pimping, as my style of learning tended to be researching things I did not know on my own. I eventually learned how to ask questions of peers, coworkers, nurses and residents again, getting through third year and occasionally even surviving the pimping as my body of knowledge grew.

  And then we come to this rotation, where I am pimped not just by the attending, to which i have become accustomed, but I am often pimped in front of the patient. Which adds a whole other layer of pressure. Imagine you have just been introduced as a graduating medical student, and now you are being asked to come up with differentials, treatments and plans in front of someone with NO MEDICAL KNOWLEDGE while someone with INSANE MEDICAL KNOWLEDGE judges your attempt to respond with something coherent in about 10 seconds or less?

  In most cases, this leads to epic fail. Not because I wouldnt be able to reason out the answer, but doing so in the ridiculosly limited alloted time leads to me throwing out usually the first couple things that pop into mind. Now lets say that 50% of the time this answer is correct. (that is a generous estimate, but moving on)

  Even when i hit the nail on the head, the doctor either moves on to successive questions until i am stumped, or simply takes the response, completes the patient exam and moves on. No, good job, thats correct, or really achknowledgment at all. Soon as I get something wrong however, it is a “well there is a resound case of i’m not sure” or “you really need to look that up”

  Again, no blatant putdowns. Now i am not saying i need a pat on the head and a treat everytime i do something correctly. But an occasional realization that I do not have the same knowledge in the field as someone who has been practicing 20+ years, nor should i would be nice. I hate doubting myself, and when the only time i am ever given advice is when i do something wrong or cant figure something out, it makes me that much more insecure about trying to give answers in the future, which in turn appears as more hesitation indicating i dont know an answer which leads to more negative feedback. It’s a vicious cycle

  The point of this whole little emo-fest i have been having here?

  I still like opthalmology. I am still learning a pretty decent amount. I am pretty sure I made a mistake in choosing to do this rotation at this location just because i wanted to get in one more optho audition rotation before interview season. I will be very glad when the rotation ends and I can go back home to chicago, LA, or wherever.

  I originally sat down to write about what I saw in the office today, and this just happened to come out. So i will postpone weekend adventures and what i saw til another post, as right now i really just need to grab a drink and desperately try to get enough studying done so i am prepared for anything that might be asked of me tomorrow.

  Sometimes, I really dislike my private, keep to myself nature.
  

  -Almost Dr J

  • 9:29 pm
  • 1 Comment